Agency Information Collection Activity: CHAMPVA Benefits-Application, Claim, Other Health Insurance, Potential Liability & Miscellaneous Expenses, 29883-29884 [2021-11618]

Download as PDF Federal Register / Vol. 86, No. 105 / Thursday, June 3, 2021 / Notices DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0219] Agency Information Collection Activity: CHAMPVA Benefits— Application, Claim, Other Health Insurance, Potential Liability & Miscellaneous Expenses Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: 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: Written comments and recommendations on the proposed collection of information should be received on or before August 2, 2021. ADDRESSES: Submit written comments on the collection of information through Federal Docket Management System (FDMS) at www.Regulations.gov or to Janel Keyes, Office of Regulations, Appeals, and Policy (10BRAP), Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420 or email to Janel.Keyes@va.gov. Please refer to ‘‘OMB Control No. 2900– 0219’’ in any correspondence. During the comment period, comments may be viewed online through FDMS. FOR FURTHER INFORMATION CONTACT: Maribel Aponte, Office of Enterprise and Integration, Data Governance Analytics (008), 1717 H Street NW, Washington, DC 20006, (202) 266–4688 or email maribel.aponte@va.gov. Please refer to ‘‘OMB Control No. 2900–0219’’ in any correspondence. 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 khammond on DSKJM1Z7X2PROD with NOTICES SUMMARY: VerDate Sep<11>2014 17:23 Jun 02, 2021 Jkt 253001 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. Authority: Public Law 104–13; 44 U.S.C. 3501–3521. Title: CHAMPVA Benefits— Application, Claim, Other Health Insurance, Potential Liability & Miscellaneous Expenses. OMB Control Number: 2900–0219. Type of Review: Reinstatement with change of a previously 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). 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 PO 00000 Frm 00147 Fmt 4703 Sfmt 4703 29883 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 and/or Vietnam 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 and Vietnam 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 chapter 51 of 38 U.S.C. or 38 CFR 17.276 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. If such person or entity remains dissatisfied with the reconsideration determination, the person or entity is permitted to submit a written request for additional review. 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 E:\FR\FM\03JNN1.SGM 03JNN1 29884 Federal Register / Vol. 86, No. 105 / Thursday, June 3, 2021 / Notices Programs. The person requesting the services must submit medical documentation or applicable supporting material for review. Affected Public: Individuals and 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. By direction of the Secretary. Maribel Aponte, VA PRA Clearance Officer, Office of Enterprise and Integration/Data Governance Analytics, Department of Veterans Affairs. [FR Doc. 2021–11618 Filed 6–2–21; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS Solicitation of Nominations for Appointment to the Advisory Committee on Tribal and Indian Affairs, Amended ACTION: Notice. The Department of Veterans Affairs (VA), Office of Public and Intergovernmental Affairs (OPIA), Office of Tribal Government Relations (OTGR), is seeking nominations of qualified candidates to be considered for appointment as a member of the Advisory Committee on Tribal and Indian Affairs (‘‘the Committee’’). DATES: Nominations for membership on the Committee must be received no later than 5:00 p.m. EST on June 16, 2021. ADDRESSES: All nomination packages (Application, should be mailed to the khammond on DSKJM1Z7X2PROD with NOTICES SUMMARY: VerDate Sep<11>2014 17:23 Jun 02, 2021 Jkt 253001 Office of Tribal Government Relations, 810 Vermont Ave. NW, Suite 915H (075), Washington, DC 20420 or email us at tribalgovernmentconsultation@ va.gov. Ms. Stephanie Birdwell and David ‘‘Clay’’ Ward, Office of Tribal Government Relations, 810 Vermont Ave. NW, Ste 915H (075), Washington, DC 20420, Telephone (202) 461–7400. A copy of the Committee charter can be obtained by contacting Mr. David ‘‘Clay’’ Ward or by accessing the website managed by OTGR at https://www.va.gov/TRIBAL GOVERNMENT/index.asp. SUPPLEMENTARY INFORMATION: In carrying out the duties set forth, the Committee responsibilities include, but not limited to: (1) Identify for the Department evolving issues of relevance to Indian tribes, tribal organizations and Native American Veterans relating to programs and services of the Department; (2) Propose clarifications, recommendations and solutions to address issues raised at tribal, regional and national levels, especially regarding any tribal consultation reports; (3) Provide a forum for Indian tribes, tribal organizations, urban Indian organizations, Native Hawaiian organizations and the Department to discuss issues and proposals for changes to Department regulations, policies and procedures; (4) Identify priorities and provide advice on appropriate strategies for tribal consultation and urban Indian organizations conferring on issues at the tribal, regional, or national levels; (5) Ensure that pertinent issues are brought to the attention of Indian tribes, tribal organizations, urban Indian organizations and Native Hawaiian organizations in a timely manner, so that feedback can be obtained; (6) Encourage the Secretary to work with other Federal agencies and Congress so that Native American Veterans are not denied the full benefit of their status as both Native Americans and Veterans; (7) Highlight contributions of Native American Veterans in the Armed Forces; (8) Make recommendations on the consultation policy of the Department on tribal matters; (9) Support a process to develop an urban Indian organization confer policy to ensure the Secretary confers, to the maximum extent practicable, with urban Indian organizations; and (10) With the Secretary’s written approval, conduct other duties as recommended by the Committee. FOR FURTHER INFORMATION CONTACT: PO 00000 Frm 00148 Fmt 4703 Sfmt 4703 Authority: The Committee was established in accordance with section 7002 of Public Law 116–315 (H.R. 7105—Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020). In accordance with Public Law 116–315, the Committee provides advice and guidance to the Secretary of Veterans Affairs on all matters relating to Indian tribes, tribal organizations, Native Hawaiian organizations and Native American Veterans. The Committee serves in an advisory capacity and advises the Secretary on ways the Department can improve the programs and services of the Department to better serve Native American Veterans. Committee members make recommendations to the Secretary regarding such activities. Membership Criteria: OTGR is requesting nominations for upcoming vacancies on the Committee. The Committee will be composed of 15 members. As required by statute, the members of the Committee are appointed by the Secretary from the general public, including: (1) At least one member of each of the 12 service areas of the Indian Health Service is represented in the membership of the Committee nominated by Indian tribes or tribal organization. (2) At least one member of the Committee represents the Native Hawaiian Veteran community nominated by a Native Hawaiian Organization. (3) At least one member of the Committee represents urban Indian organizations nominated by a national urban Indian organization. (4) Not fewer than half of the members are Veterans, unless the Secretary determines that an insufficient number of qualified Veterans were nominated. (5) No member of the Committee may be an employee of the Federal Government. In accordance with Public Law 116– 315, the Secretary determines the number and terms of service for members of the Committee, which are appointed by the Secretary, except that a term of service of any such member may not exceed a term of two years. Additionally, a member may be reappointed for one additional term at the Secretary’s discretion. Professional Qualifications: In addition to the criteria above, VA seeks— (1) Diversity in professional and personal qualifications; E:\FR\FM\03JNN1.SGM 03JNN1

Agencies

[Federal Register Volume 86, Number 105 (Thursday, June 3, 2021)]
[Notices]
[Pages 29883-29884]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-11618]



[[Page 29883]]

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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.

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

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: Written comments and recommendations on the proposed collection 
of information should be received on or before August 2, 2021.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at www.Regulations.gov 
or to Janel Keyes, Office of Regulations, Appeals, and Policy (10BRAP), 
Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 
20420 or email to [email protected]. Please refer to ``OMB Control No. 
2900-0219'' in any correspondence. During the comment period, comments 
may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Maribel Aponte, Office of Enterprise 
and Integration, Data Governance Analytics (008), 1717 H Street NW, 
Washington, DC 20006, (202) 266-4688 or email [email protected]. 
Please refer to ``OMB Control No. 2900-0219'' in any correspondence.

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.
    Authority: Public Law 104-13; 44 U.S.C. 3501-3521.
    Title: CHAMPVA Benefits--Application, Claim, Other Health 
Insurance, Potential Liability & Miscellaneous Expenses.
    OMB Control Number: 2900-0219.
    Type of Review: Reinstatement with change of a previously 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).

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 and/or Vietnam 
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 and Vietnam 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 chapter 51 
of 38 U.S.C. or 38 CFR 17.276 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. If such person or entity remains dissatisfied with 
the reconsideration determination, the person or entity is permitted to 
submit a written request for additional review.
    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

[[Page 29884]]

Programs. The person requesting the services must submit medical 
documentation or applicable supporting material for review.
    Affected Public: Individuals and 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.

    By direction of the Secretary.
Maribel Aponte,
VA PRA Clearance Officer, Office of Enterprise and Integration/Data 
Governance Analytics, Department of Veterans Affairs.
[FR Doc. 2021-11618 Filed 6-2-21; 8:45 am]
BILLING CODE 8320-01-P
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