Reasonable Charges for Inpatient Medical Severity-Diagnosis Related Groups (MS-DRG) and Skilled Nursing Facility (SNF) Medical Services; v4.21 Fiscal Year (FY) 2021 Update
| Published date | 22 September 2020 |
| Citation | 85 FR 59606 |
| Record Number | 2020-20894 |
| Section | Notices |
| Court | Veterans Affairs Department |
Federal Register, Volume 85 Issue 184 (Tuesday, September 22, 2020)
[Federal Register Volume 85, Number 184 (Tuesday, September 22, 2020)]
[Notices]
[Pages 59606-59607]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-20894]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Inpatient Medical Severity-Diagnosis
Related Groups (MS-DRG) and Skilled Nursing Facility (SNF) Medical
Services; v4.21 Fiscal Year (FY) 2021 Update
AGENCY: Department of Veterans Affairs (VA).
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This document updates the acute inpatient and SNF/sub-acute
inpatient facility charges. The updated charges are based on MS-DRGs
for fiscal year (FY) 2021.
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 CFR sets
forth the 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 2020 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 (v3.26). This Table
A corresponds to the Table A referenced in a notice published in the
Federal Register on September 30, 2019 (see 84 FR 51727). Table A
(v4.21) referenced in this notice provides updated charges based on the
FY 2021 MS-DRGs and will replace Table A (v3.26) 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, title ``Acute Inpatient,'' and Table O,
title ``SNF,'' on the VHA Office of Community Care's website under the
v3.27 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 (v3.26). This Table B corresponds to the Table B referenced in
a notice published in the Federal Register on September 30, 2019 (see
84 FR 51727). Table B referenced in this notice is v4.21, which
provides an update to the all-inclusive nationwide SNF/sub-acute
inpatient facility per diem charge and will replace Table B
[[Page 59607]]
(v3.26) 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, 2020.
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 a notice published in the Federal Register on
September 30, 2019 (see 84 FR 51727).
The list of data sources presented in Supplementary Table 1 (v4.21)
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. Brooks D.
Tucker, Acting Chief of Staff, Department of Veterans Affairs, approved
this document on September 16, 2020 for publication.
Luvenia Potts,
Regulation Development Coordinator, Office of Regulation Policy &
Management, Office of the Secretary, Department of Veterans Affairs.
[FR Doc. 2020-20894 Filed 9-21-20; 8:45 am]
BILLING CODE 8320-01-P
