Adaptive Equipment Allowance

Published date12 March 2020
Citation85 FR 14429
Record Number2020-04564
SectionProposed rules
CourtVeterans Affairs Department
Federal Register, Volume 85 Issue 49 (Thursday, March 12, 2020)
[Federal Register Volume 85, Number 49 (Thursday, March 12, 2020)]
                [Proposed Rules]
                [Pages 14429-14442]
                From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
                [FR Doc No: 2020-04564]
                =======================================================================
                -----------------------------------------------------------------------
                DEPARTMENT OF VETERANS AFFAIRS
                38 CFR Part 17
                RIN 2900-AP39
                Adaptive Equipment Allowance
                AGENCY: Department of Veterans Affairs.
                ACTION: Proposed rule.
                -----------------------------------------------------------------------
                SUMMARY: This document proposes to amend the Department of Veterans
                Affairs (VA) regulations governing the provision of a monetary
                allowance to certain veterans and eligible members of the Armed Forces
                who require adaptive equipment to operate an automobile or other
                conveyance. This proposed rule would establish in regulation a VA
                Adaptive Equipment Schedule for Automobiles and Other Conveyances to
                calculate the amount of the monetary allowance for adaptive equipment
                (AE) based on industry standards and our experience administering this
                program. This rulemaking addresses reimbursement to eligible persons
                who have paid for AE and payments made by VA directly to registered AE
                providers, but not the eligibility requirements to receive adaptive
                equipment.
                DATES: Comments must be received by VA on or before May 11, 2020.
                ADDRESSES: Written comments may be submitted through http://www.Regulations.gov; by mail or hand-delivery to: Director, Office of
                Regulation Policy and Management (00REG), Department of Veterans
                Affairs, 810 Vermont Avenue NW, Room 1064, Washington, DC 20420; or by
                fax to (202) 273-9026. (This is not a toll-free telephone number.)
                Comments should indicate that they are submitted in response to ``RIN
                2900-AP39, Adaptive Equipment Allowance.'' Copies of comments received
                will be available for public inspection in the Office of Regulation
                Policy and Management, Room 1064, between the hours of 8 a.m. and 4:30
                p.m., Monday through Friday (except holidays). Please
                [[Page 14430]]
                call (202) 461-4902 for an appointment. (This is not a toll-free
                telephone number.) In addition, during the comment period, comments may
                be viewed online through the Federal Docket Management System (FDMS) at
                http://www.Regulations.gov.
                FOR FURTHER INFORMATION CONTACT: Penny Nechanicky, National Program
                Director, Prosthetics Sensory Aids Service (10P4R), Department of
                Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420. (202)
                461-0337 (This is not a toll-free number).
                SUPPLEMENTARY INFORMATION: Section 3902(b) of Title 38, United States
                Code (U.S.C.) requires VA to provide eligible persons with ``the
                adaptive equipment deemed necessary to insure that the eligible person
                will be able to operate [an] automobile or other conveyance in a manner
                consistent with such person's own safety and the safety of others and
                so as to satisfy the applicable standards of licensure established by
                the State of such person's residency or other proper licensing
                authority.'' Under 38 U.S.C. 3901, eligible persons include veterans
                and members of the Armed Forces who have been diagnosed with one or
                more specified disabilities. Under section 3901(2), adaptive equipment
                is defined to include, but is not limited to, power steering, power
                brakes, power window lifts, power seats, air conditioning, and other
                equipment necessary to help the eligible individual enter, exit, or
                operate the automobile or other conveyance.
                 VA implements these statutory authorities through regulation at
                Title 38 Code of Federal Regulations (CFR) sections 17.155-17.159.
                Because VA does not have the capacity to build or install AE for
                automobiles or other conveyances, VA instead reimburses eligible
                persons or pays registered providers for the cost of the AE. See 38 CFR
                17.156. This rulemaking addresses reimbursement to eligible persons who
                have paid for the AE. Additionally, we address payments made to
                registered providers. VA does not address the eligibility requirements
                to receive AE in this rulemaking. AE is individually prescribed to
                assist the eligible person to operate, or ride safely as a passenger,
                in an automobile or other conveyance. In order to claim AE benefits, an
                eligible person must complete VA Form 10-1394 after they purchase new
                (which includes equipment that has been installed or used for one year
                or less from the date of manufacture) or used AE, and must complete the
                form if requesting payment or reimbursement for repair to AE. On the
                form, the eligible person indicates they are seeking reimbursement for
                AE or that payment should be made directly to a registered provider
                that pre-installed, modified, or altered the AE.
                Sec. 17.156 Eligibility for Automobile Adaptive Equipment
                 This section addresses eligibility for automobile adaptive
                equipment as well as payment or reimbursement by VA for repair,
                replacement, or reinstallation of such equipment. Consistent with 38
                U.S.C. 3902(b), the introductory text for this section states that VA
                may provide automobile adaptive equipment ``if the Under Secretary for
                Health or designee determines that such equipment is deemed necessary
                to insure that the eligible person will be able to operate the
                automobile or other conveyance in a manner consistent with such
                person's safety and so as to satisfy the applicable standards of
                licensure established by the State of such person's residency or other
                proper licensing authority.'' VA believes that this introductory text
                does not reflect a definite link between this section and limiting
                parameters to this benefit found in the two sections that immediately
                follow. We propose adding at the end of this sentence ``subject to the
                definitions and limitations in sections 17.157 and 17.158'' to address
                the issue.
                 Current paragraph (b) provides that payment or reimbursement of
                reasonable costs for the repair, replacement, or reinstallation of
                adaptive equipment deemed necessary for the operation of the automobile
                may be authorized by VA. Consistent with the proposed change to this
                section's introductory text, we propose revising this paragraph to
                state that VA will reimburse or pay for adaptive equipment for
                automobiles and other conveyances subject to the requirements of 38 CFR
                17.158(b).
                Sec. 17.157 Definitions
                 Current Sec. 17.157 is titled ``Definition--adaptive equipment,''
                and the regulatory text defines that term. We would expand this section
                to define other terms relevant to VA's provision of automobile adaptive
                equipment and amend the title to read ``Definitions'' consistent with
                this proposed change. In addition, we would make minor revisions to the
                definition of ``adaptive equipment'' for purposes of readability and
                clarity. In the first sentence of that definition, we would change
                ``claimant'' to ``eligible person'' to harmonize the definition with
                other proposed changes to the rule. Adaptive equipment is currently
                defined to include ``any term specified by the Under Secretary for
                Health or designee.'' Adaptive equipment is generally understood to
                refer to tangible pieces of equipment rather than words or terms.
                Accordingly, we would amend the definition to refer to any item.
                 In addition, we propose to define the types of registered providers
                VA deems eligible to receive payments from this program along with
                other definitions appropriate to AE. The Department of Transportation's
                National Highway Traffic Safety Administration (NHTSA) is the U.S.
                government agency responsible for developing and enforcing automobile
                safety standards under U.S.C. Title 49 and its implementing
                regulations. Since NHTSA develops and enforces automobile safety
                standards, VA thinks it prudent to utilize their already existing
                definitions. VA defers to NHTSA's expertise in developing and enforcing
                safety standards as established in regulations and acknowledges it as a
                resource for identifying registered providers to accommodate all
                persons with disabilities. Additionally, VA proposes to rely on NHTSA
                expertise in order to ensure that installations and equipment meet
                appropriate quality standards. More information is located on NHTSA's
                website and brochures at: http://www.nhtsa.gov/Driving+Safety/Disabled+Drivers.
                 The first term VA would define is manufacturer. For the purposes of
                this program, VA would adopt and use the statutory definition of
                manufacturer as used in the National Traffic and Motor Vehicle Safety
                Act (``The Safety Act''). See 49 U.S.C. 30102(a)(6). The Safety Act is
                an appropriate reference source in our proposed rule because the Act
                and NHTSA's regulations require vehicle manufacturers to certify that
                their vehicles comply with all applicable Federal Motor Vehicle Safety
                Standards (FMVSSs) at the time of manufacture. See 49 U.S.C. 30112; 49
                CFR part 567. The Safety Act defines manufacturer as a person
                manufacturing or assembling motor vehicles or motor vehicle equipment
                or importing motor vehicles or motor vehicle equipment for resale. VA
                would not restate the definition of manufacturer in the regulation text
                in the event the Title 49 definition changes in the future.
                 VA would also define the term modifier. VA would define modifier to
                mean ``a motor vehicle repair business that modifies a motor vehicle to
                enable a person with a disability to operate, or ride as a passenger
                in, the motor vehicle.'' This language is based on the NHTSA rule that
                requires any motor vehicle repair business that modifies a motor
                vehicle to enable a person with a disability to operate, or ride as a
                passenger in, the motor vehicle and
                [[Page 14431]]
                intends to avail itself of the regulatory exemption related to making
                motor vehicle safety devices inoperative to furnish certain information
                to NHTSA. NHTSA administers a program of registering modifiers of AE
                pursuant to 49 CFR 595.6 as part of its authority to regulate and
                enforce rules on vehicle safety. Participating modifiers can be found
                at: http://www.nhtsa.gov/apps/modifier/index.htm. The definition would
                also provide that ``VA does not approve, endorse, or assess the
                abilities of any modifiers to perform any requested or represented
                modification services.'' Because modification issues are beyond the
                scope of our expertise, VA would not approve, endorse, or assess the
                abilities of any of the listed modifiers to perform any requested or
                represented modification services.
                 VA would define altered vehicle by cross-referencing NHTSA
                regulations in 49 CFR 567.3. Section 567.3 defines altered vehicle as a
                completed vehicle previously certified in accordance with 49 CFR 567.4
                or 567.5 that has been altered other than by the addition,
                substitution, or removal of readily attachable components, such as
                mirrors or tire and rim assemblies, or by minor finishing operations
                such as painting, before the first purchase of the vehicle other than
                for resale, in such a manner as may affect the conformity of the
                vehicle with one or more Federal Motor Vehicle Safety Standard(s) or
                the validity of the vehicle's stated weight ratings or vehicle type
                classification. VA would not restate the definition of altered vehicle
                in the regulation text in the event it changes in the future.
                 VA would define alterer by cross-referencing NHTSA regulations in
                49 CFR 567.3. Section 567.3 defines alterer as a person who alters by
                addition, substitution, or removal of components (other than readily
                attachable components) a certified vehicle before the first purchase of
                the vehicle other than for resale. VA would not restate the definition
                of alterer in the regulation text in the event it changes in the
                future.
                 VA would define registered provider and unregistered provider. In
                the proposed definition section, VA would classify all manufacturers,
                modifiers, and alterers registered on the NHTSA Modifiers
                Identification Database, currently available at http://www.nhtsa.gov/apps/modifier/index.htm, as registered providers. VA would classify any
                individual or entity not registered with NHTSA as an unregistered
                provider.
                 As discussed below, VA would provide reimbursement for roadside
                services. The terms roadside assistance or roadside services are
                commonly used by automobile clubs, automobile dealers, and automobile
                insurers to refer to a variety of emergency roadside services provided
                to covered drivers including towing a vehicle, mechanical labor at the
                breakdown site, changing a flat tire, battery service, providing
                essential fuels and fluids such as gasoline necessary to operate the
                vehicle, or providing a locksmith if the driver is locked out of the
                vehicle. These services focus on vehicle operability, not issues
                related to problems with adaptive equipment that may arise at the home
                of an eligible person or when an eligible person is on the road. VA
                proposes to define roadside service for purposes of this rulemaking to
                mean emergency roadside services provided to an eligible person
                performed in connection with the repair, reinstallation, or replacement
                of adaptive equipment already installed in the automobile or other
                conveyance. The term would be limited solely to services provided to
                make the adaptive equipment operational and does not include mechanical
                repair of the engine or other vehicle systems, towing, providing
                essential fuels and fluids such as gasoline necessary to operate the
                vehicle, or providing locksmith services. We note that some adaptive
                equipment requires electrical power provided by the vehicle battery.
                Providing battery service in those instances would be included in
                services provided to make the adaptive equipment operational.
                 Finally, VA would define the term VA Adaptive Equipment Schedule
                for Automobiles and Other Conveyances (the Schedule) to mean the VA
                schedule that contains the maximum allowable reimbursement amounts for
                the listed adaptive equipment. The Schedule would also include the
                maximum hourly labor rates for installation, repair, reinstallation,
                and replacement of this equipment and allowable fees that VA will pay.
                The amounts listed on the Schedule are based on the National Mobility
                Equipment Dealers Association's (NMEDA) Average Price Survey for 2018
                and represent the historical input of members of the mobility equipment
                industry across the United States. The Schedule is discussed in greater
                detail below. VA believes that the Schedule is needed to bring
                consistency across not only similar jurisdictions but also national
                consistency for the same products and services.
                Sec. 17.158 Limitations on Assistance
                 This rulemaking would revise 38 CFR 17.158, which addresses
                limitations on when VA will pay or reimburse for AE. Current paragraph
                (a) places a limit on the number of automobiles or other conveyances
                for which VA will pay or reimburse AE. An eligible person is not
                entitled to AE for more than two automobiles or other conveyances at
                any one time or during any four-year period except when, due to
                circumstances beyond control of such person, one of the automobiles or
                conveyances for which adaptive equipment was provided during the
                applicable four-year period is no longer available for the use of such
                person. Paragraph (a) would remain unchanged except for the insertion
                of a paragraph header, a minor wording change, and insertion of a comma
                for purposes of clarity.
                 Current paragraph (a)(1) addresses when VA considers circumstances
                to be beyond the control of the eligible person. This subparagraph
                would remain unchanged with the exception of clarifying punctuation
                changes and removing the term ``vehicle'' and inserting in its places
                the phrase ``automobile or other conveyance'' to ensure terminology is
                consistent with that used in the statute. Current paragraph (a)(2)
                addresses those instances in which VA considers the eligible person to
                still retain beneficial use of an automobile or other conveyance even
                though that mode of transportation has been sold, given or transferred
                to another person or entity. This subparagraph would remain unchanged
                except for removing the term ``vehicle'' and inserting in its places
                the phrase ``automobile or other conveyance'' and removing the term
                ``such person'' at the end of the subparagraph and inserting in its
                place ``spouse, family member or other person residing in the same
                household as the eligible person'' for purposes of clarity. VA believes
                the proposed changes to paragraph (a) are nonsubstantive in nature.
                 In proposed paragraph (b)(1) we would address the issue of balance
                billing for any amounts for adaptive equipment not paid by VA. To
                ensure that neither the veteran nor their insurer is billed by the
                provider when VA is responsible for payment, we would state that
                payments made for adaptive equipment that is authorized under this
                section shall constitute payment in full and shall extinguish the
                eligible person's liability to the registered provider. The registered
                provider may not impose any additional charge on the eligible person
                for any adaptive equipment that is authorized under this section and
                for which payment is made by VA. VA has a mandate under 38 U.S.C.
                3902(b)(1) to provide each eligible person the adaptive equipment
                deemed necessary to insure that the
                [[Page 14432]]
                eligible person will be able to operate the automobile or other
                conveyance in a manner consistent with such person's own safety and the
                safety of others. By accepting payment for adaptive equipment, the
                provider agrees that monies received from VA operate as payment in full
                for the adaptive equipment.
                 Current paragraph (b) states that the amount VA may reimburse
                eligible persons for AE is subject to a dollar amount for specific
                items established from time to time by the Under Secretary for Health.
                Current VA practice is to update the allowable reimbursable amounts for
                certain equipment on a biennial basis to reflect changes in retail
                prices using standard industry pricing. The current rule does not
                address reimbursement for AE services provided by registered versus
                unregistered providers. While current paragraph (b) addresses only
                reimbursement of adaptive equipment to eligible persons, it has been
                longstanding VA practice to also allow payment to registered providers
                as discussed below. VA proposes to amend paragraph (b) to address these
                issues and to establish a standard, publicly available schedule of
                allowable payments or reimbursable amounts for the calculation and
                provision of AE payments or reimbursements authorized by 38 U.S.C.
                3902.
                 We propose to amend paragraph (b) to state that VA will reimburse
                or pay for adaptive equipment that VA determines is needed based on the
                information submitted and the Schedule. In addition to payment or
                reimbursement rates for specific types of AE listed in the Schedule, VA
                would pay or reimburse for roadside service, waste disposal fees, and
                hourly labor rates listed in the Schedule, subject to this section.
                Schedule labor rates would be classified as ``In Shop (low
                technology)'' or ``High Technology'' based on what NMEDA considers low
                and high technology as explained in the discussion about the proposed
                Schedule. High Technology would mean labor performed on or modification
                of adaptive equipment devices or systems that are capable of
                controlling vehicle functions or driving controls, and operate with a
                designed logic system, or interface or integrate with an electronic
                system of the vehicle. In Shop (low technology) would mean labor
                performed on adaptive equipment or modifications that do not meet the
                definition of High Technology.
                 Payment or reimbursement rates would be based on the Schedule in
                effect on the date installation, reinstallation, replacement, or repair
                is complete. As discussed below, VA would pay or reimburse the lesser
                of the Schedule rate, invoice, or estimate. To determine the
                reimbursement or payment rate VA would use the appropriate amount in
                the Schedule for comparison. VA believes that it is appropriate to use
                the Schedule in effect on the date installation, reinstallation,
                replacement, or repair is complete as the comparator since the right to
                reimbursement or payment matures on that date. These proposed changes
                would specify the parameters for reimbursement or payment for AE.
                 Proposed paragraph (b)(2) would identify the persons who are
                eligible to receive AE payments or reimbursements and address the type
                of documentation that must be submitted for payment or reimbursement.
                We would establish different documentation requirements for
                reimbursement to eligible persons based on whether services are
                provided by a registered or unregistered provider. As discussed above,
                we would define registered provider in Sec. 17.157 to mean a
                manufacturer, modifier, or alterer registered with the NHTSA Modifiers
                Identification Database. The purpose of this database is to provide a
                running and cumulative listing of all businesses that have sought
                identification as a vehicle modifier under the requirements of 49 CFR
                part 595. NHTSA does not approve or endorse any of the modifiers who
                have furnished information under part 595. Any manufacturer, modifier,
                or alterer who is not registered is considered an unregistered
                provider.
                 VA would use the Schedule for calculating the amount reimbursed to
                eligible persons or payments made to registered providers. VA would
                review for approval all required documentation (e.g., estimates,
                invoices, bill of sale, paid receipts, Form 10-1394). VA is providing
                the Schedule for notice and comment in connection with this rulemaking
                at www.prosthetics.va.gov. The proposed Schedule includes the amounts
                for all equipment costs (e.g., installations, repairs, reinstallations,
                replacements) and hourly labor rates. Paragraph (b)(2)(i) through (ii)
                would authorize reimbursements to persons eligible to receive the AE
                benefit based on the existing eligibility regulations at 38 CFR
                17.156(a). In proposed paragraph (b)(2)(i), eligible persons who have
                purchased AE from registered providers would receive reimbursement in
                accordance with (b)(2)(i) after they have paid for the AE. The eligible
                person must complete and submit to VA for approval a VA Form 10-1394,
                an itemized estimate, and provide VA with either a final itemized: (1)
                Invoice, (2) paid receipt, or (3) bill of sale for the purchase.
                 VA recognizes that not all adaptive equipment would require a
                registered provider. Paragraph (b)(2)(ii), would authorize VA's
                reimbursement of eligible persons who purchased AE from unregistered
                providers. VA would require the eligible person to provide written
                proof (e.g., final itemized invoice, paid receipt, bill of sale) of
                their pre-installed or repaired AE in an effort to track costs and
                prevent waste. Additionally, the eligible person must complete and
                submit to VA for approval a VA Form 10-1394. Only after the eligible
                person provides written proof, may VA reimburse the eligible person for
                the incurred expenses performed by an unregistered provider. This is
                consistent with current VA practice, and VA believes it reduces
                transactional costs for eligible persons and unregistered providers
                along with expediting the administrative aspects of the AE allowance.
                 In paragraph (b)(2)(iii), VA would address payments to registered
                providers. Section 3902(b) of Title 38 of the United States Code and
                current 38 CFR 17.158(b) do not specify whether VA may make payments to
                the entity installing or otherwise modifying the automobile or other
                conveyance. However, this has been VA practice because it reduces
                transactional costs for eligible persons and registered providers. It
                is current VA practice that either the eligible person or registered
                provider may submit requests for direct payment to a registered
                provider. Procedurally, proposed paragraph (b)(2)(iii) would function
                identically to proposed paragraph (b)(2)(i). VA would pay registered
                providers for AE (e.g., installations, repairs, reinstallations,
                replacements, hourly labor rates) furnished to eligible persons
                identified in 38 CFR 17.156(a). The eligible person or the registered
                provider would complete VA Form 10-1394 and submit an itemized estimate
                prior to the completion of work. Note that the eligible person must
                sign the form as the applicant. Additionally, the eligible person or
                registered provider would provide VA with a final itemized invoice
                after the work is completed. The NHTSA Modifiers Identification
                Database is currently available at http://www.nhtsa.gov/apps/modifier/index.htm. This website would assist VA or eligible persons to locate
                and identify registered providers.
                 Proposed paragraph (b)(2)(iv) would address those instances where
                an eligible person files an application for reimbursement or payment
                for installation, repair or replacement of adaptive equipment performed
                outside of the United States where an invoice,
                [[Page 14433]]
                estimate, or bill of sale is calculated in a foreign currency. We would
                state that in this case, the application must include the conversion
                rate from the foreign currency to U.S. dollars, and calculation of the
                invoice, estimate, or bill of sale amount in U.S. dollars.
                 Proposed paragraph (b)(3) would establish how VA would use the
                Schedule for calculating the amount reimbursed to eligible persons or
                payments made to registered providers for labor costs. VA proposes
                creating a Schedule that would set national payment/reimbursement rates
                utilizing the high cost itemized in NMEDA's Average Price Survey, which
                is published annually. The 2018 survey was mailed to 324 dealers, and
                125 responded. The NMEDA Average Price Survey groups similar types of
                adaptive equipment installations or conversion into separate
                categories; provides average, low, and high reported costs for
                provision of adaptive equipment in different U.S. geographical regions;
                and provide a U.S. Summary reflecting average costs in the U.S. for
                each specific type of adaptive equipment installations or conversion.
                The example Schedule, as would the published VA Schedule, reflects high
                costs from the U.S. Summary tables in the NMEDA Average Price Survey.
                VA's proposed Schedule would resemble NMEDA's Average Price Survey for
                2018, which represents the historical input of members of the mobility
                equipment industry across the United States providing fair and
                representative prices for our program. We note that there may be some
                regional variation in costing, but VA believes that establishing a
                Schedule which would be applicable on a national level is the most
                equitable option. The example Schedule below differs from the NMEDA
                Average Price Survey in one important aspect, as would the Schedule VA
                would publish in conjunction with a final rulemaking. The NMEDA Average
                Price Survey distinguishes between domestic and foreign vehicles
                adaptive equipment costs for Lower Floor Conversions. NMEDA states that
                ``domestic'' refers to domestic vehicles built in the U.S. by an
                American manufacturer, and ``foreign'' refers to vehicles manufactured
                either inside or outside the U.S. by a foreign based company. However,
                VA believes that distinguishing between adaptive equipment costs based
                on this definition is confusing in that many automobile manufacturers
                that have been historically viewed as foreign now build or assemble
                vehicles in the U.S, and American automobile manufacturers now assemble
                vehicles outside the U.S. To avoid confusion, VA would not distinguish
                between costs related to installation of adaptive equipment performed
                on domestic or foreign vehicles, and we would list the higher cost for
                the various types of vehicle configurations (e.g., manual or powered
                side entry, manual or powered rear entry).
                 VA will make the Schedule publicly available for usage by eligible
                persons requesting reimbursements and registered providers requesting
                payments. VA welcomes the public to submit comments on this Schedule
                which we set forth below. The Schedule below would be what the Schedule
                would look like if this proposed rule were effective today. We will
                publish the final Schedule in the notice section of the Federal
                Register in conjunction with the publication of the final rule. The
                Schedule would be available [website address to be inserted in final
                rule] after September 30 of each calendar year to include any cost of
                living adjustments. This would coincide with the Veterans Benefits
                Administration's (VBA) annual budget period, which begins on October 1.
                Additionally, the October 1 date would be after the Consumer Price
                Indices (CPI) are updated on June 30 of each calendar year to allow for
                consideration of the increases in the reimbursement amounts in the
                Schedule.
                Example--VA Adaptive Equipment Schedule for Automobiles and Other
                Conveyances
                 Notes: 1. NMEDA includes pick up trucks under the mini van
                conversion schedule.
                 2. Consistent with NMEDA classifications, Full size Van conversions
                are reflected under the Raised Top schedule while Mini Van conversions
                are under Lowered Floor Conversions.
                ------------------------------------------------------------------------
                
                ------------------------------------------------------------------------
                Lowered Floor Conversions (Mini Vans and Pick Up Trucks):
                 Manual Side Entry Fold Out............................... $28,995
                 Manual Side Entry In-Floor............................... 28,995
                 Powered Side Entry Fold Out.............................. 30,975
                 Powered Side Entry In Floor.............................. 30,675
                 Manual Rear Entry........................................ 26,995
                 Powered Rear Entry....................................... 28,995
                 Transit Connect Rear Entry............................... 21,000
                 Structurally Modified Pick Up Truck...................... 31,500
                 Power Topper Pick Up Truck............................... 18,995
                Raised Top Conversions (Full size Vans):
                 Reinforced Cage (Roll Cage).............................. 8,500
                 Raised Door.............................................. 6,300
                 Raised Door with Existing High Top....................... 7,500
                Vehicle Lifts (Wheelchair, Scooter, Powerchair, Etc.):
                 Dual Post Platform....................................... 8,900
                 Dual Post Split Platform................................. 9,500
                 Under Vehicle Lift....................................... 15,995
                 Suspension and Drive Shaft Modifications................. 7,800
                Wheelchair Tie Downs:
                 Manual................................................... 4,275
                 Retractable.............................................. 3,750
                 Electric with Bracket.................................... 3,900
                Scooter Lifts/Carriers:
                 Pickup Truck Lift: 200 lb................................ 3,800
                 Outside Hitch Lift: 250 lbs.............................. 4,225
                 Inside Hoist Lift: Automatic 250 lbs..................... 750
                 Inside Hoist Lift: Semiautomatic 250 lbs................. 950
                 Capacity Platform Style Lift: 350 lbs. or less........... 2,850
                Hand Controls:
                 Mechanical............................................... 1,650
                [[Page 14434]]
                
                 Pneumatic................................................ 18,000
                 Electronic/Digital Gas and Brake......................... 32,000
                 Electronic Digital Steering.............................. 42,000
                 Joystick Gas & Brake..................................... 80,000
                 Power Gear Selector...................................... 4,700
                 Spinner Knob............................................. 173
                 Tri-Pin Spinner Knob..................................... 375
                Switches for Lifts and Openers:
                 Dash Switches............................................ 1,499
                 Remote Control Entry..................................... 2,400
                 Hand Held Pendant........................................ 500
                 Outside Magnetic Switches................................ 995
                Entry System:
                 Power Door Swing......................................... 7,127
                 Magnetic Switches........................................ 995
                 Remote Control........................................... 2,400
                Sensitized Steering:
                 Reduced/Low Effort (Rack & Pinion)....................... 5,500
                 Zero Effort (Rack and Pinion)............................ 5,500
                 Emergency Backup System (Rack & Pinion).................. 4,200
                 Reduce/Low Effort (Electric)............................. 9,800
                 Zero Effort (Electric)................................... 9,800
                 Back Up (Electric Steering).............................. 4,400
                Sensitized Braking and Parking Brake:
                 Reduced/Low Effort....................................... 2,900
                 Zero Effort.............................................. 2,950
                 Emergency Backup System.................................. 3,250
                 Manual Parking........................................... 295
                 Electric Parking......................................... 3,600
                Driving Aids:
                 Adapted Key Holder....................................... 350
                 Pedal Extenders 6-12''................................... 1,500
                 Pedal Extenders 2'' each................................. 649
                 Cross Over Gear.......................................... 389
                 Turn Signal Extensions................................... 389
                 Left Foot Accelerator with Pedal Block................... 1,850
                Non-Driving Aids:
                 Automatic Transmission................................... 1,363
                 Air Conditioning......................................... 920
                 Rubber Flooring.......................................... 800
                Seating:
                 Turing Seat: Auto........................................ 10,800
                 Power Seat Base: 6 way................................... 4,500
                 Removable Driver Seat Base............................... 2,300
                 Leather Seating.......................................... 1,110
                 Power Seats.............................................. 708
                Labor Rates:
                 In Shop (low technology) Labor (Per Hour)................ 130
                 High-Technology Labor (Per Hour)......................... 175
                 Roadside Service (per incident).......................... 200
                Fees:
                 Waste Disposal Fee (flat fee per incident)............... 75
                ------------------------------------------------------------------------
                 The Schedule reflects two hourly labor rates, In Shop (low
                technology) and High Technology labor. We would distinguish between
                what would fall under High Technology and In Shop (low technology)
                based on what NMEDA considers high technology and low technology, with
                the In Shop labor rate correlating to labor on a low technology device
                or system. The NMEDA QAP-103 Guideline 2018 edition states that High
                Technology devices or systems are those that meet the following
                conditions: Devices capable of controlling vehicle functions or driving
                controls, and operate with a designed logic system, or interface or
                integrate with an electronic system of the vehicle. Examples include
                powered gas/brake systems; power park brake integrated with a powered
                gas/brake system; reduced effort steering systems; horizontal steering
                system; reduced effort brake systems; backups for primary controls.
                Other examples of High Technology listed by NMEDA are remote panel or
                switch array interfacing with OEM electronics; wiring extension for OEM
                electronics; and powered transmission shifter.
                 NMEDA Guidelines state that Low Technology includes all other
                devices or modifications that do not meet the definition of High
                Technology devices or modifications. Examples include a manual gas/
                brake hand control; left foot accelerator pedal; park brake lever or
                stand-alone powered park brake; steering terminal device; remote horn
                button (grounding system); turn signal crossover lever; switch
                extension on OEM controls; transmission shifter lever; and transfer
                seat base.
                 In proposed paragraph (b)(3)(i), for any labor costs associated
                with the installation of AE by a registered provider, VA will reimburse
                or pay the lesser of the relevant Schedule hourly labor rate multiplied
                by the number of hours listed by the registered provider; labor costs
                included in the itemized estimate; or the hourly labor rate provided by
                the registered provider in the final itemized invoice multiplied by the
                number of hours listed by the registered provider. Under current VA
                practice, the eligible veteran or
                [[Page 14435]]
                registered provider submits an itemized estimate as part of the claims
                process or a final invoice. However, VA has not previously specified in
                a rulemaking that we would pay the lesser of the written, itemized
                estimated labor rate or the labor rate listed in the Schedule.
                 In proposed paragraph (b)(3)(ii), VA will specify that it will not
                reimburse or pay labor costs for pre-installed (i.e., original
                equipment manufacturer) equipment.
                 Finally, proposed (b)(3)(iii) would state that VA would not
                reimburse or pay labor costs to unregistered providers. Since VA's
                definition of registered provider serves as an umbrella for
                manufacturers, modifiers, and alterers covered by either the Safety Act
                or NHTSA regulations, there are requisite standards each group must
                adhere to prior to registration. As stated above, manufacturers certify
                that their vehicles comply with all applicable FMVSSs at the time of
                manufacture. See 49 U.S.C. 30112; 49 CFR part 567. NHTSA administers a
                program of registering modifiers of AE pursuant to 49 CFR 595.6 as part
                of its authority to regulate and enforce rules on vehicle safety.
                Moreover, under 49 CFR 567.3, alterer is defined as a person who alters
                by addition, substitution, or removal of components (other than readily
                attachable components) a certified vehicle before the first purchase of
                the vehicle other than for resale. Manufacturers, modifiers, and
                alterers are formally established business entities. VA believes each
                registered entity, operating consistent with NHTSA guidelines,
                possesses well defined cost schemes and uniform labor pricing.
                Conversely, almost anyone can serve as an unregistered provider, and
                unregistered providers may not possess the necessary training or access
                to information that would tend to normalize or standardize expended
                labor time. To ensure some control over programmatic costs, VA would
                not reimburse or pay labor costs of unregistered providers.
                 Proposed paragraph (b)(4) would state that VA will reimburse an
                eligible person who meets the requirements of (b)(2)(i) or (ii), or pay
                a registered provider who meets the requirements of (b)(2)(iii) for new
                adaptive equipment (including equipment that has been installed or used
                for one year or less from the date of manufacturer) listed in the
                Schedule as follows: VA will pay the lesser of the amount for the new
                adaptive equipment listed in either a final itemized invoice, paid
                receipt, or bill of sale for the purchase, or the amount established in
                the Schedule; VA will reimburse or pay any labor costs consistent with
                paragraph (b)(3) of Sec. 17.158. Generally, the timeline for
                determining whether adaptive equipment is new commences with the date
                of manufacture, and VA would consider adaptive equipment to be new if
                installed within one year of manufacture, as it would still be covered
                under the manufacturer's warranty. We would use a ``lesser of'' formula
                similar to that used for reimbursement or payment of labor costs.
                 Proposed paragraph (b)(5) would apply to reimbursement or payment
                for used adaptive equipment. VA does not believe it is appropriate to
                reimburse or pay for the cost of used equipment older than five (5)
                years. As the functional lifespan of AE is generally not more than five
                (5) years, this is consistent with current practice. However, we have
                never formally stated this policy in regulation. According to NHTSA,
                all registered providers must keep in original or photocopied form
                documentation that a vehicle has been modified in accordance with 49
                CFR 595.6 no less than five (5) years after the vehicle has been
                modified or after being delivered to an individual. See 49 CFR
                595.7(b), (d) through (e).
                 Proposed paragraph (b)(5)(i) would establish that for used
                equipment listed in the Schedule that is more than one (1) year old
                from the date of manufacture, VA would depreciate it by twenty (20%)
                percent per year from the time the equipment was pre-installed or
                installed as new on an automobile or other conveyance to the time of
                its reinstallation for which reimbursement or payment is being sought
                for a period up to five (5) years. VA would reimburse an eligible
                person, who meets the requirements of (b)(2)(i) or (ii), or pay a
                registered provider who meets the requirements of (b)(2)(iii) the
                lesser of the amount of the adaptive equipment listed in the final
                itemized invoice, paid receipt, or bill of sale for the purchase or the
                amount established in the Schedule reduced by twenty (20%) percent for
                each year from the time the equipment was pre-installed or installed on
                the vehicle for a period up to five (5) years. VA would reimburse or
                pay any labor costs consistent with paragraph (b)(3) of this section,
                but will not reimburse or pay labor costs for used equipment that is
                more than five years old from the date of manufacture because we do not
                recommend using such equipment (see discussion above regarding the
                functional lifespan of adaptive equipment).
                 The proposed rule contemplates an annual 20% depreciation in
                reimbursement or payment for used adaptive equipment, with no
                reimbursement or payment for any used equipment more than five years
                old. In contrast, VA Manual MP4, Part IV, Chapter 18, section 18A.03
                paragraph l provides that the maximum equipment reimbursable rate for
                prescribed adaptive equipment on a used vehicle will be reduced by 10
                percent for each year of vehicle age up to a maximum reduction of 90
                percent. Installation of new prescribed equipment on a used vehicle
                will not be prorated. In practice VA Manual MP4, which is utilized by
                VBA, bases the reimbursement rate for prescribed adaptive equipment on
                a used vehicle on the age of the vehicle regardless of the age of the
                adaptive equipment. Annual depreciation for reimbursement or payment
                for used adaptive equipment reflected in the proposed rule, in
                contrast, would be based on VA's determination that the adaptive
                equipment depreciates at a faster rate than the vehicle itself and the
                functional lifespan of that equipment is five years. Because of the
                finite functional lifespan of adaptive equipment, VA does not recommend
                use of any specific adaptive equipment older than five years.
                 Proposed paragraph (b)(6) would establish that for any AE that does
                not appear on the Schedule but meets the definition of adaptive
                equipment in Sec. 17.157, VA would reimburse an eligible person who
                meets the requirements of (b)(2)(i), (ii), or pay a registered
                provider, who meets the requirements of (b)(2)(iii), the lesser of the
                cost of the adaptive equipment when equal to or less than what VA has
                paid for a similar item in the past or, when available, the
                commercially available price for a similar item. If the commercially
                available price for a similar item is not available VA will pay or
                reimburse the billed charge.
                 The Schedule is a finite list of AE items that VA frequently
                reimburses or pays for, thus the means for determining reimbursement or
                payment rates for items that do not appear on the Schedule is defined.
                VA would reimburse or pay for items that do not appear on the Schedule
                provided the equipment still meets the definition of AE under 38 CFR
                17.157.
                 In many cases, VA will have paid for a similar item in the past, or
                VA will be able to compare the item to other items available
                commercially. Therefore, authorizing payment of actual cost by
                obtaining the final invoice, paid receipt, or bill of sale for the
                purchase would provide VA with information that can be used in future
                revisions to the Schedule. VA would examine all final invoices, paid
                receipts, or bills of sale in
                [[Page 14436]]
                order to ensure a measure of cost control and that the estimate is
                appropriate for the AE item. VA would require that the final invoice,
                paid receipt, or bill of sale be equal to or lesser than the prices
                paid by VA or in the commercial sector for similar items. In those
                cases where there is no commercially available item that can be used
                for comparison, VA will pay the billed charge. VA can then use that
                billed charge as an available benchmark for determining reimbursement
                or payment rates of that or similar items in the future.
                 Proposed paragraph (b)(6)(ii) would establish that VA will
                reimburse or pay any labor costs consistent with paragraph (b)(3) of
                this section.
                 Proposed paragraph (b)(7) would establish the online location for
                the Schedule. VA is storing the Schedule on its own website at
                www.prosthetics.va.gov. It would state that VA will establish the
                Schedule for each fiscal year after September 30, 2019 and publish that
                Schedule on a publicly accessible page on the www.prosthetics.va.gov
                website. VA intends to also make the Schedule available upon request at
                any VA medical facility.
                 We note that some eligible veterans reside outside the United
                States. The NMEDA Average Price Survey, on which the Schedule would be
                based, reflects responses on costs in the survey and represents the
                historical input of NMEDA members of the mobility equipment industry in
                the United States and Canada. VA is aware of no source for determining
                average prices for adaptive equipment provided in any foreign country
                other than Canada. In addition, we note that inclusion in the NHTSA
                Modifiers Identification Database requires those listed in the database
                to abide by NHTSA standards, which are only applicable in the United
                States or U.S. Territories. The NMEDA Average Price Survey reflects
                responses from adaptive equipment providers within the United States,
                and the NHTSA Modifiers Identification Database lists adaptive
                equipment providers located in the United States including those in
                U.S. Territories. As we base our definition of registered provider on
                the database, most if not all adaptive equipment providers located
                outside the United States would likely be unregistered providers. Given
                that we have no reliable way to determine average prices for adaptive
                equipment provided in any foreign country other than Canada, VA would
                use the Schedule as a comparator when an eligible person residing
                outside the United States seeks reimbursement for adaptive equipment
                provided by an unregistered provider located outside the United States.
                The Schedule would apply to all eligible persons meeting the
                requirements of (b)(2)(i), (ii), as well as registered and unregistered
                providers.
                 To assist with determining reimbursement and payment amounts, VA
                would rely on the Consumer Price Index (CPI) to update the costs on the
                Schedule for all AE. The Consumer Price Index (CPI) is a measure of the
                average change over time in the prices paid by urban consumers for a
                market basket of consumer goods and services (e.g., utilities,
                automotive fuel, food items, construction). VA believes applying the
                CPI to payments and reimbursements for adaptive equipment is an
                appropriate method of adjusting rates as it is a measure of the average
                change over time in the prices paid by urban consumers for consumer
                goods and services. Currently, VA uses the CPI as a method of ensuring
                certain benefits reflect cost of living increases (e.g., automobile
                allowance, specially adapted housing grants, payments for burial and
                funeral expenses). This is discussed in further detail below.
                 The CPI tracks a myriad of different segments of the economy and
                also provides more global indices based on classes of consumers paired
                with segments of the economy. VA would increase the reimbursement
                amounts in the Schedule using the indices for two expenditure
                categories of the Consumer Price Index (CPI) for All Urban Consumers.
                The index for the expenditure category for ``motor vehicle parts and
                equipment'' will be used to calculate the increase in the reimbursement
                amount for adaptive equipment on the Schedule, and the index for
                ``motor vehicle maintenance and repair'' will be used to calculate the
                increase in the reimbursement amount for labor. Such increases to the
                Schedule for adaptive equipment and labor would be equal to the
                percentage by which the respective index increased during the 12-month
                period ending with the last month for which CPI data is available. In
                the event that such index does not increase during such period, there
                would be no change to the Schedule for the reimbursement amounts for
                which the index is used to calculate increases. VA would round up to
                the whole dollar any amounts for the new fiscal year in the Schedule,
                because this decreases the administrative burden on VA and creates less
                data entry errors. Additionally, rounding up in this manner would make
                it easier for VA to update the Schedule.
                 Finally, VA proposes changes to paragraph (c). Current paragraph
                (c) addresses limitations on reimbursement for repair of AE. It limits
                such reimbursement to AE installed on the current vehicles of record,
                and only to basic components authorized as AE. It also establishes
                criteria for what types of expenses are reimbursable. We would amend
                this paragraph to focus on repair of used AE and address reimbursement
                standards and documentation required from an eligible person and a
                registered provider.
                 We would state that reimbursement or payment for a repair to an
                item of used adaptive equipment may be provided for adaptive equipment
                installed on an automobile or other conveyance that meets the
                limitations of paragraph (a) of this section. VA will pay or reimburse
                labor costs associated with the repairs in accordance with paragraph
                (b)(3) of this section. VA will reimburse an eligible person meeting
                the requirements of (b)(2)(i) or (ii) the lesser of the amount of the
                adaptive equipment listed in either a final itemized invoice, paid
                receipt, or bill of sale for the purchase. VA will reimburse a
                registered provider meeting the requirements of (b)(2)(iii) the lesser
                of the amount of the adaptive equipment listed in the final itemized
                invoice, paid receipt, or bill of sale for the purchase. These
                requirements would be consistent with other proposed provisions
                addressing reimbursement or payment. VA would not pay for repairs to
                new equipment (i.e., OEM equipment) because new equipment already
                possesses warranties and a retailer or manufacturer already has an
                obligation to replace defective equipment.
                Paperwork Reduction Act
                 Although this action contains provisions constituting collections
                of information, at proposed 38 CFR 17.158(b) under the Paperwork
                Reduction Act of 1995 (44 U.S.C. 3501-3521), no new or proposed revised
                collections of information are associated with this proposed rule. The
                information collection requirements for 38 CFR 17.158(b) are currently
                approved by the Office of Management and Budget (OMB) and have been
                assigned OMB control number 2900-0188.
                Regulatory Flexibility Act
                 The Secretary hereby certifies that this proposed rule 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. 601-612.
                 On December 14, 2016, the President signed into law the Veterans
                Mobility Safety Act of 2016, Public Law 114-256 (hereinafter ``the
                Act''). Section 3 of the Act, codified at 38 U.S.C. 3902 Note,
                [[Page 14437]]
                requires VA to update its policy on adaptive equipment no later than
                one year after the date of enactment of the Act, and it requires VA to
                develop a comprehensive policy requiring quality standards for
                providers who provide modification services to veterans under VA's
                adaptive equipment program. This policy must include management of the
                adaptive equipment program, development and consistent application of
                standards for safety and quality of equipment and installation of
                equipment through this program, certification of a provider by a
                manufacturer or third party, nonprofit organization if the Secretary
                designates the quality standards of such entities as meeting or
                exceeding VA's standards, education and training for VA personnel who
                administer this program, compliance with the Americans with
                Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) when furnishing
                adaptive equipment at a facility, and allowance, where technically
                appropriate, for veterans to receive modifications at their residence
                or location of choice.
                 VA conducted public hearings with NHTSA, industry representatives,
                manufacturers of adaptive equipment, and other entities with expertise
                in the installation, repair, replacement, and manufacturing of adaptive
                equipment or development of mobility accreditation standards for
                adaptive equipment in compliance with section 3 of Public Law 114-256.
                VA published a Federal Register Notice (FRN) requesting information and
                comments to assist in the development of the program required by the
                Act on February 2, 2017. See 82 FR 9114. VA received numerous comments
                from adaptive equipment manufacturers, providers, trade associations,
                and other interested external stakeholders. Additionally, VA met in
                person with several parties, including adaptive equipment
                manufacturers, alterers and modifiers; and adaptive equipment related
                associations who requested to meet with VA concerning their comments to
                the FRN. During these discussions, these parties explained their
                individual interpretations of section 3 of the Act and individual
                opinions on the implementation of the Act's provisions, including the
                impact of certain quality and safety standards on small businesses.
                 The comments and feedback we received during this consultative
                period informed this rulemaking, and the comments allowed us to
                understand and consider the various positions different entities had on
                implementing the requirements of the law along with the impact of
                certain quality and safety standards on small businesses. As a result
                of these consultative activities and consistent with the requirements
                of section 3(b)(1) of the Act, we propose the above rulemaking as a
                necessary element in management of VA's adaptive equipment program.
                 In proposed 38 CFR 17.157 we would define Modifier to mean a motor
                vehicle repair business that modifies a motor vehicle to enable a
                person with a disability to operate, or ride as a passenger in, the
                motor vehicle. Alterer would mean the same as in 49 CFR 567.3.
                Registered provider would mean a manufacturer, modifier, or alterer
                registered with the Department of Transportation's National Highway
                Traffic Safety Administration (NHTSA) Modifiers Identification Database
                (``Database'') currently available at http://www.nhtsa.gov/apps/modifier/index.htm. Any manufacturer, modifier, or alterer who is not
                registered would be considered an unregistered provider. The proposed
                rule would establish a national schedule for the maximum allowable
                reimbursement amounts for the listed adaptive equipment. The schedule
                would also include the maximum hourly labor rates for installation,
                repair, reinstallation, and replacement of this equipment and allowable
                fees that VA will pay for. It would also establish standards for
                applying for reimbursement or payment for items listed in this schedule
                and delineate limitations on VA's payment for adaptive equipment and
                related services.
                 The database, accessed on November 13, 2019, lists a total of 1,047
                modifiers. Many modifiers reflected in the database have multiple
                listings, with some having more than 15 separate listings.
                 For purposes of information collection under the Paperwork
                Reduction Act for OMB Control Number 2900-0188, we consider likely
                respondents to be veterans, servicemembers, and adaptive equipment
                modifiers who are requesting a payment for adaptive equipment. We
                estimate the number of respondents to this information collection to be
                6,800 annually. Of that number 6,250 would be eligible persons
                (veterans or servicemembers). In a related proposed rulemaking we
                stated that VA believes that rulemaking would impact 550 modifiers. In
                analyzing the Regulatory Flexibility Act effect here we would base our
                analysis on that number, and based on our proposed definition of
                modifier we will refer to these 550 as registered providers. The
                proposed rule also addresses unregistered providers. Unregistered
                providers are those that are not listed in the NHTSA database, and VA
                believes it is not possible to determine an accurate number for
                unregistered providers, some of which may be individuals rather than
                small entities. NHTSA has advised that it does not know the number of
                modifiers, alterers, or manufacturers of adaptive equipment that have
                not registered in the database. For purposes of this analysis we will
                assume 100 unregistered providers would provide services under this
                proposed rule.
                 The North American Industry Classification System (NAICS) is the
                standard used by Federal statistical agencies in classifying business
                establishments for the purpose of collecting, analyzing, and publishing
                statistical data related to the U.S. business economy. VA has
                identified three broad categories of NAICS codes that we believe
                encompasses the term manufacturer in the proposed rule. We propose to
                define that term to mean the same as that found at 49 U.S.C.
                30102(a)(6), which includes a person manufacturing or assembling motor
                vehicles or motor vehicle equipment; or importing motor vehicles or
                motor vehicle equipment for resale. While the definition of
                manufacturer found at 49 U.S.C. 30102(a)(6) is broad, including the
                manufacturing, assembly, or import of motor vehicles, the proposed rule
                focuses narrowly on reimbursement and payment for installation,
                replacement, or repair of adaptive equipment. Applying the relevant
                part of the statutory definition of manufacturer, the proposed rule
                focuses on a person manufacturing or assembling motor vehicle adaptive
                equipment, or the import of motor vehicle adaptive equipment for
                resale. We note here that major automobile manufacturers do not convert
                automobiles or vans for their disabled customers.
                 NAICS Code 336390--Other Motor Vehicle Parts Manufacturing,
                comprises establishments primarily engaged in manufacturing and/or
                rebuilding motor vehicle parts and accessories (except motor vehicle
                gasoline engines and engine parts, motor vehicle electrical and
                electronic equipment, motor vehicle steering and suspension components,
                motor vehicle brake systems, motor vehicle transmissions and power
                train parts, motor vehicle seating and interior trim, and motor vehicle
                stampings). NAICS Code 339113, Surgical Appliance and Supplies
                Manufacturing, comprises establishments primarily engaged in
                manufacturing surgical appliances and supplies. Examples of products
                made by these establishments are orthopedic devices, prosthetic
                appliances, surgical dressings, crutches,
                [[Page 14438]]
                surgical sutures, personal industrial safety devices (except protective
                eyewear), hospital beds, and operating room tables. NAICS Code 423120--
                Motor Vehicle Supplies and New Parts Merchant Wholesalers comprises
                establishments primarily engaged in the merchant wholesale distribution
                of motor vehicle supplies, accessories, tools, and equipment; and new
                motor vehicle parts (except new tires and tubes).
                 These three NAICS codes cover a broad range of manufacturers of
                either medical equipment or motor vehicle equipment, including
                manufacturers VA believes would be subject to this proposed rule. While
                the categories are overinclusive we believe that analysis of the
                regulatory impact based on these codes will result in a reasonable
                approximation of costs or impact of the proposed rule on small entities
                engaged in the manufacture of adaptive equipment.
                 Applying the small business standards promulgated in 13 CFR
                121.201, a small entity for NAICS Code 336390 is 1,000 employees or
                less; NAICS Code 339113 is 750 employees or less; and NAICS Code 423120
                is 200 employees or less. Data compiled by the US Census Bureau from
                the 2012 Statistics of U.S. Businesses (SUSB) found at https://www.census.gov/data/tables/2012/econ/susb/2012-susb-annual.html
                reflects the following for the NAICS codes:
                ----------------------------------------------------------------------------------------------------------------
                 Enterprise Estimated Estimated
                 NAICS code employment Number of receipts receipts per
                 size firms ($1,000) firm ($1,000)
                ----------------------------------------------------------------------------------------------------------------
                336390.......................................... https://www.census.gov/data/tables/2012/econ/susb/2012-susb-annual.html reflects that most, if not all, of
                the 32,427 entities in NAICS Code 811121 would qualify as a small
                entity based on 13 CFR 121.201.
                 As noted with manufacturers who would be affected by this proposed
                rule, NAISC Code 811121 is very broad, applying to 32,427 business
                entities. However, only a small percentage of those entities would be
                subject to the proposed rule as an alterer or modifier of adaptive
                equipment. We believe that this NAISC code is the appropriate code for
                any registered providers not already captured by the other three codes
                listed above as well as unregistered providers that would qualify as a
                business entity. We believe that number is accurate for purposes of
                determining whether this proposed rule would have a significant
                economic impact on a substantial number of small entities as they are
                defined in the Regulatory Flexibility Act.
                 Proposed 38 CFR 17.158 addresses limitations on payment. Proposed
                paragraph (b) would state that VA will reimburse or pay for adaptive
                equipment based on the information submitted and the VA Adaptive
                Equipment Schedule for Automobiles and Other Conveyances (Schedule). In
                addition to payment or reimbursement rates for specific types of
                adaptive equipment listed in the Schedule, VA will pay or reimburse
                labor costs, roadside service, and waste disposal fees consistent with
                the Schedule. Payment or reimbursement rates are based on the Schedule
                in effect on the date installation, reinstallation, replacement, or
                repair is complete. The Schedule would establish, inter alia, a
                national monetary limit on payment or reimbursement for adaptive
                equipment.
                [[Page 14439]]
                 The Schedule is based on results of the NMEDA 2018 Annual Price
                Survey. The survey was mailed to 324 dealers; 125 were returned (39%).
                Reported returns by region: North 27% (34), South 22% (27), West 27%
                (34), Midwest 24% (30).The example of the schedule we publish in this
                proposed rulemaking reflects the high limit for prices reported by the
                125 respondents to the survey. The high reported price limit for
                individual items reflected in the NMEDA survey is significantly higher
                than the low reported price in some instances. To highlight one
                example, for lowered floor conversions of mini vans, domestic powered
                side entry conversions reported by 33 North Region respondents, the
                high price is $29,818; average is $28,706 and low price is $2,995. The
                survey results do not reflect variations in the type of specific
                categories of adaptive equipment that are included in these reported
                prices. Generally, there is a close correlation between average prices
                and high prices reported for the individual categories of adaptive
                equipment. Typically, South and Midwest regions reported lower prices
                than other regions. VA believes that the survey responses are a valid
                representation of regional costs and that the number of respondents in
                each region supports that conclusion.
                 The proposed rule states that VA will reimburse eligible persons
                identified in 38 CFR 17.156(a) who have purchased adaptive equipment
                (e.g., installations, repairs, reinstallations, replacements) from
                registered providers. The eligible person must sign and submit to VA a
                completed VA Form 10-1394, an itemized estimate, and provide VA with
                either a final itemized invoice, paid receipt, or bill of sale for the
                purchase. VA may reimburse eligible persons identified in 38 CFR
                17.156(a) who have purchased adaptive equipment (e.g., installations,
                repairs, reinstallations, replacements) from unregistered providers.
                The eligible person must submit to VA a completed VA Form 10-1394 and a
                final itemized invoice, paid receipt, or bill of sale for the purchase.
                In addition, VA will pay registered providers for adaptive equipment
                (e.g., installations, repairs, reinstallations, replacements) furnished
                to eligible persons identified in 38 CFR 17.156(a). The eligible person
                or the registered provider must submit to VA a completed VA Form 10-
                1394 and an itemized estimate prior to the completion of work. The
                eligible person or registered provider must provide VA with a final
                itemized invoice after the work is completed. See 38 CFR
                17.158(b)(2)(i) through (iii). Labor costs per hour for registered
                providers would be reimbursed or paid based on the lesser amount of
                what is reflected in the Schedule, the estimate, or the final invoice.
                No payment for labor costs would be approved for pre-installed (i.e.,
                original equipment manufacturer) equipment, or labor costs billed by an
                unregistered provider. See 38 CFR 17.158(b)(3).
                 For installation of new adaptive equipment, VA would pay or
                reimburse the lesser of the amount for the new adaptive equipment
                listed in either a final itemized invoice, paid receipt, or bill of
                sale for the purchase, or the amount established in the Schedule. 38
                CFR 17.158(b)(4).
                 VA will use two representative categories of adaptive equipment
                costs from the NMEDA 2018 Annual Price Survey to estimate economic
                impact on small entities: adaptive equipment under the Lowered Floor
                Conversion--Mini Van (15 listed options); and adaptive hand controls (8
                listed options). VA believes these categories are a reasonable
                representation of adaptive equipment costs. VA will likewise analyze
                in-shop and high-tech hourly labor rates.
                 Lowered Floor Conversion--Mini Van
                 [Averages of all 15 categories in dollars]
                ------------------------------------------------------------------------
                
                ------------------------------------------------------------------------
                Average cost................... 24,206 .......................
                High cost...................... 25,186 980 above Average cost.
                Low cost....................... 13,855 11,331 below High cost,
                 10,351 below Average.
                ------------------------------------------------------------------------
                 Hand Controls
                 [Averages of all 8 categories in dollars]
                ------------------------------------------------------------------------
                
                ------------------------------------------------------------------------
                Average cost................... 17,070 .......................
                High cost...................... 22,362 5,292 above Average.
                Low cost....................... 1,727 20,635 below High,
                 15,343 below Average.
                ------------------------------------------------------------------------
                 Retail Labor Rates/Hr--In Shop Labor
                 [In dollars]
                ------------------------------------------------------------------------
                
                ------------------------------------------------------------------------
                Average........................ 112 .......................
                High........................... 130 18 above Average.
                Low............................ 95 35 below High, 17 below
                 Average.
                ------------------------------------------------------------------------
                 Retail Labor Rates/Hr--High-Tech Labor
                 [In dollars]
                ------------------------------------------------------------------------
                
                ------------------------------------------------------------------------
                Average........................ 138 .......................
                High........................... 175 38 above Average.
                Low............................ 95 80 below High, 43 below
                 Average.
                ------------------------------------------------------------------------
                 As noted above, VA believes that approximately 6,250 eligible
                persons will apply for adaptive equipment payment or reimbursement
                annually. For purposes of this analysis we are assuming a total of 550
                registered
                [[Page 14440]]
                providers and 100 unregistered providers will provide services under
                this proposed rule. We do not have accurate information readily
                available on regional distribution of either eligible persons,
                registered providers, or unregistered providers. We will assume for
                purposes of this analysis that adaptive equipment services for eligible
                persons will be equally distributed between providers, as we believe an
                analysis based on actual distribution would not impact our conclusions.
                Rounding up to the whole person, each provider would provide services
                to 10 eligible persons.
                 VA would reimburse or pay for adaptive equipment at the amount
                invoiced or per the Schedule, whichever is less. For mini-van
                conversions, assuming a provider billed at the Schedule amount, the
                provider would experience a net gain of $980 to $11,331 per transaction
                over invoicing at a different amount. Hand control adaptive equipment
                costs vary from $5,292 to $20,635 from the High cost per transaction.
                Assuming the maximum difference in invoicing for all 10 assumed
                clients, each provider would show a total impact of $113,310 to
                $206,350 annually. Labor costs per hour vary from $95 to $130 per hour
                for in shop labor, and $95 to $175 for high tech labor. We note that
                unregistered providers would not be eligible for payment for labor
                costs and would experience a loss of potential revenue as a result. If
                we assume a 4-hour assignment requiring high tech labor, that would
                amount to $700 per transaction.
                 Given the relatively small number of eligible persons, cost
                variations for provision of adaptive equipment, and the estimate of
                gross receipts for affected small entities in the identified NAICS
                codes, VA believes that this proposed rule 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. 601-612. Therefore,
                pursuant to 5 U.S.C. 605(b), the initial and final regulatory
                flexibility analysis requirements of 5 U.S.C. 603 and 604 do not apply.
                Executive Orders 12866, 13563, and 13771
                 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.
                The Office of Information and Regulatory Affairs has determined that
                this rule is not 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 website at
                http://www.va.gov/orpm/, by following the link for ``VA Regulations
                Published From FY 2004 Through Fiscal Year to Date.''
                 This rule is not an E.O. 13771 regulatory action because this rule
                is not significant under E.O. 12866.
                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 proposed rule would have no such
                effect on State, local, and tribal governments, or on the private
                sector.
                Catalog of Federal Domestic Assistance Numbers
                 The Catalog of Federal Domestic Assistance numbers and titles for
                the programs affected by this document are as follows: 64.009, Veterans
                Medical Care Benefits; 64.013, Veterans Prosthetic Appliances.
                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.
                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. Pamela
                Powers, Chief of Staff, Department of Veterans Affairs, approved this
                document on March 2, 2020, for publication.
                Consuela Benjamin,
                Regulation Development Coordinator, Office of Regulation Policy &
                Management, Office of the Secretary, Department of Veterans Affairs.
                 For the reasons stated in the preamble, the Department of Veterans
                Affairs proposes to amend 38 CFR part 17 as follows:
                PART 17--MEDICAL
                0
                1. Amend the authority citation for part 17 by adding the following:
                 Sections 17.156 and 17.157 are also issued under 38 U.S.C. 3901
                and 3902.
                 Section 17.158 is also issued under 38 U.S.C. 3902 and 3903.
                0
                2. Amend Sec. 17.156 by:
                0
                a. Revising the introductory paragraph;
                0
                b. Revising paragraph (b); and
                0
                c. Removing the Authority citation at the end of the section.
                 The revisions read as follows:
                Sec. 17.156 Eligibility for automobile adaptive equipment.
                 Automobile adaptive equipment may be authorized if the Under
                Secretary for Health or designee determines that such equipment is
                deemed necessary to insure that the eligible person will be able to
                operate the automobile or other conveyance in a manner consistent with
                such person's safety and so as to satisfy the applicable standards of
                licensure established by the State of such person's residency or other
                proper licensing authority subject to the definitions and limitations
                in Sec. Sec. 17.157 and 17.158.
                * * * * *
                 (b) VA will reimburse or pay for adaptive equipment for automobiles
                and other conveyances subject to the requirements of 38 CFR 17.158(b).
                0
                3. Revise Sec. 17.157 to read as follows:
                Sec. 17.157 Definitions.
                 For the purposes of this part:
                 Adaptive equipment means equipment which must be part of or added
                to a conveyance manufactured for sale to the general public to make it
                safe for use by the eligible person and enable that person and the
                conveyance to meet the applicable standards of licensure. Adaptive
                equipment includes any item specified by the Under Secretary for Health
                or designee as ordinarily
                [[Page 14441]]
                necessary for any of the classes of losses or combination of such
                losses specified in 38 CFR 17.156, or as deemed necessary in an
                individual case for an eligible person. Adaptive equipment includes,
                but is not limited to, a basic automatic transmission, power steering,
                power brakes, power window lifts, power seats, air-conditioning
                equipment when necessary for the health and safety of the veteran, and
                special equipment necessary to assist the eligible person into or out
                of the automobile or other conveyance, regardless of whether the
                automobile or other conveyance is to be operated by the eligible person
                or is to be operated for such person by another person; and any
                modification of the interior space of the automobile or other
                conveyance if needed because of the physical condition of such person
                in order for such person to enter or operate the vehicle.
                 Manufacturer means the same as in 49 U.S.C. 30102(a)(6).
                 Modifier means a motor vehicle repair business that modifies a
                motor vehicle to enable a person with a disability to operate, or ride
                as a passenger in, the motor vehicle. VA does not approve, endorse, or
                assess the abilities of any modifiers to perform any requested or
                represented modification services.
                 Altered vehicle means the same as in 49 CFR 567.3.
                 Alterer means the same as in 49 CFR 567.3
                 Registered provider means a manufacturer, modifier, or alterer
                registered with the Department of Transportation's National Highway
                Traffic Safety Administration (NHTSA) Modifiers Identification Database
                currently available at http://www.nhtsa.gov/apps/modifier/index.htm.
                Any manufacturer, modifier, or alterer who is not registered is
                considered an unregistered provider.
                 Roadside service means emergency roadside services provided to an
                eligible person performed in connection with the repair,
                reinstallation, or replacement of adaptive equipment already installed
                in the automobile or other conveyance. The term is limited solely to
                services provided to make the adaptive equipment operational and does
                not include mechanical repair of the engine or other vehicle systems,
                towing, providing essential fuels and fluids such as gasoline necessary
                to operate the vehicle, or providing locksmith services.
                 VA Adaptive Equipment Schedule for Automobiles and Other
                Conveyances (``Schedule'') means the VA schedule that contains the
                maximum allowable reimbursement amounts for the listed adaptive
                equipment. The Schedule also includes the maximum hourly labor rates
                for installation, repair, reinstallation, and replacement of this
                equipment and allowable fees that VA will pay.
                0
                4. Revise Sec. 17.158 to read as follows:
                Sec. 17.158 Limitations on assistance.
                 (a) General. An eligible person will not be provided adaptive
                equipment for more than two automobiles or other conveyances at any one
                time or during any four-year period except when, due to circumstances
                beyond the control of such person, one of the automobiles or other
                conveyances for which adaptive equipment was provided during the
                applicable four-year period is no longer available for the use of such
                person.
                 (1) Circumstances beyond the control of the eligible person are
                those where the automobile or other conveyance was lost due to fire,
                theft, accident, or court action; when repairs are so costly as to be
                prohibitive; or a different automobile or other conveyance is required
                due to a change in the eligible person's physical condition.
                 (2) For purposes of paragraph (a)(1) of this section, an eligible
                person shall be deemed to have access to and use of an automobile or
                other conveyance for which the Department of Veterans Affairs has
                provided adaptive equipment if that eligible person has sold, given or
                transferred the automobile or other conveyance to a spouse, family
                member or other person residing in the same household as the eligible
                person; or to a business owned by the eligible person, spouse, family
                member or other person residing in the same household as the eligible
                person.
                 (b) Basis for payment or reimbursement. VA will reimburse or pay
                for adaptive equipment that VA determines is needed in accordance with
                this section based on the information submitted and the VA Adaptive
                Equipment Schedule for Automobiles and Other Conveyances (Schedule). In
                addition to paying or reimbursing for specific types of adaptive
                equipment listed in the Schedule, VA will pay, or reimburse for
                roadside service, and waste disposal fees consistent with the Schedule.
                Determination of payment or reimbursement rates are based on the
                Schedule in effect on the date installation, reinstallation,
                replacement, or repair is complete. Schedule labor rates are classified
                as ``In Shop (low technology)'' or ``High Technology.'' High Technology
                means labor performed on or modification of adaptive equipment devices
                or systems that are capable of controlling vehicle functions or driving
                controls, and operate with a designed logic system, or interface or
                integrate with an electronic system of the vehicle. In Shop (low
                technology) means labor performed on adaptive equipment all other
                devices or modifications that do not meet the definition of High
                Technology.
                 (1) Payments made for adaptive equipment that is authorized under
                this section shall constitute payment in full and shall extinguish the
                eligible person's liability to the registered provider. The registered
                provider may not impose any additional charge on the eligible person
                for any adaptive equipment that is authorized under this section and
                for which payment is made by VA.
                 (2) This paragraph sets forth what must be submitted to VA in order
                for VA to reimburse or pay for adaptive equipment.
                 (i) Reimbursement when services performed by registered providers.
                VA will reimburse eligible persons identified in 38 CFR 17.156(a) who
                have purchased adaptive equipment (e.g., installations, repairs,
                reinstallations, replacements) from registered providers. The eligible
                person must submit to VA a completed VA Form 10-1394, an itemized
                estimate, and provide VA with either a final itemized: (1) Invoice, (2)
                paid receipt, or (3) bill of sale for the purchase.
                 (ii) Reimbursement when services performed by unregistered
                providers. VA will reimburse eligible persons identified in 38 CFR
                17.156(a) who have purchased adaptive equipment (e.g., installations,
                repairs, reinstallations, replacements) from unregistered providers.
                The eligible person must submit to VA a completed VA Form 10-1394 and a
                final itemized (1) invoice, (2) paid receipt, or (3) bill of sale for
                the purchase.
                 (iii) Payments to registered providers for adaptive equipment. VA
                will pay registered providers for adaptive equipment (e.g.,
                installations, repairs, reinstallations, replacements) furnished to
                eligible persons identified in 38 CFR 17.156(a). The following must be
                submitted before VA will pay. The eligible person or the registered
                provider must sign and submit to VA a completed VA Form 10-1394 and an
                itemized estimate prior to the completion of work. The eligible person
                or registered provider must provide VA with a final itemized invoice
                after the work is completed.
                 (iv) In the case of any installation, repair or replacement of
                adaptive equipment performed outside of the United States where an
                invoice, estimate, or bill of sale is calculated in a foreign currency,
                an application submitted under this paragraph must
                [[Page 14442]]
                include the conversion rate from the foreign currency to U.S. dollars,
                and calculation of the invoice, estimate, or bill of sale amount in
                U.S. dollars.
                 (3) VA will reimburse or pay labor costs as follows:
                 (i) For any labor costs associated with the installation of
                adaptive equipment by a registered provider, VA will reimburse or pay
                the lesser of:
                 (A) The relevant Schedule hourly labor rate, per paragraph (b) of
                this section, multiplied by the number of hours listed by the
                registered provider;
                 (B) The labor costs included in the itemized estimate; or
                 (C) The hourly labor rate provided by the registered provider in
                the final itemized invoice multiplied by the number of hours listed by
                the registered provider.
                 (ii) VA does not reimburse or pay labor costs for pre-installed
                (i.e., original equipment manufacturer) equipment.
                 (iii) VA does not reimburse or pay labor costs of unregistered
                providers.
                 (4) New adaptive equipment. VA will reimburse an eligible person
                who meets the requirements of (b)(2)(i) or (ii) of this section, or pay
                a registered provider who meets the requirements of (b)(2)(iii) of this
                section for new adaptive equipment (including equipment that has been
                installed or used for one year or less from the date of manufacture
                listed in the Schedule as follows:
                 (i) VA will pay the lesser of the amount for the new adaptive
                equipment listed in either a final itemized: (1) Invoice, (2) paid
                receipt, or (3) bill of sale for the purchase; or (4) the amount listed
                in the Schedule.
                 (ii) VA will reimburse or pay any labor costs consistent with
                paragraph (b)(3) of this section.
                 (5) Used adaptive equipment. For used adaptive equipment listed in
                the Schedule that is more than one (1) year old from the date of
                manufacture:
                 (i) VA will depreciate it by twenty (20%) percent per year from the
                time the equipment was pre-installed or installed as new on an
                automobile or other conveyance to the time of its reinstallation for
                which reimbursement or payment is being sought for a period up to five
                (5) years. VA will reimburse an eligible person, who meets the
                requirements of (b)(2)(i) or (ii) of this section, or pay a registered
                provider who meets the requirements of (b)(2)(iii) of this section the
                lesser of the amount of the adaptive equipment listed in the final
                itemized invoice, paid receipt, or bill of sale for the purchase or the
                amount listed in the Schedule reduced by twenty (20%) percent for each
                year from the time the equipment was pre-installed or installed on the
                automobile or other conveyance for a period up to five (5) years.
                 (ii) VA will reimburse or pay any labor costs consistent with
                paragraph (b)(3) of this section, but will not reimburse or pay labor
                costs for used equipment that is more than five (5) years old from the
                date of manufacture.
                 (6) Unlisted adaptive equipment. For adaptive equipment not listed
                in the Schedule but meeting the definition of adaptive equipment in 38
                CFR 17.157, VA will reimburse an eligible person who meets the
                requirements of (b)(2)(i) or (ii) of this section, or pay a registered
                provider who meets the requirements of (b)(2)(iii) of this section:
                 (i) The lesser of the cost of the adaptive equipment when equal to
                or less than what VA has paid for a similar item in the past or, when
                available, the commercially available price for a similar item. If the
                price of a similar commercially available item is not available, or VA
                has not previously paid for a similar item, VA will pay or reimburse
                the billed charges.
                 (ii) VA will reimburse or pay any labor costs consistent with
                paragraph (b)(3) of this section.
                 (7) VA will establish the Schedule for each fiscal year after
                September 30, 2019 and publish that Schedule on a publicly accessible
                page on the www.prosthetics.va.gov website. VA will increase the
                reimbursement amounts in the Schedule using the indices for two
                expenditure categories of the Consumer Price Index (CPI) for All Urban
                Consumers. The index for the expenditure category for ``motor vehicle
                parts and equipment'' will be used to calculate the increase in the
                reimbursement amounts for adaptive equipment on the Schedule, and the
                index for ``motor vehicle maintenance and repair'' will be used to
                calculate the increase in the reimbursement amounts for labor. Such
                increases to the Schedule for adaptive equipment and labor will be
                equal to the percentage by which the respective index increased during
                the 12-month period ending with the last month for which CPI data is
                available. In the event that such index does not increase during such
                period, there will be no change to the Schedule for the reimbursement
                amounts for which the index is used to calculate increases. The amounts
                for the new fiscal year will be rounded up to the whole dollar amount.
                 (c) Repair of used adaptive equipment. Reimbursement or payment for
                a repair to an item of used adaptive equipment may be provided for
                adaptive equipment installed on an automobile or other conveyance that
                meets the limitations of paragraph (a) of this section. VA will pay or
                reimburse labor costs associated with the repairs in accordance with
                paragraph (b)(3) of this section.
                 (1) For repairs to used adaptive equipment, VA will reimburse the
                eligible person meeting the requirements of (b)(2)(i) or (ii) of this
                section as follows: the lesser of the amount of the adaptive equipment
                listed in either a final itemized: (1) Invoice, (2) paid receipt, or
                (3) bill of sale for the purchase.
                 (2) For repairs to used adaptive equipment, VA will reimburse a
                registered provider meeting the requirements of (b)(2)(iii) of this
                section as follows: The lesser of the amount of the adaptive equipment
                listed in the final itemized (1) invoice, (2) paid receipt, or (3) bill
                of sale for the purchase.
                 (The Office of Management and Budget has approved the information
                collection requirements in this section under control number 2900-
                0188.)
                [FR Doc. 2020-04564 Filed 3-11-20; 8:45 am]
                 BILLING CODE 8320-01-P
                

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT