episode of care is assumed to generate two visits to account for the initial visit and a follow-up visit (See Table 7). Table 7: Wait-Time Eligible- Estimated Number of Bills Eligible for Reimbursement of Third Party Cost Sharing Updated March 2015 – VA estimated its cost of reimbursing third party cost shares by applying a 3.7% CPI-U medical inflation rate to the FY 2013 average third party cost share of $78 per bill. The resulting $81 average third party cost share was applied to the estimated number of claims generated by this group of Veterans. VA was able to determine this amount because it collects patient responsibility or cost sharing amounts from electronic explanation of benefits (EEOBs) from those third-party payers from whom VA receives reimbursement for non-service-connected care. The reimbursement of costs shares would be between $1.4 million and $14 million (See Table 8.) Table 8: Wait-Time Eligible- Estimated Reimbursement of Third Party Cost Sharing- Updated March 2015 The total cost of care in FY2015 for the eligible Veterans on 30-day wait list and the EWL that may elect to receive non-VA care under VCP is estimated to be between $115 million and $1.151 billion. See Table 9. Table 9: Wait-Time Eligible- Base Year 2015 Total Cost of Care - 30-Day and EWL- Updated March 2015 Using a similar methodology as what was provided in the FY 2015 base year methodology, the estimated costs of FY 2016 and FY 2017 were estimated by decreasing the number of Veterans on the base year (FY2015) wait list by 25 percent in FY 2016 and by 50 percent in FY 2017. This assumption accounts for the anticipated reduction in the wait list, as VA increases its internal capacity to deliver care at a VA medical facility through additional hiring, together with the acquisition of the accompanying space through leasing or construction. A projected annual CPI-U medical inflation rate of 3.8% in FY 2016 and 3.9% in FY 2017 was applied to all out year
episode of care is assumed to generate two visits to account for the initial visit and a follow-up visit (See Table 7). Table 7: Wait-Time Eligible- Estimated Number of Bills Eligible for Reimbursement of Third Party Cost Sharing – Updated March 2015 VA estimated its cost of reimbursing third party cost shares by applying a 3.7% CPI-U medical inflation rate to the FY 2013 average third party cost share of $78 per bill. The resulting $81 average third party cost share was applied to the estimated number of claims generated by this group of Veterans. VA was able to determine this amount because it collects patient responsibility or cost sharing amounts from electronic explanation of benefits (EEOBs) from those third-party payers from whom VA receives reimbursement for non-service-connected care. The reimbursement of costs shares would be between $1.4 million and $14 million (See Table 8.) Table 8: Wait-Time Eligible- Estimated Reimbursement of Third Party Cost Sharing- Updated March 2015 The total cost of care in FY2015 for the eligible Veterans on 30-day wait list and the EWL that may elect to receive non-VA care under VCP is estimated to be between $115 million and $1.151 billion. See Table 9. Table 9: Wait-Time Eligible- Base Year 2015 Total Cost of Care - 30-Day and EWL- Updated March 2015 Using a similar methodology as what was provided in the FY 2015 base year methodology, the estimated costs of FY 2016 and FY 2017 were estimated by decreasing the number of Veterans on the base year (FY2015) wait list by 25 percent in FY 2016 and by 50 percent in FY 2017. This assumption accounts for the anticipated reduction in the wait list, as VA increases its internal capacity to deliver care at a VA medical facility through additional hiring, together with the acquisition of the accompanying space through leasing or construction. A projected annual CPI-U medical inflation rate of 3.8% in FY 2016 and 3.9% in FY 2017 was applied to all out year
RegMgmt_ImpactAnalysisAP24Final_20150818.docx