[Federal Register Volume 62, Number 84 (Thursday, May 1, 1997)]
[Proposed Rules]
[Pages 23731-23736]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-11257]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AI65
Provision of Health Care to Vietnam Veterans' Children With Spina
Bifida
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
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SUMMARY: This document proposes to establish regulations regarding
Vietnam veterans' children with spina bifida by providing for the
provision of health care needed for the spina bifida or any disability
that is associated with such condition. This is necessary for providing
health care to such children in accordance with recently enacted
legislation. A companion document (RIN: 2900-AI70) concerning a
proposal to provide for payment of a monetary allowance to a Vietnam
veteran's child with spina bifida is set forth in the Proposed Rules
section of this issue of the Federal Register.
DATES: Comments must be received by VA on or before June 30, 1997.
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-AI65.'' 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 a.m. and 4:30 p.m., Monday through Friday
(except holidays).
FOR FURTHER INFORMATION CONTACT: Robert De Vesty, Health Systems
Specialist, Office of Public Health and Environmental Hazards (13),
Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington DC
20420, telephone (202) 273-8456.
SUPPLEMENTARY INFORMATION: This document proposes to amend the
``Medical regulations (38 CFR part 17),'' by setting forth new
Secs. 17.900-17.905 regarding the provision of health care to Vietnam
Veterans' children with spina bifida. Spina bifida is a congenital
birth defect, characterized by defective closure of the bones
surrounding the spinal cord. The spinal cord and its covering (the
meninges) may protrude through the defect.
The provisions of 38 U.S.C. Chapter 18 (Public Law 104-204, section
421, September 26, 1996) provide for three separate types of benefits
for Vietnam veterans' children who suffer from spina bifida: (1)
Monthly monetary allowances (2) provision of health care needed for the
spina bifida or any disability that is associated with such condition,
and (3) provision of vocational training and rehabilitation.
This document proposes to set forth a mechanism regarding provision
of health care to Vietnam Veterans' children with spina bifida. In
large part the proposed regulations restate statutory provisions.
[[Page 23732]]
As a condition of eligibility for the provision of health care
under proposed Secs. 17.900-17.905, it is proposed that a recipient
must be eligible for a monetary allowance under the provisions setting
forth a mechanism for monthly monetary payments relating to spina
bifida. This would ensure that each recipient would have been
determined to be a Vietnam Veteran's child suffering from spina bifida,
and would obviate the need for duplicative medical determinations. In
this regard, it is noted that monetary allowance would be awarded if
the parent is determined to be a Vietnam veteran; if the child is
determined, based on medical evidence, to suffer from spina bifida; and
if the parent has not been dishonorably discharged (38 U.S.C. 101(2)).
The provisions of Secs. 17.900 through 19.905 and the rationale for
such provisions are contained in the companion document (RIN: 2900-
AI70) discussed above in the SUMMARY portion of this document.
The proposal explains, consistent with the authorizing legislation,
that the proposed provisions are not intended to be a comprehensive
insurance plan and do not cover health care unrelated to spina bifida.
The statutory provisions state that ``the Secretary may provide
health care directly or by contract or other arrangement with any
health care provider.'' It is proposed that any health care paid for by
VA be provided only by ``approved health care providers.'' In this
regard, it is proposed that such health care providers be only those
approved by the Health Care Financing Administration (HCFA), Department
of Defense (DoD) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS), Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA), or Joint Commission on
Accreditation of Healthcare Organizations (JCAHO), or those who possess
a state license or certificate. This appears to provide reasonable
assurance that individuals providing health care are qualified to do
so.
Under the proposal VA officials may inform spina bifida patients,
parents, or guardians that health care may be available at not-for-
profit charitable entities. This would allow recipients to consider
such sources for health care.
The proposal includes a note clarifying when VA is the exclusive
payer for health care provided. The note states that VA would provide
payment under the proposal only for health care relating to spina
bifida or a disability that is associated with such condition. The note
also states that VA is the exclusive payer for services authorized
under this proposal regardless of any third-party insurer, Medicare,
Medicaid, health plan, or any other plan or program providing health
care coverage. The note further states that any third-party insurer,
Medicare, Medicaid, health plan, or any other plan or program providing
health care coverage would be responsible according to its provisions
for payment for health care not relating to spina bifida and not
constituting a disability that is associated with such condition.
It is proposed as a condition of payment that preauthorization from
a preauthorization specialist of the Health Administration Center (P.O.
Box 65025, Denver, CO 80206-9025) be required in accordance with
prescribed procedures for case management, durable medical equipment,
home care, professional counseling, mental health services, respite
care, training, substance abuse treatment, dental services,
transplantation services or travel (including any necessary costs for
meals and lodging en route, and accompaniment by an attendant or
attendants--other than mileage at the General Services Administration
rate for privately owned automobiles). This will help VA provide
necessary care.
Under the proposal, payment to approved health care providers would
be made using the methodology already established for the Civilian
Health and Medical Program of the Department of Veterans Affairs
(CHAMPVA) (see 38 CFR 17.270 et seq.). We believe this methodology
based on Medicare and DoD principles would result in fair payments and
allow VA to utilize a payment mechanism already in place.
It is proposed that claims from approved health care providers be
submitted to the Health Administration Center for payment and that the
claims contain specified information. The Center already provides the
same types of services for eligible veterans' dependents under the
CHAMPVA program. Also, the specified information appears to be
necessary to make determinations concerning authorization for payment.
The proposal also includes time frames for submission of claims to
ensure an orderly and efficient payment system. Further, it is proposed
that in response to a request for payment, VA will provide an
explanation of benefits to ensure that VA determinations of payments
would be understood by claimants.
The proposal sets forth a review/appeal process concerning
determinations relating to the provision of health care or payment. A
note also would be added to state that the final decision of the Health
Administration Center Director concerning provision of health care or
payment will inform the claimant of further appellate rights for
appeals to the Board of Veterans' Appeals.
Consistent with the statutory scheme, we propose that payments made
shall constitute payment in full. The proposed rule also includes a
specific list of items that would be excluded from payment since we
believe they were not intended to be subject to payment.
The proposal includes provisions concerning medical records. It is
proposed that copies of medical records generated outside VA that
relate to activities for which VA provided payment and that VA
determines are necessary to adjudicate claims under Secs. 17.900-17.905
of this part, must be provided to VA at no charge when requested by VA.
Paperwork Reduction Act of 1995
The Office of Management and Budget (OMB) has determined that the
proposed Secs. 17.902-17.904 of 38 CFR contain 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-AI65''.
Preauthorization--Sec. 17.902
Title: Preauthorization for Provision of Certain Health Care to
Vietnam Veterans' Children with Spina Bifida.
Summary of collection of information: The provisions of the
proposed 38 CFR 17.902 would require individuals to submit a to a
preauthorization specialist of the Health Administration Center a
preauthorization application for health
[[Page 23733]]
care consisting of case management, durable medical equipment, home
care, professional counseling, mental health services, respite care,
training, substance abuse treatment, dental services, transplantation
services or travel (other than mileage at the General Services
Administration rate for privately owned automobiles). The
preauthorization application would contain the child's name and social
security number; the type of service requested; the medical
justification; the estimated cost; and the name, address, and telephone
number of the provider.
Description of need for information and proposed use of
information: Such information would be necessary to make
preauthorization determinations in accordance with proposed 38 CFR
17.902.
Description of likely respondents: Individuals seeking provisions
of health care to Vietnam veterans' children with spina bifida.
Estimated number of respondents: 600 to 2000.
Estimated frequency of responses: One time.
Estimated total annual reporting and recordkeeping burden: 500
hours.
Estimated annual burden per collection: 15 minutes each.
Payment of Claims--Sec. 17.903
Title: Payment of Claims for Provision of Health Care to Vietnam
Veterans' Children with Spina Bifida.
Summary of collection of information: The provisions of the
proposed 38 CFR 17.903 would require that, as a condition of payment,
claims from ``approved health care providers'' for health care provided
under 38 CFR 17.900 must include the following information, as
appropriate: With respect to patient identification information: The
veteran's and patient's full name, social security numbers, patient's
address, and date of birth; with respect to patient treatment
information (inpatient and outpatient services): Full name and address
(such as hospital or physician), remittance address, physical location
where services were rendered, individual provider's professional status
(M.D., Ph.D., R.N., etc.), and provider tax identification number (TIN)
or Social Security Number (SSN); with respect to patient treatment
information (inpatient institutional services): Dates of service
(specific and inclusive); summary level itemization (by revenue code);
dates of service for all absences from a hospital or other approved
institution during a period for which inpatient benefits are being
claimed; principal diagnosis established, after study, to be chiefly
responsible for causing the patient's hospitalization; all secondary
diagnoses; all procedures performed; discharge status of the patient;
and institution's Medicare provider number; with respect to patient
treatment information for all health care providers and ancillary
outpatient services: Diagnosis, procedure code for each procedure,
service or supply for each date of service, and individual billed
charge for each procedure, service or supply for each date of service;
with respect to prescription drugs and medicines: Name and address of
pharmacy where drug was dispensed, name of drug, National Drug Code
(NDC) for drug provided, strength, quantity date dispensed, and
pharmacy receipt for each drug dispensed.
Description of need for information and proposed use of
information: Such information would be necessary to make payment
determinations in accordance with proposed 38 CFR 17.903.
Description of likely respondents: Individuals seeking provision of
health care to Vietnam Veterans' children with spina bifida.
Estimated number of respondents: 600 to 2000.
Estimated frequency of responses: 10.
Estimated total annual reporting and recordkeeping burden: 2,000
hours.
Estimated annual burden per collection: 6 minutes per item.
Review/Appeal process--Sec. 17.904
Title: Review/Appeal process regarding provision of health care or
payment relating to provision of health care to Vietnam Veterans'
Children with Spina Bifida.
Summary of collection of information: The provisions of the
proposed 38 CFR 17.904 would establish a review process regarding
disagreements by a Vietnam veteran's child or representative with a
determination concerning authorization of health care or a health care
provider's disagreement with a determination regarding payment. The
person or entity requesting reconsideration of such determination would
be required to submit such request to the Chief, Administrative
Division, Health Administration Center, in writing within one year of
the date of initial determination. The request must state why the
decision is in error and include any new and relevant information not
previously considered. After reviewing the matter, a benefits advisor
would issue a written determination to the person or entity seeking
reconsideration. If such person or entity remains dissatisfied with the
determination, the person or entity would be permitted to make a
written request for review by the Director, Health Administration
Center.
Description of need for information and proposed use of
information: The information proposed to be collected under 17.904
appears to be necessary to make review and appeal determinations.
Description of likely respondents: Beneficiaries and providers
disagreeing with determinations regarding covered services and
benefits.
Estimated number of respondents: 100.
Estimated frequency of responses: 10.
Estimated total annual reporting and recordkeeping burden: 334
hours.
Estimated annual burden per collection: 20 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;
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.
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. It is estimated that there are only between
600 and 2,000 Vietnam veterans' children who suffer from spina bifida.
They are widely geographically diverse and the health care provided to
them would not have a significant impact on any small businesses.
Therefore, pursuant to 5 U.S.C. 605(b),
[[Page 23734]]
the proposed rule is exempt from the initial and final regulatory
flexibility analysis requirements of sections 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: March 21, 1997.
Jesse Brown,
Secretary of Veterans Affairs.
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 new Secs. 17.900-
17.905 are added to read as follows:
Health Care for a Vietnam Veteran's Child with Spina Bifida
Sec.
17.900 Spina Bifida--Provision of health care.
17.901 Definitions.
17.902 Preauthorization.
17.903 Payment.
17.904 Review appeal process.
17.905 Medical records.
Health Care for a Vietnam Veteran's Child with Spina Bifida
Sec. 17.900 Spina Bifida--Provision of health care.
(a) VA shall provide a Vietnam veteran's child who has been
determined under Sec. 3.814 of this title to suffer from spina bifida
with such health care as the Secretary determines is needed by the
child for the spina bifida or any disability that is associated with
such condition. This is not intended to be a comprehensive insurance
plan and does not cover health care unrelated to spina bifida.
(b) Health care provided under this section shall be provided
directly by VA, by contract with an approved health care provider, or
by other arrangement with an approved health care provider. VA may
inform spina bifida patients, parents, or guardians that health care
may be available at not-for-profit charitable entities.
(Authority: 38 U.S.C. 101(2), 1801-1806)
Note: VA provides payment under this section only for health
care relating to spina bifida or a disability that is associated
with such condition. VA is the exclusive payer for services
authorized under this section regardless of any third party insurer,
Medicare, Medicaid, health plan, or any other plan or program
providing health care coverage. Any third-party insurer, Medicare,
Medicaid, health plan, or any other plan or program providing health
care coverage would be responsible according to its provisions for
payment for health care not relating to spina bifida and not
constituting a disability that is associated with such condition.
Sec. 17.901 Definitions.
For the purpose of this section--
Approved health care provider means a health care provider approved
by the Health Care Financing Administration (HCFA), Department of
Defense Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS), Civilian Health and Medical Program of the Department of
Veterans Affairs (CHAMPVA), Joint Commission on Accreditation of Health
care Organizations (JCAHO), or any health care provider approved for
providing health care pursuant to a state license or certificate. An
entity or individual shall be deemed to be an approved health care
provider only when acting within the scope of the approval, license, or
certificate.
Child means the same as defined at Sec. 3.814(c) of this title.
Habilitative and rehabilitative care means such professional
counseling, guidance services and treatment programs (other than
vocational training under 38 U.S.C. 1804) as are necessary to develop,
maintain, or restore, to the maximum extent practicable, the
functioning of a disabled person.
Health care means home care, hospital care, nursing home care,
outpatient care, preventive care, habilitative and rehabilitative care,
case management, and respite care; and includes the training of
appropriate members of a child's family or household in the care of the
child; and the provisions of such pharmaceuticals, supplies, equipment,
devices, appliances, assistive technology, direct transportation costs
to and from approved health care providers (including any necessary
costs for meals and lodging en route, and accompaniment by an attendant
or attendants), and other materials as the Secretary determines
necessary.
Health care provider means any entity or individual who furnishes
health care, including specialized spina bifida clinics, health care
plans, insurers, organizations, and institutions.
Home care means medical care, habilitative and rehabilitative care,
preventive health services, and health-related services furnished to an
individual in the individual's home or other place of residence.
Hospital care means care and treatment furnished to an individual
who has been admitted to a hospital as a patient.
Nursing home care means care and treatment furnished to an
individual who has been admitted to a nursing home as a resident.
Outpatient care means care and treatment including preventive
health services, furnished to an individual other than hospital care or
nursing home care.
Preventive care means care and treatment furnished to prevent
disability or illness, including periodic examinations, immunizations,
patient health education, and such other services as the Secretary
determines necessary to provide effective and economical preventive
health care.
Respite care means care furnished on an intermittent basis for a
limited period to an individual who resides primarily in a private
residence when such care will help the individual continue residing in
such private residence.
Spina bifida means all forms and manifestations of spina bifida
except spina bifida occulta (this includes complications or associated
medical conditions which are adjunct to spina bifida according to the
scientific literature).
Vietnam veteran means the same as defined at Sec. 3.814(b) of this
title.
(Authority: 38 U.S.C. 101(2), 1801-1806)
Sec. 17.902 Preauthorization.
Preauthorization from a preauthorization specialist of the Health
Administration Center is required for health care consisting of case
management, durable medical equipment, home care, professional
counseling, mental health services, respite care, training, substance
abuse treatment, dental services, transplantation services or travel
(other than mileage at the General Services Administration rate for
privately owned automobiles). These services will be authorized only in
those cases where there is a demonstrated medical need. Applications
for provision of health care requiring preauthorization shall either
[[Page 23735]]
be made by telephone at (800) 733-8387, or in writing to Health
Administration Center, P.O. Box 65025, Denver, CO 80206-9025. The
application shall contain the following:
(a) Name of Child,
(b) Child's Social Security number,
(c) Name of veteran,
(d) Veteran's Social Security number,
(e) Type of service requested,
(f) Medical justification,
(g) Estimated cost, and
(h) Name, address, and telephone number of provider.
(Authority: 38 U.S.C. 101(2), 1801-1806)
Sec. 17.903 Payment.
(a) (1) Payment under this section will be determined utilizing the
same payment methodologies as provided for under the Civilian Health
and Medical Program of the Department of Veterans Affairs (CHAMPVA)
(see 38 CFR 17.720 et seq.).
(2) As a condition of payment, claims from approved health care
providers for health care provided under this section must be filed
with the Health Administration Center, P.O. Box 65025, Denver, CO
80206-9025, no later than:
(i) One year after the date of service; or
(ii) In the case of inpatient care, one year after the date of
discharge; or
(iii) In the case of retroactive approval for health care, 180 days
following beneficiary notification of authorization.
(3) Claims for health care provided under the provisions of
Secs. 17.900 through 17.905 of this part shall contain, as appropriate,
the information set forth in paragraphs (a)(3)(i) through (a)(3)(v) of
this section.
(i) Patient identification information:
(A) Full name,
(B) Address,
(C) Date of birth, and
(D) Social Security number.
(ii) Provider identification information (inpatient and outpatient
services):
(A) Full name and address (such as hospital or physician),
(B) Remittance address,
(C) Address where services were rendered,
(D) Individual provider's professional status (M.D., Ph.D., R.N.,
etc.), and
(E) Provider tax identification number (TIN) or Social Security
number.
(iii) Patient treatment information (long-term care or
institutional services):
(A) Dates of service (specific and inclusive),
(B) Summary level itemization (by revenue code),
(C) Dates of service for all absences from a hospital or other
approved institution during a period for which inpatient benefits are
being claimed,
(D) Principal diagnosis established, after study, to be chiefly
responsible for causing the patient's hospitalization,
(E) All secondary diagnoses,
(F) All procedures performed,
(G) Discharge status of the patient, and
(H) Institution's Medicare provider number.
(iv) Patient treatment information for all other health care
providers and ancillary outpatient services such as durable medical
equipment, medical requisites and independent laboratories:
(A) Diagnosis,
(B) Procedure code for each procedure, service or supply for each
date of service, and
(C) Individual billed charge for each procedure, service or supply
for each date of service.
(v) Prescription drugs and medicines and pharmacy supplies:
(A) Name and address of pharmacy where drug was dispensed,
(B) Name of drug,
(C) Drug Code for drug provided,
(D) Strength,
(E) Quantity,
(F) Date dispensed,
(G) Pharmacy receipt for each drug dispensed (including billed
charge), and
(H) Diagnosis.
(b) Health care payment shall be provided in accordance with the
provisions of Secs. 17.900 through 17.905 of this part. However, the
following are specifically excluded from payment:
(1) Care as part of a grant study or research program,
(2) Care considered experimental or investigational,
(3) Drugs not approved by the U.S. Food and Drug Administration for
commercial marketing,
(4) Services, procedures or supplies for which the beneficiary has
no legal obligation to pay, such as services obtained at a health fair,
(5) Services provided outside the scope of the provider's license
or certification, and
(6) Services rendered by providers suspended or sanctioned by a
Federal agency.
(c) Payments made in accordance with the provisions of Secs. 17.900
through 17.905 of this part shall constitute payment in full.
Accordingly, the health care provider or agent for the health care
provider may not impose any additional charge for any services for
which payment is made by VA.
(d) Explanation of benefits (EOB). When a claim under the
provisions of Secs. 17.900 through 17.905 of this part is adjudicated,
an EOB will be sent to the beneficiary or guardian and the provider.
The EOB provides at a minimum, the following information:
(1) Name and address of recipient,
(2) Description of services and/or supplies provided,
(3) Dates of services or supplies provided,
(4) Amount billed,
(5) Determined allowable amount,
(6) To whom payment, if any, was made, and
(7) Reasons for denial (if applicable).
(Authority: 38 U.S.C. 101(2), 1801-1806)
Sec. 17.904 Review appeal process.
If a health care provider, Vietnam veteran's child or
representative disagrees with a determination concerning provision of
health care or a health care provider disagrees with a determination
concerning payment, the person or entity may request reconsideration.
Such request must be submitted in writing within one year of the date
of the initial determination to the Chief, Administrative Division,
Health Administration Center, P.O. Box 65025, Denver, CO 80206-9025.
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 dispute will be returned to the sender without further
consideration. After reviewing the matter, including any relevant
supporting documentation, a benefits advisor will issue a written
determination to the person or entity seeking reconsideration that
affirms, reverses or modifies the previous decision. If the person or
entity seeking reconsideration is still dissatisfied, within 30 days of
the date of the decision he or she may make a written request for
review by the Director, Health Administration Center, P.O. Box 65025,
Denver, CO 80206-9025. The Director will review the claim and any
relevant supporting documentation and issue a decision in writing that
affirms, reverses or modifies the previous decision.
(Authority: 38 U.S.C. 101(2), 1801-1806)
Note: The final decision of the Director will inform the
claimant of further appellate rights for an appeal to the Board of
Veterans Appeals.
Sec. 17.905 Medical records.
Copies of medical records generated outside VA that relate to
activities for which VA is asked to provide payment, and that VA
determines are necessary to adjudicate claims under Secs. 17.900
through 17.905 of this part, must be provided to VA at no cost.
[[Page 23736]]
(Authority: 38 U.S.C. 101(2), 1801-1806)
[FR Doc. 97-11257 Filed 4-30-97; 8:45 am]
BILLING CODE 8320-01-P
