Reasonable Charges for Inpatient Medical Severity-Diagnosis Related Groups (MS-DRG) and Skilled Nursing Facility (SNF) Medical Services; v3.26, Fiscal Year (FY) 2020 Update
| Published date | 30 September 2019 |
| Citation | 84 FR 51727 |
| Record Number | 2019-21329 |
| Section | Notices |
| Court | Veterans Affairs Department |
Federal Register, Volume 84 Issue 189 (Monday, September 30, 2019)
[Federal Register Volume 84, Number 189 (Monday, September 30, 2019)]
[Notices]
[Pages 51727-51728]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-21329]
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DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Inpatient Medical Severity-Diagnosis
Related Groups (MS-DRG) and Skilled Nursing Facility (SNF) Medical
Services; v3.26, Fiscal Year (FY) 2020 Update
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
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SUMMARY: This document updates the acute inpatient and the skilled
nursing facility (SNF)/sub-acute inpatient facility charges. The
updated charges are based on the Medicare severity-diagnosis related
groups (MS-DRG) for Fiscal Year (FY) 2020.
FOR FURTHER INFORMATION CONTACT: Romona Greene, Office of Community
Care, Revenue Operations, Payer Relations and Services, Rates and
Charges (10D1C1), Veterans Health Administration, Department of
Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420; email:
[email protected]; telephone: (202) 382-2521 (This is not a toll-
free number.)
SUPPLEMENTARY INFORMATION: Section 17.101(a)(1) of title 38 of the Code
of Federal Regulations (CFR) sets forth the Department of Veterans
Affairs (VA) medical regulations concerning ``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 of 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. The methodologies for establishing
billed amounts for several types of charges are found in 38 CFR 17.101;
however, this notice will only address the acute inpatient and the SNF/
sub-acute inpatient facility charges.
Based on the methodologies set forth in 38 CFR 17.101(b), this
notice updates the acute inpatient facility charges that were based on
the FY 2019 MS-DRGs. Acute inpatient facility charges by MS-DRGs are
posted on the Veterans Health Administration (VHA) Office of Community
Care's website, at the following link: www.va.gov/communitycare/revenue_ops/payer_rates.asp, under the ``Reasonable Charges Data
Tables'' section, Inpatient Data Table, as Table A (v3.24). This Table
A corresponds to the Table A referenced in 83 Federal Register (FR)
47412, September 19, 2018. Table A (v3.26) referenced in this notice
provides updated charges based on the FY 2020 MS-DRGs and will replace
Table A (v3.24) posted on the VHA Office of Community Care's website.
Also, this document updates the SNF/sub-acute inpatient facility
all-inclusive per diem charge using the methodologies set forth in 38
CFR 17.101(c). This charge is adjusted by a geographic area factor that
is based on the location where the care is provided. For the geographic
area factors, see Table N, Acute Inpatient, and Table O, SNF, on the
VHA Office of Community Care's website under the v3.25 link in the
``Reasonable Charges Data Tables'' section. Tables N and O are not
being updated by this notice. The SNF/sub-acute inpatient facility per
diem charge is posted on the VHA Office of Community Care's website
under the ``Reasonable Charges Data Tables'' section, Table B (v3.24).
This Table B corresponds to the Table B referenced in 83 FR 47412,
September 19, 2018. Table B referenced in this notice is v3.26, which
provides an update to the all-inclusive nationwide SNF/sub-acute
inpatient facility per diem charge and will replace Table B (v3.24)
posted on the VHA Office of Community Care's website.
The charges in this notice for acute inpatient and SNF/sub-acute
inpatient facility services are effective October 1, 2019.
This notice is retaining the table designations used for acute
inpatient facility charges by MS-DRGs, which are posted on the VHA
Office of Community Care's website under ``Reasonable Charges Data
Tables.'' This notice is also retaining the table designation used for
SNF/sub-acute inpatient facility charges, which are also posted on the
VHA Office of Community Care's website. Accordingly, the tables
identified as being updated by this notice correspond to the applicable
tables referenced in 83 FR 47412, September 19, 2018.
The list of data sources presented in Supplementary Table 1 (v3.26)
reflects the updated data sources used to establish the updated charges
described in this notice and will be posted on the VHA Office of
Community Care's website under the ``Reasonable Charges Data Sources''
section.
The list of VA medical facility locations is also updated. In
Supplementary Table 3, posted on the VHA Office of Community Care's
website under the VA Medical Facility Locations section, VA set forth
the list of VA medical facility locations, which includes the first
three digits of their zip codes and provider-based/non-provider-based
designations.
Consistent with VA's regulations, the updated data tables and
supplementary tables containing the changes described in this notice
will be posted on the VHA Office of Community Care's website, under the
``Payer Rates and Charges'' information section.
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.
[[Page 51728]]
Dated: September 26, 2019.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
the Secretary, Department of Veterans Affairs.
[FR Doc. 2019-21329 Filed 9-27-19; 8:45 am]
BILLING CODE 8320-01-P
