[Federal Register Volume 74, Number 125 (Wednesday, July 1, 2009)]
[Rules and Regulations]
[Pages 31373-31374]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-15484]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR PART 17
RIN 2900-AM99
Civilian Health and Medical Program of the Department of Veterans
Affairs (CHAMPVA): Preauthorization of Durable Medical Equipment
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: This document amends the Department of Veterans Affairs (VA)
medical regulations for the Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA) preauthorization section by
increasing the dollar ceiling for purchase or rental of durable medical
equipment (DME) from $300 to $2,000.
DATES: Effective Date: The final rule is effective July 31, 2009.
FOR FURTHER INFORMATION CONTACT: Lisa Brown, Chief, Policy Management
Division, VA Health Administration Center, P.O. Box 460948, Denver,
Colorado 80246; (303) 331-7882. (This is not a toll-free number).
SUPPLEMENTARY INFORMATION: In a document published in the Federal
Register on October 28, 2008 (73 FR 63914), VA proposed to amend its
medical regulations at 38 CFR Part 17 concerning CHAMPVA benefits.
Specifically, it proposed to amend Sec. 17.273(e) regarding durable
medical equipment (DME) by increasing the dollar ceiling for purchase
or rental of durable medical equipment (DME) from the $300 to $2,000.
CHAMPVA is a VA medical benefits program for (1) spouses and
children of veterans who have a permanent and total service-connected
disability and (2) surviving spouses and children of veterans who died
as a result of a service-connected disability or while rated
permanently and totally disabled from a service-connected disability,
or who died in the active military, naval, or air service in the line
of duty and there is not otherwise entitlement to Department of Defense
TRICARE benefits. DME is included among the health care items that are
available to CHAMPVA beneficiaries. To ensure that DME purchases and
rental are medically necessary, appropriate and within the Department's
budgetary constraints, VA requires non-VA providers to obtain
preauthorization before the purchase or rental of DME for a CHAMPVA
beneficiary when the cost of the DME exceeds $300. DME purchases
greater than $300 are currently reviewed twice, i.e., first when a
request is submitted for preauthorization and again when the claim is
officially submitted for payment.
The current rate was put in place in 1973. Since the cost of common
DME items has steadily increased, this ceiling no longer reflects
current costs. Raising the dollar amount to $2,000 would make the
administrative processing of DME claims easier for CHAMPVA
beneficiaries and providers as well as for VA, since claims under that
amount will only be reviewed once.
VA provided a 60-day comment period that ended December 29, 2008.
[[Page 31374]]
We received one comment from five individuals who jointly expressed
their support for the proposed amendment to Sec. 17.273(e). Based on
the rationale set forth in the proposed rule, we are adopting the
provisions of the proposed rule as a final rule without change.
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995, requires that agencies
prepare an assessment of anticipated costs and benefits before
developing 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 given 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 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 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, 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.
VA has examined the economic, interagency, budgetary, legal, and
policy implications of this final rule and has concluded that it is not
a significant regulatory action under the Executive Order 12866.
Regulatory Flexibility Act
The Secretary of Veterans Affairs hereby certifies that this
regulatory amendment 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 rule is exempt
from the initial and final regulatory flexibility analyses requirements
of section 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, 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: June 22, 2009.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
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For the reasons stated above, the Department of Veterans Affairs amends
38 CFR part 17 as follows:
PART 17--MEDICAL
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1. The authority citation for part 17 continues to read as follows:
Authority: 38 U.S.C. 501, 1721, and as noted in specific
sections.
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2. Revise paragraph (e) of Sec. 17.273 to read as follows:
Sec. 17.273 Preauthorization.
* * * * *
(e) Durable medical equipment with a purchase or total rental price
in excess of $2,000.
* * * * *
Authority: 38 U.S.C. 501, 1781.
[FR Doc. E9-15484 Filed 6-30-09; 8:45 am]
BILLING CODE 8320-01-P