[Federal Register Volume 63, Number 39 (Friday, February 27, 1998)]
[Proposed Rules]
[Pages 9990-9992]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-5122]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AJ03
Reconsideration of Denied Claims
AGENCY: Department of Veterans Affairs.
[[Page 9991]]
ACTION: Proposed rule.
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SUMMARY: This document proposes to amend the Department of Veterans
Affairs' ``Medical'' regulations by adding a new section to set forth
reconsideration procedures available if requested by an individual or
entity who made a claim for benefits administered by the Veterans
Health Administration and who disagrees with the initial decision
denying the claim. It is anticipated that these procedures would not
only allow for more reflective decisions at the local level but would
also allow some disputes to be resolved without the need for further
appeal to the Board of Veterans Appeals.
DATES: VA must receive comments on or before April 28, 1998.
ADDRESSES: Mail or hand deliver written comments to: Director, Office
of Regulations Management (02D), Department of Veterans Affairs, 810
Vermont Avenue, NW, Room 1154, Washington, DC 20420. Comments should
indicate that they are submitted in response to ``RIN 2900-AJ03.'' All
written comments received will be available for public inspection at
the above address in the Office of Regulations Management, Room 1158,
between the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday
(except holidays).
FOR FURTHER INFORMATION CONTACT: Troy L. Baxley, Health Administration
Service (10C3), Department of Veterans Affairs, 810 Vermont Avenue, NW,
Washington DC, 20420, telephone (202) 273-8301. (This is not a toll-
free number).
SUPPLEMENTARY INFORMATION: This document proposes to amend the
``Medical'' regulations (38 CFR part 17) by adding a new Sec. 17.133 to
set forth reconsideration procedures available if requested by an
individual or entity who made a claim for benefits administered by the
Veterans Health Administration (VHA) (e.g., reimbursement for non-VA
care not authorized in advance, reimbursement for beneficiary travel
expenses, reimbursement for home improvements or structural
alterations) and who disagrees with the initial decision denying the
claim in whole or in part. These procedures would not be mandatory and
a claimant may choose to appeal the denied claim to the Board of
Veterans Appeals pursuant to 38 USC 7105 without using the new
reconsideration procedures. The new reconsideration procedures would
not be applicable in those cases where other specific reconsideration
procedures apply. For example, there are specific reconsideration
provisions applicable to denied claims for CHAMPVA and spina bifida
benefits.
As set forth in the text portion of this document, the
reconsideration procedures would provide for a written request for
reconsideration, reasons why the decision is in error, submission of
any new and relevant information, opportunity for an informal meeting
(with transcription upon request), and a written decision.
This informal reconsideration procedure would allow for more
reflective decisions at the local level and would allow some disputes
to be resolved without the need for further appeal to the Board of
Veterans Appeals.
This regulation would supersede manual provisions for appeals of
VHA decisions found at M-1, Part I, Chap. 1, Section X. The manual
provisions are outdated and confusing, and included references to
specific procedures that were previously rescinded.
Paperwork Reduction Act of 1995
The Office of Management and Budget (OMB) has determined that
proposed 38 CFR 17.133 contains collections of information under the
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). Accordingly,
under section 3507(d) of the Act, VA has submitted a copy of this
rulemaking action to OMB for its review of the collections of
information.
OMB assigns a control number for each collection of information it
approves. VA may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a
currently valid OMB control number.
Comments on the proposed collections of information should be
submitted to the Office of Management and Budget, Attention: Desk
Officer for the Department of Veterans Affairs, Office of Information
and Regulatory Affairs, Washington, DC 20503, with copies mailed or
hand-delivered to: Director, Office of Regulations Management (02D),
Department of Veterans Affairs, 810 Vermont Ave., NW, Room 1154,
Washington, DC 20420. Comments should indicate that they are submitted
in response to ``RIN 2900-AJ03''.
Reconsideration of Denied Claims--Section 17.133
Title: Reconsideration process available if requested by an
individual or entity who made a claim for benefits administered by the
Veterans Health Administration and who disagrees with the initial
decision denying the claim in whole or in part.
Summary of collection of information: The provisions of proposed 38
CFR 17.133 would add a new informal voluntary review process to
existing appellate rights procedures. The person or entity requesting
reconsideration would be required to submit such request to the
Director of the VA healthcare facility of jurisdiction. It must be
submitted in writing within one year of the date of the initial
decision. The request must state why the decision is in error and
include any new and relevant information not previously considered. The
request for reconsideration may include a request for a meeting with
the VA decisionmaker, the claimant, and the claimant's representative
(if the claimant wishes to have a representative present). Such a
meeting shall only be for the purpose of discussing the issues and
shall not include formal procedures (such as presentation and cross-
examination of witnesses). The meeting will be taped and transcribed by
VA, if requested by the claimant, and a copy of the transcription shall
be provided to the claimant. After reviewing the matter, the
decisionmaker (the Chief, Health Administration Service, or equivalent)
shall issue a written decision that affirms, reverses, or modifies the
initial decision.
Description of need for information and proposed use of
information: The information proposed to be collected under 17.133
appears to be necessary to initiate the reconsideration process.
Description of likely respondents: Individuals or other entities
who make a claim for benefits administered by VHA and are denied.
Estimated number of respondents: 101,652.
Estimated frequency of responses: one time.
Estimated total annual reporting and recordkeeping burden: 16,942
hours.
Estimated annual burden per collection: 10 minutes per item.
The Department considers comments by the public on proposed
collections of information in--
Evaluating whether the proposed collections of information
are necessary for the proper performance of the functions of the
Department, including whether the information will have practical
utility;
Evaluating the accuracy of the Department's estimate of
the burden of the proposed collections of information, including the
validity of the methodology and assumptions used;
[[Page 9992]]
Enhancing the quality, usefulness, and clarity of the
information to be collected; and
Minimizing the burden of the collections of information on
those who are to respond, including responses through the use of
appropriate automated, electronic, mechanical, or other technological
collection techniques or other forms of information technology, e.g.,
permitting electronic submission of responses.
OMB is required to make a decision concerning the collection of
information contained in this proposed rule between 30 and 60 days
after publication of this document in the Federal Register. Therefore,
a comment to OMB is best assured of having its full effect if OMB
receives it within 30 days of publication. This does not affect the
deadline for the public to comment on the proposed regulations.
Regulatory Flexibility Act
The Secretary hereby certifies that the adoption of the proposed
rule would not have a significant impact on a substantial number of
small entities as they are defined in the Regulatory Flexibility Act
(RFA), 5 U.S.C. 601-612. Although the adoption of the proposed rule
could affect small businesses, it would not have a significant impact
on any small business. Therefore, pursuant to 5 U.S.C. 605(b), the
proposed rule is exempt from the initial and final regulatory
flexibility analysis requirements of Secs. 603 and 604.
There are no Catalog of Federal Domestic Assistance program
numbers.
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 professions, 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, Veterans.
Approved: February 23, 1998.
Togo D. West, Jr.,
Acting Secretary.
For the reasons set forth in the preamble, 38 CFR part 17 is
proposed to be amended as follows:
PART 17--MEDICAL
1. The authority citation for part 17 continues to read as follows:
Authority: 38 U.S.C. 501(a), 1721, unless otherwise noted.
2. In part 17, an undesignated center heading and Sec. 17.133 are
added to read as follows:
RECONSIDERATION OF DENIED CLAIMS
Sec. 17.133 Procedures.
(a) Scope. This section sets forth reconsideration procedures
available to an individual or entity who made a claim for benefits
administered by the Veterans Health Administration (VHA) and who
disagrees with the initial decision denying the claim in whole or in
part. These procedures are not mandatory, and a claimant may choose to
appeal the denied claim to the Board of Veterans Appeals pursuant to 38
U.S.C. 7105 without utilizing the provisions of this section. These
procedures do not apply when other regulations providing
reconsideration procedures do apply (e.g., CHAMPVA (38 CFR 17.84),
spina bifida (38 CFR 17.904)). Otherwise, this section applies to all
claims for VHA benefits (e.g., reimbursement for non-VA care not
authorized in advance, reimbursement for beneficiary travel expenses,
reimbursement for home improvements or structural alterations, etc.).
Submitting a request for reconsideration shall constitute a notice of
disagreement for purposes of filing a timely notice of disagreement
under 38 U.S.C. 7105(b).
(b) Process. A request for reconsideration under this section must
be submitted in writing to the Director of the healthcare facility of
jurisdiction within one year of the date of the initial decision. The
request must state why it is concluded that the decision is in error
and must include any new and relevant information not previously
considered. Any request for reconsideration that does not identify the
reason for the dispute will be returned to the sender without further
consideration. The request for reconsideration may include a request
for a meeting with the VA decisionmaker, the claimant, and the
claimant's representative (if the claimant wishes to have a
representative present). Such a meeting shall only be for the purpose
of discussing the issues and shall not include formal procedures (such
as presentation and cross-examination of witnesses). The meeting will
be taped and transcribed by VA if requested by the claimant and a copy
of the transcription shall be provided to the claimant. After reviewing
the matter, the decisionmaker (the Chief, Health Administration
Service, or equivalent) shall issue a written decision that affirms,
reverses, or modifies the initial decision.
Note to Sec. 17.133: The final decision of the decisionmaker
will inform the claimant of further appellate rights for an appeal
to the Board of Veterans Appeals.
(Authority: 38 U.S.C. 511)
[FR Doc. 98-5122 Filed 2-26-98; 8:45 am]
BILLING CODE 8320-01-P
