16056 Federal Register / Vol. 60, No. 60 / Wednesday, March 29, 1995 / Rules and Regulations

SUPPLEMENTARY INFORMATION:

Closed Captioning Requirements for

Computer Systems Used As Television

Receivers

Several manufacturers have requested

information on the requirements for

displaying closed captioning as they

apply to computers that have the

capability to receive television signals.

This Public Notice describes the Office

of Engineering and Technology’s (OET)

interpretation of the requirements of the

Television Decoder Circuitry Act of

1990, and the rules implementing that

Act, as they apply to computer systems.

As indicated below, computer systems

that are sold with a monitor that has a

‘‘viewable picture’’ size of 13 inches or

greater and that have the capability to

receive television service must be able

to display closed captions transmitted

on television signals. Closed captioning

capability is not required for smaller

monitors, for systems without television

reception capability, for computers sold

without monitors, or for ‘‘plug-in’’

circuit boards that add television

reception capability.

Section 15.119 of the Commission’s

rules, and the Television Decoder

Circuitry Act of 1990 (Pub. L. 101–431)

upon which this rule section is based,

require that all devices designed to

receive television pictures broadcast

simultaneously with sound be equipped

with built-in decoder circuitry designed

to display closed-captioned television

transmissions when such a device is

manufactured in the United States or

imported for use in the United States,

and its television picture screen is 33

cm (13 inches) or greater in size. See 47

CFR 15.119 and 47 U.S.C. 303(u) and

330(b).

Personal computers can now be

equipped to receive and display

broadcast television programming. This

capability can be marketed in a variety

or ways. For example, built-in TV

receiver capability can be included in

personal computers that are marketed as

complete systems, e.g., systems that

include both a computer and monitor.

Built-in TV receiver capability can also

be included in personal computers sold

without a monitor. In addition, TV

receiver capability can be provided on

plug-in circuit cards that can be used to

add TV reception capability to an

existing personal computer.

The screen sizes for TV receivers and

monitors used with personal computers

traditionally have been measured

differently by manufacturers in the two

industries. TV receiver screen size is

measured on the basis of the ‘‘viewable

picture’’ area, in accordance with

Federal Trade Commission (FTC)

regulations. See 16 CFR Part 410.

Computer monitors traditionally are

measured on the basis of the overall

physical size of the picture tube. In

many cases, computer monitors

marketed as 1⁄4 inches or larger actually

have a viewable picture size of less than

33 cm (13 inches). We note that the

majority of computer monitors being

sold now have a viewable picture size

that is smaller than 33 cm (13 inches),

although the number of models with

larger picture sizes is increasing.

OET interprets that the requirements

of § 15.119 apply to computer systems

that have the capability to receive TV

broadcast signals and include a monitor

that has a ‘‘viewable picture’’ size of 33

cm (13 inches) or larger, as measured in

accordance with the FTC regulations, 16

CFR Part 410. For purposes of this

interpretation, a computer system may

be a single unit, with the computer and

monitor in the same housing, or

separate computer and monitor units.

As a practical matter, computers and

monitors sold together as systems are

often marketed with separate prices.

This allows consumers greater

flexibility in choosing a system that

meets their needs. OET interprets that

where computers and monitors are

priced separately but sold together, i.e.,

as part of the same business transaction,

they are nonetheless computer systems

for purposes of the closed caption

display capability requirements and

must comply with those requirements if

the ‘‘viewable picture’’ of the monitor is

33 cm (13 inches) or larger.

The requirements of § 15.119 do not

apply to:

—Computers or computer systems that

do not have the capability to receive

TV broadcast signals;

—Computers sold without monitors;

—Computer systems with monitors that

do not have a viewable picture of 33

cm (13′′) or larger; or,

—Separate ‘‘plug-in ’’ circuit boards.

In issuing this interpretation, we wish

to emphasize that we recognize the

importance of closed captioning display

as a feature of TV reception capability

included in personal computers. We

therefore will monitor the practices of

the computer industry with regard to

this feature, particularly with regard to

the practices of selling computers and

monitors together, and will consider

appropriate action in the future as may

be necessary to ensure this feature is

adequately available to the public.

By the Chief, Office of Engineering and

Technology.

Office of Engineering and Technology

contact: Richard Engelman at (202) 776–

1626.

Federal Communications Commission.

William F. Caton,

Acting Secretary.

[FR Doc. 95–7650 Filed 3–28–95; 8:45 am]

BILLING CODE 6712–01–M

OFFICE OF PERSONNEL

MANAGEMENT

48 CFR Parts 1604 and 1652

RIN 3206–AG30

Federal Employees Health Benefits

Acquisition Regulation Filing Health

Benefit Claims; Addition of Contract

Clause

AGENCY: Office of Personnel

Management.

ACTION: Interim regulations with request

for comments.

SUMMARY: The Office of Personnel

Management (OPM) is issuing interim

regulations to add a new contract clause

of the Federal Employees Health

Benefits Acquisition Regulation

(FEHBAR). The clause clarifies for both

FEHB carriers and covered individuals

the circumstances under which OPM

may render a decision regarding a

covered individual who asks OPM to

review a health benefits plan’s denial of

a claim if the plan has either affirmed

its denial when the covered individual

requested reconsideration, or failed to

respond to the covered individual’s

request for reconsideration as provided

by OPM’s regulations. The clause

further clarifies the circumstances under

which claimants may seek court review

of benefit denials under the FEHB

Program. The purpose of these interim

regulations is to clarify that covered

individuals who wish to bring legal

action regarding a denial of an FEHB

benefit must pursue such claim against

OPM. Further, the interim regulations

clarify the administrative review

process that must precede legal action

in the courts.

DATES: These interim regulations are

effective March 29, 1995. Comments

must be received on or before May 30,

1995.

ADDRESSES: Send written comments to

Lucretia F. Myers, Assistant Director for

Insurance Programs, Retirement and

Insurance Service, Office of Personnel

Management, P.O. Box 57, Washington,

DC 20044; or deliver to OPM, Room

3451, 1900 E Street NW., Washington,

DC; or FAX to (202) 606–0633.

FOR FURTHER INFORMATION CONTACT:

Margaret Sears, (202) 606–0004.

SUPPLEMENTARY INFORMATION:

Historically, OPM has required that
Federal Register / Vol. 60, No. 60 / Wednesday, March 29, 1995 / Rules and Regulations 16057

covered individuals who want to bring

suit because an FEHB carrier has denied

their claim for health benefits must sue

the carrier, not OPM. These interim

regulations provide that legal actions

arising out of a denial of FEHB benefits

should be brought against OPM rather

than the FEHB carrier that made the

initial denial decision. Because OPM

has the authority under the FEHB law

to order the carrier to pay the claim,

OPM has determined it is appropriate

under current statute for the covered

individuals to bring suit against OPM if

OPM declines to order the carrier to pay

the claim. The clause clarifies the

process and circumstances for bringing

legal actions under the FEHB Program

and gives the administrative review

process that must be completed before

suit is brought.

The legislative history of § 8902(j),

title 5, United States Code, shows that

Congress intended OPM (at that time the

Civil Service Commission) to provide an

administrative appeal process, binding

upon the carriers, that would save

covered individuals the expense and

delay of being forced into the courts to

recover on meritorious claims for

benefits. Based upon this directive and

its central role in the administration of

the FEHB Program, OPM established a

detailed administrative review process

for benefits claims leading to a final

decision on such claims by OPM. It is

OPM’s view that this administrative

review process must be followed before

legal action is pursued in the courts.

Further, the matter to be reviewed by a

court upon appeal is the OPM decision

affirming the carrier’s denial of benefits,

with the court’s review being limited to

an examination of OPM’s administrative

decision to deny the claim for payment

or services.

Health insurance contracts under the

FEHB Program are Federal contracts

under 5 U.S.C., chapter 89. Accordingly,

legal actions concerning disputes arising

or relating to those contracts are

controlled by Federal, rather than State

law. Congress, in the FEHB Act,

mandated Federal uniformity for all

matters that relate to (1) the nature or

extent of coverage; (2) benefits; and (3)

payment of benefits under the FEHB

Program. By statute, all health insurance

contracts require the carrier to agree to

pay or provide a health service or

supply in an individual case if OPM

finds that the covered individual is

entitled to the benefit under the terms

of the contract. Congress also directed

OPM to take a central role in

determining whether a health service or

supply should be provided in

individual cases to covered individuals

and, if it should be provided, to require

carriers to pay for such health service or

supply. These interim regulations

reaffirm the principle of uniformity in

the FEHB Program by providing that in

judicial disputes regarding the denial of

a health benefits claim, review is to be

limited to the record that was before

OPM and that was the basis of the OPM

decision to disallow the benefit. In the

event that an appropriate court

concludes that benefits should have

been awarded under the FEHB Act, the

court possesses ample authority to

require OPM to order that such

payments be made to the covered

individual from the carrier. These

interim regulations clarify that OPM

intends for its decision to be upheld

unless the Court concludes that the

OPM decision affirming the carrier’s

denial of benefits was inconsistent with

the standard for final agency action

under applicable Federal law.

The new clause reflects the

administrative review procedures that

must precede court review. These

procedures are prescribed by regulations

at 5 CFR 890.105 and reflects minor

changes that OPM is making to 5 CFR

890.105 by interim regulations being

published in conjunction with this

interim regulation The new clause also

reflects regulations and 5 CFR 890.107

regarding court review and reflects

changes OPM is making to 5 CFR

890.107 by regulations also being

published in conjunction with this

interim regulations.

OPM proposes to incorporate these

procedures into the FEHB contract by

adding a new clause 1652.204–72,

Filing Health Benefit Claims/Court

Review of Disputed Claims, to Subpart

1652.2 of the Federal Employees Health

Benefits Acquisition Regulation

(FEHBAR).

Regulatory Flexibility Act

I certify that this regulation will not

have a significant economic impact on

a substantial number of small entities

because the regulation merely

incorporates administrative procedures

and regulatory requirements into FEHB

contracts.

List of Subjects in 48 CFR Parts 1604

and 1652

Government employees, Government

procurement, Health insurance.

Office of Personnel Management.

James B. King,

Director.

Accordingly, OPM proposes to amend

48 CFR chapter 16 as follows:

PART 1604—ADMINISTRATIVE

MATTERS

1. The authority citation for parts

1604 and 1652 continue to read as

follows:

Authority: 5 U.S.C. 8913; 40 U.S.C. 486(c);

48 CFR 1.301.

2. In part 1604 subpart 1604.71 is

added to read as follows:

Subpart 1604.71—Disputed Health

Benefit Claims

1604.7101 Filing Health Benefit Claims/

Court Review of Disputed Claims.

Guidelines for an Federal Employees

Health Benefit (FEHB) Program covered

individual to file a claim for payment or

service and for legal actions on disputed

health benefit claims are found at 5 CFR

890.105 and 890.107, respectively. The

contract clause at 1652.204–72 of this

chapter, reflecting this guidance, must

be inserted in all FEHB Program

contracts.

PART 1652—CONTRACT CLAUSES

3. Subpart 1652.2 is amended by

adding section 1652.204–72 to read as

follows:

Subpart 1652.2—Texts of FEHBP

Clauses

1652.204–72 Filing Health Benefit Claims/

Court Review of Disputed Claims.

As prescribed in 1604.7101 of this

chapter, the following clause must be

inserted in all FEHB Program contracts.

FILING HEALTH BENEFIT CLAIMS/COURT

REVIEW OF DISPUTED CLAIMS

(a) General. The Carrier resolves claims

filed under the Plan. All health benefit

claims must be submitted initially to the

Carrier. If the Carrier denies a claim (or a

portion of a claim), the covered individual

may ask the Carrier to reconsider its denial.

If the Carrier affirms its denial or fails to

respond as required by paragraph (b) of this

clause, the covered individual may ask OPM

to review the claim. A covered individual

must exhaust both the Carrier and OPM

review processes specified in this clause

before seeking judicial review of the denied

claim.

(b) Time limits for reconsidering a claim.

(1) The covered individual has 1 year from

the date of the notice to the covered

individual that a claim (or a portion of a

claim) was denied by the Carrier in which to

submit a written request for reconsideration

to the Carrier.

(2) The Carrier has 30 days after the date

of receipt of a timely-filed request for

reconsideration to:

(i) Affirm the denial in writing to the

covered individual;

(ii) Pay the bill or provide the service; or

(iii) Request from the covered individual or

provider additional information needed to
16058 Federal Register / Vol. 60, No. 60 / Wednesday, March 29, 1995 / Rules and Regulations

make a decision on the claim. The Carrier

must simultaneously notify the covered

individual of the information requested if it

requests additional information from a

provider. The Carrier has 30 days after the

date the information is received to affirm the

denial in writing to the covered individual or

pay the bill or provide the service. The

Carrier must make its decision based on the

evidence it has if the covered individual or

provider does not respond within 60 days

after the date of the Carrier’s notice

requesting additional information. The

Carrier must then send written notice to the

covered individual of its decision on the

claim. The covered individual may request

OPM review as provided in paragraph (b)(3)

of this clause if the Carrier fails to act within

30 days after the covered individual’s request

for reconsideration or the Carrier’s receipt of

additional information.

(3) The covered individual may write to

OPM and request that OPM review the

Carrier’s decision if the Carrier either affirms

its denial of a claim or fails to respond to a

covered individual’s written request for

reconsideration within 30 days after the date

it receives the request or within 30 days after

the date it receives the additional

information requested. The covered

individual must submit the request for OPM

review within the time limit specified in

paragraph (e)(1) of this clause.

(4) The Carrier may extend the time limit

for a covered individual’s submission of

additional information to the Carrier when

the covered individual shows he or she was

not notified of the time limit or was

prevented by circumstances beyond his or

her control from submitting the additional

information.

(c) Information required to process requests

for reconsideration. (1) The covered

individual must put the request to the Carrier

to reconsider a claim in writing and give the

reasons, in terms of applicable brochure

provisions, that the denied claim should

have been approved.

(2) If the Carrier needs additional

information from the covered individual to

make a decision, it must:

(i) Specifically identify the information

needed;

(ii) State the reason the information is

required to make a decision on the claim;

(iii) Specify the time limit (60 days after

the date of the Carrier’s request) for

submitting the information; and

(iv) State the consequences of failure to

respond within the time limit specified, as

set out in paragraph (b)(2) of this clause.

(d) Carrier determinations. The Carrier

must provide written notice to the covered

individual of its determination. If the Carrier

affirms the initial denial, the notice must

inform the covered individual of:

(1) The specific and detailed reasons for

the denial;

(2) The covered individual’s right to

request a review by OPM; and

(3) The requirement that requests for OPM

review must be received within 90 days after

the date of the Carrier’s denial notice and

include a copy of the denial notice as well

as documents to support the covered

individual’s position.

(e) OPM review. (1) If the covered

individual seeks further review of the denied

claim, the covered individual must make a

request to OPM to review the Carrier’s

decision. Such a request to OPM must be

made:

(i) Within 90 days after the date of the

Carrier’s notice to the covered individual that

the denial was affirmed; or

(ii) If the Carrier fails to respond to the

covered individual as provided in paragraph

(b)(2) of this clause, within 120 days after the

date of the covered individual’s timely

request for reconsideration by the Carrier; or

(iii) Within 120 days after the date the

Carrier requests additional information from

the covered individual, or the date the

covered individual is notified that the Carrier

is requesting additional information from a

provider. OPM may extend the time limit for

a covered individual’s request for OPM

review when the covered individual shows

he or she was not notified of the time limit

or was prevented by circumstances beyond

his or her control from submitting the request

for OPM review within the time limit.

(2) In reviewing a claim denied by the

Carrier, OPM may

(i) Request that the covered individual

submit additional information;

(ii) Obtain an advisory opinion from an

independent physician;

(iii) Obtain any other information as may

in its judgment be required to make a

determination; or

(iv) Make its decision based solely on the

information the covered individual provided

with his or her request for review.

(3) When OPM requests information from

the Carrier, the Carrier must release the

information within 30 days after the date of

OPM’s written request unless a different time

limit is specified by OPM in its request.

(4) Within 90 days after receipt of the

request for review, OPM will either:

(i) Give a written notice of its decision to

the covered individual and the Carrier; or

(ii) Notify the individual of the status of

the review. If OPM does not receive

requested evidence within 15 days after

expiration of the applicable time limit in

paragraph (e)(3) of this clause, OPM may

make its decision based solely on

information available to it at that time and

give a written notice of its decision to the

covered individual and to the Carrier.

(f) Court review. (1) A suit to compel

enrollment under § 890.102 of Title 5, Code

of Federal Regulations, must be brought

against the employing office that made the

enrollment decision.

(2) A suit to review the legality of OPM’s

regulations under this part must be brought

against the Office of Personnel Management.

(3) Federal Employees Health Benefits

(FEHB) carriers resolve FEHB claims under

authority of Federal statute (chapter 89, title

5, United States Code). A covered individual

may seek judicial review of OPM’s final

action on the denial of a health benefits

claim. A legal action to review final action

by OPM involving such denial of health

benefits must be brought against OPM. The

recovery in such a suit will be limited to the

amount of benefits in dispute.

(4) An action under paragraph (f)(3) of this

clause to recover on a claim for health

benefits:

(i) May not be brought prior to exhaustion

of the administrative remedies provided in

paragraphs (a) through (e) of this clause;

(ii) May not be brought later than

December 31 of the third year after the year

in which the care or service was provided;

and

(iii) Will be limited to the record that was

before OPM when it rendered its decision

affirming the Carrier’s denial of benefits.

(End of Clause)

[FR Doc. 95–7792 Filed 3–28–95; 8:45 am]

BILLING CODE 6325–01–M

NATIONAL AERONAUTICS AND

SPACE ADMINISTRATION

48 CFR Parts 1801, 1804, 1806, 1808,

1813, 1815, 1816, 1832, 1836, 1840,

1841, 1842, 1845, 1851, 1852, and 1870

[NFSD 89–18]

RIN 2700–AB83

NASA FAR Supplement; Miscellaneous

Amendments

AGENCY: Office of Procurement,

Acquisition Liaison Division, National

Aeronautics and Space Administration

(NASA).

ACTION: Final rule.

SUMMARY: This document amends the

NASA Federal Acquisition Regulation

Supplement (NFS) to reflect a number of

miscellaneous changes dealing with

NASA internal and administrative

matters, such as the NASA FAR

Supplement rewrite, procurement

integrity, cost-reimbursement contracts,

architect-engineer services, acquisition

of utility services, and audit tracking

and resolution.

EFFECTIVE DATE: March 31, 1995.

FOR FURTHER INFORMATION CONTACT: Mr.

David K. Beck, (202) 358–0482; e-mail:

dbeck@proc.hq.nasa.gov.

SUPPLEMENTARY INFORMATION:

Background

A cross-reference is added to

1813.7104(a) due to FAC 90–24. The

FAC allows the head of contracting

activity to exclude contracting officers

(with micro-purchase authority only)

from the procurement integrity

definition of ‘‘procurement official’’ if

the HCA determines that it is unlikely

that the contracting officer’s

acquisitions will exceed $20,000 in any

12-month period.

Sections 1816.301, 1816.301–3 and

1816.403 are removed due to FAC 90–

24’s removal of FAR 16.301 and 16.403.