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, 9068-9071 [E8-3003]
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9068
Federal Register / Vol. 73, No. 33 / Tuesday, February 19, 2008 / Proposed Rules
Commission shall provide individuals
with disabilities covered by this section
with the information and data involved
by an alternative means of access that
allows the individual to use the
information and data.
14. Section 1615.140 is revised to read
as follows:
§ 1615.140
Employment.
No qualified individual with a
disability shall, on the basis of
disability, be subjected to
discrimination in employment under
any program or activity conducted by
the Commission. The definitions,
requirements, and procedures of section
501 of the Rehabilitation Act of 1973 (29
U.S.C. 791), as established by this
Commission in 29 CFR part 1614, shall
apply to employment in federally
conducted programs or activities. As
noted in 29 CFR 1614.203(b), the
standards used to determine whether
section 501 of the Rehabilitation Act has
been violated in a complaint alleging
non-affirmative action employment
discrimination under part 1614 shall be
the standards applied under Title I and
Title V (sections 501 through 504 and
510) of the Americans with Disabilities
Act of 1990, as amended (42 U.S.C.
12101, 12111, 12201) as such sections
relate to employment. These standards
are set forth in the Commission’s ADA
regulations at 29 CFR part 1630. If a
section 501 complaint is filed against
the Commission in the part 1614
process and it is found to include a
separate section 508 claim, the part
1614 process will be used to process the
section 501 claim. The section 508
claim will be processed separately in
accordance with the procedures set
forth at § 1615.170.
§ 1615.150
[Amended]
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15. Section 1615.150(c) and (d) are
removed.
16. Section 1615.170 is amended as
follows:
A. Revise paragraphs (a), (b), and (c).
B. Revise the first sentences of
paragraphs (d)(1) and (d)(2).
C. Revise the third and fourth
sentences of paragraph (i).
D. Revise paragraph (j).
E. Revise the first sentence of
paragraph (k).
F. Add a new paragraph (n).
The revisions and additions read as
follows:
§ 1615.170
Compliance procedures.
(a) Except as provided in paragraph
(b) of this section, this section applies
to all allegations of discrimination on
the basis of disability in programs or
activities conducted by the Commission
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in violation of section 504. This section
also applies to all complaints alleging a
violation of the agency’s responsibility
to procure electronic and information
technology under section 508 whether
filed by members of the public or EEOC
employees or applicants.
(b) The Commission shall process
complaints alleging violations of section
504 with respect to employment
according to the procedures established
by EEOC in 29 CFR part 1614 pursuant
to section 501 of the Rehabilitation Act
of 1973 (29 U.S.C. 791). With regard to
employee claims concerning agency
procurements made in violation of
section 508, the procedures set out in
paragraphs (d) through (m) of this
section shall be used.
(c) Responsibility for implementation
and operation of this section shall be
vested in the Director, Office of Equal
Opportunity (Director of OEO).
(d) * * * (1) * * * Any person who
believes that he or she has been
subjected to discrimination prohibited
by this part or that the agency’s
procurement of electronic and
information technology has violated
section 508, or authorized
representative of such person, may file
a complaint with the Director of OEO.
* * *
(2) * * * Complaints shall be filed
with the Director of OEO within one
hundred and eighty calendar days of the
alleged acts of discrimination. * * *
*
*
*
*
*
(i) * * * An appeal shall be deemed
filed on the date it is postmarked, or, in
the absence of a postmark, on the date
it is received by the Chair at EEOC
headquarters. It should be clearly
marked ‘‘Appeal of Section 504
decision’’ or ‘‘Appeal of Section 508
decision’’ and should contain specific
objections explaining why the person
believes the initial decision was
factually or legally wrong. * * *
(j) Timely appeals shall be decided by
the Chair of the Commission unless the
Commission determines that an appeal
raises a policy issue which should be
addressed by the full Commission.
(1) The Chair will draft a decision
within 30 days of receipt of an appeal
and circulate it to the Commission.
(2) If a Commissioner believes an
appeal raises a policy issue that should
be addressed by the full Commission, he
or she shall so inform the Chair by
notice in writing within ten calendar
days of the circulation of the draft
decision on appeal.
(3) If the Chair does not receive such
written notice, the decision on appeal
shall be issued.
(4) If the Chair receives written notice
as described in subparagraph (2), the
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Commission shall resolve the appeal
through a vote.
(k) The Commission shall notify the
complainant of the results of the appeal
within ninety calendar days of the
receipt of the appeal from the
complainant. * * *
*
*
*
*
*
(n) Civil actions. The remedies,
procedures, and rights set forth in
sections 505(a)(2) and 505(b) of the
Rehabilitation Act, 29 U.S.C. 794a(a)(2)
and 794a(b) shall be the remedies,
procedures, and rights available to any
individual with a disability filing a
complaint under this section.
Dated: February 7, 2008.
Naomi C. Earp,
Chair.
[FR Doc. E8–2863 Filed 2–15–08; 8:45 am]
BILLING CODE 6570–01–P
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
Department of Veterans Affairs.
Proposed rule.
AGENCY:
ACTION:
SUMMARY: This document proposes to
amend the Department of Veterans
Affairs (VA) regulations for the Civilian
Health and Medical Program of the
Department of Veterans Affairs
(CHAMPVA) to expand the benefits
available by covering, in addition to
currently-covered prostheses, any nondental prostheses determined medically
necessary for treatment of certain
medical conditions. It also proposes to
no longer exclude coverage of enuretic
(bed-wetting) devices. In addition, this
document proposes to make changes in
delegations of authority, technical
changes, and nonsubstantive changes
for purposes of clarity in VA’s
regulations governing CHAMPVA.
DATES: Comments must be received on
or before April 21, 2008.
ADDRESSES: Written comments may be
submitted through https://
www.Regulations.gov; by mail or hand
delivery to the Director, Regulations
Management (00REG), Department of
Veterans Affairs, 810 Vermont Ave.,
NW., Room 1068, Washington, DC
20420; or by fax to (202) 273–9026.
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Federal Register / Vol. 73, No. 33 / Tuesday, February 19, 2008 / Proposed Rules
Comments should indicate that they are
submitted in response to ‘‘RIN 2900AM22—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.’’ Copies of
comments received will be available for
public inspection in the Office of
Regulation Policy and Management,
Room 1063B, between the hours of 8
a.m. and 4:30 p.m., Monday through
Friday (except holidays). Please call
(202) 461–4902 for an appointment.
(This is not a toll-free number.) In
addition, during the comment period,
comments may be viewed online
through the Federal Docket Management
System (FDMS) at https://
www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT:
Richard M. Trabert, Policy &
Compliance 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: This
document proposes to amend VA’s
medical regulations in 38 CFR part 17
concerning CHAMPVA. CHAMPVA is a
VA medical benefits program for certain
(1) spouses and children of veterans
who have a permanent and total serviceconnected disability and (2) surviving
spouses and children of veterans who
died as a result of a service-connected
disability or while rated permanently or
totally disabled from a serviceconnected disability, or who died in the
active military, naval, or air service in
the line of duty. CHAMPVA is
authorized at 38 U.S.C. 1781 (formerly
38 U.S.C. 1713). To be eligible for
CHAMPVA benefits, among other
requirements, the spouses, surviving
spouses, and children may not be
otherwise eligible for medical care
under 10 U.S.C. chapter 55 (authorizing
TRICARE, formerly CHAMPUS; referred
to in this preamble as TRICARE/
CHAMPUS). By the terms of section
1781(b), VA is required to provide
benefits under CHAMPVA in the same
or similar manner and subject to the
same or similar limitations as medical
care that is furnished to certain
dependents and survivors of active duty
and retired members of the Armed
Forces under TRICARE/CHAMPUS.
Needed medical care is largely provided
to CHAMPVA beneficiaries through
non-VA providers.
This proposed rule would amend 38
CFR 17.272, ‘‘Benefits limitations/
exclusions,’’ in accordance with the
requirements under 38 U.S.C. 1781(b) to
furnish CHAMPVA benefits ‘‘in the
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same or similar manner and with the
same or similar limitations’’ as medical
care under TRICARE/CHAMPUS.
First, we propose to add certain
prostheses to the benefits available
under the CHAMPVA program to be
consistent with benefits authorized for
TRICARE/CHAMPUS in section 702 of
Public Law 105–85 (1999), the National
Defense Authorization Act for Fiscal
Year 1998. That statutory provision
amended TRICARE/CHAMPUS
coverage to include prosthetic devices
‘‘as determined by the Secretary of
Defense to be necessary because of
significant conditions resulting from
trauma, congenital anomalies, or
disease.’’ The Department of Defense
(DoD) amended the TRICARE/
CHAMPUS regulations in 32 CFR 199.4
accordingly. See 65 FR 58224–25, Sept.
28, 2000 (final rule); 64 FR 45453–
45454, August 20, 1999 (interim final
rule). As discussed in the preambles in
those rulemaking documents, DoD
determined that noses, ears, and fingers
are examples of additional prostheses
that are authorized under that statutory
amendment for TRICARE/CHAMPUS
coverage. See 65 FR 58224; 64 FR
45453–45454. The regulations
promulgated by DoD exclude from
coverage all dental prostheses, ‘‘except
for those specifically required in
connection with otherwise covered
orthodontia directly related to the
surgical correction of a cleft palate
anomaly.’’ 32 CFR 199.4(g)(48).
Under VA’s current regulations for
CHAMPVA at 38 CFR 17.272(a)(44),
coverage for the purchase of prosthetic
devices is limited to artificial limbs,
voice prostheses, eyes, items surgically
inserted in the body as an integral part
of a surgical procedure, and dental
prostheses that are specifically required
in connection with otherwise covered
orthodontia directly related to the
surgical correction of a cleft palate
anomaly. (These are also subject to the
requirements generally applicable to
CHAMPVA benefits, including being
medically necessary and appropriate for
the treatment of a condition.) We
propose to amend § 17.272(a)(44) to
extend prosthetic coverage to any other
prostheses (other than dental
prostheses) considered medically
necessary because of significant
conditions resulting from trauma,
congenital anomalies, or disease. The
proposed changes to § 17.272(a)(44) are
also intended to clarify that ears, noses,
and fingers and the prostheses currently
referred to in § 17.272(a)(44)(i) through
(iv) are examples of what the newlylisted category would include.
Consistent with 32 CFR 199.4(g)(48),
dental prostheses would continue to be
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excluded except as specifically
provided in current § 17.272(a)(44)(v).
As another change authorized under
the statutory requirement to furnish
CHAMPVA benefits in the same or
similar manner and with the same or
similar limitations as medical care
under TRICARE/CHAMPUS, we
propose to amend § 17.272(a)(52) to
permit enuretic (bed-wetting) devices
(alarms) to be furnished to CHAMPVA
beneficiaries. This proposed change
would be consistent with DoD’s
regulations at 32 CFR 199.4(g)(58). That
paragraph was amended to no longer
exclude such devices. See 67 FR 18825,
Apr. 17, 2002. Currently, enuretic (bedwetting) devices and enuretic
conditioning programs are excluded
from CHAMPVA coverage. The
proposed rule would remove the
exclusion for enuretic (bed-wetting)
devices now found at § 17.272(a)(52),
but would, like TRICARE/CHAMPUS,
continue to exclude enuretic
conditioning programs. We believe it is
in the public interest to implement in
the CHAMPVA program this TRICARE/
CHAMPUS change. The basis for
excluding enuretic conditioning
programs is to restrict the payment for
professional guidance on the use of
these devices to an authorized health
care provider, such as the attending
physician, a physician assistant, or a
nurse practitioner.
This proposed rule would also amend
the delegations of authority in 38 CFR
17.275, ‘‘Claim filing deadline,’’ and 38
CFR 17.276, ‘‘Appeal/review process.’’
Currently, § 17.275(b) provides that only
the ‘‘Center Director’’ has the authority
to grant exceptions to the claim filing
deadline. This proposed rule would
amend § 17.275(b) by referring to the
Center Director by his or her title, the
‘‘Director, Health Administration
Center’’, and would permit the Director
to extend that authority to his or her
designee. Similarly, § 17.276 currently
provides that, in response to a
beneficiary’s request for review of a
decision by a CHAMPVA benefits
advisor, only the Center Director has the
authority to issue a decision that is the
final decision with respect to benefit
coverage and computation of benefits,
and that affirms, reverses, or modifies
the prior decision. This proposed rule
would amend § 17.276 to permit the
Director, Health Administration Center,
or his or her designee, to issue that final
decision.
Finally, the proposed rule would
make technical changes and other
nonsubstantive changes for purposes of
clarity in §§ 17.270 through 17.278.
These include technical changes to
conform with Public Law 107–135,
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Federal Register / Vol. 73, No. 33 / Tuesday, February 19, 2008 / Proposed Rules
which redesignated the statutory section
authorizing the CHAMPVA program as
38 U.S.C. 1781 (formerly 38 U.S.C.
1713).
Regulatory Flexibility Act
The Secretary of Veterans Affairs
hereby certifies that this proposed rule
would 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 proposed rule is exempt from the
initial and final regulatory flexibility
analysis requirements of sections 603
and 604.
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).
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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 the
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 proposed rule would have no
such effect on State, local, and tribal
governments, or on the private sector.
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 ‘‘significant
regulatory action,’’ requiring review by
the 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
governments or communities; (2) create
a serious inconsistency or otherwise
interfere with an action taken or
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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 proposed rule have
been examined and it has been
determined not to be a significant
regulatory action under Executive Order
12866.
(Authority: 38 U.S.C. 501, 1781)
3. Amend § 17.271 by revising the
authority citations after paragraph (a)
and at the end of the section to read as
follows:
§ 17.271
Eligibility.
(a) * * *
(Authority: 38 U.S.C. 501, 1781)
*
*
*
*
*
(Authority: 38 U.S.C. 501, 1781)
This proposed 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.
4. Amend § 17.272 by:
a. Redesignating paragraphs (a)(44)(i)
through (a)(44)(iv) as paragraphs
(a)(44)(ii)(A) through (D), respectively.
b. Redesignating paragraph (a)(44)(v)
as new paragraph (a)(44)(i).
c. Adding paragraphs (a)(44)(ii)
introductory text and (a)(44)(ii)(E).
d. Revising paragraph (a)(52) and the
authority citation.
The additions and revisions read as
follows:
List of Subjects in 38 CFR Part 17
§ 17.272
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 professionals,
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, and Veterans.
(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.
*
*
*
*
*
Approved: February 11, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans.
5. Amend § 17.273 by revising the
authority citation to read as follows:
Catalog of Federal Domestic Assistance
Benefits limitations/exclusions.
(Authority: 38 U.S.C. 501, 1781)
For the reasons stated above, the
Department of Veterans Affairs proposes
to amend 38 CFR part 17 as follows:
§ 17.273
PART 17—MEDICAL
1. The authority citation for part 17
continues to read as follows:
6. Amend § 17.274 by revising the
authority citation to read as follows:
§ 17.274
*
*
Preauthorization.
*
*
*
(Authority: 38 U.S.C. 501, 1781)
*
2. Amend § 17.270 by:
a. In paragraph (a), removing ‘‘1713’’
and adding, in its place, ‘‘1781’’.
b. In paragraph (b), removing ‘‘this
section’’ and adding, in its place,
‘‘§§ 17.270 through 17.278’’, removing
‘‘ ‘‘fiscal’’ year refers to October 1’’, and
adding, in its place, ‘‘ ‘‘fiscal year’’ refers
to October 1’’.
c. Revising the authority citation.
The revision reads as follows:
7. Amend § 17.275 by:
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’’.
b. Adding an authority citation at the
end of the section.
The addition reads as follows:
§ 17.270
§ 17.275
*
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General provisions.
*
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Cost sharing.
Authority: 38 U.S.C. 501, 1721, and as
noted in specific sections.
*
*
*
(Authority: 38 U.S.C. 501, 1781)
*
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Claim filing deadline.
*
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(Authority: 38 U.S.C. 501, 1781)
§ 17.276
*
Appeal/review process.
*
*
*
*
FOR FURTHER INFORMATION CONTACT:
(Authority: 38 U.S.C. 501, 1781)
Richard Langston at 202–287–1339 or
Richard.Langston@hq.doe.gov.
*
*
*
*
*
9. Amend § 17.277 by adding an
authority citation to read as follows:
SUPPLEMENTARY INFORMATION:
§ 17.277 Third-party liability/medical care
cost recovery.
*
*
*
*
*
(Authority: 28 U.S.C. 2651; 38 U.S.C. 501,
1781)
10. Amend § 17.278 by adding an
authority citation to read as follows:
§ 17.278
*
Confidentiality of records.
*
*
*
*
(Authority: 5 U.S.C. 552, 552a; 38 U.S.C. 501,
1781, 5701, 7332)
[FR Doc. E8–3003 Filed 2–15–08; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF ENERGY
48 CFR Parts 904, 952 and 970
RIN 1991–AB71
Department of Energy.
Notice of proposed rulemaking.
AGENCY:
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SUMMARY: The Department of Energy
(DOE) is proposing to amend the
Department of Energy Acquisition
Regulation (DEAR) to revise the security
clause used in all contracts and
subcontracts involving access
authorizations to specifically require
background checks and tests for the
absence of any illegal drug, as defined
in DOE regulations of uncleared
personnel (employment applicants and
current employees) who will require
access authorizations. Background
checks would not be required for
applicants for DOE access authorization
who possess a current access
authorization from another Federal
agency.
DATES: Written comments on the
proposed rulemaking must be received
on or before close of business March 20,
2008.
VerDate Aug<31>2005
16:24 Feb 15, 2008
I. Background
II. Section-by-Section Analysis
III. Procedural Requirements
A. Review Under Executive Order 12866
B. Review Under Executive Order 12988
C. Review Under the Regulatory Flexibility
Act
D. Review Under the Paperwork Reduction
Act
E. Review Under the National
Environmental Policy Act
F. Review Under Executive Order 13132
G. Review Under the Unfunded Mandates
Reform Act of 1995
H. Review Under the Treasury and General
Government Appropriations Act, 1999
I. Review Under Executive Order 13211
J. Review Under the Treasury and General
Government Appropriations Act, 2001
K. Approval by the Office of the Secretary
of Energy
I. Background
Acquisition Regulation: Security
Clause
ACTION:
This proposed rule is
available and comments may be
submitted to the Federal Electronic
Rulemaking Portal at https://
www.regulations.gov. Comments may
also be submitted electronically to
Richard.Langston@hq.doe.gov.
Comments may be mailed to: Richard
Langston, Procurement Policy Analyst;
MA–61/Forrestal Building; U.S.
Department of Energy; 1000
Independence Avenue, SW.;
Washington, DC 20585.
ADDRESSES:
8. Amend § 17.276 by:
a. Removing ‘‘Center Director’’ and
‘‘Director’’ each time they appear and
adding, in their place, ‘‘Director, Health
Administration Center, or his or her
designee’’.
b. Revising the authority citation.
c. In the Note, removing ‘‘20 CFR’’
and adding, in its place ‘‘38 CFR’’.
The revision reads as follows:
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Many DOE contractor and
subcontractor employees require access
authorizations for access to classified
information (Restricted Data, Formerly
Restricted Data, or National Security
Information) or certain quantities of
special nuclear material in order to
perform official duties. Section 904.404
is being revised to add a requirement in
paragraph (d)(1) that the security clause
is required in any contract that will
involve contractor employees’ access to
special nuclear material. That
requirement reflects past DOE practice
and is being added to make the
instruction clear and complete. Section
952.204–2, Security requirements, is
revised by changing the title of the
section to ‘‘Security’’ and by revising its
introductory text to conform to the more
recent Federal Acquisition Regulation
format. Some of the requirements at
970.2201–1–2 are appropriate to other
types of contracts if access
authorizations are required, so language
at 970.2201–1–2 is being restated in the
security clause.
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9071
II. Section-by-Section Analysis
The Department proposes to amend
the DEAR as follows:
Section 904.401 is amended to revise
the definitions of classified information
and Restricted Data.
Section 904.404, Solicitation
provision and contract clause, is
amended by adding ‘‘or access to special
nuclear materials’’ after ‘‘classified
information’’ at the end of the first
sentence of paragraph (d)(1).
Section 952.204–2, Security
requirements, is amended by revising its
title to ‘‘Security’’; by revising the
definitions in paragraphs (c) through (g);
by revising the title of paragraph (h)
from ‘‘Security clearances of personnel’’
to ‘‘Access authorizations for
personnel’’ and redesignating its text as
paragraph (h)(1); by adding new
paragraphs (h)(2) and (i); by
redesignating existing paragraphs (i) and
(j) as (j) and (k); and by adding new
paragraphs (l) and (m). Paragraphs
(h)(2), (i), and (i)(1) contain language
similar to that found in management
and operating contract policy guidance
at 970.2201–1–2(a)(1) and (2). The
language in (h)(2) has been augmented
by referencing the criteria at 10 CFR
710.8 that are used to grant or deny
access authorizations, by adding a
requirement that a candidate for a DOE
access authorization must be tested to
demonstrate the absence of any illegal
drug, as defined in 10 CFR 707.4, and
by directing contractors to select for
employment only those whom they
believe can pass the rigorous
background investigation required for
such positions. A new paragraph (h)(3)
has been added making it clear that drug
testing is applicable to all employees on
an applicant, random or ‘‘for cause’’
basis. Paragraph (i), Criminal liability is
amended to add ‘‘special nuclear
material, and other Government
property’’ to ‘‘classified information’’ as
items the contractor must protect.
Paragraph (j), Foreign Ownership,
Control or Influence, is amended by
moving the flow down to subcontracts
requirement of (j)(4) to (l) and
redesignating paragraph (j)(5) as (j)(4).
New paragraph (k), Employment
announcements, requires that
contractors include a notice in vacancy
announcements for positions requiring
access authorizations that background
checks and testing for the absence of
any illegal drug, as defined in 10 CFR
707.4, will be performed, and that the
Federal government may conduct a
background investigation, subsequent
reinvestigations, and, in the case of
counterintelligence positions (as
defined in 10 CFR 709.3), a
E:\FR\FM\19FEP1.SGM
19FEP1
]]>Agencies
[Federal Register Volume 73, Number 33 (Tuesday, February 19, 2008)]
[Proposed Rules]
[Pages 9068-9071]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-3003]
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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: Proposed rule.
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SUMMARY: This document proposes to amend the Department of Veterans
Affairs (VA) regulations for the Civilian Health and Medical Program of
the Department of Veterans Affairs (CHAMPVA) to expand the benefits
available by covering, in addition to currently-covered prostheses, any
non-dental prostheses determined medically necessary for treatment of
certain medical conditions. It also proposes to no longer exclude
coverage of enuretic (bed-wetting) devices. In addition, this document
proposes to make changes in delegations of authority, technical
changes, and nonsubstantive changes for purposes of clarity in VA's
regulations governing CHAMPVA.
DATES: Comments must be received on or before April 21, 2008.
ADDRESSES: Written comments may be submitted through https://
www.Regulations.gov; by mail or hand delivery to the Director,
Regulations Management (00REG), Department of Veterans Affairs, 810
Vermont Ave., NW., Room 1068, Washington, DC 20420; or by fax to (202)
273-9026.
[[Page 9069]]
Comments should indicate that they are submitted in response to ``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.'' Copies of comments received will be available for public
inspection in the Office of Regulation Policy and Management, Room
1063B, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday
(except holidays). Please call (202) 461-4902 for an appointment. (This
is not a toll-free number.) In addition, during the comment period,
comments may be viewed online through the Federal Docket Management
System (FDMS) at https://www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT: Richard M. Trabert, Policy &
Compliance 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: This document proposes to amend VA's medical
regulations in 38 CFR part 17 concerning CHAMPVA. CHAMPVA is a VA
medical benefits program for certain (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 or totally
disabled from a service-connected disability, or who died in the active
military, naval, or air service in the line of duty. CHAMPVA is
authorized at 38 U.S.C. 1781 (formerly 38 U.S.C. 1713). To be eligible
for CHAMPVA benefits, among other requirements, the spouses, surviving
spouses, and children may not be otherwise eligible for medical care
under 10 U.S.C. chapter 55 (authorizing TRICARE, formerly CHAMPUS;
referred to in this preamble as TRICARE/CHAMPUS). By the terms of
section 1781(b), VA is required to provide benefits under CHAMPVA in
the same or similar manner and subject to the same or similar
limitations as medical care that is furnished to certain dependents and
survivors of active duty and retired members of the Armed Forces under
TRICARE/CHAMPUS. Needed medical care is largely provided to CHAMPVA
beneficiaries through non-VA providers.
This proposed rule would amend 38 CFR 17.272, ``Benefits
limitations/exclusions,'' in accordance with the requirements under 38
U.S.C. 1781(b) to furnish CHAMPVA benefits ``in the same or similar
manner and with the same or similar limitations'' as medical care under
TRICARE/CHAMPUS.
First, we propose to add certain prostheses to the benefits
available under the CHAMPVA program to be consistent with benefits
authorized for TRICARE/CHAMPUS in section 702 of Public Law 105-85
(1999), the National Defense Authorization Act for Fiscal Year 1998.
That statutory provision amended TRICARE/CHAMPUS coverage to include
prosthetic devices ``as determined by the Secretary of Defense to be
necessary because of significant conditions resulting from trauma,
congenital anomalies, or disease.'' The Department of Defense (DoD)
amended the TRICARE/CHAMPUS regulations in 32 CFR 199.4 accordingly.
See 65 FR 58224-25, Sept. 28, 2000 (final rule); 64 FR 45453-45454,
August 20, 1999 (interim final rule). As discussed in the preambles in
those rulemaking documents, DoD determined that noses, ears, and
fingers are examples of additional prostheses that are authorized under
that statutory amendment for TRICARE/CHAMPUS coverage. See 65 FR 58224;
64 FR 45453-45454. The regulations promulgated by DoD exclude from
coverage all dental prostheses, ``except for those specifically
required in connection with otherwise covered orthodontia directly
related to the surgical correction of a cleft palate anomaly.'' 32 CFR
199.4(g)(48).
Under VA's current regulations for CHAMPVA at 38 CFR 17.272(a)(44),
coverage for the purchase of prosthetic devices is limited to
artificial limbs, voice prostheses, eyes, items surgically inserted in
the body as an integral part of a surgical procedure, and dental
prostheses that are specifically required in connection with otherwise
covered orthodontia directly related to the surgical correction of a
cleft palate anomaly. (These are also subject to the requirements
generally applicable to CHAMPVA benefits, including being medically
necessary and appropriate for the treatment of a condition.) We propose
to amend Sec. 17.272(a)(44) to extend prosthetic coverage to any other
prostheses (other than dental prostheses) considered medically
necessary because of significant conditions resulting from trauma,
congenital anomalies, or disease. The proposed changes to Sec.
17.272(a)(44) are also intended to clarify that ears, noses, and
fingers and the prostheses currently referred to in Sec.
17.272(a)(44)(i) through (iv) are examples of what the newly-listed
category would include. Consistent with 32 CFR 199.4(g)(48), dental
prostheses would continue to be excluded except as specifically
provided in current Sec. 17.272(a)(44)(v).
As another change authorized under the statutory requirement to
furnish CHAMPVA benefits in the same or similar manner and with the
same or similar limitations as medical care under TRICARE/CHAMPUS, we
propose to amend Sec. 17.272(a)(52) to permit enuretic (bed-wetting)
devices (alarms) to be furnished to CHAMPVA beneficiaries. This
proposed change would be consistent with DoD's regulations at 32 CFR
199.4(g)(58). That paragraph was amended to no longer exclude such
devices. See 67 FR 18825, Apr. 17, 2002. Currently, enuretic (bed-
wetting) devices and enuretic conditioning programs are excluded from
CHAMPVA coverage. The proposed rule would remove the exclusion for
enuretic (bed-wetting) devices now found at Sec. 17.272(a)(52), but
would, like TRICARE/CHAMPUS, continue to exclude enuretic conditioning
programs. We believe it is in the public interest to implement in the
CHAMPVA program this TRICARE/CHAMPUS change. The basis for excluding
enuretic conditioning programs is to restrict the payment for
professional guidance on the use of these devices to an authorized
health care provider, such as the attending physician, a physician
assistant, or a nurse practitioner.
This proposed rule would also amend the delegations of authority in
38 CFR 17.275, ``Claim filing deadline,'' and 38 CFR 17.276, ``Appeal/
review process.'' Currently, Sec. 17.275(b) provides that only the
``Center Director'' has the authority to grant exceptions to the claim
filing deadline. This proposed rule would amend Sec. 17.275(b) by
referring to the Center Director by his or her title, the ``Director,
Health Administration Center'', and would permit the Director to extend
that authority to his or her designee. Similarly, Sec. 17.276
currently provides that, in response to a beneficiary's request for
review of a decision by a CHAMPVA benefits advisor, only the Center
Director has the authority to issue a decision that is the final
decision with respect to benefit coverage and computation of benefits,
and that affirms, reverses, or modifies the prior decision. This
proposed rule would amend Sec. 17.276 to permit the Director, Health
Administration Center, or his or her designee, to issue that final
decision.
Finally, the proposed rule would make technical changes and other
nonsubstantive changes for purposes of clarity in Sec. Sec. 17.270
through 17.278. These include technical changes to conform with Public
Law 107-135,
[[Page 9070]]
which redesignated the statutory section authorizing the CHAMPVA
program as 38 U.S.C. 1781 (formerly 38 U.S.C. 1713).
Regulatory Flexibility Act
The Secretary of Veterans Affairs hereby certifies that this
proposed rule would 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 proposed rule is
exempt from the initial and final regulatory flexibility analysis
requirements of sections 603 and 604.
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).
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 the 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 proposed rule would have no such effect on
State, local, and tribal governments, or on the private sector.
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 ``significant regulatory action,'' requiring review
by the 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 governments 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 proposed rule have been examined and it has been
determined not to be a significant regulatory action under Executive
Order 12866.
Catalog of Federal Domestic Assistance
This proposed 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 care, 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, Scholarships and fellowships, Travel
and transportation expenses, and Veterans.
Approved: February 11, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans.
For the reasons stated above, the Department of Veterans Affairs
proposes to amend 38 CFR part 17 as follows:
PART 17--MEDICAL
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.
2. Amend Sec. 17.270 by:
a. In paragraph (a), removing ``1713'' and adding, in its place,
``1781''.
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''.
c. Revising the authority citation.
The revision reads as follows:
Sec. 17.270 General provisions.
* * * * *
(Authority: 38 U.S.C. 501, 1781)
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)
4. Amend Sec. 17.272 by:
a. Redesignating paragraphs (a)(44)(i) through (a)(44)(iv) as
paragraphs (a)(44)(ii)(A) through (D), respectively.
b. Redesignating paragraph (a)(44)(v) as new paragraph (a)(44)(i).
c. Adding paragraphs (a)(44)(ii) introductory text and
(a)(44)(ii)(E).
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)
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)
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)
7. Amend Sec. 17.275 by:
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''.
b. Adding an authority citation at the end of the section.
The addition reads as follows:
Sec. 17.275 Claim filing deadline.
* * * * *
[[Page 9071]]
(Authority: 38 U.S.C. 501, 1781)
8. Amend Sec. 17.276 by:
a. Removing ``Center Director'' and ``Director'' each time they
appear and adding, in their place, ``Director, Health Administration
Center, or his or her designee''.
b. Revising the authority citation.
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)
* * * * *
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)
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. E8-3003 Filed 2-15-08; 8:45 am]
BILLING CODE 8320-01-P
