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Notice

Cost-Based and Inter-Agency Billing Rates for Medical Care or Services Provided by the Department of Veterans Affairs

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AGENCY:

Department of Veterans Affairs.

ACTION:

Notice.

SUMMARY:

This document updates the Cost-Based and Inter-Agency billing rates for medical care or services provided by the U.S. Department of Veterans Affairs (VA).

DATES:

Effective Date: The rates set forth in this notice are effective November 4, 2014 and until further notice.

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FOR FURTHER INFORMATION CONTACT:

Romona Greene, Chief Business Office (10NB), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 382-2521. (This is not a toll free number.)

End Further Info End Preamble Start Supplemental Information

SUPPLEMENTARY INFORMATION:

VA's methodology for computing Cost-Based and Inter-Agency billing rates for medical care or services provided by VA is set forth in 38 CFR 17.102(h). Two sets of rates are obtained by applying this methodology, Cost-Based rates and Inter-Agency rates. Cost-Based rates apply to medical care and services that are provided by VA:

(a) In error or based on tentative eligibility;

(b) In a medical emergency;

(c) To pensioners of allied nations; or

(d) For research purposes in circumstances under which VA medical care appropriation is to be reimbursed by VA research appropriation.

Inter-Agency rates apply to medical care and services that are provided by VA to beneficiaries of the Department of Defense (DoD) or other Federal agencies, when the care or services provided is not covered by an applicable sharing agreement. The Inter-Agency rates contained in this notice do not apply to sharing agreements between VA and DoD unless otherwise stated.

The calculations for the Cost-Based and Inter-Agency rates are the same with two exceptions. Inter-Agency rates are all inclusive and are not broken down into three components (Physician; Ancillary; and Nursing, Room and Board), and Inter-Agency rates do not include standard fringe benefit costs that cover government employee retirement, disability costs, and return on fixed assets. When VA pays for medical care or services from a non-VA source under circumstances in which the Cost-Based or Inter-Agency Rates would apply if the care or services had been provided by VA, the charge for such care or services will be the actual amount paid by VA for the care or services. Inpatient charges will be at the per diem rates shown for the type of bed section or discrete treatment unit providing the care.

The following table depicts the Cost Based and Inter-Agency Rates which are effective upon publication of this notice. These rates supersede those established by the Federal Register notice published on July 11, 2011 at 76 FR 40749.

Cost-based ratesInter-agency rates
A. Hospital Care per inpatient day
General Medicine:
All Inclusive Rate$3,313$3,142
Physician397
Ancillary863
Nursing Room and Board2,053
Neurology:
All Inclusive Rate3,1522,993
Physician461
Ancillary832
Nursing Room and Board1,859
Rehabilitation Medicine:
All Inclusive Rate2,4802,353
Physician282
Ancillary758
Nursing Room and Board1,440
Blind Rehabilitation:
Start Printed Page 65480
All Inclusive Rate1,6411,557
Physician132
Ancillary815
Nursing Room and Board694
Spinal Cord Injury:
All Inclusive Rate2,2012,089
Physician273
Ancillary554
Nursing Room and Board1,374
Surgery:
All Inclusive Rate5,1654,899
Physician569
Ancillary1,567
Nursing Room and Board3,029
General Psychiatry:
All Inclusive Rate1,6111,527
Physician152
Ancillary254
Nursing Room and Board1,205
Substance Abuse (Alcohol and Drug Treatment):
All Inclusive Rate1,3631,294
Physician130
Ancillary315
Nursing Room and Board918
Psychosocial Residential Rehabilitation Program:
All Inclusive Rate650616
Physician41
Ancillary68
Nursing Room and Board541
Intermediate Medicine:
All Inclusive Rate2,2492,135
Physician111
Ancillary330
Nursing Room and Board1,808
Polytrauma Inpatient:
All Inclusive Rate3,2173,058
Physician365
Ancillary983
Nursing Room and Board1,869
B. Nursing Home Care, Per Day
All Inclusive Rate1,0821,025
Physician34
Ancillary146
Nursing Room and Board902
C. Outpatient Medical Treatments
Outpatient Visit (to include Ineligible Dental Care)236222
Physical Medicine & Rehabilitation Service Outpatient Visit443419
Outpatient Polytrauma/Traumatic Brain Injury586561
Start Signature

Dated: October 30, 2014.

By Direction of the Secretary.

William F. Russo,

Acting Director, Office of Regulation Policy and Management, Office of the General Counsel, U.S. Department of Veterans Affairs.

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[FR Doc. 2014-26148 Filed 11-3-14; 8:45 am]

BILLING CODE 8320-01-P