[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.

0
For the reasons stated above, the Department of Veterans Affairs amends 
38 CFR part 17 as follows:

PART 17--MEDICAL

0
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.


0
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