Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AE64

Civilian Health and Medical Program of the Department of Veterans

Affairs (CHAMPVA)

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: This document proposes to amend regulations concerning medical

care for survivors and dependents of certain veterans, hereinafter

referred to as the Civilian Health and Medical Program of the

Department of Veterans Affairs (CHAMPVA). These proposed regulations

would establish basic policies and procedures governing the

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administration of the CHAMPVA program, including CHAMPVA claims

processing procedures and a description of benefits and services.

DATES: Comments must be received on or before December 31, 1996.

ADDRESSES: Mail or hand deliver written comments 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-AE64.'' All

written comments 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: Susan Schmetzer, Health Administration

Center (formerly CHAMPVA Center), P.O. Box 65023, Denver, CO 80206-

5023, at (303) 331-7552. (This is not a toll-free number).

SUPPLEMENTARY INFORMATION: The provisions of 38 U.S.C. 1713 authorize

VA to provide medical care to the dependents and survivors of certain

veterans ``in the same or similar manner and subject to the same or

similar limitations'' as medical care is furnished by the Department of

Defense (DoD) to certain dependents and survivors of active duty and

retired members of the Armed Forces under 10 United States Code,

Chapter 55, Civilian Health and Medical Program of the Uniformed

Services (CHAMPUS). This document proposes to amend VA regulations to

include CHAMPVA claims processing procedures.

It is also noted that during the past several years VA has made

changes with respect to CHAMPVA claims processing services. Previously,

VA had an agreement with DoD to contract with commercial claims

processors (fiscal intermediaries) for the processing of VA claims.

However, in an effort to both contain costs and to improve services to

the beneficiaries, VA now conducts its own claims processing services

and has consolidated the operations in Denver, Colorado.

The Secretary hereby certifies that these regulatory amendments

would not have a significant economic impact on a substantial number of

small entities as they are defined in the Regulatory Flexibility Act, 5

U.S.C. Sec. 601-612. These amendments would not cause significant

economic impact on health care providers, suppliers, or entities since

only a small portion of their business concerns CHAMPVA beneficiaries.

The proposed rule would mostly impact individuals who are VA

beneficiaries. Pursuant to 5 U.S.C. 605(b), these amendments are exempt

from the initial and final regulatory flexibility analyses requirements

of sections 603 and 604.

The Catalog of Federal Domestic Assistance Program numbers are

64.009, 64.010, 64.011.

Lists of Subjects in 38 CFR Part 17

Alcoholism, Claims, Dental services, Drug abuse, Foreign relations,

Government contracts, Grant programs-Health, Health care, Health

facilities, Health professions, Medical devices, Medical research,

Mental health programs, Nursing home care, Philippines, Veterans.

Approved

Jesse Brown,

Secretary of Veterans Affairs.

For the reasons set out in the preamble, 38 CFR part 17 is proposed

to be amended as set forth below:

PART 17--MEDICAL

1. The authority citation for part 17 continues to read as follows:

Authority: 38 U.S.C. 501, 1721, unless otherwise noted.

2. Section 17.84 is removed.

3. A new center heading consisting of Secs. 17.270-17.278 is added

to read as follows:

Civilian Health and Medical Program of the Department of Veterans

Affairs (CHAMPVA)--Medical Care for Survivors and Dependents of Certain

Veterans

Sec.

17.270 General Provisions

17.271 Eligibility

17.272 Benefit Limitations/Exclusions

17.273 Preauthorization

17.274 Cost Sharing

17.275 Claim Filing Deadline

17.276 Appeal/Review Process

17.277 Third Party Liability/Medical Care Cost Recovery

17.278 Confidentiality of Records

Sec. 17.270 General Provisions.

(a) CHAMPVA is the Civilian Health and Medical Program of the

Department of Veterans Affairs. Pursuant to 38 U.S.C. 1713, VA is

authorized to provide medical care in the same or similar manner and

subject to the same or similar limitations as medical care furnished to

certain dependents and survivors of active duty and retired members of

the Armed Forces. The CHAMPVA program is designed to accomplish this

purpose. Under CHAMPVA, VA shares the cost of medically necessary

services and supplies for eligible beneficiaries as set forth below.

(b) For purposes of this section, the definitions of ``child,''

``service-connected condition/disability,'' ``spouse,'' and ``surviving

spouse'' shall be those set forth further in 38 U.S.C. 101. The term

``fiscal'' year refers to October 1, through September 30.

(Authority: 38 U.S.C. 1713)

Sec. 17.271 Eligibility.

(a) The following persons are eligible for CHAMPVA benefits

provided that they are not eligible for CHAMPUS or Medicare Part A

(except as noted in 17.271).

(1) The spouse or child of a veteran who has been adjudicated by VA

as having a permanent and total service-connected disability;

(2) The surviving spouse or child of a veteran who died as a result

of an adjudicated service-connected condition(s); or who, at the time

of death, was adjudicated permanently and totally disabled from a

service-connected condition(s);

(3) The surviving spouse or child of a person who died on active

military service and in the line of duty and not due to such person's

own misconduct; and

(4) An eligible child who is pursuing a full-time course of

instruction approved under 38 U.S.C. Chapter 36, and who incurs a

disabling illness or injury while pursuing such course (between terms,

semesters or quarters; or during a vacation or holiday period) which is

not the result of his or her own willful misconduct and which results

in the inability to continue or resume the chosen program of education

shall remain eligible for medical care until:

(i) the end of the six-month period beginning on the date the

disability is removed; or

(ii) the end of the two-year period beginning on the date of the

onset of the disability; or

(iii) the twenty-third birthday of the child, whichever occurs

first.

(Authority: 38 U.S.C. 1713)

(b) Persons who lose eligibility for CHAMPVA by becoming

potentially eligible for Medicare Part A as a result of reaching age 65

or who qualify for Medicare Part A benefits on the basis of a

disability, including end stage renal disease, may re-establish CHAMPVA

eligibility by submitting documentation from the Social Security

Administration (SSA) certifying their non-entitlement to or exhaustion

of Medicare Part A benefits. Persons under age 65 who are enrolled in

both Medicare Part A and B

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may become potentially eligible for CHAMPVA as a secondary payer to

Medicare. In cases where CHAMPVA eligibility is restored upon

exhaustion of Medicare benefits, CHAMPVA coverage will extend even

during subsequent periods of Medicare eligibility. When both CHAMPVA

and Medicare eligibility exist, CHAMPVA shall be the secondary payer.

(Authority: 38 U.S.C. 1713(d))

Sec. 17.272 Benefits Limitations/Exclusions.

(a) Benefits cover allowable expenses for medical services and

supplies that are medically necessary and appropriate for the treatment

of a condition and that are not specifically excluded from program

coverage. Covered benefits may have limitations. The fact that a

physician may prescribe, order, recommend, or approve a service or

supply does not, of itself, make it medically necessary or make the

charge an allowable expense, even though it is not listed specifically

as an exclusion. The following are specifically excluded from program

coverage:

(1) Services, procedures or supplies for which the beneficiary has

no legal obligation to pay, or for which no charge would be made in the

absence of coverage under a health benefits plan.

(2) Services and supplies required as a result of an occupational

disease or injury for which benefits are payable under workers'

compensation or similar protection plan (whether or not such benefits

have been applied for or paid) except when such benefits are exhausted

and are otherwise not excluded from CHAMPVA coverage.

(3) Services and supplies that are paid directly or indirectly by a

local, state or Federal government agency (Medicaid excluded),

including court-ordered treatment.

(4) Services and supplies that are not medically or psychologically

necessary for the diagnosis or treatment of a covered condition

(including mental disorder) or injury.

(5) Radiology, laboratory, and pathological services and machine

diagnostic testing not related to a specific illness or injury or a

definitive set of symptoms.

(6) Services and supplies above the appropriate level required to

provide necessary medical care.

(7) Services and supplies related to an inpatient admission

primarily to perform diagnostic tests, examinations, and procedures

that could have been and are performed routinely on an outpatient

basis.

(8) Postpartum inpatient stay of a mother for purposes of staying

with the newborn infant (primarily for the purpose of breast feeding

the infant) when the infant (but not the mother) requires the extended

stay; or continued inpatient stay of a newborn infant primarily for

purposes of remaining with the mother when the mother (but not the

newborn infant) requires extended postpartum inpatient stay.

(9) Therapeutic absences from an inpatient facility or residential

treatment center (RTC).

(10) Custodial care.

(11) Inpatient stays primarily for domiciliary care purposes.

(12) Inpatient stays primarily for rest or rest cures.

(13) Services and supplies provided as a part of, or under, a

scientific or medical study, grant, or research program.

(14) Services and supplies not provided in accordance with accepted

professional medical standards or related to experimental or

investigational procedures or treatment regimens.

(15) Services or supplies prescribed or provided by a member of the

beneficiary's immediate family, or a person living in the beneficiary's

or sponsor's household.

(16) Services and supplies that are (or are eligible to be) payable

under another medical insurance or program, either private or

governmental, such as coverage through employment or Medicare.

(17) Service or supplies subject to preauthorization (see

Sec. 17.273) which were obtained without the required preauthorization;

and services and supplies which were not provided according to the

terms of the preauthorization.

(18) Inpatient stays primarily to control or detain a runaway

child, whether or not admission is to an authorized institution.

(19) Services and supplies in connection with cosmetic surgery.

(20) Electrolysis.

(21) Dental care with the following exceptions:

(i) Dental care that is medically necessary in the treatment of an

otherwise covered medical condition is an integral part of the

treatment of such medical condition, and is essential to the control of

the primary medical condition.

(ii) Dental care required in preparation for, or as a result of,

radiation therapy for oral or facial cancer.

(iii) Gingival Hyperplasia.

(iv) Loss of jaw substance due to direct trauma to the jaw or due

to treatment of neoplasm.

(v) Intraoral abscess when it extends beyond the dental alveolus.

(vi) Extraoral abscess.

(vii) Cellulitis and osteitis which is clearly exacerbating and

directly affecting a medical condition currently under treatment.

(viii) Repair of fracture, dislocation, and other injuries of the

jaw, to include removal of teeth and tooth fragments only when such

removal is incidental to the repair of the jaw.

(ix) Treatment for stabilization of myofascial pain dysfunction

syndrome, also referred to as temporomandibular joint (TMJ) syndrome.

Authorization is limited to initial radiographs, up to four office

visits, and the construction of an occlusal splint.

(x) Total or complete ankyloglossia.

(xi) Adjunctive dental and orthodontic support for cleft palate.

(xii) Prosthetic replacement of jaw due to trauma or cancer.

(22) Nonsurgical treatment of obesity or morbid obesity for dietary

control or weight reduction (with the exception of gastric bypass,

gastric stapling, or gastroplasty procedures in connection with morbid

obesity when determined to be medically necessary).

(23) Services and supplies related to transsexualism or other

similar conditions such as gender dysphoria (including, but not limited

to, intersex surgery and psychotherapy, except for ambiguous genitalia

which was documented to be present at birth).

(24) Sex therapy, sexual advice, sexual counseling, sex behavior

modification, psychotherapy for mental disorders involving sexual

deviations (e.g., transvestic fetish), or other similar services, and

any supplies provided in connection with therapy for sexual

dysfunctions or inadequacies.

(25) Removal of corns or calluses or trimming of toenails and other

routine podiatry services, except those required as a result of a

diagnosed systemic medical disease affecting the lower limbs, such as

severe diabetes.

(26) Services and supplies, to include psychological testing,

provided in connection with a specific developmental disorder. The

following exception applies: Diagnostic and evaluative services

required to arrive at a differential diagnosis for an otherwise

eligible child unless the state is required to provide those services

under Public Law 94-142, Education for All Handicapped Children Act of

1975 as amended, See 20 U.S.C. Chapter 33.

(27) Surgery to reverse voluntary surgical sterilization

procedures.

(28) Services and supplies related to artificial insemination

(including semen donors and semen banks), in vitro fertilization,

gamete intrafallopian

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transfer and all other noncoital reproductive technologies.

(29) Nonprescription contraceptives.

(30) Diagnostic tests to establish paternity of a child; or tests

to determine sex of an unborn child.

(31) Preventive care (such as routine, annual, or employment-

requested physical examinations; routine screening procedures; and

immunizations). The following exceptions apply:

(i) Well-baby care from birth to the age of two years, including

newborn examination, phenylketonuria (PKU) testing and newborn

circumcision.

(ii) Rabies vaccine following an animal bite.

(iii) Tetanus vaccine following an accidental injury.

(iv) Rh immune globulin.

(v) Pap smears.

(vi) Mammography tests.

(vii) Genetic testing and counseling determined to be medically

necessary.

(viii) Chromosome analysis in cases of habitual abortion or

infertility.

(ix) Gamma globulin.

(32) Chiropractic and naturopathic services.

(33) Counseling services that are not medically necessary in the

treatment of a diagnosed medical condition (such as educational

counseling; vocational counseling; and counseling for socioeconomic

purposes, stress management, life style modification, etc.).

(34) Acupuncture, whether used as a therapeutic agent or as an

anesthetic.

(35) Hair transplants, wigs, or hairpieces, except that benefits

may be extended for one wig or hairpiece per beneficiary (lifetime

maximum) when the attending physician certifies that alopecia has

resulted from treatment of malignant disease and the beneficiary

certifies that a wig or hairpiece has not been obtained previously

through the U.S. Government (including the Department of Veterans

Affairs). The wig or hairpiece benefit does not include coverage for

the following:

(i) Maintenance, wig or hairpiece supplies, or replacement of the

wig or hairpiece.

(ii) Hair transplant or any other surgical procedure involving the

attachment of hair or a wig or hairpiece to the scalp.

(iii) Any diagnostic or therapeutic method or supply intended to

encourage hair growth.

(36) Self-help, academic education or vocational training services

and supplies.

(37) Exercise equipment, spas, whirlpools, hot tubs, swimming

pools, health club membership or other such charges or items.

(38) General exercise programs, even if recommended by a physician.

(39) Services of an audiologist or speech therapist, except when

prescribed by a physician and rendered as a part of treatment addressed

to the physical defect itself and not to any educational or

occupational deficit.

(40) Eye exercises or visual training (orthoptics).

(41) Eye and hearing examinations except when rendered in

connection with medical or surgical treatment of a covered illness or

injury or in connection with well-baby care.

(42) Eyeglasses, spectacles, contact lenses, or other optical

devices with the following exceptions:

(i) When necessary to perform the function of the human lens, lost

as a result of intraocular surgery, ocular injury or congenital

absence.

(ii) Pinhole glasses prescribed for use after surgery for detached

retina.

(iii) Lenses prescribed as ``treatment'' instead or surgery for the

following conditions:

(A) Contact lenses used for treatment of infantile glaucoma.

(B) Corneal or scleral lenses prescribed in connection with

treatment of keratoconus.

(C) Scleral lenses prescribed to retain moisture when normal

tearing is not present or is inadequate.

(D) Corneal or scleral lenses prescribed to reduce a corneal

irregularity other than astigmatism.

(iv) The specified benefits are limited to one set of lenses

related to one qualifying eye condition as set forth in (iii)(A-D) of

this Section. If there is a prescription change requiring a new set of

lenses, but still related to the qualifying eye condition, benefits may

be extended for a second set of lenses, subject to medical review.

(43) Hearing aids or other auditory sensory enhancing devices.

(44) Prostheses with the following exceptions:

(i) Artificial limbs and eyes, or items inserted surgically in the

body as an integral part of a surgical procedure.

(ii) Dental prostheses specifically required in connection with

otherwise covered orthodontia directly related to the surgical

correction of a cleft palate anomaly.

(45) Orthopedic shoes, arch supports, shoe inserts, and other

supportive devices for the feet, including custom-made built-up shoes,

or regular shoes later built up with the following exception: Shoes

that are an integral part of an orthopedic brace and which cannot be

used separately from the brace are covered.

(46) Services or advice rendered by telephone or other telephonic

device, including remote monitoring, except for transtelephonic

monitoring of cardiac pacemakers.

(47) Air conditioners, humidifiers, dehumidifiers, and purifiers.

(48) Elevators or wheelchair lifts.

(49) Alterations to living spaces or permanent features attached

thereto, even when necessary to accommodate installation of covered

durable medical equipment or to facilitate entrance or exit.

(50) Items of clothing, even if required by virtue of an allergy

(such as cotton fabric versus synthetic fabric and vegetable-dyed

shoes).

(51) Food, food substitutes, vitamins or other nutritional

supplements, including those related to prenatal care for a home

patient whose condition permits oral feeding.

(52) Enuretic (bed-wetting) devices; enuretic conditioning

programs.

(53) Autopsy and post-mortem examinations.

(54) All camping, even when organized for a specific therapeutic

purpose (such as diabetic camp or a camp for emotionally disturbed

children), or when offered as a part of an otherwise covered treatment

plan.

(55) Housekeeping, homemaker, or attendant services, including a

sitter or companion.

(56) Personal comfort or convenience items, such as beauty and

barber services, radio, television, and telephone.

(57) Smoking cessation services and supplies.

(58) Megavitamin psychiatric therapy; orthomolecular psychiatric

therapy.

(59) All transportation except for specialized transportation with

life sustaining equipment, when medically required for the treatment of

a covered condition.

(60) Inpatient mental health services in excess of 30 days in any

fiscal year (or in an admission), in the case of a patient 19 years of

age or older; 45 days in any fiscal year (or in an admission), in the

case of a patient under 19 years of age; or 150 days of residential

treatment care in any fiscal year (or in an admission), unless a waiver

for extended coverage is granted in advance.

(61) Outpatient mental health services in excess of 23 visits in a

fiscal year, unless a waiver for extended coverage is granted in

advance.

(62) Institutional services for partial hospitalization in excess

of 60 treatment days in any fiscal year (or in an admission), unless a

waiver for extended coverage is granted in advance.

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(63) Detoxification in a hospital setting or rehabilitation

facility in excess of seven days.

(64) Outpatient substance abuse services in excess of 60 visits

during a benefit period. A benefit period begins with the first date of

covered service and ends 365 days later.

(65) Family therapy for substance abuse in excess of 15 visits

during a benefit period. A benefit period begins with the first date of

covered service and ends 365 days later.

(66) Services that are provided to a beneficiary who is referred to

a provider of such services by a provider who has an economic interest

in the facility to which the patient is referred, unless a waiver is

granted.

(67) Abortion, except when a physician certifies that the life of

the mother would be endangered if the fetus were carried to term.

(68) Abortion counseling.

(69) Aversion therapy.

(70) Rental or purchase of biofeedback equipment.

(71) Biofeedback therapy for treatment of ordinary muscle tension

states (including tension headaches) or for psychosomatic conditions.

(72) Drug maintenance programs where one addictive drug is

substituted for another, such as methadone substituted for heroin.

(73) Immunotherapy for malignant diseases, except for treatment of

Stage O and Stage A carcinoma of the bladder.

(74) Services and supplies provided by other than a hospital, such

as nonskilled nursing homes, intermediate care facilities, halfway

houses, homes for the aged, or other institutions of similar purpose.

(75) Services performed when the patient is not physically present.

(76) Medical photography.

(77) Special tutoring.

(78) Surgery for psychological reasons.

(79) Treatment of premenstrual syndrome (PMS).

(80) Medications not requiring a prescription, except for insulin.

(81) Thermography.

(82) Removal of tattoos.

(83) Penile implant/testicular prosthesis procedures and related

supplies for psychological impotence.

(84) Dermabrasion of the face.

(85) Chemical peeling for facial wrinkles.

(86) Panniculectomy, body sculpting procedures.

(b) CHAMPVA-determined allowable amount.

(1) The term allowable amount is the maximum CHAMPVA-determined

level of payment to a hospital or other authorized institutional

provider, a physician or other authorized individual professional

provider, or other authorized provider for covered services. The

CHAMPVA-allowable amount is determined prior to cost sharing and the

application of deductibles and/or other health insurance.

(2) A Medicare-participating hospital must accept the CHAMPVA-

determined allowable amount for inpatient services as payment-in-full.

(Reference 42 CFR Parts 489 and 1003).

(3) An authorized provider of covered medical services or supplies

shall accept the CHAMPVA-determined allowable amount as payment-in-

full.

(4) A provider who has collected and not made an appropriate

refund, or attempts to collect from the beneficiary, any amount in

excess of the CHAMPVA-determined allowable amount may be subject to

exclusion from Federal benefit programs.

(Authority: 38 U.S.C. 1713)

Sec. 17.273 Preauthorization.

(a) Preauthorization or advance approval is required for any of the

following:

(1) Non-emergent inpatient mental health and substance abuse care,

including admission of emotionally disturbed children and adolescents

to residential treatment centers.

(2) All admissions to a partial hospitalization program (including

alcohol rehabilitation).

(3) Outpatient mental health visits in excess of 23 per calendar

year and/or more than two (2) sessions per week.

(4) Dental care.

(5) Durable medical equipment with a purchase price in excess of

$300.00.

(6) Organ transplants.

(Authority: 38 U.S.C. 1713)

Sec. 17.274 Cost sharing.

(a) With the exception of services obtained directly from VA

medical facilities, CHAMPVA is a cost-sharing program in which the cost

of covered services is shared with the beneficiary. In addition to the

beneficiary cost share, an annual (calendar year) outpatient deductible

requirement ($50 per beneficiary or $100 per family) must be satisfied

prior to the payment of outpatient benefits. There is no deductible for

inpatient services. CHAMPVA pays the CHAMPVA-determined allowable

amount less the deductible, if applicable, and less the beneficiary

cost share. To provide financial protection against the impact of a

long-term illness or injury, an annual cost limit or ``catastrophic

cap'' has been placed on the beneficiary cost-share amount for covered

services and supplies. This annual cap on cost sharing is $7,500 per

CHAMPVA-eligible family. Credits to the annual catastrophic cap are

limited to the applied annual deductible(s) and the beneficiary cost-

share amount. Costs above the CHAMPVA-allowable amount, as well as

costs associated with noncovered services, are not credited to the

catastrophic cap computation.

(b) If the CHAMPVA benefit payment is under $1.00, payment will not

be issued. Catastrophic cap and deductible will, however, be credited.

(Authority: 38 U.S.C. 1713)

Sec. 17.275 Claim filing deadline.

(a) Unless an exception is granted under paragraph (b) of this

subsection, claims for medical services and supplies must be filed with

the Center no later than:

(1) One year after the date of service; or

(2) In the case of inpatient care, one year after the date of

discharge; or

(3) In the case of retroactive approval for medical services/

supplies, 180 days following beneficiary notification of authorization;

or

(4) In the case of retroactive approval of CHAMPVA eligibility, 180

days following notification to the beneficiary of authorization for

services occurring on or after the date of first eligibility.

(b) Requests for an exception to the claim filing deadline must be

submitted, in writing, to the Center and include a complete explanation

of the circumstances resulting in late filing along with all available

supporting documentation. Each request for an exception to the claim

filing deadline will be reviewed individually and considered on its own

merit. The Center Director may grant exceptions to the requirements in

paragraph (a) if he or she determines that there was good cause for

missing the filing deadline. For example, when dual coverage exists,

the CHAMPVA allowable amount cannot be determined until after the

primary insurance carrier has adjudicated the claim. In such

circumstances an exception may be granted provided that the delay on

the part of the primary insurance carrier is not attributable to the

beneficiary. Delays due to provider billing procedures do not

constitute a valid basis for an exception.

Sec. 17.276 Appeal/review process.

Notice of the initial determination regarding payment of CHAMPVA

benefits will be provided to the beneficiary on a CHAMPVA

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Explanation of Benefits (EOB) form. The EOB form is generated by the

CHAMPVA automated payment processing system. If a beneficiary disagrees

with the determination concerning covered services or calculation of

benefits, he or she may request reconsideration. Such requests must be

submitted to the Center in writing within one year of the date of the

initial determination. The request must state why the beneficiary

believes 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

claimant without further consideration. After reviewing the claim and

any relevant supporting documentation, a CHAMPVA benefits advisor will

issue a written determination to the beneficiary that affirms, reverses

or modifies the previous decision. If the beneficiary is still

dissatisfied, within 30 days of the date of the decision he or she may

make a written request for review by the Center Director. 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. The decision of the Director with respect to benefit

coverage and computation of benefits is final.

(Authority: 38 U.S.C. 1713)

Note: Denial of CHAMPVA benefits based on legal eligibility

requirements may be appealed to the Board of Veterans Appeals in

accordance with 38 C.F.R. Part 20. Medical determinations are not

appealable to the Board. 20 C.F.R. Sec. 20.101.

Sec. 17.277 Third Part Liability/Medicare Cost Recovery.

The Center will actively pursue third party liability/medical care

cost recovery in accordance with 38 CFR 1.900, et seq.

Sec. 17.278 Confidentiality of records.

Confidentiality of records will be maintained in accordance with 38

CFR 1.500, et seq.

[FR Doc. 96-27668 Filed 10-31-96; 8:45 am]

BILLING CODE 8320-01-P