[Federal Register Volume 73, Number 214 (Tuesday, November 4, 2008)]
[Rules and Regulations]
[Pages 65552-65553]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-26245]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AM22


Civilian Health and Medical Program of the Department of Veterans 
Affairs (CHAMPVA): Expansion of Benefit Coverage for Prostheses and 
Enuretic (Bed-Wetting) Devices; Miscellaneous Provisions

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

-----------------------------------------------------------------------

SUMMARY: This document adopts a final rule amending the Department of 
Veterans Affairs (VA) medical regulations for the Civilian Health and 
Medical Program of the Department of Veterans Affairs (CHAMPVA) to 
expand benefits by covering any non-dental prostheses determined 
medically necessary for the treatment of certain medical conditions and 
by removing the exclusion from coverage of enuretic (bed-wetting) 
devices. In addition, this final rule makes changes in delegations of 
authority, technical changes, and nonsubstantive changes for purposes 
of clarity in VA's regulations governing CHAMPVA.

DATES: Effective Date: This final rule is effective December 4, 2008.

FOR FURTHER INFORMATION CONTACT: Richard M. Trabert, Policy Management 
Division, VA Health Administration Center, P.O. Box 65020, Denver, CO 
80206-9020; (303) 331-7549. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: In a document published in the Federal 
Register on February 19, 2008 (73 FR 9068), VA proposed to amend its 
medical regulations at 38 CFR part 17 concerning CHAMPVA benefits. 
Specifically, it proposed to extend prosthetic coverage to any 
prostheses (other than dental prostheses) considered medically 
necessary because of significant conditions resulting from trauma, 
congenital anomalies, or disease. Also, it proposed to remove the 
exclusion of enuretic (bed-wetting) devices (alarms) but would continue 
to exclude enuretic conditioning programs. Additionally, the document 
proposed to amend the delegations of authority in 38 CFR 17.275, Claim 
filing deadline, and 38 CFR 17.276, Appeal/review process. Finally, the 
document proposed to make technical and other nonsubstantive changes 
for purposes of clarity, including to conform with Public Law 107-135, 
which redesignated the statutory section authorizing the CHAMPVA 
program as 38 U.S.C. 1781 (formerly 38 U.S.C. 1713). VA provided a 60-
day comment period that ended April 19, 2008. VA received no comments. 
Based on the rationale set forth in the proposed rule and in this 
document, we are adopting the provisions of the proposed rule as a 
final rule without change, except for a technical change regarding the 
authority citation for 38 CFR part 17.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before issuing any rule that may result in expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any year. This final rule would have no such effect on 
State, local, and tribal governments, or on the private sector.

Paperwork Reduction Act of 1995

    This document contains no provisions constituting a new collection 
of information under the Paperwork Reduction Act of 1995 (44 U.S.C. 
3501-3521).

Executive Order 12866

    Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, when regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety, 
and other advantages; distributive impacts; and equity). The Executive 
Order classifies a rule as a ``significant regulatory action'' 
requiring review by Office of Management and Budget (OMB) unless OMB 
waives such review, as any regulatory action that is likely to result 
in a rule that may: (1) Have an annual effect on the economy of $100 
million or more or adversely affect in a material way the economy, a 
sector of the economy, productivity,

[[Page 65553]]

competition, jobs, the environment, public health or safety, or State, 
local, or tribal government or communities; (2) create a serious 
inconsistency or otherwise interfere with an action taken or planned by 
another agency; (3) materially alter the budgetary impact of 
entitlements, grants, user fees, or loan programs or the rights and 
obligations of recipients thereof; or (4) raise novel legal or policy 
issues arising out of legal mandates, the President's priorities, or 
the principles set forth in the Executive Order.
    The economic, interagency, budgetary, legal, and policy 
implications of this final rule have been examined and it has been 
determined not to be a significant regulatory action under Executive 
Order 12866.

Regulatory Flexibility Act

    The Secretary of Veterans Affairs hereby certifies that this final 
rule 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. Individuals eligible for CHAMPVA 
benefits are widely dispersed geographically and thus services provided 
to them would not have a significant impact on any small entity. 
Therefore, pursuant to 5 U.S.C. 605(b), this final rule is exempt from 
the initial and final regulatory flexibility analysis requirements of 
sections 603 and 604.

Catalog of Federal Domestic Assistance

    This final rule affects the Civilian Health and Medical Program of 
the Department of Veterans Affairs (CHAMPVA), for which there is no 
Catalog of Federal Domestic Assistance program number.

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 facilities, Health professionals, Health records, Homeless, 
Medical and dental schools, Medical devices, Medical research, Mental 
health programs, Nursing homes, Philippines, Reporting and 
recordkeeping requirements, Travel and transportation expenses, and 
Veterans.

    Approved: October 28, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.

0
For the reasons stated above, VA amends 38 CFR part 17 as follows:

PART 17--MEDICAL

0
1. Revise the authority citation for part 17 to read as follows:

    Authority: 38 U.S.C. 501, 1721, and as noted in specific 
sections.


0
2. Amend Sec.  17.270 by:
0
a. In paragraph (a), removing ``1713'' and adding, in its place, 
``1781''.
0
b. In paragraph (b), removing ``this section'' and adding, in its 
place, ``Sec. Sec.  17.270 through 17.278'', removing ``fiscal'' year 
refers to October 1'', and adding, in its place, ``fiscal year'' refers 
to October 1''.
0
c. Revising the authority citation.
    The revision reads as follows:


Sec.  17.270  General provisions.

* * * * *

(Authority: 38 U.S.C. 501, 1781)



0
3. Amend Sec.  17.271 by revising the authority citations after 
paragraph (a) and at the end of the section to read as follows:


Sec.  17.271  Eligibility.

    (a) * * *

(Authority: 38 U.S.C. 501, 1781)

* * * * *

(Authority: 38 U.S.C. 501, 1781)



0
4. Amend Sec.  17.272 by:
0
a. Redesignating paragraphs (a)(44)(i) through (a)(44)(iv) as 
paragraphs (a)(44)(ii)(A) through (D), respectively.
0
b. Redesignating paragraph (a)(44)(v) as new paragraph (a)(44)(i).
0
c. Adding paragraphs (a)(44)(ii) introductory text and (a)(44)(ii)(E).
0
d. Revising paragraph (a)(52) and the authority citation.
    The additions and revisions read as follows:


Sec.  17.272  Benefits limitations/exclusions.

    (a) * * *
    (44) * * *
    (ii) Any prostheses, other than dental prostheses, determined to be 
medically necessary because of significant conditions resulting from 
trauma, congenital anomalies, or disease, including, but not limited 
to:
* * * * *
    (E) Ears, noses, and fingers.
* * * * *
    (52) Enuretic (bed-wetting) conditioning programs.
* * * * *

(Authority: 38 U.S.C. 501, 1781)



0
5. Amend Sec.  17.273 by revising the authority citation to read as 
follows:


Sec.  17.273  Preauthorization.

* * * * *

(Authority: 38 U.S.C. 501, 1781)



0
6. Amend Sec.  17.274 by revising the authority citation to read as 
follows:


Sec.  17.274  Cost sharing.

* * * * *

(Authority: 38 U.S.C. 501, 1781)



0
7. Amend Sec.  17.275 by:
0
a. In paragraph (b), removing ``Center Director'' and adding, in its 
place, ``Director, Health Administration Center, or his or her 
designee''; and removing ``paragraph (a) if'' and adding, in its place, 
``paragraph (a) of this section if''.
0
b. Adding an authority citation at the end of the section.
    The addition reads as follows:


Sec.  17.275  Claim filing deadline.

* * * * *

(Authority: 38 U.S.C. 501, 1781)



0
8. Amend Sec.  17.276 by:
0
a. Removing ``Center Director'' and ``Director'' each time they appear 
and adding, in their place, ``Director, Health Administration Center, 
or his or her designee''.
0
b. Revising the authority citation.
0
c. In the Note, removing ``20 CFR'' and adding, in its place ``38 
CFR''.
    The revision reads as follows:


Sec.  17.276  Appeal/review process.

* * * * *

(Authority: 38 U.S.C. 501, 1781)

* * * * *


0
9. Amend Sec.  17.277 by adding an authority citation to read as 
follows:


Sec.  17.277  Third-party liability/medical care cost recovery.

* * * * *

(Authority: 28 U.S.C. 2651; 38 U.S.C. 501, 1781)



0
10. Amend Sec.  17.278 by adding an authority citation to read as 
follows:


Sec.  17.278  Confidentiality of records.

* * * * *

(Authority: 5 U.S.C. 552, 552a; 38 U.S.C. 501, 1781, 5701, 7332)


 [FR Doc. E8-26245 Filed 11-3-08; 8:45 am]
BILLING CODE 8320-01-P