[Federal Register Volume 62, Number 106 (Tuesday, June 3, 1997)]
[Rules and Regulations]
[Pages 30240-30242]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-14349]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AI60
Guidelines for Furnishing Sensori-neural Aids (i.e., Eyeglasses,
Contact Lenses, Hearing Aids)
AGENCY: Department of Veterans Affairs.
ACTION: Interim final rule.
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SUMMARY: This document amends the Department of Veterans Affairs (VA)
medical regulations to provide guidelines for when VA will furnish
veterans with sensori-neural aids (i.e., eyeglasses, contact lenses,
hearing aids). These amendments are necessary to implement a
requirement imposed in the recently enacted Veterans' Health
[[Page 30241]]
Care Eligibility Reform Act of 1996, Pub. L. 104-262.
DATES: This interim final rule is effective June 3, 1997. Comments must
be received on or before August 4, 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-AI60.'' 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 8:00 a.m. and 4:30 p.m., Monday through Friday
(except holidays).
FOR FURTHER INFORMATION CONTACT: Frederick Downs, Jr., Chief
Consultant, Prosthetics and Sensory Aids Service Strategic Healthcare
Group (113), Department of Veterans Affairs, 810 Vermont Avenue, NW.,
Washington, DC 20420, (202) 273-8515.
SUPPLEMENTARY INFORMATION: This document amends the VA medical
regulations set forth at 38 CFR part 17. It adds a new section to the
regulations to provide specific guidance on when VA will furnish
veterans with sensori-neural aids (i.e., eyeglasses, contact lenses,
hearing aids).
Prior to the enactment of Public Law 104-262, VA's authority to
furnish prosthetic devices and appliances to veterans on an outpatient
basis was very limited. That law significantly expanded VA's authority
to furnish such devices and appliances on an outpatient basis. The new
law provided that VA could furnish needed prosthetic devices and
appliances to any veteran otherwise receiving health-care services from
VA. The law further provided, however, that VA could furnish needed
sensori-neural aids, a type of prosthetic device, only in accordance
with guidelines promulgated by the Secretary. This provision in the law
effectively authorizes VA to impose limitations on the provision of
those sensori-neural aids.
This interim final rule provides that VA will furnish needed
sensori-neural aids (i.e., eyeglasses, contact lenses, hearing aids) to
the following veterans:
(1) Those with a compensable service-connected disability;
(2) Those who are former prisoners of war;
(3) Those in receipt of benefits under 38 U.S.C. 1151;
(4) Those in receipt of increased pension based on the need for
regular aid and attendance or by reason of being permanently
housebound;
(5) Those who have a visual or hearing impairment that resulted
from the existence of another medical condition for which the veteran
is receiving VA care, or which resulted from treatment of that medical
condition;
(6) Those with a significant functional or cognitive impairment
evidenced by deficiencies in the ability to perform activities of daily
living, but not including routinely occurring visual or hearing
impairments; and
(7) Those visually or hearing impaired so severely that the
provision of sensori-neural aids is necessary to permit active
participation in their own medical treatment.
Examples of medical conditions which could cause visual or hearing
impairments permitting VA to furnish sensori-neural aids under
paragraph (5) include stroke, diabetes, multiple sclerosis, vascular
disease and geriatric chronic illnesses, when they result in visual or
hearing impairment. Examples of treatment of medical conditions which
could cause impairments permitting the furnishing of devices under that
paragraph might include treatment with ototoxic drugs, or performance
of surgery on the eye or ear, such as cataract surgery.
Examples of significant functional or cognitive impairment under
paragraph (6) are: one or more basic activities of daily living
impairment, cognitive impairment as measured by a mental status
examination, and recurrent falls with the contributing cause being
visual impairment.
An example of when VA might furnish sensori-neural aids under
paragraph (7) to permit a patient to participate in his or her own
treatment would be a geriatric patient with a severe visual or hearing
loss which, combined with other age-related infirmities, makes
communication extremely difficult or impossible absent receipt of a
sensori-neural aid. Another example would be a blind veteran with a
hearing loss who needs a hearing aid to participate in training at a VA
Blind Rehabilitation Center.
VA will provide sensori-neural aids to the first four groups of
veterans because Congress determined in section 104 of Public Law 104-
262 that they have the highest priority to receive VA health-care
benefits. VA also will provide sensori-neural aids to the fifth, sixth
and seventh groups of veterans due to their substantial needs.
This interim final rule also provides that VA will furnish needed
hearing aids to those veterans who have service-connected hearing
disabilities rated 0 percent if there is a service-connected organic
conductive, mixed, or sensory hearing impairment, and loss of pure tone
hearing sensitivity in the low, mid, or high-frequency range or a
combination of frequency ranges which contribute to a loss of
communication ability; however, hearing aids are to be provided only as
needed for the service-connected hearing condition. VA will provide
hearing aids to this group because of their service-connected hearing
disability.
Section 103(a) of Public Law 104-262 provides that VA ``may not
furnish sensori-neural aids other than in accordance with guidelines
which the Secretary shall prescribe.'' Section 103(b) of this law
requires that the guidelines be established on or before November 8,
1996 (``(n)ot later than 30 days after the date of the enactment of
this Act.''). Under these circumstances, the Secretary finds under 5
U.S.C. 553 (b) and (d) that prior notice-and-comment and a 30-day delay
of the effective date are impractical, unnecessary, and contrary to the
public interest, and that there is good cause for dispensing with these
procedures.
Because no notice of proposed rulemaking was required in connection
with the adoption of this final rule, no regulatory flexibility
analysis is required under the Regulatory Flexibility Act (5 U.S.C.
601-612). Even so, the Secretary hereby certifies that these regulatory
amendments will not have a significant economic impact on a substantial
number of small entities as they are defined in the Regulatory
Flexibility Act 5 U.S.C. 601-612. These amendments do not affect any
small entities.
This regulatory action has been reviewed by the Office of
Management and Budget under Executive Order 12866.
The Catalog of Federal Domestic Assistance program number is
64.013.
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.
[[Page 30242]]
Approved: December 23, 1996.
Jesse Brown,
Secretary of Veterans Affairs.
For the reasons set forth in the preamble, 38 CFR part 17 is
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. An undesignated center heading and a new Sec. 17.149 are added
to read as follows:
Prosthetic, Sensory, and Rehabilitative Aids
Sec. 17.149 Sensori-neural Aids.
(a) Notwithstanding any other provision of this part, VA will
furnish needed sensori-neural aids (i.e., eyeglasses, contact lenses,
hearing aids) only to veterans otherwise receiving VA care or services
and only as provided in this section.
(b) VA will furnish needed sensori-neural aids (i.e., eyeglasses,
contact lenses, hearing aids) to the following veterans:
(1) Those with a compensable service-connected disability;
(2) Those who are former prisoners of war;
(3) Those in receipt of benefits under 38 U.S.C. 1151;
(4) Those in receipt of increased pension based on the need for
regular aid and attendance or by reason of being permanently
housebound;
(5) Those who have a visual or hearing impairment that resulted
from the existence of another medical condition for which the veteran
is receiving VA care, or which resulted from treatment of that medical
condition;
(6) Those with a significant functional or cognitive impairment
evidenced by deficiencies in activities of daily living, but not
including normally occurring visual or hearing impairments; and
(7) Those visually or hearing impaired so severely that the
provision of sensori-neural aids is necessary to permit active
participation in their own medical treatment.
(c) VA will furnish needed hearing aids to those veterans who have
service-connected hearing disabilities rated 0 percent if there is
organic conductive, mixed, or sensory hearing impairment, and loss of
pure tone hearing sensitivity in the low, mid, or high-frequency range
or a combination of frequency ranges which contribute to a loss of
communication ability; however, hearing aids are to be provided only as
needed for the service-connected hearing disability.
(Authority: 38 U.S.C. 1701(6)(A)(i))
3. The undesignated center heading preceding Sec. 17.150 is
removed.
[FR Doc. 97-14349 Filed 6-2-97; 8:45 am]
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