Provision of Health Care to Vietnam Veterans' Children With Spina Bifida

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.

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

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