82 FR 21119 - Payment or Reimbursement for Certain Medical Expenses for Camp Lejeune Family Members

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 82, Issue 86 (May 5, 2017)

The Department of Veterans Affairs (VA) adopts as final an interim final rule addressing payment or reimbursement of certain medical expenses for family members of Camp Lejeune veterans. Under this rule, VA reimburses family members, or pays providers, for medical expenses incurred as a result of certain illnesses and conditions that may be associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune (Camp Lejeune), North Carolina, from August 1, 1953, to December 31, 1987. Payment or reimbursement is made within the limitations set forth in statute and Camp Lejeune family members receive hospital care and medical services that are consistent with the manner in which we provide hospital care and medical services to Camp Lejeune veterans. The statutory authority has since been amended to also include certain veterans' family members who resided at Camp Lejeune, North Carolina, for no less than 30 days (consecutive or nonconsecutive) between August 1, 1953, and December 31, 1987. This final rule will reflect that statutory change and will address public comments received in response to the interim final rule.

[Federal Register Volume 82, Number 86 (Friday, May 5, 2017)]
[Rules and Regulations]
[Pages 21119-21123]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-09163]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AO79


Payment or Reimbursement for Certain Medical Expenses for Camp 
Lejeune Family Members

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) adopts as final an 
interim final rule addressing payment or reimbursement of certain 
medical expenses for family members of Camp Lejeune veterans. Under 
this rule, VA reimburses family members, or pays providers, for medical 
expenses incurred as a result of certain illnesses and conditions that 
may be associated with contaminants present in the base water supply at 
U.S. Marine Corps Base Camp Lejeune (Camp Lejeune), North Carolina, 
from August 1, 1953, to December 31, 1987. Payment or reimbursement is 
made within the limitations set forth in statute and Camp Lejeune 
family members receive hospital care and medical services that are 
consistent with the manner in which we provide hospital care and 
medical services to Camp Lejeune veterans. The statutory authority has 
since been amended to also include certain veterans' family members who 
resided at Camp Lejeune, North Carolina, for no less than 30 days 
(consecutive or nonconsecutive) between August 1, 1953, and December 
31, 1987. This final rule will reflect that statutory change and will 
address public comments received in response to the interim final rule.

DATES: Effective Date: This final rule is effective May 5, 2017.

FOR FURTHER INFORMATION CONTACT: Karyn Barrett, Director, Program 
Administration Directorate, Chief Business Office Purchased Care 
(10NB3), Veterans Health Administration, Department of Veterans 
Affairs, 810 Vermont Ave. NW., Washington, DC 20420, (303) 331-7500. 
(This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: On September 24, 2014, VA published an 
interim final rule to implement 38 U.S.C. 1787, which was created by 
section 102 of the Honoring America's Veterans and Caring for Camp 
Lejeune Families Act of 2012, Public Law 112-154 (the Act). 79 FR 
57415-57421, Sept. 24, 2014. The Act requires VA to reimburse family 
members of Camp Lejeune veterans, or pay providers, when they have 
exhausted all claims and remedies against a third party for payment of 
medical care for any of the 15 specified illnesses and conditions. We 
received a total of 14 comments. One commenter fully supported the 
interim final rule and did not suggest any changes to it. Several 
comments related to provisions of 38 CFR 17.400, the regulation 
governing hospital care and medical services for Camp Lejeune veterans 
and coverage for certain illnesses or conditions. That regulation was 
the subject of a separate rulemaking. See 81 FR 46603-46606 (July 18, 
2016). Three comments expressed general dissatisfaction with the 
interim final rule but neither opposed a specific provision of the 
regulation nor suggested how the regulation should be changed. As a 
result, these comments do not address any matter to which VA can 
respond and so will not be addressed here.
    All of the issues raised by other commenters that criticized at 
least one portion of the rule can be grouped together by similar topic, 
and we have organized our discussion of the comments accordingly.

Concerns Over Covered Illnesses or Conditions

    Several commenters referenced medical conditions that are not 
listed in the definition of covered illness or condition in 38 CFR 
17.400(b). One commenter suggested that the reimbursement provisions of 
Sec.  17.410 should apply to all illnesses or defects that science has 
shown were caused by exposure to the chemicals in the Camp Lejeune 
water supply. However, 38 U.S.C. 1787 limits payment or reimbursement 
for hospital care and medical services for Camp Lejeune family members 
to the 15 covered illnesses and conditions specified in 38 U.S.C. 
1710(e)(1)(F). VA does not have the authority to expand the payment or 
reimbursement provisions of 38 U.S.C. 1787 beyond those specified in 
the statute. We therefore make no changes in the final rule.
    One commenter expressed concern that the regulation identified the 
15 statutory covered illnesses and conditions but also noted the 
reference, found in the preamble to the interim final rule, 79 FR at 
57417, to VA's intent to consider any newly available science. The 
comment suggests that newly available science might identify other 
illnesses or conditions caused by exposure to the contaminated water at 
Camp Lejeune and thus expand the list of covered illnesses and 
conditions. However, as stated in the interim final rule, 79 FR at 
57417, any such science

[[Page 21120]]

is intended only to refine VA's clinical guidelines with respect to 
determining the cause or causes of a Camp Lejeune family member's 
illness. The enumerated list of covered illnesses and conditions 
referenced in 38 U.S.C. 1787 cannot be expanded by regulation.

Timeliness of Claims

    One commenter suggested that the two-year filing requirement of 
Sec.  17.410(d)(1)(i) was too short. This commenter noted the 
possibility that family members may not have had access to medical care 
to determine whether an illness was related to Camp Lejeune residency. 
This comment suggests the existence of a requirement to demonstrate a 
causal relationship between an illness or condition and residence at 
Camp Lejeune. However, under Sec.  17.410(d)(3), a family member will 
be eligible for payment or reimbursement for certain hospital care and 
medical services for a covered illness or condition unless VA makes a 
clinical finding, in accordance with VA clinical guidelines, that the 
illness or condition resulted from a cause other than the family 
member's residence at Camp Lejeune. The commenter also stated that a 
``large segment'' of family members might not know of the contamination 
today. The United States Marine Corps has taken steps over the past few 
years to publicize the issue of contaminants in the water at Camp 
Lejeune, and is making a continuing effort to contact individuals who 
were stationed there during the relevant time period and provide 
pertinent information. VA believes the two-year time frame provides an 
adequate period for affected family members to obtain and submit 
supporting evidence. Moreover, the two-year limit in paragraph 
(d)(1)(i) is consistent with VA's review of applications for 
retroactive copayment exemptions made by Camp Lejeune veterans under 
Sec.  17.400(d).
    Another commenter criticized the limitation of claims to expenses 
incurred after March 26, 2013. However, 38 U.S.C. 1787(b)(1) covers 
family members' claims only to the extent and in the amount provided in 
advance in appropriations for such purpose. Because March 26, 2013, is 
the date on which VA received appropriations to pay family members' 
claims, VA does not have the authority to pay claims for hospital care 
and medical services received before that date.

Medical Evaluations by Non-VA Physicians

    One commenter found ``unacceptable'' the information required of 
family members' treating physicians under Sec.  17.410(d)(2). This 
commenter suggested that VA needs to locate qualified occupational 
physicians and pay for expert opinions as part of the family members' 
treatment ``rather than strictly as part of a VA claim denial 
process.'' The commenter also criticized the application of VA clinical 
guidelines by VA physicians as applied to the opinions of family 
members' personal physicians regarding their patients' illnesses or 
conditions on the basis that VA clinicians were ``people who have never 
examined the patient.'' This comment misinterprets the intent of Sec.  
17.410(d)(2) and (d)(3), which do not establish a means for VA to rebut 
the diagnosis of a family member's physician. This is not an 
adversarial process in which VA requires the family member to undergo 
an independent medical examination, followed by an administrative 
weighing of the evidence to establish causation. The process is more 
analogous to submitting a claim for reimbursement to a health insurer. 
Because VA is not going to be conducting clinical examinations, 
paragraphs (d)(2) and (d)(3) establish a process whereby we rely on the 
clinical determinations made by family members' treating physicians who 
have conducted such examinations. VA will use this information to reach 
the clinical determinations described in Sec.  17.410(d)(3). The rule 
provides that a family member will be eligible for payment or 
reimbursement for certain hospital care and medical services for a 
covered illness or condition unless VA makes a clinical finding, in 
accordance with VA clinical guidelines, that the illness or condition 
resulted from a cause other than the family member's residence at Camp 
Lejeune. This is consistent with the statute at 38 U.S.C. 1787(a). The 
statute requires VA to apply clinical guidelines to determine, per 38 
U.S.C. 1787(b)(2), whether the illness or condition resulted from a 
cause other than the residence of the family member at Camp Lejeune 
during a covered period.
    The commenter also stated that VA would always be liable for full 
payment or reimbursement because most health care insurance policies 
contain exclusions and exceptions for poisonings, chemical or 
occupational exposure. The statute at 38 U.S.C. 1787(b)(3) authorizes 
VA to provide payment or reimbursement for hospital care or medical 
services provided to a family member only after the family member or 
the health care provider has exhausted without success all claims and 
remedies reasonably available to the family member or provider against 
a third party for payment of such care or services, including with 
respect to health-plan contracts. The regulation at Sec.  17.410(d)(5) 
is consistent with the statute, providing that VA is the payer of last 
resort after all other claims and remedies have been exhausted. The 
purpose of 38 U.S.C. 1787 is to ensure that the family member receives 
reimbursement for monies spent on, or the provider receives payment 
for, treatment of illnesses or conditions that are now covered, and 
that the family member has no residual financial liability for that 
treatment. We make no change based on this comment.

Amendment of 38 U.S.C. 1787

    After passage of the Act (Pub.L. 112-154), Congress subsequently 
passed Public Law 113-235, the Consolidated and Further Continuing 
Appropriations Act, 2015 (``the Consolidated Act''), which President 
Obama signed into law on December 16, 2014. Division I, Title II, sec. 
243 of the law amended 38 U.S.C. 1710(e)(1)(F) by striking ``January 1, 
1957,'' and inserting ``August 1, 1953.'' This added a new cohort of 
veterans to the group who are eligible for care pursuant to 38 U.S.C. 
1710(e)(1)(F), namely, veterans who served on active duty in the Armed 
Forces at Camp Lejeune, North Carolina, for not fewer than 30 days 
during the period from August 1, 1953, to December 31, 1956 (the ``1953 
cohort''). Consequently, this amendment expanded eligibility for 
payment and reimbursement for certain health care to qualifying family 
members of Camp Lejeune veterans in the 1953 cohort.
    Pursuant to the Consolidated Act, VA amends Sec.  17.410 in this 
final rule to account for the change in the date that begins the period 
of eligibility for Camp Lejeune veterans to receive VA hospital care 
and medical services. First, we amend the definition of ``Camp Lejeune 
family member'' in Sec.  17.410(b) by deleting ``January 1, 1957'' and 
adding in its place ``August 1, 1953.'' In addition, because the 
amendment is not retroactive, we amend Sec.  17.410(d)(1) to clarify 
that the family members of the 1953 cohort are not eligible for payment 
or reimbursement for hospital care and medical services received before 
December 16, 2014, the effective date of the Consolidated Act. More 
specifically, we amend Sec.  17.410(d)(1) by making a clarifying change 
to paragraph (d)(1)(i), adding a new paragraph (d)(1)(ii), and re-
designating existing paragraph (d)(1)(ii) as paragraph (d)(1)(iii). 
Section 17.410(d)(1)(i) addresses retroactive payment or reimbursement 
for hospital and medical services to the Camp

[[Page 21121]]

Lejeune family member of a Camp Lejeune veteran who served on active 
duty at Camp Lejeune between January 1, 1957, and December 31, 1987 
(``the 1957 cohort''). We amend Sec.  17.410(d)(1)(i) to specifically 
address retroactive reimbursement for hospital care and medical 
services provided before the date of application of a family member of 
a Camp Lejeune veteran in the 1957 cohort, and add a new paragraph 
(d)(1)(ii) to address separately retroactive reimbursement for hospital 
care and medical services provided before the date of application of a 
Camp Lejeune family member of a Camp Lejeune veteran in the 1953 
cohort. Paragraph (d)(1)(ii), addressing payment or reimbursement for 
hospital care and medical services provided on or after the date an 
application is filed, is re-designated as paragraph (d)(1)(iii) and 
remains otherwise unchanged. We make no other changes to Sec.  17.410 
based on the Consolidated Act.
    We also make a technical amendment to Sec.  17.410(d)(2), which 
required a Camp Lejeune family member's physician to certify that the 
claimed hospital care or medical services were provided for an illness 
or condition ``listed in Sec.  17.400(d)(1).'' Section 17.400 has since 
been amended to remove the list of covered illnesses and conditions 
from paragraph (d)(1) of that section and add the list as the 
definition of ``covered illness or condition'' in paragraph (b) of that 
section. 81 FR at 46603. Accordingly, we revise Sec.  17.410(d)(2) to 
reference the definition of ``covered illness or condition'' in Sec.  
17.400(b).

Miscellaneous

    One commenter stated that the comment period provided was too short 
and should be extended. The Administrative Procedures Act requires 
federal agencies to provide the public with adequate notice of a 
proposed rule followed by a meaningful opportunity to comment on the 
rule's content. 5 U.S.C. 553. The requirement to provide the public 
with adequate notice of a proposed rule is generally achieved through 
the publication of a notice of proposed rulemaking in the Federal 
Register. Once adequate notice is provided, the agency must provide 
interested persons with a meaningful opportunity to comment on the 
proposed rule through the submission of written data, views, or 
arguments. Executive Order 12866 directs that in most cases the public 
comment period on a proposed rule should be not less than 60 days. The 
same principles apply to comment periods for interim final rules. 
Comment periods may be extended where there is a showing of inadequate 
notice, the proposed rulemaking presents novel or complex issues, or a 
responsive public comment prompts the agency to consider a different 
approach to the issues addressed in the proposed rulemaking. Here, the 
rulemaking is consistent with a statutory mandate for VA to reimburse 
family members, or pay providers, for medical expenses incurred as a 
result of certain illnesses and conditions that may be attributed to 
exposure to contaminants in the drinking water at Camp Lejeune during a 
specified time period. The rulemaking does not deviate from the 
statutory parameters, and does not present any novel or complex issues. 
VA believes that it provided sufficient notice and opportunity for the 
public to comment.
    Based on the rationale set forth in the interim final rule and in 
this document, VA is adopting the provisions of the interim final rule 
as a final rule with changes as noted above.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as revised by this 
final rulemaking, represents VA's implementation of its legal authority 
on this subject. Other than future amendments to this regulation or 
governing statutes, no contrary guidance or procedures are authorized. 
All existing or subsequent VA guidance must be read to conform with 
this rulemaking if possible or, if not possible, such guidance is 
superseded by this rulemaking.

Administrative Procedure Act

    The Secretary of Veterans Affairs finds under 38 U.S.C. 553(b)(B) 
that there is good cause to publish a portion of this final rule 
without prior opportunity for public comment, and under 5 U.S.C. 
553(d)(3) that there is good cause to publish this portion of the rule 
with an immediate effective date. This rulemaking amends Sec.  17.410 
to incorporate a provision mandated by Congress. See Public Law 113-
235. Notice and public comment is unnecessary because it could not 
result in any change to this provision. Further, since the public law 
became effective on its date of enactment, VA believes it is 
impracticable and contrary to law and the public interest to delay this 
rule for the purpose of soliciting advance public comment or to have a 
delayed effective date. In addition, through this rulemaking VA adopts 
as final an interim final rule for which we provided notice and 
opportunity for the public to comment. Substantive comments received in 
the interim final rule have been addressed in this rulemaking.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before issuing any rule that may result in the expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any one year. This final rule will have no such effect on 
State, local, and tribal governments, or on the private sector.

Paperwork Reduction Act

    The Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3507) requires 
that VA consider the impact of paperwork and other information 
collection burdens imposed on the public. Under 44 U.S.C. 3507(a), an 
agency may not collect or sponsor the collection of information, nor 
may it impose an information collection requirement unless it displays 
a currently valid Office of Management and Budget (OMB) control number. 
See also 5 CFR 1320.8(b)(3)(vi).
    This final rule will impose the following amended information 
collection requirements. Section 17.410(c) of title 38, CFR, requires 
an individual applying for benefits associated with hospital care and 
medical services for Camp Lejeune family members to submit an 
application to VA. VA Form 10068, ``Camp Lejeune Family Member Program 
Application'' is used for that purpose. Section 17.410(d)(1) requires a 
Camp Lejeune family member or provider of care or services to submit a 
timely claim for payment or reimbursement. Section 17.410(d)(2) 
requires the provider of a Camp Lejeune family member to certify that a 
Camp Lejeune family member has been diagnosed with one of the 15 
required illnesses or conditions. Section 17.410 requires VA to 
maintain timely information about the Camp Lejeune family member in 
order to correctly identify the individual in VA's system, and to 
submit any information or reimbursements. OMB approved these new 
information collection requirements associated with the interim final 
rule on an emergency basis and assigned OMB control number 2900-0822. 
Pursuant to the Consolidated Act, VA amends these forms to require 
applicants to certify that they resided at Camp Lejeune between 1953 
and 1987. The information collection is pending OMB approval. Notice of 
OMB approval for this information collection will be

[[Page 21122]]

published in a future Federal Register document.

Regulatory Flexibility Act

    The Secretary hereby certifies that this final rule will 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. 601-12. 
This final rule will directly affect only individuals and will not 
affect any small entities. Therefore, pursuant to 5 U.S.C. 605(b), this 
rulemaking is exempt from the initial and final flexibility analysis 
requirements of 5 U.S.C. 603 and 604.

Executive Order 12866 and Executive Order 13563

    Executive Orders 12866 and 13563 direct agencies to assess the 
costs and benefits of available regulatory alternatives and, when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health, and safety effects, and other advantages; distributive impacts; 
and equity). Executive Order 13563 (Improving Regulation and Regulatory 
Review) emphasizes the importance of quantifying both costs and 
benefits, reducing costs, harmonizing rules, and promoting flexibility. 
Executive Order 12866 (Regulatory Planning and Review) defines a 
``significant regulatory action,'' requiring review by OMB as any 
regulatory action that is likely to result in a rule that may: (1) Have 
an annual effect on the economy of $100 million or more or adversely 
affect in a material way the economy, a sector of the economy, 
productivity, competition, jobs, the environment, public health or 
safety, or State, local, or tribal governments or communities; (2) 
create a serious inconsistency or otherwise interfere with an action 
taken or planned by another agency; (3) materially alter the budgetary 
impact of entitlements, grants, user fees, or loan programs or the 
rights and obligations of recipients thereof; or (4) raise novel legal 
or policy issues arising out of legal mandates, the President's 
priorities, or the principles set forth in this Executive Order.
    The economic, interagency, budgetary, legal, and policy 
implications of this final rule have been examined, and it has been 
determined not to be a significant regulatory action under Executive 
Order 12866. VA's impact analysis can be found as a supporting document 
at http://www.regulations.gov, usually within 48 hours after the 
rulemaking document is published. Additionally, a copy of the 
rulemaking and its impact analysis are available on VA's Web site at 
http://www.va.gov/orpm/, by following the link for ``VA Regulations 
Published From FY 2004 Through Fiscal Year to Date.''

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance numbers and titles for 
the program affected by this rule are 64.007, Blind Rehabilitation 
Centers; 64.008, Veterans Domiciliary Care; 64.009, 64.009, Veterans 
Medical Care Benefits, Veterans Medical Care Benefits; 64.010, Veterans 
Nursing Home Care; 64.012, Veterans Prescription Service; 64.013, 
Veterans Prosthetic Appliances; 64.014, Veterans State Domiciliary 
Care; 64.015, Veterans State Nursing Home Care; 64.022, Veterans Home 
Based Primary Care.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. Gina S. 
Farrisee, Deputy Chief of Staff, Department of Veterans Affairs, 
approved this document on April 24, 2017, for publication.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, 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, Reporting and recordkeeping requirements, 
Travel and transportation expenses, Veterans.

    Dated: May 2, 2017.
Janet Coleman,
Chief, Office of Regulation Policy & Management, Office of the 
Secretary, Department of Veterans Affairs.
    Accordingly, the interim rule amending 38 CFR part 17 which was 
published at 79 FR 57415 on September 24, 2014, is adopted as final 
with the following change:

PART 17--MEDICAL

0
1. The authority citation for part 17 is revised to read as follows:

    Authority: 38 U.S.C. 501, and as noted in specific sections.
    Section 17.38 also issued under 38 U.S.C. 101, 501, 1701, 1705, 
1710, 1710A, 1721, 1722, 1782, and 1786.
    Section 17.169 also issued under 38 U.S.C. 1712C.
    Sections 17.380 and 17.412 are also issued under sec. 260, 
Public Law 114-223, 130 Stat. 857.
    Section 17.410 is also issued under 38 U.S.C. 1787.
    Section 17.415 is also issued under 38 U.S.C. 7301, 7304, 7402, 
and 7403.
    Sections 17.640 and 17.647 are also issued under sec. 4, Public 
Law 114-2, 129 Stat. 30.
    Sections 17.641 through 17.646 are also issued under 38 U.S.C. 
501(a) and sec. 4, Public Law 114-2, 129 Stat. 30.


0
2. Revise Sec.  17.410 to read as follows:


Sec.  17.410  Hospital care and medical services for Camp Lejeune 
family members.

    (a) General. In accordance with this section and subject to the 
availability of funds appropriated for such purpose, VA will provide 
payment or reimbursement for certain hospital care and medical services 
furnished to Camp Lejeune family members by non-VA health care 
providers.
    (b) Definitions. For the purposes of this section:
    Camp Lejeune has the meaning set forth in Sec.  17.400(b).
    Camp Lejeune family member means an individual who:
    (i) Resided at Camp Lejeune (or was in utero while his or her 
mother either resided at Camp Lejeune or served at Camp Lejeune under 
Sec.  17.400(b)) for at least 30 (consecutive or nonconsecutive) days 
during the period beginning on August 1, 1953, and ending on December 
31, 1987; and
    (ii) Meets one of the following criteria:
    (A) Is related to a Camp Lejeune veteran by birth;
    (B) Was married to a Camp Lejeune veteran; or
    (C) Was a legal dependent of a Camp Lejeune veteran.
    Camp Lejeune veteran has the meaning set forth in Sec.  17.400(b).
    Health-plan contract has the meaning set forth in Sec.  17.1001(a).
    Third party has the meaning set forth in Sec.  17.1001(b).
    (c) Application. An individual may apply for benefits under this 
section by completing and submitting an application form.
    (d) Payment or reimbursement of certain medical care and hospital 
services. VA will provide payment or reimbursement for hospital care 
and medical services provided to a Camp Lejeune family member by a non-
VA provider if all of the following are true:
    (1) The Camp Lejeune family member or provider of care or services 
has submitted a timely claim for payment or reimbursement, which means:

[[Page 21123]]

    (i) In the case of a Camp Lejeune family member who resided at Camp 
Lejeune between January 1, 1957, and December 31, 1987, for hospital 
care and medical services received prior to the date an application for 
benefits is filed per paragraph (c) of this section, the hospital care 
and medical services must have been provided on or after March 26, 
2013, but no more than 2 years prior to the date that VA receives the 
application. The claim for payment or reimbursement must be received by 
VA no more than 60 days after VA approves the application;
    (ii) In the case of a Camp Lejeune family member who resided at 
Camp Lejeune between August 1, 1953, and December 31, 1956, for 
hospital care and medical services received prior to the date an 
application for benefits is filed per paragraph (c) of this section, 
the hospital care and medical services must have been provided on or 
after December 16, 2014, but no more than 2 years prior to the date 
that VA receives the application. The claim for payment or 
reimbursement must be received by VA no more than 60 days after VA 
approves the application;
    (iii) For hospital care and medical services provided on or after 
the date an application for benefits is filed per paragraph (c) of this 
section, the claim for payment or reimbursement must be received by VA 
no more than 2 years after the later of either the date of discharge 
from a hospital or the date that medical services were rendered;
    (2) The Camp Lejeune family member's treating physician certifies 
that the claimed hospital care or medical services were provided for a 
covered illness or condition as defined in Sec.  17.400(b), and 
provides information about any co-morbidities, risk factors, or other 
exposures that may have contributed to the illness or condition;
    (3) VA makes the clinical finding, under VA clinical practice 
guidelines, that the illness or condition did not result from a cause 
other than the residence of the family member at Camp Lejeune;
    (4) VA would be authorized to provide the claimed hospital care or 
medical services to a veteran under VA's medical benefits package in 
Sec.  17.38;
    (5) The Camp Lejeune family member or hospital care or medical 
service provider has exhausted without success all claims and remedies 
reasonably available to the family member or provider against a third 
party, including health-plan contracts; and
    (6) Funds were appropriated to implement 38 U.S.C. 1787 in a 
sufficient amount to permit payment or reimbursement.
    (e) Payment or reimbursement amounts. Payments or reimbursements 
under this section will be in amounts determined in accordance with 
this paragraph (e).
    (1) If a third party is partially liable for the claimed hospital 
care or medical services, then VA will pay or reimburse the lesser of 
the amount for which the Camp Lejeune family member remains personally 
liable or the amount for which VA would pay for such care under 
Sec. Sec.  17.55 and 17.56.
    (2) If VA is the sole payer for hospital care and medical services, 
then VA will pay or reimburse in accordance with Sec. Sec.  17.55 and 
17.56, as applicable.
    (The information collection requirements have been submitted to OMB 
and are pending OMB approval.)
[FR Doc. 2017-09163 Filed 5-4-17; 8:45 am]
 BILLING CODE 8320-01-P