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Notice

Cost-Based and Inter-Agency Billing Rates for Medical Care or Services Provided by the Department of Veterans Affairs for FY 2020

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Start Preamble

ADDRESSES:

The 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 Department of Veterans Affairs (VA) furnished in certain circumstances.

DATES:

The rates set forth herein are effective October 1, 2019.

Start Further Info

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.)

End Further Info End Preamble Start Supplemental Information

SUPPLEMENTARY INFORMATION:

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

Cost-Based rates apply to medical care and services that are provided by VA under § 17.102(a), (b), (d) and (g), respectively, in the following circumstances:

  • In error or based on tentative eligibility,
  • In a medical emergency,
  • To pensioners of allied nations, and
  • For research purposes in circumstances under which the medical care appropriation shall be reimbursed from the research appropriation.

Inter-Agency rates apply to medical care and services that are provided by VA under § 17.102(c) and (f), respectively, in the following circumstances when the care or services provided are not covered by any applicable sharing agreement in accordance with § 17.102(e):

  • To beneficiaries of the Department of Defense or other Federal agencies; and
  • To military retirees with chronic disability.

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 (i.e., Physician; Ancillary; and Nursing, Room and Board), and 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 that are effective October 1, 2019 and will remain in effect until the next fiscal year Federal Register update. These rates supersede those established by the Federal Register notice published on August 28, 2018, at 83 FR 43958.

Cost-based ratesInter-agency rates
A. Hospital Care per inpatient day:
General Medicine:
All Inclusive Rate$4,301$4,156
Physician515
Ancillary1,121
Nursing Room and Board2,665
Neurology:
All Inclusive Rate4,2324,086
Physician620
Ancillary1,117
Nursing Room and Board2,495
Rehabilitation Medicine:
All Inclusive Rate2,9102,803
Physician331
Ancillary889
Nursing Room and Board1,690
Blind Rehabilitation:
All Inclusive Rate1,9951,920
Physician161
Ancillary991
Nursing Room and Board843
Spinal Cord Injury:
All Inclusive Rate2,6362,540
Physician327
Ancillary663
Nursing Room and Board1,646
Surgery:
All Inclusive Rate7,5267,272
Physician829
Ancillary2,283
Nursing Room and Board4,414
General Psychiatry:
All Inclusive Rate2,1742,091
Physician205
Start Printed Page 51729
Ancillary342
Nursing Room and Board1,627
Substance Abuse (Alcohol and Drug Treatment):
All Inclusive Rate2,2322,147
Physician213
Ancillary516
Nursing Room and Board1,503
Psychosocial Residential Rehabilitation Program:
All Inclusive Rate826797
Physician52
Ancillary87
Nursing Room and Board687
Intermediate Medicine:
All Inclusive Rate3,3013,182
Physician162
Ancillary484
Nursing Room and Board2,655
Poly-trauma Inpatient:
All Inclusive Rate3,2233,097
Physician366
Ancillary985
Nursing Room and Board1,872
B. Nursing Home Care, Per Day:
All Inclusive Rate1,3611,311
Physician42
Ancillary184
Nursing Room and Board1135
C. Outpatient Medical Treatments:
Outpatient Visit (to include Ineligible Emergency Dental Care)389376
Outpatient Physical Medicine & Rehabilitation Service Visit238228
Outpatient Poly-trauma/Traumatic Brain Injury671649
Note: Outpatient Prescriptions will be billed at Drug Cost plus Administrative Fee.

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. Robert L. Wilkie, Secretary, Department of Veterans Affairs, approved this document on September 26, 2019, for publication.

Start Signature

Dated: September 26, 2019.

Jeffrey M. Martin,

Assistant Director, Office of Regulation Policy & Management, Office of the Secretary, Department of Veterans Affairs.

End Signature End Supplemental Information

[FR Doc. 2019-21330 Filed 9-27-19; 8:45 am]

BILLING CODE 8320-01-P