Notice2021-27377
Reasonable Charges for Outpatient Medical Care or Services; v4.225, Calendar Year (CY) 2022 Update and National Average Administrative Prescription Drug Charge Update
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
December 17, 2021
Effective
January 1, 2022
Issuing agencies
Veterans Affairs Department
Abstract
This VA notice updates the data for calculating what VA refers to as the Reasonable Charges collected or recovered by VA for medical care or services provided or furnished by VA to a veteran. 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.
Full Text
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<title>Federal Register, Volume 86 Issue 240 (Friday, December 17, 2021)</title>
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[Federal Register Volume 86, Number 240 (Friday, December 17, 2021)]
[Notices]
[Pages 71707-71708]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-27377]
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DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Outpatient Medical Care or Services;
v4.225, Calendar Year (CY) 2022 Update and National Average
Administrative Prescription Drug Charge Update
AGENCY: Department of Veterans Affairs (VA).
ACTION: Notice.
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SUMMARY: This VA notice updates the data for calculating what VA refers
to as the Reasonable Charges collected or recovered by VA for medical
care or services provided or furnished by VA to a veteran. 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.
DATES: This change is effective January 1, 2022.
FOR FURTHER INFORMATION CONTACT: Debra Vatthauer, Office of Finance,
Revenue Operations, Payer Relations and Services, Rates and Charges,
Veterans Health Administration, Department of Veterans Affairs, 128
Bingham Road, Suite 1000, Asheville, NC 28806; email:
<a href="/cdn-cgi/l/email-protection#f09495928291de869184849891859582b08691de979f86"><span class="__cf_email__" data-cfemail="ec88898e9e8dc29a8d9898848d99899eac9a8dc28b839a">[email protected]</span></a>; telephone: 608-821-7346 (This is not a toll-
free number).
SUPPLEMENTARY INFORMATION: 38 CFR 17.101(a)(1) sets forth VA's
collection or recovery regulations, pursuant to 38 U.S.C. 1729, 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; 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. VA refers to the charges for services
as derived under 38 CFR 17.101 as ``reasonable charges.'' 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(a)(2) 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 in a notice in the Federal Register (FR) or will be
posted on VA's website at: <a href="https://www.va.gov/communitycare/revenue_ops/payer_rates.asp">https://www.va.gov/communitycare/revenue_ops/payer_rates.asp</a>.
Certain charges are updated as stated in this notice and will be
effective on January 1, 2022.
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 section 17.101(a)(8).
Based on the methodologies set forth in section 17.101, this notice
provides an update to charges for CY 2022 HCPCS Level II and Current
Procedural Terminology 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
are based on the methodologies and data sources described in section
17.101. The nationwide charges will be posted on VA's website at:
<a href="https://www.va.gov/communitycare/revenue_ops/payer_rates.asp">https://www.va.gov/communitycare/revenue_ops/payer_rates.asp</a> under the
heading ``Reasonable Charges Data Tables'' and identified as ``v4.225
Data Tables (Outpatient and Professional).''
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 13, 2021 (86 FR
50953).
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 will be posted on VA's website under the heading
``VA Medical Facility Locations'' and identified as ``v4.225 (Jan
22).''
Consistent with section 17.101 (a)(2), the updated data and
supplementary tables containing the changes described in this notice
will be posted on VA's website at <a href="https://www.va.gov/communitycare/revenue_ops/payer_rates.asp">https://www.va.gov/communitycare/revenue_ops/payer_rates.asp</a> under the heading ``Reasonable Charges
Rules, Notices and Federal Register'' and identified as ``v4.225
Federal Register Notice 01/01/22 (Outpatient and Professional)''. The
updated data, and supplementary tables containing the changes described
will be effective until changed by a subsequent FR notice. Consistent
with section 17.101(a)(3), the list of data sources used for
calculating the actual charge amounts listed above also will be posted
on VA's website under the heading ``Reasonable Charges Data Sources''
and identified as ``Reasonable Charges v4.225 Data Sources (Outpatient
and Professional) (PDF).''
Section 17.101(m) establishes the charges for prescription drugs
not administered during treatment, as part of medical care or services
provided or furnished by VA to a veteran under section 17.101(a)(1) 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.
As indicated in section 17.101(m), when VA provides or furnishes
prescription drugs not administered during treatment, within the scope
of care described in section 17.101(a)(1), charges billed separately
for such
[[Page 71708]]
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) further describes 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.
Consistent with section 17.101(a)(2), the national average
administrative cost calculated by VA under section 17.101(m) will be
posted online on VA's website at: <a href="https://www.va.gov/communitycare/revenue_ops/payer_rates.asp">https://www.va.gov/communitycare/revenue_ops/payer_rates.asp</a> under the heading ``Reasonable Charges
Rules, Notices and Federal Register and identified as CY 22 National
Average Administrative Cost (PDF)'', to be effective on January 1,
2022. The national average administrative cost posted will be effective
until changed by a subsequent FR notice.
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved this
document on December 10, 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. 2021-27377 Filed 12-16-21; 8:45 am]
BILLING CODE 8320-01-P
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