§ 17.102 Charges for care or services.

Charges at the indicated rates shall be made for Department of Veterans Affairs hospital care or medical services (including, but not limited to, dental services, supplies, medicines, orthopedic and prosthetic appliances, and domiciliary or nursing home care) as follows:

(g) Furnished for research purposes. Charges will not be made for medical services, including transportation, furnished as part of an approved Department of Veterans Affairs research project, except that if the services are furnished to a person who is not eligible for the services as a veteran, the medical care appropriation shall be reimbursed from the research appropriation at the same rates used for billings under paragraph (b) of this section.

(h) Computation of charges. 

The method for computing the charges under paragraphs (a), (b), (d), (f), and (g), and the last sentence of paragraph (c) of this section is based on the Cost Distribution Report, which sets forth the actual basic costs and per diem rates by type of inpatient care and outpatient visit. Factors for depreciation of buildings and equipment and Central Office overhead are added, based on accounting manual instructions. Additional factors are added for interest on capital investment and for standard fringe benefit costs covering government employee retirement and disability costs. The current year billing rates are projected on prior year actual rates by applying the budgeted percentage increase. In addition, based on the detail available in the Cost Distribution Report, VA intends to, on each bill break down the all-inclusive rate into its three principal components; namely, physician cost, ancillary services cost, and nursing, room and board cost. The rates generated by the foregoing methodology are the same rates prescribed by the Office of Management and Budget and published in the Federal Register for use under the Federal Medical Care Recovery Act, 42 U.S.C. sections 2651-2653. 

Paragraph (b) Furnished in a medical emergency. Charges at rates prescribed by the Under Secretary for Health shall be made for any inpatient or outpatient care or services rendered any person in a medical emergency who was not eligible for such care or services as a veteran, if:

(1) The care or services were rendered as a humanitarian service, under §17.43( c)(1) or §17.95 to a person neither claiming eligibility as a veteran nor for whom the establishment of eligibility as a veteran was expected, or

(2) The person for whom care or services were rendered was a Department of Veterans Affairs employee or a member of a Department of Veterans Affairs employee's family.

a. When medical services are furnished on an inpatient or outpatient basis as part of an approved research project to a person (veteran or nonveteran) purely for the research program and not as a part of approved medical care to an eligible veteran, the research appropriation must reimburse the medical care appropriation according to provisions of VA Regulation 6062(G) at the applicable rates in appendix 15A. Billing for services obtained from non-VA sources exclusively for research purposes (travel, special procedures, etc.) will be for the same amount charged the VA.

b. The Medical Administration Service Billing activity will submit a memorandum to Fiscal Service through the Chief of Staff requesting that the medical appropriation be reimbursed from the research appropriation for the cost of medical services furnished solely for research purposes. The billing will indicate the name of the person provided services, social security number, dates of care, type of services, total cost, and the research project number to which the charges are to be allocated.

a. Ancillary medical services support for which equitable charges are to be applied against the Medical and Prosthetic Research appropriation are those provided from Direct Medical Care cost centers 221 through 229. When the continuity of the Medical Care ancillary service to the Medical Research program has been established, it is essential that there be an equitable distribution of costs for these services between the Medical Care and the Medical Research appropriations.

b. The criterion to be applied against each ancillary service is whether or not this service is required for patient care, regardless of its contribution to the Medical Research program. If the service is a part of the patient care requirement, it is not to be charged against the Medical Research program.

c. Only those services that are provided above and beyond patient care needs will be charged to the Medical Research program. Each month a realistic estimate of the proportionate cost applicable to the Medical Research program will be developed. An OF1017G, Journal Voucher, will be prepared in this amount charging the Medical and Prosthetic Research appropriation and crediting the Medical Care appropriation. Charges will be made to the applicable cost center and subaccount 2580.

a. Costs of administrative support service to Medical Research programs will be borne entirely by the Medical Care appropriation. These services include support activities such as fiscal, supply, building management (400 and 500 series of accounts). Etc.

b. Other costs to be borne entirely by the Medical Care appropriation are those services of physicians, dentists, and nurses engaged in research work on less than a full-time basis and for whom placement on Medical Research rolls has not been specifically approved by Central Office.

c. Costs for administrative support services, and services of physicians, dentists, and nurses engaged in research work on less than a full-time basis will continue to be budgeted and charged to the Medical Care appropriation with no part of such costs charged to the Medical Research program.