[Federal Register Volume 62, Number 84 (Thursday, May 1, 1997)]
[Proposed Rules]
[Pages 23731-23736]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-11257]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AI65


Provision of Health Care to Vietnam Veterans' Children With Spina 
Bifida

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: This document proposes to establish regulations regarding 
Vietnam veterans' children with spina bifida by providing for the 
provision of health care needed for the spina bifida or any disability 
that is associated with such condition. This is necessary for providing 
health care to such children in accordance with recently enacted 
legislation. A companion document (RIN: 2900-AI70) concerning a 
proposal to provide for payment of a monetary allowance to a Vietnam 
veteran's child with spina bifida is set forth in the Proposed Rules 
section of this issue of the Federal Register.

DATES: Comments must be received by VA on or before June 30, 1997.

ADDRESSES: Mail or hand deliver written comments to: Director, Office 
of Regulations Management (02D), Department of Veterans Affairs, 810 
Vermont Avenue, NW, Room 1154, Washington, DC 20420. Comments should 
indicate that they are submitted in response to ``RIN 2900-AI65.'' All 
written comments received will be available for public inspection at 
the above address in the Office of Regulations Management, Room 1158, 
between the hours of 8 a.m. and 4:30 p.m., Monday through Friday 
(except holidays).

FOR FURTHER INFORMATION CONTACT: Robert De Vesty, Health Systems 
Specialist, Office of Public Health and Environmental Hazards (13), 
Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington DC 
20420, telephone (202) 273-8456.

SUPPLEMENTARY INFORMATION: This document proposes to amend the 
``Medical regulations (38 CFR part 17),'' by setting forth new 
Secs. 17.900-17.905 regarding the provision of health care to Vietnam 
Veterans' children with spina bifida. Spina bifida is a congenital 
birth defect, characterized by defective closure of the bones 
surrounding the spinal cord. The spinal cord and its covering (the 
meninges) may protrude through the defect.
    The provisions of 38 U.S.C. Chapter 18 (Public Law 104-204, section 
421, September 26, 1996) provide for three separate types of benefits 
for Vietnam veterans' children who suffer from spina bifida: (1) 
Monthly monetary allowances (2) provision of health care needed for the 
spina bifida or any disability that is associated with such condition, 
and (3) provision of vocational training and rehabilitation.
    This document proposes to set forth a mechanism regarding provision 
of health care to Vietnam Veterans' children with spina bifida. In 
large part the proposed regulations restate statutory provisions.

[[Page 23732]]

    As a condition of eligibility for the provision of health care 
under proposed Secs. 17.900-17.905, it is proposed that a recipient 
must be eligible for a monetary allowance under the provisions setting 
forth a mechanism for monthly monetary payments relating to spina 
bifida. This would ensure that each recipient would have been 
determined to be a Vietnam Veteran's child suffering from spina bifida, 
and would obviate the need for duplicative medical determinations. In 
this regard, it is noted that monetary allowance would be awarded if 
the parent is determined to be a Vietnam veteran; if the child is 
determined, based on medical evidence, to suffer from spina bifida; and 
if the parent has not been dishonorably discharged (38 U.S.C. 101(2)). 
The provisions of Secs. 17.900 through 19.905 and the rationale for 
such provisions are contained in the companion document (RIN: 2900-
AI70) discussed above in the SUMMARY portion of this document.
    The proposal explains, consistent with the authorizing legislation, 
that the proposed provisions are not intended to be a comprehensive 
insurance plan and do not cover health care unrelated to spina bifida.
    The statutory provisions state that ``the Secretary may provide 
health care directly or by contract or other arrangement with any 
health care provider.'' It is proposed that any health care paid for by 
VA be provided only by ``approved health care providers.'' In this 
regard, it is proposed that such health care providers be only those 
approved by the Health Care Financing Administration (HCFA), Department 
of Defense (DoD) Civilian Health and Medical Program of the Uniformed 
Services (CHAMPUS), Civilian Health and Medical Program of the 
Department of Veterans Affairs (CHAMPVA), or Joint Commission on 
Accreditation of Healthcare Organizations (JCAHO), or those who possess 
a state license or certificate. This appears to provide reasonable 
assurance that individuals providing health care are qualified to do 
so.
    Under the proposal VA officials may inform spina bifida patients, 
parents, or guardians that health care may be available at not-for-
profit charitable entities. This would allow recipients to consider 
such sources for health care.
    The proposal includes a note clarifying when VA is the exclusive 
payer for health care provided. The note states that VA would provide 
payment under the proposal only for health care relating to spina 
bifida or a disability that is associated with such condition. The note 
also states that VA is the exclusive payer for services authorized 
under this proposal regardless of any third-party insurer, Medicare, 
Medicaid, health plan, or any other plan or program providing health 
care coverage. The note further states that any third-party insurer, 
Medicare, Medicaid, health plan, or any other plan or program providing 
health care coverage would be responsible according to its provisions 
for payment for health care not relating to spina bifida and not 
constituting a disability that is associated with such condition.
    It is proposed as a condition of payment that preauthorization from 
a preauthorization specialist of the Health Administration Center (P.O. 
Box 65025, Denver, CO 80206-9025) be required in accordance with 
prescribed procedures for case management, durable medical equipment, 
home care, professional counseling, mental health services, respite 
care, training, substance abuse treatment, dental services, 
transplantation services or travel (including any necessary costs for 
meals and lodging en route, and accompaniment by an attendant or 
attendants--other than mileage at the General Services Administration 
rate for privately owned automobiles). This will help VA provide 
necessary care.
    Under the proposal, payment to approved health care providers would 
be made using the methodology already established for the Civilian 
Health and Medical Program of the Department of Veterans Affairs 
(CHAMPVA) (see 38 CFR 17.270 et seq.). We believe this methodology 
based on Medicare and DoD principles would result in fair payments and 
allow VA to utilize a payment mechanism already in place.
    It is proposed that claims from approved health care providers be 
submitted to the Health Administration Center for payment and that the 
claims contain specified information. The Center already provides the 
same types of services for eligible veterans' dependents under the 
CHAMPVA program. Also, the specified information appears to be 
necessary to make determinations concerning authorization for payment. 
The proposal also includes time frames for submission of claims to 
ensure an orderly and efficient payment system. Further, it is proposed 
that in response to a request for payment, VA will provide an 
explanation of benefits to ensure that VA determinations of payments 
would be understood by claimants.
    The proposal sets forth a review/appeal process concerning 
determinations relating to the provision of health care or payment. A 
note also would be added to state that the final decision of the Health 
Administration Center Director concerning provision of health care or 
payment will inform the claimant of further appellate rights for 
appeals to the Board of Veterans' Appeals.
    Consistent with the statutory scheme, we propose that payments made 
shall constitute payment in full. The proposed rule also includes a 
specific list of items that would be excluded from payment since we 
believe they were not intended to be subject to payment.
    The proposal includes provisions concerning medical records. It is 
proposed that copies of medical records generated outside VA that 
relate to activities for which VA provided payment and that VA 
determines are necessary to adjudicate claims under Secs. 17.900-17.905 
of this part, must be provided to VA at no charge when requested by VA.

Paperwork Reduction Act of 1995

    The Office of Management and Budget (OMB) has determined that the 
proposed Secs. 17.902-17.904 of 38 CFR contain collections of 
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3520). Accordingly, under section 3507(d) of the Act, VA has submitted 
a copy of this rulemaking action to OMB for its review of the 
collections of information.
    OMB assigns a control number for each collection of information it 
approves. VA 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.
    Comments on the proposed collections of information should be 
submitted to the Office of Management and Budget, Attention: Desk 
Officer for the Department of Veterans Affairs, Office of Information 
and Regulatory Affairs, Washington, DC 20503, with copies mailed or 
hand-delivered to: Director, Office of Regulations Management (02D), 
Department of Veterans Affairs, 810 Vermont Ave., NW, Room 1154, 
Washington, DC 20420. Comments should indicate that they are submitted 
in response to ``RIN 2900-AI65''.

Preauthorization--Sec. 17.902

    Title: Preauthorization for Provision of Certain Health Care to 
Vietnam Veterans' Children with Spina Bifida.
    Summary of collection of information: The provisions of the 
proposed 38 CFR 17.902 would require individuals to submit a to a 
preauthorization specialist of the Health Administration Center a 
preauthorization application for health

[[Page 23733]]

care consisting of case management, durable medical equipment, home 
care, professional counseling, mental health services, respite care, 
training, substance abuse treatment, dental services, transplantation 
services or travel (other than mileage at the General Services 
Administration rate for privately owned automobiles). The 
preauthorization application would contain the child's name and social 
security number; the type of service requested; the medical 
justification; the estimated cost; and the name, address, and telephone 
number of the provider.
    Description of need for information and proposed use of 
information: Such information would be necessary to make 
preauthorization determinations in accordance with proposed 38 CFR 
17.902.
    Description of likely respondents: Individuals seeking provisions 
of health care to Vietnam veterans' children with spina bifida.
    Estimated number of respondents: 600 to 2000.
    Estimated frequency of responses: One time.
    Estimated total annual reporting and recordkeeping burden: 500 
hours.
    Estimated annual burden per collection: 15 minutes each.

Payment of Claims--Sec. 17.903

    Title: Payment of Claims for Provision of Health Care to Vietnam 
Veterans' Children with Spina Bifida.
    Summary of collection of information: The provisions of the 
proposed 38 CFR 17.903 would require that, as a condition of payment, 
claims from ``approved health care providers'' for health care provided 
under 38 CFR 17.900 must include the following information, as 
appropriate: With respect to patient identification information: The 
veteran's and patient's full name, social security numbers, patient's 
address, and date of birth; with respect to patient treatment 
information (inpatient and outpatient services): Full name and address 
(such as hospital or physician), remittance address, physical location 
where services were rendered, individual provider's professional status 
(M.D., Ph.D., R.N., etc.), and provider tax identification number (TIN) 
or Social Security Number (SSN); with respect to patient treatment 
information (inpatient institutional services): Dates of service 
(specific and inclusive); summary level itemization (by revenue code); 
dates of service for all absences from a hospital or other approved 
institution during a period for which inpatient benefits are being 
claimed; principal diagnosis established, after study, to be chiefly 
responsible for causing the patient's hospitalization; all secondary 
diagnoses; all procedures performed; discharge status of the patient; 
and institution's Medicare provider number; with respect to patient 
treatment information for all health care providers and ancillary 
outpatient services: Diagnosis, procedure code for each procedure, 
service or supply for each date of service, and individual billed 
charge for each procedure, service or supply for each date of service; 
with respect to prescription drugs and medicines: Name and address of 
pharmacy where drug was dispensed, name of drug, National Drug Code 
(NDC) for drug provided, strength, quantity date dispensed, and 
pharmacy receipt for each drug dispensed.
    Description of need for information and proposed use of 
information: Such information would be necessary to make payment 
determinations in accordance with proposed 38 CFR 17.903.
    Description of likely respondents: Individuals seeking provision of 
health care to Vietnam Veterans' children with spina bifida.
    Estimated number of respondents: 600 to 2000.
    Estimated frequency of responses: 10.
    Estimated total annual reporting and recordkeeping burden: 2,000 
hours.
    Estimated annual burden per collection: 6 minutes per item.

Review/Appeal process--Sec. 17.904

    Title: Review/Appeal process regarding provision of health care or 
payment relating to provision of health care to Vietnam Veterans' 
Children with Spina Bifida.
    Summary of collection of information: The provisions of the 
proposed 38 CFR 17.904 would establish a review process regarding 
disagreements by a Vietnam veteran's child or representative with a 
determination concerning authorization of health care or a health care 
provider's disagreement with a determination regarding payment. The 
person or entity requesting reconsideration of such determination would 
be required to submit such request to the Chief, Administrative 
Division, Health Administration Center, in writing within one year of 
the date of initial determination. The request must state why the 
decision is in error and include any new and relevant information not 
previously considered. After reviewing the matter, a benefits advisor 
would issue a written determination to the person or entity seeking 
reconsideration. If such person or entity remains dissatisfied with the 
determination, the person or entity would be permitted to make a 
written request for review by the Director, Health Administration 
Center.
    Description of need for information and proposed use of 
information: The information proposed to be collected under 17.904 
appears to be necessary to make review and appeal determinations.
    Description of likely respondents: Beneficiaries and providers 
disagreeing with determinations regarding covered services and 
benefits.
    Estimated number of respondents: 100.
    Estimated frequency of responses: 10.
    Estimated total annual reporting and recordkeeping burden: 334 
hours.
    Estimated annual burden per collection: 20 minutes per item.
    The Department considers comments by the public on proposed 
collections of information in--
     Evaluating whether the proposed collections of information 
are necessary for the proper performance of the functions of the 
Department, including whether the information will have practical 
utility;
     Evaluating the accuracy of the Department's estimate of 
the burden of the proposed collections of information, including the 
validity of the methodology and assumptions used;
     Enhancing the quality, usefulness, and clarity of the 
information to be collected; and
     Minimizing the burden of the collections of information on 
those who are to respond, including responses through the use of 
appropriate automated, electronic, mechanical, or other technological 
collection techniques or other forms of information technology, e.g., 
permitting electronic submission of responses.
    OMB is required to make a decision concerning the collection of 
information contained in this proposed rule between 30 and 60 days 
after publication of this document in the Federal Register. Therefore, 
a comment to OMB is best assured of having its full effect if OMB 
receives it within 30 days of publication. This does not affect the 
deadline for the public to comment on the proposed regulations.
    The Secretary hereby certifies that the adoption of the proposed 
rule would not have a significant impact on a substantial number of 
small entities as they are defined in the Regulatory Flexibility Act 
(RFA), 5 U.S.C. 601-612. It is estimated that there are only between 
600 and 2,000 Vietnam veterans' children who suffer from spina bifida. 
They are widely geographically diverse and the health care provided to 
them would not have a significant impact on any small businesses. 
Therefore, pursuant to 5 U.S.C. 605(b),

[[Page 23734]]

the proposed rule is exempt from the initial and final regulatory 
flexibility analysis requirements of sections 603 and 604.
    There are no Catalog of Federal Domestic Assistance program 
numbers.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
Government contracts, Grant programs-health, Grant programs-veterans, 
Health care, Health facilities, Health professions, Health records, 
Homeless, Medical and dental schools, Medical devices, Medical 
research, Mental health programs, Nursing homes, Philippines, Reporting 
and recordkeeping requirements, Scholarships and fellowships, Travel 
and transportation expenses, Veterans.

    Approved: March 21, 1997.
Jesse Brown,
Secretary of Veterans Affairs.

    For the reasons set forth in the preamble, 38 CFR part 17 is 
proposed to be amended as follows:

PART 17--MEDICAL

    1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501(a), 1721, unless otherwise noted.

    2. In part 17, an undesignated center heading and new Secs. 17.900-
17.905 are added to read as follows:

Health Care for a Vietnam Veteran's Child with Spina Bifida

Sec.
17.900  Spina Bifida--Provision of health care.
17.901  Definitions.
17.902  Preauthorization.
17.903  Payment.
17.904  Review appeal process.
17.905  Medical records.

Health Care for a Vietnam Veteran's Child with Spina Bifida


Sec. 17.900  Spina Bifida--Provision of health care.

    (a) VA shall provide a Vietnam veteran's child who has been 
determined under Sec. 3.814 of this title to suffer from spina bifida 
with such health care as the Secretary determines is needed by the 
child for the spina bifida or any disability that is associated with 
such condition. This is not intended to be a comprehensive insurance 
plan and does not cover health care unrelated to spina bifida.
    (b) Health care provided under this section shall be provided 
directly by VA, by contract with an approved health care provider, or 
by other arrangement with an approved health care provider. VA may 
inform spina bifida patients, parents, or guardians that health care 
may be available at not-for-profit charitable entities.

(Authority: 38 U.S.C. 101(2), 1801-1806)

    Note: VA provides payment under this section only for health 
care relating to spina bifida or a disability that is associated 
with such condition. VA is the exclusive payer for services 
authorized under this section regardless of any third party insurer, 
Medicare, Medicaid, health plan, or any other plan or program 
providing health care coverage. Any third-party insurer, Medicare, 
Medicaid, health plan, or any other plan or program providing health 
care coverage would be responsible according to its provisions for 
payment for health care not relating to spina bifida and not 
constituting a disability that is associated with such condition.


Sec. 17.901  Definitions.

    For the purpose of this section--
    Approved health care provider means a health care provider approved 
by the Health Care Financing Administration (HCFA), Department of 
Defense Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS), Civilian Health and Medical Program of the Department of 
Veterans Affairs (CHAMPVA), Joint Commission on Accreditation of Health 
care Organizations (JCAHO), or any health care provider approved for 
providing health care pursuant to a state license or certificate. An 
entity or individual shall be deemed to be an approved health care 
provider only when acting within the scope of the approval, license, or 
certificate.
    Child means the same as defined at Sec. 3.814(c) of this title.
    Habilitative and rehabilitative care means such professional 
counseling, guidance services and treatment programs (other than 
vocational training under 38 U.S.C. 1804) as are necessary to develop, 
maintain, or restore, to the maximum extent practicable, the 
functioning of a disabled person.
    Health care means home care, hospital care, nursing home care, 
outpatient care, preventive care, habilitative and rehabilitative care, 
case management, and respite care; and includes the training of 
appropriate members of a child's family or household in the care of the 
child; and the provisions of such pharmaceuticals, supplies, equipment, 
devices, appliances, assistive technology, direct transportation costs 
to and from approved health care providers (including any necessary 
costs for meals and lodging en route, and accompaniment by an attendant 
or attendants), and other materials as the Secretary determines 
necessary.
    Health care provider means any entity or individual who furnishes 
health care, including specialized spina bifida clinics, health care 
plans, insurers, organizations, and institutions.
    Home care means medical care, habilitative and rehabilitative care, 
preventive health services, and health-related services furnished to an 
individual in the individual's home or other place of residence.
    Hospital care means care and treatment furnished to an individual 
who has been admitted to a hospital as a patient.
    Nursing home care means care and treatment furnished to an 
individual who has been admitted to a nursing home as a resident.
    Outpatient care means care and treatment including preventive 
health services, furnished to an individual other than hospital care or 
nursing home care.
    Preventive care means care and treatment furnished to prevent 
disability or illness, including periodic examinations, immunizations, 
patient health education, and such other services as the Secretary 
determines necessary to provide effective and economical preventive 
health care.
    Respite care means care furnished on an intermittent basis for a 
limited period to an individual who resides primarily in a private 
residence when such care will help the individual continue residing in 
such private residence.
    Spina bifida means all forms and manifestations of spina bifida 
except spina bifida occulta (this includes complications or associated 
medical conditions which are adjunct to spina bifida according to the 
scientific literature).
    Vietnam veteran means the same as defined at Sec. 3.814(b) of this 
title.

(Authority: 38 U.S.C. 101(2), 1801-1806)


Sec. 17.902  Preauthorization.

    Preauthorization from a preauthorization specialist of the Health 
Administration Center is required for health care consisting of case 
management, durable medical equipment, home care, professional 
counseling, mental health services, respite care, training, substance 
abuse treatment, dental services, transplantation services or travel 
(other than mileage at the General Services Administration rate for 
privately owned automobiles). These services will be authorized only in 
those cases where there is a demonstrated medical need. Applications 
for provision of health care requiring preauthorization shall either

[[Page 23735]]

be made by telephone at (800) 733-8387, or in writing to Health 
Administration Center, P.O. Box 65025, Denver, CO 80206-9025. The 
application shall contain the following:
    (a) Name of Child,
    (b) Child's Social Security number,
    (c) Name of veteran,
    (d) Veteran's Social Security number,
    (e) Type of service requested,
    (f) Medical justification,
    (g) Estimated cost, and
    (h) Name, address, and telephone number of provider.

(Authority: 38 U.S.C. 101(2), 1801-1806)


Sec. 17.903  Payment.

    (a) (1) Payment under this section will be determined utilizing the 
same payment methodologies as provided for under the Civilian Health 
and Medical Program of the Department of Veterans Affairs (CHAMPVA) 
(see 38 CFR 17.720 et seq.).
    (2) As a condition of payment, claims from approved health care 
providers for health care provided under this section must be filed 
with the Health Administration Center, P.O. Box 65025, Denver, CO 
80206-9025, no later than:
    (i) One year after the date of service; or
    (ii) In the case of inpatient care, one year after the date of 
discharge; or
    (iii) In the case of retroactive approval for health care, 180 days 
following beneficiary notification of authorization.
    (3) Claims for health care provided under the provisions of 
Secs. 17.900 through 17.905 of this part shall contain, as appropriate, 
the information set forth in paragraphs (a)(3)(i) through (a)(3)(v) of 
this section.
    (i) Patient identification information:
    (A) Full name,
    (B) Address,
    (C) Date of birth, and
    (D) Social Security number.
    (ii) Provider identification information (inpatient and outpatient 
services):
    (A) Full name and address (such as hospital or physician),
    (B) Remittance address,
    (C) Address where services were rendered,
    (D) Individual provider's professional status (M.D., Ph.D., R.N., 
etc.), and
    (E) Provider tax identification number (TIN) or Social Security 
number.
    (iii) Patient treatment information (long-term care or 
institutional services):
    (A) Dates of service (specific and inclusive),
    (B) Summary level itemization (by revenue code),
    (C) Dates of service for all absences from a hospital or other 
approved institution during a period for which inpatient benefits are 
being claimed,
    (D) Principal diagnosis established, after study, to be chiefly 
responsible for causing the patient's hospitalization,
    (E) All secondary diagnoses,
    (F) All procedures performed,
    (G) Discharge status of the patient, and
    (H) Institution's Medicare provider number.
    (iv) Patient treatment information for all other health care 
providers and ancillary outpatient services such as durable medical 
equipment, medical requisites and independent laboratories:
    (A) Diagnosis,
    (B) Procedure code for each procedure, service or supply for each 
date of service, and
    (C) Individual billed charge for each procedure, service or supply 
for each date of service.
    (v) Prescription drugs and medicines and pharmacy supplies:
    (A) Name and address of pharmacy where drug was dispensed,
    (B) Name of drug,
    (C) Drug Code for drug provided,
    (D) Strength,
    (E) Quantity,
    (F) Date dispensed,
    (G) Pharmacy receipt for each drug dispensed (including billed 
charge), and
    (H) Diagnosis.
    (b) Health care payment shall be provided in accordance with the 
provisions of Secs. 17.900 through 17.905 of this part. However, the 
following are specifically excluded from payment:
    (1) Care as part of a grant study or research program,
    (2) Care considered experimental or investigational,
    (3) Drugs not approved by the U.S. Food and Drug Administration for 
commercial marketing,
    (4) Services, procedures or supplies for which the beneficiary has 
no legal obligation to pay, such as services obtained at a health fair,
    (5) Services provided outside the scope of the provider's license 
or certification, and
    (6) Services rendered by providers suspended or sanctioned by a 
Federal agency.
    (c) Payments made in accordance with the provisions of Secs. 17.900 
through 17.905 of this part shall constitute payment in full. 
Accordingly, the health care provider or agent for the health care 
provider may not impose any additional charge for any services for 
which payment is made by VA.
    (d) Explanation of benefits (EOB). When a claim under the 
provisions of Secs. 17.900 through 17.905 of this part is adjudicated, 
an EOB will be sent to the beneficiary or guardian and the provider. 
The EOB provides at a minimum, the following information:
    (1) Name and address of recipient,
    (2) Description of services and/or supplies provided,
    (3) Dates of services or supplies provided,
    (4) Amount billed,
    (5) Determined allowable amount,
    (6) To whom payment, if any, was made, and
    (7) Reasons for denial (if applicable).

(Authority: 38 U.S.C. 101(2), 1801-1806)


Sec. 17.904  Review appeal process.

    If a health care provider, Vietnam veteran's child or 
representative disagrees with a determination concerning provision of 
health care or a health care provider disagrees with a determination 
concerning payment, the person or entity may request reconsideration. 
Such request must be submitted in writing within one year of the date 
of the initial determination to the Chief, Administrative Division, 
Health Administration Center, P.O. Box 65025, Denver, CO 80206-9025. 
The request must state why it is concluded that the decision is in 
error and must include any new and relevant information not previously 
considered. Any request for reconsideration that does not identify the 
reason for dispute will be returned to the sender without further 
consideration. After reviewing the matter, including any relevant 
supporting documentation, a benefits advisor will issue a written 
determination to the person or entity seeking reconsideration that 
affirms, reverses or modifies the previous decision. If the person or 
entity seeking reconsideration is still dissatisfied, within 30 days of 
the date of the decision he or she may make a written request for 
review by the Director, Health Administration Center, P.O. Box 65025, 
Denver, CO 80206-9025. The Director will review the claim and any 
relevant supporting documentation and issue a decision in writing that 
affirms, reverses or modifies the previous decision.

(Authority: 38 U.S.C. 101(2), 1801-1806)

    Note: The final decision of the Director will inform the 
claimant of further appellate rights for an appeal to the Board of 
Veterans Appeals.


Sec. 17.905  Medical records.

    Copies of medical records generated outside VA that relate to 
activities for which VA is asked to provide payment, and that VA 
determines are necessary to adjudicate claims under Secs. 17.900 
through 17.905 of this part, must be provided to VA at no cost.


[[Page 23736]]


(Authority: 38 U.S.C. 101(2), 1801-1806)

[FR Doc. 97-11257 Filed 4-30-97; 8:45 am]
BILLING CODE 8320-01-P