[Federal Register Volume 89, Number 169 (Friday, August 30, 2024)]
[Notices]
[Pages 70692-70694]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-19505]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0219]


Agency Information Collection Activity: CHAMPVA Benefits--
Application, Claim, Other Health Insurance, Potential Liability & 
Miscellaneous Expenses

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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[[Page 70693]]

SUMMARY: Veterans Health Administration (VHA), Department of Veterans 
Affairs (VA), is announcing an opportunity for public comment on the 
proposed collection of certain information by the agency. Under the 
Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to 
publish notice in the Federal Register concerning each proposed 
collection of information, including each proposed extension of a 
currently approved collection, and allow 60 days for public comment in 
response to the notice.

DATES:  Comments must be received on or before October 29, 2024.

ADDRESSES: Comments must be submitted through www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: 
    Program-specific information: Rebecca Mimnall, 202-695-9434, 
[email protected].
    VA PRA information: Maribel Aponte, 202-461-8900, 
[email protected].

SUPPLEMENTARY INFORMATION: Under the PRA of 1995, Federal agencies must 
obtain approval from the Office of Management and Budget (OMB) for each 
collection of information they conduct or sponsor. This request for 
comment is being made pursuant to section 3506(c)(2)(A) of the PRA.
    With respect to the following collection of information, VHA 
invites comments on: (1) whether the proposed collection of information 
is necessary for the proper performance of VHA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VHA's estimate of the burden of the proposed collection of 
information; (3) ways to enhance the quality, utility, and clarity of 
the information to be collected; and (4) ways to minimize the burden of 
the collection of information on respondents, including through the use 
of automated collection techniques or the use of other forms of 
information technology.
    Title: CHAMPVA Benefits--Application, Claim, Other Health 
Insurance, Potential Liability & Miscellaneous Expenses.
    OMB Control Number: 2900-0219. https://www.reginfo.gov/public/do/PRASearch. (Once at this link, you can enter the OMB Control Number to 
find the historical versions of this Information Collection.)
    Type of Review: Revision of a currently approved collection.
    Abstract: This information collection includes several forms, as 
well as a review and appeal process, which are used to administer the 
Civilian Health and Medical Program of the Department of Veterans 
Affairs (CHAMPVA). Although the burden numbers have not changed since 
the last PRA clearance, the collection is being revised to include a 
portal for submission of the information in the 10-10d program 
application form, which is expected to be completed by the end of 
calendar year 2024. This portal will allow applicants to complete and 
submit VA Form 10-10d electronically rather than by submission of a 
hard copy form, which has been the standard application process prior 
to technological advancement allowing electronic submission and 
processing. This portal represents a separate avenue for applicants to 
submit VA Form 10-10d; however, it does not affect the burden of 
collection for applicants or VA.

VA Form 10-10d: Application for CHAMPVA Benefits
VA Form 10-7959a: CHAMPVA Claim Form
VA Form 10-7959c: CHAMPVA Other Health Insurance (OHI) Certification
VA Form 10-7959d: CHAMPVA Potential Liability Claim
VA Form 10-7959e: VA Claim for Miscellaneous Expenses

Review and Appeal Process

Clinical Review

    a. VA Form 10-10d, Application for CHAMPVA Benefits, is used to 
determine eligibility of persons applying for healthcare benefits under 
the CHAMPVA program in accordance with 38 U.S.C. 501 and 1781.
    b. VA Form 10-7959a, CHAMPVA Claim Form, is used to adjudicate 
claims for CHAMPVA benefits in accordance with 38 U.S.C. 501 and 1781, 
and 10 U.S.C. 1079 and 1086. This information is required for accurate 
adjudication and processing of beneficiary submitted claims. The claim 
form is also instrumental in the detection and prosecution of fraud. In 
addition, the claim form is the only mechanism to obtain, on an interim 
basis, other health insurance (OHI) information.
    c. VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI) 
Certification, is used to systematically obtain OHI information and to 
correctly coordinate benefits among all liable parties. Except for 
Medicaid and health insurance policies that are purchased exclusively 
for the purpose of supplementing CHAMPVA benefits, CHAMPVA is always 
the secondary payer of healthcare benefits (38 U.S.C. 501 and 1781, and 
10 U.S.C. 1086).
    d. VA Form 10-7959d, CHAMPVA Potential Liability Claim, provides 
basic information from which potential third party liability can be 
assessed. The Federal Medical Care Recovery Act (42 U.S.C. 2651-2653) 
mandates recovery of costs associated with healthcare services related 
to an injury/illness caused by a third party. Additional authority 
includes 38 U.S.C. 501; 38 CFR 1.900 et seq.; 10 U.S.C. 1079 and 1086; 
42 U.S.C. 2651-2653; and Executive Order 9397.
    e. VA Form 10-7959e, VA Claim for Miscellaneous Expenses, is used 
to adjudicate claims for certain children of Korea, Vietnam, and 
Thailand veterans authorized under 38 U.S.C., chapter 18, as amended by 
section 401, Public Law 106-419 and section 102, Public Law 108-183. 
VA's medical regulations 38 CFR part 17 (17.900 through 17.905) 
establish regulations regarding provision of health care for certain 
children of Korea, Vietnam, and Thailand veterans and women Vietnam 
veterans' children born with spina bifida and certain other covered 
birth defects. These regulations also specify the information to be 
included in requests for preauthorization and claims from approved 
health care providers.
    f. Review and Appeal Process pertains to the approval of health 
care, or approval for payment relating to the provision of health care, 
under the Veteran Family Member Programs. The provisions of the 
Veterans Appeals Improvement and Modernization Act of 2017 (AMA, Pub. 
L. 115-55), chapter 51 of 38 U.S.C., or legacy claims under 38 CFR 
17.277 and 38 CFR 17.904 establish a review process regarding 
disagreements by an eligible beneficiary of a Veteran Family Member 
Program, provider, veteran, or other representative of the veteran or 
beneficiary, with a determination concerning provision of health care 
or a health care provider's disagreement with a determination regarding 
payment. The person or entity requesting reconsideration of such 
determination is required to submit such a request in writing 
(including electronic where available). If such person or entity 
remains dissatisfied with the determination, the person or entity is 
permitted to submit a written request for additional review (VHA Notice 
2024-07).
    g. Clinical Review pertains to the requirement of VHA to 
preauthorize certain medical services under 38 CFR 17.273 and 38 CFR 
17.902. Clinical review determines if services are medically necessary 
and appropriate to allow under the Veteran Family Member Programs. The 
person requesting the services must submit medical documentation or 
applicable supporting material for review.

[[Page 70694]]

    Affected Public: Individuals or Households.
    Estimated Annual Burden: 34,548 total hours.
    VA Form 10-10d--8,963 hours.
    VA Form 10-7959a--9,167 hours.
    VA Form 10-7959c--8,947 hours.
    VA Form 10-7959d--239 hours.
    VA Form 10-7959e--200 hours.
    Review and Appeal Process--6,255 hours.
    Clinical Review--777 hours.
    Estimated Average Burden Per Respondent:
    VA Form 10-10d--10 minutes.
    VA Form 10-7959a--10 minutes.
    VA Form 10-7959c--10 minutes.
    VA Form 10-7959d--7 minutes.
    VA Form 10-7959e--15 minutes.
    Review and Appeal Process--30 minutes.
    Clinical Review--20 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 180,142 total.
    VA Form 10-10d--53,775.
    VA Form 10-7959a--55,000.
    VA Form 10-7959c--53,680.
    VA Form 10-7959d--2,045.
    VA Form 10-7959e--800.
    Review and Appeal Process--12,510.
    Clinical Review--2,332.
    Authority: 44 U.S.C. 3501 et seq.

Maribel Aponte,
VA PRA Clearance Officer, Office of Enterprise and Integration/Data 
Governance Analytics, Department of Veterans Affairs.
[FR Doc. 2024-19505 Filed 8-29-24; 8:45 am]
BILLING CODE 8320-01-P