Reasonable Charges for Medical Care or Services; v3.23, 2018 Calendar Year Update and National Average Administrative Prescription Drug Charge Update, 59213-59214 [2017-26950]

Agencies

• DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 82, Number 239 (Thursday, December 14, 2017)]
[Notices]
[Pages 59213-59214]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-26950]



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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; v3.23, 2018 
Calendar Year Update and National Average Administrative Prescription 
Drug Charge Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: This Department of Veterans Affairs (VA) notice updates the 
data for calculating the ``Reasonable Charges'' collected or recovered 
by VA for medical care or services. This notice also updates the 
``National Average Administrative Prescription Costs'' for purposes of 
calculating VA's charges for prescription drugs that were not 
administered during treatment, but provided or furnished by VA to a 
veteran.

FOR FURTHER INFORMATION CONTACT: Romona Greene, Office of Community 
Care, Revenue Operations, Payer Relations and Services, Rates and 
Charges (10D1C1), Veterans Health Administration (VHA), Department of 
Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202) 
382-2521. (This is not a toll free number).

SUPPLEMENTARY INFORMATION: Section 17.101 of Title 38 of the Code of 
Federal Regulations sets forth the ``Reasonable Charges'' for medical 
care or services provided or furnished by VA to a veteran: ``For a 
nonservice-connected disability for which the veteran is entitled to 
care (or the payment of expenses for care) under a health plan 
contract; For a nonservice-connected disability incurred incident to 
the veteran's employment and covered under a worker's compensation law 
or plan that provides reimbursement or indemnification for such care 
and services; or For a nonservice-connected disability incurred as a 
result of a motor vehicle accident in a State that requires automobile 
accident reparations insurance.'' Section 17.101 provides the 
methodologies for establishing billed amounts for several types of 
charges; however, this notice will only address partial hospitalization 
facility charges; outpatient facility charges; physician and other 
professional charges, including professional charges for anesthesia 
services and dental services; pathology and laboratory charges; 
observation care facility charges; ambulance and other emergency 
transportation charges; and charges for durable medical equipment, 
drugs, injectables, and other medical services, items, and supplies 
identified by Healthcare Common Procedure Coding System (HCPCS) Level 
II codes.
    Section 17.101 provides that the actual charge amounts at 
individual VA medical facilities based on these methodologies and the 
data sources used for calculating those actual charge amounts will 
either be published as a notice in the Federal Register or will be 
posted on the internet site of the Veterans Health Administration 
Office of Community Care's website at https://www.va.gov/communitycare/revenue_ops/payer_rates.asp.
    Certain charges are hereby updated as stated in this notice and 
will be effective on January 1, 2018.
    In cases where VA has not established charges for medical care or 
services provided or furnished at VA expense (by either VA or non-VA 
providers) under other provisions or regulations, the method for 
determining VA's charges is set forth at 38 CFR 17.101(a)(8).
    Based on the methodologies set forth in Sec.  17.101, this notice 
provides an update to charges for 2018 HCPCS Level II and Current 
Procedural Terminology (CPT) codes. Charges are also being updated 
based on more recent versions of data sources for the following charge 
types: partial hospitalization facility charges; outpatient facility 
charges; physician and other professional charges, including 
professional charges for anesthesia services and dental services; 
pathology and laboratory charges; observation care facility charges; 
ambulance and other emergency transportation charges; and charges for 
durable medical equipment, drugs, injectables, and other medical 
services, items, and supplies identified by HCPCS Level II codes. As of 
the date of this notice, the actual charge amounts at individual VA 
medical facilities based on the methodologies in Sec.  17.101 will be 
posted on the VHA Office of Community Care's website at https://www.va.gov/communitycare/revenue_ops/payer_rates.asp under the heading 
``Reasonable Charges Data Tables'' and identified as ``v3.23 Data 
Tables (Outpatient and Professional).''
    The list of data sources used for calculating the actual charge 
amounts listed above also will be posted on the VHA Office of Community 
Care's website under the heading ``Reasonable Charges Data Sources'' 
and identified as ``Reasonable Charges v3.23 Data Sources (Outpatient 
and Professional) (PDF).''
    Acute inpatient facility charges and skilled nursing facility/sub-
acute inpatient facility charges remain the same as set forth in the 
notice published in the Federal Register on September 25, 2017 (82 FR 
44701).
    We are also updating the list of VA medical facility locations. The 
list of VA medical facility locations, including the first three digits 
of their zip codes as well as provider-based/non-provider-based 
designations, will be posted on the VHA Office of Community Care's 
website under the heading ``VA Medical Facility Locations'' and 
identified as ``v3.23 (Jan18).''
    As indicated in 38 CFR 17.101(m), when VA provides or furnishes 
prescription drugs not administered during treatment, ``charges billed 
separately for such prescription drugs will consist of the amount that 
equals the total of the actual cost to VA for the drugs and the 
national average of VA administrative costs associated with dispensing 
the drugs for each prescription.'' Section 17.101(m) includes the 
methodology for calculating the national average administrative cost 
for prescription drug charges not administered during treatment.
    VA determines the amount of the national average administrative 
cost annually for the prior fiscal year (October through September) and 
then applies the charge at the start of the next calendar year. The 
national average administrative drug cost for calendar year 2018 is 
$16.64. This change will be posted on the VHA Office of Community 
Care's website at https://www.va.gov/COMMUNITYCARE/revenue_ops/admin_costs.asp under the heading ``CY 2018 Average Administrative Cost 
for Prescriptions.''
    Consistent with Sec.  17.101, the national average administrative 
cost, the updated data, and supplementary tables containing the changes 
described in this notice will be posted online, as indicated in this 
notice. This notice will be posted on the VHA Office of Community 
Care's website under the heading ``Federal Registers, Rules, and 
Notices'' and identified as ``v3.23 Federal Register Notice 01/01/18 
(Outpatient and Professional), and National Administrative Cost 
(PDF).'' The national average administrative cost, updated data, and 
supplementary tables containing the changes described will be effective 
until changed by a subsequent Federal Register notice.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. Gina S. 
Farrisee, Deputy Chief of Staff, Department of Veterans Affairs,

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approved this document on November 24, 2017, for publication.

    Dated: November 24, 2017.
Jeffrey Martin,
Office Program Manager, Office of Regulation Policy & Management, 
Office of the Secretary, Department of Veterans Affairs.
[FR Doc. 2017-26950 Filed 12-13-17; 8:45 am]
 BILLING CODE 8320-01-P