Notice2024-19505
Agency Information Collection Activity: CHAMPVA Benefits-Application, Claim, Other Health Insurance, Potential Liability & Miscellaneous Expenses
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
August 30, 2024
Issuing agencies
Veterans Affairs Department
Abstract
Veterans Health Administration (VHA), Department of Veterans Affairs (VA), is announcing an opportunity for public comment on the proposed collection of certain information by the agency. Under the Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension of a currently approved collection, and allow 60 days for public comment in response to the notice.
Full Text
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<title>Federal Register, Volume 89 Issue 169 (Friday, August 30, 2024)</title>
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[Federal Register Volume 89, Number 169 (Friday, August 30, 2024)]
[Notices]
[Pages 70692-70694]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-19505]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0219]
Agency Information Collection Activity: CHAMPVA Benefits--
Application, Claim, Other Health Insurance, Potential Liability &
Miscellaneous Expenses
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
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[[Page 70693]]
SUMMARY: Veterans Health Administration (VHA), Department of Veterans
Affairs (VA), is announcing an opportunity for public comment on the
proposed collection of certain information by the agency. Under the
Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to
publish notice in the Federal Register concerning each proposed
collection of information, including each proposed extension of a
currently approved collection, and allow 60 days for public comment in
response to the notice.
DATES: Comments must be received on or before October 29, 2024.
ADDRESSES: Comments must be submitted through <a href="http://www.regulations.gov">www.regulations.gov</a>.
FOR FURTHER INFORMATION CONTACT:
Program-specific information: Rebecca Mimnall, 202-695-9434,
<a href="/cdn-cgi/l/email-protection#11677970727e6163705167703f767e67"><span class="__cf_email__" data-cfemail="37415f56545847455677415619505841">[email protected]</span></a>.
VA PRA information: Maribel Aponte, 202-461-8900,
<a href="/cdn-cgi/l/email-protection#5c2a3d3f332c3d2c392e2b332e372e3938293d3f281c2a3d723b332a"><span class="__cf_email__" data-cfemail="ee988f8d819e8f9e8b9c99819c859c8b8a9b8f8d9aae988fc0898198">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: Under the PRA of 1995, Federal agencies must
obtain approval from the Office of Management and Budget (OMB) for each
collection of information they conduct or sponsor. This request for
comment is being made pursuant to section 3506(c)(2)(A) of the PRA.
With respect to the following collection of information, VHA
invites comments on: (1) whether the proposed collection of information
is necessary for the proper performance of VHA's functions, including
whether the information will have practical utility; (2) the accuracy
of VHA's estimate of the burden of the proposed collection of
information; (3) ways to enhance the quality, utility, and clarity of
the information to be collected; and (4) ways to minimize the burden of
the collection of information on respondents, including through the use
of automated collection techniques or the use of other forms of
information technology.
Title: CHAMPVA Benefits--Application, Claim, Other Health
Insurance, Potential Liability & Miscellaneous Expenses.
OMB Control Number: 2900-0219. <a href="https://www.reginfo.gov/public/do/PRASearch">https://www.reginfo.gov/public/do/PRASearch</a>. (Once at this link, you can enter the OMB Control Number to
find the historical versions of this Information Collection.)
Type of Review: Revision of a currently approved collection.
Abstract: This information collection includes several forms, as
well as a review and appeal process, which are used to administer the
Civilian Health and Medical Program of the Department of Veterans
Affairs (CHAMPVA). Although the burden numbers have not changed since
the last PRA clearance, the collection is being revised to include a
portal for submission of the information in the 10-10d program
application form, which is expected to be completed by the end of
calendar year 2024. This portal will allow applicants to complete and
submit VA Form 10-10d electronically rather than by submission of a
hard copy form, which has been the standard application process prior
to technological advancement allowing electronic submission and
processing. This portal represents a separate avenue for applicants to
submit VA Form 10-10d; however, it does not affect the burden of
collection for applicants or VA.
VA Form 10-10d: Application for CHAMPVA Benefits
VA Form 10-7959a: CHAMPVA Claim Form
VA Form 10-7959c: CHAMPVA Other Health Insurance (OHI) Certification
VA Form 10-7959d: CHAMPVA Potential Liability Claim
VA Form 10-7959e: VA Claim for Miscellaneous Expenses
Review and Appeal Process
Clinical Review
a. VA Form 10-10d, Application for CHAMPVA Benefits, is used to
determine eligibility of persons applying for healthcare benefits under
the CHAMPVA program in accordance with 38 U.S.C. 501 and 1781.
b. VA Form 10-7959a, CHAMPVA Claim Form, is used to adjudicate
claims for CHAMPVA benefits in accordance with 38 U.S.C. 501 and 1781,
and 10 U.S.C. 1079 and 1086. This information is required for accurate
adjudication and processing of beneficiary submitted claims. The claim
form is also instrumental in the detection and prosecution of fraud. In
addition, the claim form is the only mechanism to obtain, on an interim
basis, other health insurance (OHI) information.
c. VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI)
Certification, is used to systematically obtain OHI information and to
correctly coordinate benefits among all liable parties. Except for
Medicaid and health insurance policies that are purchased exclusively
for the purpose of supplementing CHAMPVA benefits, CHAMPVA is always
the secondary payer of healthcare benefits (38 U.S.C. 501 and 1781, and
10 U.S.C. 1086).
d. VA Form 10-7959d, CHAMPVA Potential Liability Claim, provides
basic information from which potential third party liability can be
assessed. The Federal Medical Care Recovery Act (42 U.S.C. 2651-2653)
mandates recovery of costs associated with healthcare services related
to an injury/illness caused by a third party. Additional authority
includes 38 U.S.C. 501; 38 CFR 1.900 et seq.; 10 U.S.C. 1079 and 1086;
42 U.S.C. 2651-2653; and Executive Order 9397.
e. VA Form 10-7959e, VA Claim for Miscellaneous Expenses, is used
to adjudicate claims for certain children of Korea, Vietnam, and
Thailand veterans authorized under 38 U.S.C., chapter 18, as amended by
section 401, Public Law 106-419 and section 102, Public Law 108-183.
VA's medical regulations 38 CFR part 17 (17.900 through 17.905)
establish regulations regarding provision of health care for certain
children of Korea, Vietnam, and Thailand veterans and women Vietnam
veterans' children born with spina bifida and certain other covered
birth defects. These regulations also specify the information to be
included in requests for preauthorization and claims from approved
health care providers.
f. Review and Appeal Process pertains to the approval of health
care, or approval for payment relating to the provision of health care,
under the Veteran Family Member Programs. The provisions of the
Veterans Appeals Improvement and Modernization Act of 2017 (AMA, Pub.
L. 115-55), chapter 51 of 38 U.S.C., or legacy claims under 38 CFR
17.277 and 38 CFR 17.904 establish a review process regarding
disagreements by an eligible beneficiary of a Veteran Family Member
Program, provider, veteran, or other representative of the veteran or
beneficiary, with a determination concerning provision of health care
or a health care provider's disagreement with a determination regarding
payment. The person or entity requesting reconsideration of such
determination is required to submit such a request in writing
(including electronic where available). If such person or entity
remains dissatisfied with the determination, the person or entity is
permitted to submit a written request for additional review (VHA Notice
2024-07).
g. Clinical Review pertains to the requirement of VHA to
preauthorize certain medical services under 38 CFR 17.273 and 38 CFR
17.902. Clinical review determines if services are medically necessary
and appropriate to allow under the Veteran Family Member Programs. The
person requesting the services must submit medical documentation or
applicable supporting material for review.
[[Page 70694]]
Affected Public: Individuals or Households.
Estimated Annual Burden: 34,548 total hours.
VA Form 10-10d--8,963 hours.
VA Form 10-7959a--9,167 hours.
VA Form 10-7959c--8,947 hours.
VA Form 10-7959d--239 hours.
VA Form 10-7959e--200 hours.
Review and Appeal Process--6,255 hours.
Clinical Review--777 hours.
Estimated Average Burden Per Respondent:
VA Form 10-10d--10 minutes.
VA Form 10-7959a--10 minutes.
VA Form 10-7959c--10 minutes.
VA Form 10-7959d--7 minutes.
VA Form 10-7959e--15 minutes.
Review and Appeal Process--30 minutes.
Clinical Review--20 minutes.
Frequency of Response: Once annually.
Estimated Number of Respondents: 180,142 total.
VA Form 10-10d--53,775.
VA Form 10-7959a--55,000.
VA Form 10-7959c--53,680.
VA Form 10-7959d--2,045.
VA Form 10-7959e--800.
Review and Appeal Process--12,510.
Clinical Review--2,332.
Authority: 44 U.S.C. 3501 et seq.
Maribel Aponte,
VA PRA Clearance Officer, Office of Enterprise and Integration/Data
Governance Analytics, Department of Veterans Affairs.
[FR Doc. 2024-19505 Filed 8-29-24; 8:45 am]
BILLING CODE 8320-01-P
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