Processing Certain Claims for Payment for Transportation, Care, and Services, 67863-67865 [2024-18651]
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Federal Register / Vol. 89, No. 163 / Thursday, August 22, 2024 / Rules and Regulations
anchor, or remain within the safety zone
unless authorized by the COTP New
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If authorization is granted, persons and/
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must comply with the instructions of
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16.
(d) Enforcement period. This rule will
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2024, through 12 p.m. on October 9,
2024.
Dated: August 9, 2024.
G.A. Callaghan,
Captain, U.S. Coast Guard, Captain of the
Port New Orleans.
[FR Doc. 2024–18869 Filed 8–21–24; 8:45 am]
BILLING CODE 9110–04–P
DEPARTMENT OF VETERANS
AFFAIRS
38 CFR Part 17
Processing Certain Claims for
Payment for Transportation, Care, and
Services
Department of Veterans Affairs.
Notification of guidance.
AGENCY:
ACTION:
This notification informs the
public of the Department of Veterans
Affairs’ (VA) interpretation of law and
regulations regarding timely filing for
certain claims for payment for
transportation, care and services
affected by a cybersecurity incident.
DATES: The guidance is effective August
22, 2024. Claims submitted pursuant to
this document must be received by VA
by October 31, 2024.
FOR FURTHER INFORMATION CONTACT:
Joseph Duran, Policy Directorate,
16IVCEO3, Veterans Health
Administration, Department of Veterans
Affairs, 810 Vermont Avenue NW,
Washington, DC 20420; 303–370–1637.
This is not a toll-free number.
SUPPLEMENTARY INFORMATION:
Factual Background: On February 21,
2024, a cybersecurity incident impacted
Change Healthcare (CHC). CHC serves as
a clearinghouse for a number of claims
for payment related to ambulance
transportation and health care services
under a contract with VA. This incident
prevented providers and entities from
submitting claims electronically to VA.
As of May 8, 2024, VA is able to receive
all claims electronically. Between
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SUMMARY:
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February 21, 2024, and May 8, 2024, VA
had limited or no ability to receive and
process claims because of this incident.
During this period of more than 70 days,
providers and entities were unable to, or
were limited in their ability to, submit
claims to VA for services for which VA
would normally have processed
payment that were provided either
before or during this period.
Legal Background: Entities seeking
payment from VA for ambulance
transportation and health care services
are required to comply with timely
filing requirements established by
several different provisions of law and
regulation.
Section 1703D(b) of title 38, United
States Code (U.S.C.), requires health
care entities or providers that furnish
hospital care, medical services, or
extended care services under chapter
17, title 38, U.S.C., to submit to VA
claims for payment for furnishing such
services not later than 180 days after the
date on which the entity or provider
furnished the services.
Section 17.126 requires claimants to
file a claim for reimbursement for
emergency services for serviceconnected care within 2 years of the
date the care or services were rendered,
or, in the case of care or services
rendered prior to VA adjudication
allowing service-connection, within two
years of the date the veteran was
notified by VA of the allowance of the
award of service connection.
Section 17.1004(d) of title 38, Code of
Federal Regulations (CFR), requires
claimants to file a claim for
reimbursement for emergency services
for non-service-connected care within
90 days of the latest of the date the
veteran was discharged from the facility
that furnished emergency treatment; the
date of death (but only if death occurred
during transportation to a facility for
emergency treatment or if the death
occurred during the stay in the facility
that included the provision of
emergency treatment); or the date the
veteran finally exhausted, without
success, action to obtain payment or
reimbursement for the treatment from a
third-party.
Sections 17.1225 and 17.1230 of title
38, CFR, require providers of emergent
suicide care and emergency
transportation for emergent suicide care,
respectively, to submit to VA a standard
billing form and other information as
required no later than 180 calendar days
from the date the services or
transportation was furnished.
Section 70.20(b) of title 38, CFR,
requires claimants to apply for payment
of beneficiary travel within 30 calendar
days after completing beneficiary travel
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67863
that does not include a special mode of
transportation. For travel that includes a
special mode of transportation
(including ambulances), claimants must
apply for payment of beneficiary travel
and obtain approval from VA prior to
the travel; if prior approval has not been
granted, claimants must apply for
payment within 30 calendar days after
the travel is completed. VA may pay for
transportation for emergency treatment
under separate authorities as well.
Section 17.276 of title 38, CFR,
requires claims under the Civilian
Health and Medical Program of VA
(CHAMPVA) program to be filed not
later than one year after the date of
service or the date of discharge (for
inpatient care), or within 180 days
following beneficiary notification of
authorization in the case of retroactive
approval for medical services or
supplies, generally. Requests for
extensions must be submitted in
writing, and VA may grant exceptions if
it determines there was good cause for
missing the filing deadline.
Section 17.903 of title 38, CFR,
requires claims for the Children of
Women Vietnam Veterans and the Spina
Bifida program to be filed not later than
one year after the date of service or the
date of discharge (for inpatient care), or
within 180 days following beneficiary
notification of authorization in the case
of retroactive approval for medical
services or supplies, generally.
Other claims, including those for
medical care provided through
reimbursement agreements with the
Indian Health Service, Tribal health
programs, and Urban Indian
Organizations under 25 U.S.C. 1645 and
38 U.S.C. 8153, are subject to timely
filing requirements and were also
affected by the CHC outage. Timely
filing under these reimbursement
agreements generally requires claims
submission within one year of the date
of service.
Legal Issue: The plain text of these
statutes and regulations, with the
exception of 17.276, does not include
exceptions for established timely filing
requirements. If VA applied these
statutes and regulations without
exception, it would be forced to deny
claims affected by the CHC outage as not
timely filed and thus not payable. This
would expose veterans to personal
liability in some cases for these services
through no fault of their own. It also
would result in inequitable outcomes,
where entities and providers furnished
services on behalf of VA but were
unable to be paid for reasons beyond
either VA’s or their control.
Legal Interpretation: In light of this
issue, VA is publicly stating its
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Federal Register / Vol. 89, No. 163 / Thursday, August 22, 2024 / Rules and Regulations
interpretation of these statutes and
regulations that affected providers and
entities are not subject to the timely
filing requirements established by the
statutes and regulations described in
this document, subject to the terms and
conditions articulated in this document.
VA’s legal basis for this position is its
interpretation of these statutes and
regulations in light of the common law.
The Supreme Court has noted that,
‘‘where a common law principle is well
established . . . the courts may take it
as given that Congress has legislated
with an expectation that the principle
will apply except ‘when a statutory
purpose to the contrary is evident’.’’ See
Astoria Fed. Sav. & Loan Ass’n v.
Solimino, 501 U.S. 104, 108 (1991).
The common law principle of force
majeure refers to situations that free
parties from obligations if an
extraordinary event directly preventing
one or both parties from performing
occurs. Impossibility is another
provision in common law that generally
provides relief from requirements under
similar conditions and would apply
here as well. Under the doctrines of
both force majeure and impossibility,
the event precipitating that state must
have been unanticipated and beyond the
control of the parties. VA has
determined the CHC outage satisfies
these requirements.
The concepts of force majeure and
impossibility originated in the common
law and still apply today. VA finds no
evidence that in section 1703D(b), for
example, Congress intended a statutory
purpose inconsistent with the
application of these common law
principles. The purpose of section
1703D broadly was to ensure prompt
payment of entities or providers
furnishing care and services on VA’s
behalf. Congress stated clearly that
‘‘VA’s ability to timely and accurately
process payments to community
providers is critical to the [Community
Care] Program’s success and to ensuring
access to community care for the
increasing number of veterans who rely
on it.’’ H. Rpt. 115–671, Part 1, May 11,
2018, p. 7. Interpreting provisions in
this statute to deny the timely and
accurate payment of entities or
providers when submission delays were
not the fault of VA or the entities or
providers would be plainly contrary to
this intent and would damage the
credibility and reliability of the
Veterans Community Care Program and
VA benefits more broadly.
VA similarly interprets its regulations
regarding timely filing by applying the
same canon of statutory interpretation
described above. The Supreme Court
has held that the canons of statutory
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interpretation should be applied to
Federal regulations as well. See, e.g.
Kisor v. Wilkie, 588 U.S. ll (2019)
(‘‘And before concluding that a rule is
genuinely ambiguous, a court must
exhaust all the ‘traditional tools’ of
construction.’’)
VA has contracts or agreements for
much of the care and services that are
furnished on its behalf, and these
contracts or agreements generally
include well-established exceptions for
situations of force majeure or
impossibility. Where applicable, VA is
exercising its contractual flexibility, but
where not, VA’s interpretation here
should provide appropriate relief to
entities or providers affected by the CHC
outage.
In determining that force majeure and
impossibility precluded the timely
submission of claims, we similarly
interpret that VA is relieved of
obligations it may have otherwise
incurred, as the common law relieved
both parties of their obligations. In
general, if VA fails to pay a valid,
submitted claim, it owes interest for late
payment. However, because VA was
unable to accept claims, no late
payment period could begin that would
result in interest liability. Consequently,
VA will not pay interest on any claims
a provider attempted to submit to VA
during the outage described above.
However, if VA fails to pay claims
submitted now, it will be liable for
interest payments under relevant
provisions of law.
The vast majority of provisions in law
and regulation concerning VA health
care benefits do not affect or implicate
common law principles, but the timely
filing requirements do. Consequently,
VA’s interpretation here that common
law principles apply are limited to the
statutes and regulations identified in
this document.
Requirements for Timely Filing:
Impacted entities or providers seeking
payment may submit impacted claims
for payment by October 31, 2024.
Impacted claims covered by this
document that are received after
October 31, 2024, will not be considered
timely filed and will be denied. This
will provide Impacted entities or
providers approximately 60 days’ notice
from publication of this document to
file claims, which VA believes to be a
sufficient period of time for claims
submission in this situation.
For purposes of this document,
‘‘impacted entities and providers’’ are
those who submit medical (including
transportation) or dental claims directly
to VA for payment. ‘‘Impacted claims’’
are claims from impacted entities and
providers that would be considered not
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timely filed based on the dates of
service and the dates of the claim
submission. Impacted entities and
providers may submit impacted
medical, (including transportation)
claims, to electronic data interchange
(EDI) payor ID 12115 for services
provided to veterans, dental claims to
EDI payor ID 12116 for services
provided to veterans, medical claims to
EDI payor ID 84146 for services
provided to family members of veterans,
and dental claims to EDI payor ID 84147
for services provided to family members
of veterans. Transportation claims that
are not submitted to payor ID 12115 are
not applicable to this document and
should continue to be submitted
according to normal procedures and
requirements. Medical claims whose
timely filing period expired between
February 21, 2024, and March 23, 2024,
for payor IDs 12115 and 84146, and
dental claims whose timely filing period
expired between February 21, 2024, and
May 8, 2024, for payor IDs 12116 and
84147, will be considered timely filed if
such claims are submitted to VA by
October 31, 2024.
Claims must be submitted to VA as
they normally would be (e.g., location,
content, etc.) in accordance with
standard submission protocols.
Impacted claims may include: claims
for non-emergent medical care
furnished to veterans with a date of
service between February 21, 2023, and
March 23, 2024; claims for dental care
furnished to veterans with a date of
service between February 21, 2023, and
May 8, 2024; claims for emergency care
furnished to veterans with a date of
service between February 21, 2022, and
March 23, 2024; claims for
transportation furnished to veterans
with a date of service between February
21, 2022, and March 23, 2024; claims for
medical care furnished to eligible family
members under the Civilian Health and
Medical Program of VA (CHAMPVA),
Spina Bifida Health Care Benefits
Program (SBHCBP) or Children of
Women Vietnam Veterans (CWVV)
Health Care Benefits Program with a
date of service between February 21,
2023, and March 23, 2024; and claims
for dental care furnished to eligible
family members under CHAMPVA,
SBHCBP or CWVV with a date of service
between February 21, 2023, and May 8,
2024.
The dates of service identified above
reflect the earliest and latest possible
qualifying dates. The general
descriptions above reflect various legal
authorities, each of which may include
additional requirements regarding
timely filing, and VA will apply
additional requirements as needed. For
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Federal Register / Vol. 89, No. 163 / Thursday, August 22, 2024 / Rules and Regulations
example, VA can reimburse claims for
emergency care furnished to veterans
under several different statutory
authorities, including 38 U.S.C. 1703,
1720J, 1725, and 1728. VA’s regulations
provide for different timely filing
requirements under these authorities.
Section 1728 and its implementing
regulations require eligible entities or
providers to submit a claim within two
years of the date of service. Given the
outage for medical claims between
February 21, 2024, and March 23, 2024,
for such claims, a provider could have
attempted to submit a claim on February
21, 2024, for emergency care furnished
to a veteran on February 21, 2022, and
that claim could have been considered
timely and potentially approved by VA
(if other conditions were met). However,
under section 1725 and its
implementing regulations (specifically,
17.1004, as described above), claims
must be submitted to VA within 90 days
of the later of any of several dates or
events. If VA determined that a claim
for services furnished on February 21,
2022, that is submitted based on this
document is not payable under section
1728 but only payable under section
1725, that claim would be considered
not timely filed. VA does not expect
providers to know under what authority
they are filing claims; VA will process
received claims, as it does today, to
determine which authority is
appropriate. If providers believe VA has
denied a claim incorrectly, they are free
to appeal that decision, as they can
today.
Signing Authority
Denis McDonough, Secretary of
Veterans Affairs, approved and signed
this document on August 15, 2024, and
authorized the undersigned to sign and
submit the document to the Office of the
Federal Register for publication
electronically as an official document of
the Department of Veterans Affairs.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy
& Management, Office of General Counsel,
Department of Veterans Affairs.
[FR Doc. 2024–18651 Filed 8–21–24; 8:45 am]
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GENERAL SERVICES
ADMINISTRATION
41 CFR Parts 102–5, 102–36, 102–38,
102–39, 102–40, 102–41, and 102–42
[FMR Case 2024–01; Docket No. GSA–FMR–
2024–0001; Sequence No. 1]
RIN 3090–AK79
Federal Management Regulation;
Updating the FMR With Diversity,
Equity, Inclusion, and Accessibility
Language
Office of Government-wide
Policy (OGP), General Services
Administration (GSA).
ACTION: Final rule.
AGENCY:
GSA is issuing a final rule
that makes technical amendments to the
Federal Management Regulation (FMR)
regarding gender neutrality. These
technical amendments result in more
inclusive language by replacing genderspecific pronouns (e.g., he, she, his, her)
with non-gendered pronouns. GSA is
also correcting minor grammatical and
administrative errors in FMR parts 102–
5 and 102–42. These changes are
grammatical and technical in nature and
do not result in added costs or
associated policy changes.
DATES: This final rule is effective on
October 21, 2024.
FOR FURTHER INFORMATION CONTACT: Mr.
William Garrett, Director, Personal
Property Policy Division, Office of
Government-wide Policy, at 202–368–
8163 or personalpropertypolicy@gsa.gov
for clarification of content. For
information pertaining to status or
publication schedules, contact the
Regulatory Secretariat Division at 202–
501–4755 or GSARegSec@gsa.gov.
Please cite ‘‘FMR Case 2024–01.’’
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
Executive Order (E.O.) 13988,
Preventing and Combating
Discrimination on the Basis of Gender
Identity or Sexual Orientation, dated
January 20, 2021, establishes a policy
‘‘to prevent and combat discrimination
on the basis of gender identity or sexual
orientation, and to fully enforce Title
VII and other laws that prohibit
discrimination on the basis of gender
identity or sexual orientation.’’ The
Federal Government must be a model
for diversity, equity, inclusion, and
accessibility, where all employees are
treated with dignity and respect.
Therefore, GSA has undertaken a review
of FMR parts 102–5 and 102–33 through
102–42.
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67865
Consistent with the American
Psychological Association (APA) Style
Guide, 7th Edition, Publication Manual
Section 5.5 guidance on ‘‘Gender and
Pronoun Usage’’, GSA is replacing
gender-specific pronouns, such as he,
she, his, or her, with more inclusive and
respectful terminology to all segments of
society. Other terms that do not use
gender-specific language, such as
Administrator, Architect, employee, and
purchaser, have also been used as
appropriate.
II. Discussion of the Final Rule
A. Summary of Significant Changes
This final rule is technical in nature
and does not significantly change any
definition, operation, or interpretation
of the FMR.
B. Expected Cost Impact to the Public
There is no expected cost impact to
the public due to these technical
changes to the FMR.
III. Executive Orders 12866, 13563, and
14094
Executive Order (E.O.) 12866
(Regulatory Planning and Review)
directs agencies to assess all costs and
benefits of available regulatory
alternatives and, if regulation is
necessary, to select regulatory
approaches that maximize net benefits
(including potential economic,
environmental, public health and safety
effects, distributive impacts, and
equity). E.O. 13563 (Improving
Regulation and Regulatory Review)
emphasizes the importance of
quantifying both costs and benefits, of
reducing costs, of harmonizing rules,
and of promoting flexibility. E.O. 14094
(Modernizing Regulatory Review)
amends Section 3(f) of E.O. 12866 and
supplements and reaffirms the
principles, structures, and definitions
governing contemporary regulatory
review established in E.O. 12866 and
E.O. 13563. The Office of Management
and Budget’s Office of Information and
Regulatory Affairs (OIRA) has
determined that this rule is not a
significant regulatory action, and
therefore, it was not reviewed under
Section 6(b) of E.O. 12866.
IV. Congressional Review Act
OIRA has determined that this rule is
not a ‘‘major rule’’ under 5 U.S.C.
804(2). Title II, Subtitle E of the Small
Business Regulatory Enforcement
Fairness Act of 1996 (codified at 5
U.S.C. 801–808), also known as the
Congressional Review Act or CRA,
generally provides that before a rule
may take effect, unless excepted, the
agency promulgating the rule must
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]]>Agencies
[Federal Register Volume 89, Number 163 (Thursday, August 22, 2024)]
[Rules and Regulations]
[Pages 67863-67865]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-18651]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
Processing Certain Claims for Payment for Transportation, Care,
and Services
AGENCY: Department of Veterans Affairs.
ACTION: Notification of guidance.
-----------------------------------------------------------------------
SUMMARY: This notification informs the public of the Department of
Veterans Affairs' (VA) interpretation of law and regulations regarding
timely filing for certain claims for payment for transportation, care
and services affected by a cybersecurity incident.
DATES: The guidance is effective August 22, 2024. Claims submitted
pursuant to this document must be received by VA by October 31, 2024.
FOR FURTHER INFORMATION CONTACT: Joseph Duran, Policy Directorate,
16IVCEO3, Veterans Health Administration, Department of Veterans
Affairs, 810 Vermont Avenue NW, Washington, DC 20420; 303-370-1637.
This is not a toll-free number.
SUPPLEMENTARY INFORMATION:
Factual Background: On February 21, 2024, a cybersecurity incident
impacted Change Healthcare (CHC). CHC serves as a clearinghouse for a
number of claims for payment related to ambulance transportation and
health care services under a contract with VA. This incident prevented
providers and entities from submitting claims electronically to VA. As
of May 8, 2024, VA is able to receive all claims electronically.
Between February 21, 2024, and May 8, 2024, VA had limited or no
ability to receive and process claims because of this incident. During
this period of more than 70 days, providers and entities were unable
to, or were limited in their ability to, submit claims to VA for
services for which VA would normally have processed payment that were
provided either before or during this period.
Legal Background: Entities seeking payment from VA for ambulance
transportation and health care services are required to comply with
timely filing requirements established by several different provisions
of law and regulation.
Section 1703D(b) of title 38, United States Code (U.S.C.), requires
health care entities or providers that furnish hospital care, medical
services, or extended care services under chapter 17, title 38, U.S.C.,
to submit to VA claims for payment for furnishing such services not
later than 180 days after the date on which the entity or provider
furnished the services.
Section 17.126 requires claimants to file a claim for reimbursement
for emergency services for service-connected care within 2 years of the
date the care or services were rendered, or, in the case of care or
services rendered prior to VA adjudication allowing service-connection,
within two years of the date the veteran was notified by VA of the
allowance of the award of service connection.
Section 17.1004(d) of title 38, Code of Federal Regulations (CFR),
requires claimants to file a claim for reimbursement for emergency
services for non-service-connected care within 90 days of the latest of
the date the veteran was discharged from the facility that furnished
emergency treatment; the date of death (but only if death occurred
during transportation to a facility for emergency treatment or if the
death occurred during the stay in the facility that included the
provision of emergency treatment); or the date the veteran finally
exhausted, without success, action to obtain payment or reimbursement
for the treatment from a third-party.
Sections 17.1225 and 17.1230 of title 38, CFR, require providers of
emergent suicide care and emergency transportation for emergent suicide
care, respectively, to submit to VA a standard billing form and other
information as required no later than 180 calendar days from the date
the services or transportation was furnished.
Section 70.20(b) of title 38, CFR, requires claimants to apply for
payment of beneficiary travel within 30 calendar days after completing
beneficiary travel that does not include a special mode of
transportation. For travel that includes a special mode of
transportation (including ambulances), claimants must apply for payment
of beneficiary travel and obtain approval from VA prior to the travel;
if prior approval has not been granted, claimants must apply for
payment within 30 calendar days after the travel is completed. VA may
pay for transportation for emergency treatment under separate
authorities as well.
Section 17.276 of title 38, CFR, requires claims under the Civilian
Health and Medical Program of VA (CHAMPVA) program to be filed not
later than one year after the date of service or the date of discharge
(for inpatient care), or within 180 days following beneficiary
notification of authorization in the case of retroactive approval for
medical services or supplies, generally. Requests for extensions must
be submitted in writing, and VA may grant exceptions if it determines
there was good cause for missing the filing deadline.
Section 17.903 of title 38, CFR, requires claims for the Children
of Women Vietnam Veterans and the Spina Bifida program to be filed not
later than one year after the date of service or the date of discharge
(for inpatient care), or within 180 days following beneficiary
notification of authorization in the case of retroactive approval for
medical services or supplies, generally.
Other claims, including those for medical care provided through
reimbursement agreements with the Indian Health Service, Tribal health
programs, and Urban Indian Organizations under 25 U.S.C. 1645 and 38
U.S.C. 8153, are subject to timely filing requirements and were also
affected by the CHC outage. Timely filing under these reimbursement
agreements generally requires claims submission within one year of the
date of service.
Legal Issue: The plain text of these statutes and regulations, with
the exception of 17.276, does not include exceptions for established
timely filing requirements. If VA applied these statutes and
regulations without exception, it would be forced to deny claims
affected by the CHC outage as not timely filed and thus not payable.
This would expose veterans to personal liability in some cases for
these services through no fault of their own. It also would result in
inequitable outcomes, where entities and providers furnished services
on behalf of VA but were unable to be paid for reasons beyond either
VA's or their control.
Legal Interpretation: In light of this issue, VA is publicly
stating its
[[Page 67864]]
interpretation of these statutes and regulations that affected
providers and entities are not subject to the timely filing
requirements established by the statutes and regulations described in
this document, subject to the terms and conditions articulated in this
document.
VA's legal basis for this position is its interpretation of these
statutes and regulations in light of the common law. The Supreme Court
has noted that, ``where a common law principle is well established . .
. the courts may take it as given that Congress has legislated with an
expectation that the principle will apply except `when a statutory
purpose to the contrary is evident'.'' See Astoria Fed. Sav. & Loan
Ass'n v. Solimino, 501 U.S. 104, 108 (1991).
The common law principle of force majeure refers to situations that
free parties from obligations if an extraordinary event directly
preventing one or both parties from performing occurs. Impossibility is
another provision in common law that generally provides relief from
requirements under similar conditions and would apply here as well.
Under the doctrines of both force majeure and impossibility, the event
precipitating that state must have been unanticipated and beyond the
control of the parties. VA has determined the CHC outage satisfies
these requirements.
The concepts of force majeure and impossibility originated in the
common law and still apply today. VA finds no evidence that in section
1703D(b), for example, Congress intended a statutory purpose
inconsistent with the application of these common law principles. The
purpose of section 1703D broadly was to ensure prompt payment of
entities or providers furnishing care and services on VA's behalf.
Congress stated clearly that ``VA's ability to timely and accurately
process payments to community providers is critical to the [Community
Care] Program's success and to ensuring access to community care for
the increasing number of veterans who rely on it.'' H. Rpt. 115-671,
Part 1, May 11, 2018, p. 7. Interpreting provisions in this statute to
deny the timely and accurate payment of entities or providers when
submission delays were not the fault of VA or the entities or providers
would be plainly contrary to this intent and would damage the
credibility and reliability of the Veterans Community Care Program and
VA benefits more broadly.
VA similarly interprets its regulations regarding timely filing by
applying the same canon of statutory interpretation described above.
The Supreme Court has held that the canons of statutory interpretation
should be applied to Federal regulations as well. See, e.g. Kisor v.
Wilkie, 588 U.S. __ (2019) (``And before concluding that a rule is
genuinely ambiguous, a court must exhaust all the `traditional tools'
of construction.'')
VA has contracts or agreements for much of the care and services
that are furnished on its behalf, and these contracts or agreements
generally include well-established exceptions for situations of force
majeure or impossibility. Where applicable, VA is exercising its
contractual flexibility, but where not, VA's interpretation here should
provide appropriate relief to entities or providers affected by the CHC
outage.
In determining that force majeure and impossibility precluded the
timely submission of claims, we similarly interpret that VA is relieved
of obligations it may have otherwise incurred, as the common law
relieved both parties of their obligations. In general, if VA fails to
pay a valid, submitted claim, it owes interest for late payment.
However, because VA was unable to accept claims, no late payment period
could begin that would result in interest liability. Consequently, VA
will not pay interest on any claims a provider attempted to submit to
VA during the outage described above. However, if VA fails to pay
claims submitted now, it will be liable for interest payments under
relevant provisions of law.
The vast majority of provisions in law and regulation concerning VA
health care benefits do not affect or implicate common law principles,
but the timely filing requirements do. Consequently, VA's
interpretation here that common law principles apply are limited to the
statutes and regulations identified in this document.
Requirements for Timely Filing: Impacted entities or providers
seeking payment may submit impacted claims for payment by October 31,
2024. Impacted claims covered by this document that are received after
October 31, 2024, will not be considered timely filed and will be
denied. This will provide Impacted entities or providers approximately
60 days' notice from publication of this document to file claims, which
VA believes to be a sufficient period of time for claims submission in
this situation.
For purposes of this document, ``impacted entities and providers''
are those who submit medical (including transportation) or dental
claims directly to VA for payment. ``Impacted claims'' are claims from
impacted entities and providers that would be considered not timely
filed based on the dates of service and the dates of the claim
submission. Impacted entities and providers may submit impacted
medical, (including transportation) claims, to electronic data
interchange (EDI) payor ID 12115 for services provided to veterans,
dental claims to EDI payor ID 12116 for services provided to veterans,
medical claims to EDI payor ID 84146 for services provided to family
members of veterans, and dental claims to EDI payor ID 84147 for
services provided to family members of veterans. Transportation claims
that are not submitted to payor ID 12115 are not applicable to this
document and should continue to be submitted according to normal
procedures and requirements. Medical claims whose timely filing period
expired between February 21, 2024, and March 23, 2024, for payor IDs
12115 and 84146, and dental claims whose timely filing period expired
between February 21, 2024, and May 8, 2024, for payor IDs 12116 and
84147, will be considered timely filed if such claims are submitted to
VA by October 31, 2024.
Claims must be submitted to VA as they normally would be (e.g.,
location, content, etc.) in accordance with standard submission
protocols.
Impacted claims may include: claims for non-emergent medical care
furnished to veterans with a date of service between February 21, 2023,
and March 23, 2024; claims for dental care furnished to veterans with a
date of service between February 21, 2023, and May 8, 2024; claims for
emergency care furnished to veterans with a date of service between
February 21, 2022, and March 23, 2024; claims for transportation
furnished to veterans with a date of service between February 21, 2022,
and March 23, 2024; claims for medical care furnished to eligible
family members under the Civilian Health and Medical Program of VA
(CHAMPVA), Spina Bifida Health Care Benefits Program (SBHCBP) or
Children of Women Vietnam Veterans (CWVV) Health Care Benefits Program
with a date of service between February 21, 2023, and March 23, 2024;
and claims for dental care furnished to eligible family members under
CHAMPVA, SBHCBP or CWVV with a date of service between February 21,
2023, and May 8, 2024.
The dates of service identified above reflect the earliest and
latest possible qualifying dates. The general descriptions above
reflect various legal authorities, each of which may include additional
requirements regarding timely filing, and VA will apply additional
requirements as needed. For
[[Page 67865]]
example, VA can reimburse claims for emergency care furnished to
veterans under several different statutory authorities, including 38
U.S.C. 1703, 1720J, 1725, and 1728. VA's regulations provide for
different timely filing requirements under these authorities. Section
1728 and its implementing regulations require eligible entities or
providers to submit a claim within two years of the date of service.
Given the outage for medical claims between February 21, 2024, and
March 23, 2024, for such claims, a provider could have attempted to
submit a claim on February 21, 2024, for emergency care furnished to a
veteran on February 21, 2022, and that claim could have been considered
timely and potentially approved by VA (if other conditions were met).
However, under section 1725 and its implementing regulations
(specifically, 17.1004, as described above), claims must be submitted
to VA within 90 days of the later of any of several dates or events. If
VA determined that a claim for services furnished on February 21, 2022,
that is submitted based on this document is not payable under section
1728 but only payable under section 1725, that claim would be
considered not timely filed. VA does not expect providers to know under
what authority they are filing claims; VA will process received claims,
as it does today, to determine which authority is appropriate. If
providers believe VA has denied a claim incorrectly, they are free to
appeal that decision, as they can today.
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved and signed
this document on August 15, 2024, and authorized the undersigned to
sign and submit the document to the Office of the Federal Register for
publication electronically as an official document of the Department of
Veterans Affairs.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
General Counsel, Department of Veterans Affairs.
[FR Doc. 2024-18651 Filed 8-21-24; 8:45 am]
BILLING CODE 8320-01-P
