[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, <a href="/cdn-cgi/l/email-protection#651304060a1504150017120a170e170001100406112513044b020a13"><span class="__cf_email__" data-cfemail="611700020e1100110413160e130a130405140002152117004f060e17">[email protected]</span></a>.

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]
BILLING CODE 8320-01-P


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