[Federal Register Volume 89, Number 210 (Wednesday, October 30, 2024)]
[Notices]
[Pages 86414-86415]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-24926]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0219]
Agency Information Collection Activity Under OMB Review: 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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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995,
this notice announces that the Veterans Health Administration (VHA),
Department of Veterans Affairs (VA), will submit the collection of
information abstracted below to the Office of Management and Budget
(OMB) for review and comment. The PRA submission describes the nature
of the information collection and its expected cost and burden, and it
includes the actual data collection instrument.
DATES: Comments and recommendations for the proposed information
collection should be sent by November 29, 2024.
ADDRESSES: To submit comments and recommendations for the proposed
information collection, please type the following link into your
browser: www.reginfo.gov/public/do/PRAMain, select ``Currently under
Review--Open for Public Comments,'' then search the list for the
information collection by Title or ``OMB Control No. 2900-0219.''
FOR FURTHER INFORMATION CONTACT: VA PRA information: Maribel Aponte,
202-461-8900, [email protected].
SUPPLEMENTARY INFORMATION:
Title: CHAMPVA Benefits--Application, Claim, Other Health
Insurance, Potential Liability & Miscellaneous Expenses.
OMB Control Number: 2900-0219. https://www.reginfo.gov/public/do/PRASearch.
Type of Review: Revision of a currently approved collection.
Abstract: The 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). The collection is revised to include an increase in
burden hours based on program data that reflects an increase in claim
submissions, OHI forms, appeals and clinical reviews due to increased
enrollment. The collection also includes 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).
[[Page 86415]]
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.
An agency may not conduct or sponsor, and a person is not required
to respond to a collection of information unless it displays a
currently valid OMB control number. The Federal Register Notice with a
60-day comment period soliciting comments on this collection of
information was published at 89 FR 70692, August 30, 2024.
Affected Public: Individuals or Households.
Estimated Annual Burden: 37,867 total hours.
VA Form 10-10d--8,963 hours.
VA Form 10-7959a--12,486 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: 200,056 total.
VA Form 10-10d--53,775.
VA Form 10-7959a--74,914.
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. 2024-24926 Filed 10-29-24; 8:45 am]
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