VA's Indian Health Service/Tribal Health Program Reimbursement Agreements Program-Pharmacy Reimbursement Rate for the Lower 48 States, 29882 [2021-11624]

Download as PDF 29882 Federal Register / Vol. 86, No. 105 / Thursday, June 3, 2021 / Notices information collection by selecting ‘‘Currently under 30-day Review—Open for Public Comments’’ or by using the search function. FOR FURTHER INFORMATION CONTACT: Copies of the submissions may be obtained from Spencer W. Clark by emailing PRA@treasury.gov, calling (202) 927–5331, or viewing the entire information collection request at www.reginfo.gov. SUPPLEMENTARY INFORMATION: Internal Revenue Service (IRS) Title: State Election of Qualified Health Insurance for Health Coverage Tax Credit (HCTC). OMB Control Number: 1545–1875. Type of Review: Extension without change of a currently approved collection. Description: Revenue Procedure 2004–12 informs states how to elect a health program to be qualified health insurance for purposes of the health coverage tax credit (HCTC) under section 35 of the Internal Revenue Code. The collection of information is voluntary. However, if a state does not make an election, eligible residents of the state may be impeded in their efforts to claim the HCTC. Form: None. Affected Public: State governments. Estimated Number of Respondents: 51. Frequency of Response: Once. Estimated Total Number of Annual Responses: 51. Estimated Time per Response: 30 minutes. Estimated Total Annual Burden Hours: 26. (Authority: 44 U.S.C. 3501 et seq.) Dated: May 28, 2021. Spencer W. Clark, Treasury PRA Clearance Officer. [FR Doc. 2021–11696 Filed 6–2–21; 8:45 am] BILLING CODE 4830–01–P khammond on DSKJM1Z7X2PROD with NOTICES DEPARTMENT OF VETERANS AFFAIRS VA’s Indian Health Service/Tribal Health Program Reimbursement Agreements Program—Pharmacy Reimbursement Rate for the Lower 48 States Department of Veterans Affairs. ACTION: Notice of Tribal Consultation Session. AGENCY: VerDate Sep<11>2014 17:23 Jun 02, 2021 Jkt 253001 VA, Veterans Health Administration (VHA) will facilitate a tribal consultation regarding VA’s Indian Health Service/Tribal Health Program (IHS/THP) Reimbursement Agreements Program. VA is seeking input on adopting a pharmacy reimbursement rate for the lower 48 states. SUMMARY: Comments must be received by VA on or before July 5, 2021. ADDRESSES: Comments may be submitted to tribalgovernment consultation@va.gov or by mail at Department of Veterans Affairs, Suite 915L, 810 Vermont Avenue NW, Washington, DC 20420. FOR FURTHER INFORMATION CONTACT: Kara Hawthorne, IHS/THP Program Manager, VA Office of Community Care, at Tribal.Agreements@va.gov, or by telephone at 303–780–4826. (This is not a toll-free number.) SUPPLEMENTARY INFORMATION: Utilizing the authorities found in 25 U.S.C. 1645(c), Sharing Arrangements with Federal Agencies, and 38 U.S.C. 8153, Sharing of Health-Care Resources, VA, IHS and Tribal health care providers have created the IHS/THP Reimbursement Agreements Program. This program provides a means for IHS and THP health facilities to receive reimbursement from VA for direct care services, including pharmaceutics, provided to eligible American Indian/ Alaska Native (AI/AN) Veterans. Currently, reimbursement agreements under this program state that VA will reimburse ‘‘actual costs’’ for pharmaceuticals. In implementing this requirement, VA has realized that this term, ‘‘actual costs,’’ may be ambiguous and has led to difficulties in administering the agreements in compliance with applicable laws. VA is considering replacing the term ‘‘actual cost’’ with a more recognizable and easily calculated rate. Selecting an industry standard pharmaceutical rate structure would benefit IHS/THP sites by making it easier to understand and predict the reimbursement rate by eliminating the need to calculate actual cost. VA is proposing two distinct pharmacy payment rates for IHS and THP facilities. For IHS facilities, VA has collaborated with IHS to use the Federal Supply Schedule (FSS) or other established contract vehicles (i.e., joint national drug contracts) pharmaceutical pricing as the proposed reimbursement rate, as most of their pharmaceuticals are purchased using the FSS contract or DATES: PO 00000 Frm 00146 Fmt 4703 Sfmt 4703 other contract vehicles. The FSS contract and other contract vehicles are collectively referred to as the FSS rate. For those pharmaceuticals not available on FSS, or non-contracted drugs, claims will be paid based on the adopted rate that is agreed upon with THPs. For THP facilities, VA is suggesting using one of two industry-standard pharmacy reimbursement methodologies. These proposed methodologies are: (1) Wholesale Acquisition Cost (WAC) plus dispensing fee and (2) Average Wholesale Price (AWP), minus discount, plus dispensing fee. This written tribal consultation is seeking input on the preferred pharmacy reimbursement rate from the options above. VA suggests the following questions for response: (1) For the rates for THP facilities, what is your preferred methodology, WAC plus dispensing fee, or (2) AWP, minus discount, plus dispensing fee. (2) For the rates for THP facilities, if you identify AWP as the preferred method, what would you propose as the AWP discount percent rate for generic drugs and name brand/specialty drugs? How did you calculate or determine the proposed discount percent rate? (3) For THP dispensing fee, VA proposes to adopt an amount in line with industry standard, which is generally less than $1.00 per drug, to be applied to either selected rates (WAC or AWP). Do you agree with $1.00 per drug for a dispensing fee? If not, what do you propose the dispensing fee should be? How did you calculate or determine the proposed dispensing fee? (4) Do you have any comments on pharmacy reimbursement rates for IHS facilities and/or the related claims submission and reimbursement process? Signing Authority Denis McDonough, Secretary of Veterans Affairs, approved this document on May 26, 2021, 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. Luvenia Potts, Regulation Development Coordinator, Office of Regulation Policy & Management, Office of General Counsel, Department of Veterans Affairs. [FR Doc. 2021–11624 Filed 6–2–21; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\03JNN1.SGM 03JNN1

Agencies

[Federal Register Volume 86, Number 105 (Thursday, June 3, 2021)]
[Notices]
[Page 29882]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-11624]


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DEPARTMENT OF VETERANS AFFAIRS


VA's Indian Health Service/Tribal Health Program Reimbursement 
Agreements Program--Pharmacy Reimbursement Rate for the Lower 48 States

AGENCY: Department of Veterans Affairs.

ACTION: Notice of Tribal Consultation Session.

-----------------------------------------------------------------------

SUMMARY: VA, Veterans Health Administration (VHA) will facilitate a 
tribal consultation regarding VA's Indian Health Service/Tribal Health 
Program (IHS/THP) Reimbursement Agreements Program. VA is seeking input 
on adopting a pharmacy reimbursement rate for the lower 48 states.

DATES: Comments must be received by VA on or before July 5, 2021.

ADDRESSES: Comments may be submitted to 
[email protected] or by mail at Department of 
Veterans Affairs, Suite 915L, 810 Vermont Avenue NW, Washington, DC 
20420.

FOR FURTHER INFORMATION CONTACT: Kara Hawthorne, IHS/THP Program 
Manager, VA Office of Community Care, at [email protected], or 
by telephone at 303-780-4826. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: Utilizing the authorities found in 25 U.S.C. 
1645(c), Sharing Arrangements with Federal Agencies, and 38 U.S.C. 
8153, Sharing of Health-Care Resources, VA, IHS and Tribal health care 
providers have created the IHS/THP Reimbursement Agreements Program. 
This program provides a means for IHS and THP health facilities to 
receive reimbursement from VA for direct care services, including 
pharmaceutics, provided to eligible American Indian/Alaska Native (AI/
AN) Veterans. Currently, reimbursement agreements under this program 
state that VA will reimburse ``actual costs'' for pharmaceuticals. In 
implementing this requirement, VA has realized that this term, ``actual 
costs,'' may be ambiguous and has led to difficulties in administering 
the agreements in compliance with applicable laws. VA is considering 
replacing the term ``actual cost'' with a more recognizable and easily 
calculated rate. Selecting an industry standard pharmaceutical rate 
structure would benefit IHS/THP sites by making it easier to understand 
and predict the reimbursement rate by eliminating the need to calculate 
actual cost.
    VA is proposing two distinct pharmacy payment rates for IHS and THP 
facilities. For IHS facilities, VA has collaborated with IHS to use the 
Federal Supply Schedule (FSS) or other established contract vehicles 
(i.e., joint national drug contracts) pharmaceutical pricing as the 
proposed reimbursement rate, as most of their pharmaceuticals are 
purchased using the FSS contract or other contract vehicles. The FSS 
contract and other contract vehicles are collectively referred to as 
the FSS rate. For those pharmaceuticals not available on FSS, or non-
contracted drugs, claims will be paid based on the adopted rate that is 
agreed upon with THPs.
    For THP facilities, VA is suggesting using one of two industry-
standard pharmacy reimbursement methodologies. These proposed 
methodologies are: (1) Wholesale Acquisition Cost (WAC) plus dispensing 
fee and (2) Average Wholesale Price (AWP), minus discount, plus 
dispensing fee.
    This written tribal consultation is seeking input on the preferred 
pharmacy reimbursement rate from the options above. VA suggests the 
following questions for response:
    (1) For the rates for THP facilities, what is your preferred 
methodology, WAC plus dispensing fee, or (2) AWP, minus discount, plus 
dispensing fee.
    (2) For the rates for THP facilities, if you identify AWP as the 
preferred method, what would you propose as the AWP discount percent 
rate for generic drugs and name brand/specialty drugs? How did you 
calculate or determine the proposed discount percent rate?
    (3) For THP dispensing fee, VA proposes to adopt an amount in line 
with industry standard, which is generally less than $1.00 per drug, to 
be applied to either selected rates (WAC or AWP). Do you agree with 
$1.00 per drug for a dispensing fee? If not, what do you propose the 
dispensing fee should be? How did you calculate or determine the 
proposed dispensing fee?
    (4) Do you have any comments on pharmacy reimbursement rates for 
IHS facilities and/or the related claims submission and reimbursement 
process?

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved this 
document on May 26, 2021, 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.

Luvenia Potts,
Regulation Development Coordinator, Office of Regulation Policy & 
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2021-11624 Filed 6-2-21; 8:45 am]
BILLING CODE 8320-01-P
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