[Federal Register Volume 86, Number 105 (Thursday, June 3, 2021)]
[Notices]
[Pages 29883-29884]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-11618]



[[Page 29883]]

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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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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: Written comments and recommendations on the proposed collection 
of information should be received on or before August 2, 2021.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at www.Regulations.gov 
or to Janel Keyes, Office of Regulations, Appeals, and Policy (10BRAP), 
Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 
20420 or email to <a href="/cdn-cgi/l/email-protection#aee4cfc0cbc280e5cbd7cbddeed8cf80c9c1d8"><span class="__cf_email__" data-cfemail="f9b398979c95d7b29c809c8ab98f98d79e968f">[email protected]</span></a>. Please refer to ``OMB Control No. 
2900-0219'' in any correspondence. During the comment period, comments 
may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Maribel Aponte, Office of Enterprise 
and Integration, Data Governance Analytics (008), 1717 H Street NW, 
Washington, DC 20006, (202) 266-4688 or email <a href="/cdn-cgi/l/email-protection#345955465d5651581a55445b5a40517442551a535b42"><span class="__cf_email__" data-cfemail="264b47544f44434a0847564948524366504708414950">[email protected]</span></a>. 
Please refer to ``OMB Control No. 2900-0219'' in any correspondence.

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.
    Authority: Public Law 104-13; 44 U.S.C. 3501-3521.
    Title: CHAMPVA Benefits--Application, Claim, Other Health 
Insurance, Potential Liability & Miscellaneous Expenses.
    OMB Control Number: 2900-0219.
    Type of Review: Reinstatement with change of a previously 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).

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 and/or Vietnam 
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 and Vietnam 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 chapter 51 
of 38 U.S.C. or 38 CFR 17.276 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. If such person or entity remains dissatisfied with 
the reconsideration determination, the person or entity is permitted to 
submit a written request for additional review.
    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

[[Page 29884]]

Programs. The person requesting the services must submit medical 
documentation or applicable supporting material for review.
    Affected Public: Individuals and 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.

    By direction of the Secretary.
Maribel Aponte,
VA PRA Clearance Officer, Office of Enterprise and Integration/Data 
Governance Analytics, Department of Veterans Affairs.
[FR Doc. 2021-11618 Filed 6-2-21; 8:45 am]
BILLING CODE 8320-01-P


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