Rule2021-19470
Veterans Care Agreements
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
September 13, 2021
Effective
October 13, 2021
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) adopts as final, with no substantive changes, an interim final rule revising its medical regulations to implement VA's authority under section 102 of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which authorizes VA to enter into agreements to furnish required hospital care, medical services, and extended care services in the community when such care and services are not feasibly available to certain individuals through a VA facility, a contract, or a sharing agreement. As specified in section 1703A and this implementing rule, these agreements are called Veterans Care Agreements (VCA).
Full Text
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<title>Federal Register, Volume 86 Issue 174 (Monday, September 13, 2021)</title>
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[Federal Register Volume 86, Number 174 (Monday, September 13, 2021)]
[Rules and Regulations]
[Pages 50856-50861]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-19470]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AQ45
Veterans Care Agreements
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: The Department of Veterans Affairs (VA) adopts as final, with
no substantive changes, an interim final rule revising its medical
regulations to implement VA's authority under section 102 of the John
S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining
Internal Systems and Strengthening Integrated Outside Networks Act of
2018 (MISSION Act), which authorizes VA to enter into agreements to
furnish required hospital care, medical services, and extended care
services in the community when such care and services are not feasibly
available to certain individuals through a VA facility, a contract, or
a sharing agreement. As specified in section 1703A and this
implementing rule, these agreements are called Veterans Care Agreements
(VCA).
DATES: This rule is effective on October 13, 2021.
FOR FURTHER INFORMATION CONTACT: Joseph Duran, Office of Community Care
(10D), Veterans Health Administration, Department of Veterans Affairs,
Ptarmigan at Cherry Creek, Denver, CO 80209; (303) 372-4629. (This is
not a toll-free number.)
SUPPLEMENTARY INFORMATION: On June 6, 2018, the President signed into
law the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA
Maintaining Internal Systems and Strengthening Integrated Outside
Networks Act of 2018, Public Law 115-182, 132 Stat. 1393 (2018)
(codified as amended in scattered sections of 38 U.S.C.) (MISSION Act).
This rule adopts as final, with no substantive changes, an interim
final rule revising VA medical regulations to implement section 102 of
the MISSION Act (codified as amended at 38 U.S.C. 1703A), which
authorizes VA to enter into agreements to furnish required hospital
care, medical services, and extended care services in the community
when such care and services are not feasibly available to certain
individuals through a VA facility, a contract, or a sharing agreement.
As specified in section 1703A and this implementing rule, these
agreements are called Veterans Care Agreements (VCA).
On May 14, 2019, VA published an interim final rule to establish
the parameters of VCAs authorized under section 1703A, to include:
Establishing a certification process for entities and providers that
will seek to enter into a VCA and furnish care or services pursuant to
that agreement; establishing certain parameters governing the payment
rates that will be set forth in the terms of each VCA; and establishing
an administrative process for adjudicating disputes arising under or
related to VCAs, including those pertaining to claims for payment for
care or services provided under a VCA. 84 FR 21668. VA received input
from eight commenters in response to this interim final rule, only
three of which raised issues relevant to the rule. VA's responses to
those three commenters are summarized below.
One commenter that represents a membership consisting of long term
and post-acute care providers offered four comments that relate to VA's
implementation and use of VCAs. The comments do not expressly or
impliedly request any changes to the interim final rule, nor do they
raise any issues that would necessitate or merit any such changes.
First, the commenter noted that it wants to ensure its members
obtain access to information ``available at both the regional and
national levels'' within VA regarding VA's implementation and use of
VCAs. Relatedly, the commenter also indicated that it has heard from
some of its members that they would like VA to establish one or more
points of contact at the ``national'' level that providers could
communicate with directly when they have questions that ``regional'' VA
offices are unable to answer regarding VA's implementation and use of
VCAs. We interpret the commenter's references to information made
available and points of contact established at the ``national'' and
``regional'' levels to constitute references to when such information
[[Page 50857]]
and resources are made available by national offices of the Veterans
Health Administration (VHA) as compared to when they are made available
by Veterans Integrated Service Networks (VISN) or by individual VHA
medical facilities. In response to the commenter's input in this
regard, we note that VA currently uses a mix of organizational
components and points of contact to make information relating to VA's
implementation and use of VCAs available to entities and providers.
Certain information, resources, and points of contact are made
available at the national organizational level through the website of
VHA's national Office of Community Care.\1\ For example, VA provides
access to relevant provider educational and training resources (e.g.,
webinars of the type incidentally mentioned in the same comment), and a
related national point of contact, in this manner.\2\ However, VA also
currently makes certain information, resources, and points of contact
available only through the individual VHA medical facilities that enter
into and administer the specific VCAs to which such information,
resources, and points of contact relate. Applications for certification
under section 17.4110 of the interim final rule are processed, and VCAs
are entered into and administered, by officials at local VHA medical
facilities. Consequently, those officials and the local facility staff
are often the most reliable and efficient sources of relevant and
accurate information for an entity or provider that is considering or
is currently navigating the processes of applying for certification,
entering into a VCA with that local facility, and/or furnishing
hospital care, medical services, or extended care services pursuant to
a VCA that the entity or provider previously entered into with that
local facility. Moreover, even in instances where the responsible local
officials lack certain information requested by an entity or provider
regarding those matters, it is important that those local officials
remain the applicable VA points of contact for such entities and
providers regarding those matters. Local officials possess the
authority and responsibility for many aspects of the implementation and
use of VCAs at each local VHA medical facility, so ensuring that they
are privy to and the source of communications to entities and providers
regarding those matters (e.g., status of a provider's certification,
terms of a provider's VCA, or issues pertaining to specific
authorizations or claims) promotes consistency and efficiency in VA's
use and administration of VCAs and mitigates risk of conflicting
communications from those lacking the authority and responsibility for
those aspects of VA's implementation and use of the specific local VCAs
and processes that are the subject of such communications. If the
responsible officials at local VHA facilities lack certain information
requested by an entity or provider regarding implementation and use of
VCAs at that facility, those officials can and do utilize established
internal communication channels to consult with VISN and national VHA
offices, including the Office of Community Care, as appropriate, in
identifying such information and formulating an appropriate response.
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\1\ See <a href="https://www.va.gov/communitycare/">https://www.va.gov/communitycare/</a> (last accessed 9/8/
2021).
\2\ See <a href="https://www.va.gov/communitycare/providers/EDU_Training.asp">https://www.va.gov/communitycare/providers/EDU_Training.asp</a> (last accessed 9/8/2021).
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In its second comment, the same commenter noted that it wants to
ensure that the Centers for Medicare & Medicaid Services (CMS) and VA
communicate how CMS' Patient Driven Payment Model (PDPM), which became
effective on October 1, 2019, and the VCA reimbursement structures will
work together. As it pertains to VA, we interpret this comment as
requesting that VA communicate whether and to what extent the rates
that VA pays for care and services furnished by nursing facilities
pursuant to VCAs are based upon or influenced by CMS' PDPM case-mix
classification methodology for calculating Part A payments under
Medicare's skilled nursing facility prospective payment system (SNF
PPS). As established in Sec. 17.4120 of the interim final rule, that
information (i.e., the nexus between CMS' PDPM methodologies and rates
and VA payment methodologies and rates, if any), when applicable, will
be communicated by VA in the price terms set forth in the specific VCA
pursuant to which VA obtains the care or services at issue.
Specifically, as established in Sec. 17.4120 of the interim final
rule, the rates paid by VA for hospital care, medical services, and
extended care services furnished pursuant to a VCA will be the rates
set forth in the price terms of that specific VCA, and those price
terms will be established in compliance with the general parameters set
forth in Sec. 17.4120(a)-(e). One such parameter of particular
relevance to this comment regarding CMS' PDPM is contained in Sec.
17.4120(a), which provides in pertinent part that, subject to the
caveats and exceptions set forth in Sec. 17.4120(b)-(e), payment rates
for services furnished pursuant to VCAs will not exceed the applicable
Medicare prospective payment system amount, if any, for the period in
which the service was provided (without any changes based on the
subsequent development of information under Medicare authorities).
Given that Medicare's SNF PPS is a ``prospective payment system''
within the meaning of the foregoing limitation, and given that CMS'
PDPM currently governs how payment amounts are calculated under the SNF
PPS, the PDPM will necessarily be factored into VA's calculus when
formulating certain VCA payment rates that are subject to the general
limitation set forth in Sec. 17.4120(a). However, while the general
limitation in Sec. 17.4120(a) can affect how VA formulates pricing for
care and services obtained pursuant to VCAs, we emphasize that it is
subject to the caveats and exceptions set forth in Sec. 17.4120(b)-(e)
and we note that the existence of that general limitation does not
require or mean that the price terms set forth in any specific VCA for
care and services furnished by nursing facilities will be the same as
or based upon the payment rates, if any, for the same services under
CMS' PDPM. Instead, as previously stated, the nexus between CMS' PDPM
methodologies and rates and VA payment methodologies and rates, if any,
will be communicated by VA in the price terms set forth in the specific
VCA pursuant to which VA obtains the care or services at issue.
In its third comment, the same commenter indicated that providers
might be hesitant to enter into VCAs until the U.S. Department of
Labor's Office of Federal Contract Compliance Programs (OFCCP) issues a
Notice of Proposed Rulemaking (NPRM) that would revise certain portions
of 41 CFR subtitle B, chapter 60 that concern the obligations of
TRICARE and certain other health care providers, as federal contractors
and/or subcontractors, under the nondiscrimination and affirmative
action provisions of Executive Order (E.O.) 11246 (as amended), section
503 of the Rehabilitation Act of 1973 (as amended), and the Vietnam Era
Veterans' Readjustment Assistance Act of 1974 (as amended). We
interpret this comment as referring to the NPRM subsequently published
by OFCCP at 84 FR 59746 (Nov. 6, 2019). That NPRM culminated in a final
rule, published by OFCCP at 85 FR 39834 (Jul. 2, 2020), that revised
certain definitions set forth in 41 CFR 60-1.3, 60-300.2, and 60-741.2.
Given that the rulemaking
[[Page 50858]]
referenced in this comment has been completed, the commenter's concern
that providers might be hesitant to enter into VCAs until the
completion of that rulemaking process is no longer applicable.
In its fourth and final comment, the same commenter stated that it
wants to ensure that ``services covered under VA contracts will
continue to be covered under VCAs.'' While the intended meaning of this
comment is unclear to us, we note that, in accordance with the
statutory authority for VCAs and the interim final rule, VA can use
VCAs to obtain ``hospital care'' (as defined in 38 U.S.C. 1701(5)),
``medical services'' (as defined 38 U.S.C. 1701(6)), and ``extended
care services'' (defined as the services described in 38 U.S.C.
1710B(a)).\3\ We also note that the circumstances when VA is legally
authorized to use VCAs to obtain hospital care, medical services, or
extended care services are specified in 38 U.S.C. 1703A(a) and in Sec.
17.4115(a) of the interim final rule. Consequently, we do not make any
changes to the interim final rule based on this comment.
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\3\ See 38 U.S.C. 1703A(a)(1)(A) (authorizing VA to use VCAs to
obtain ``hospital care, a medical service, or an extended care
service'' in certain circumstances); 38 U.S.C. 1701(5)-(6) (defining
the terms ``hospital care'' and ``medical services'' for purposes of
38 U.S.C. chapter 17, which includes section 1703A); 38 CFR 17.4100
(defining the terms ``hospital care,'' ``medical services,'' and
``extended care services'' for purposes of sections 17.4100-
17.4135).
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One commenter that represents a membership consisting of hearing
health care professionals, including licensed hearing aid specialists,
offered several comments in response to the interim final rule. Some of
those comments pertain to matters that are outside the scope of this
rulemaking and which do not implicate any considerations that would
necessitate or merit any changes to the interim final rule. For
example, the commenter urged VA to develop and implement the
qualifications, which VA is authorized to prescribe pursuant to 38
U.S.C. 7402(b)(14), for hearing aid specialists appointed to positions
in VHA in accordance with 38 U.S.C. 7401. The commenter also urged VA
to include hearing aid specialists appointed pursuant to 38 U.S.C. 7401
in the audiology teams that operate in VHA facilities. The government
personnel matters raised in these comments, including whether and when
VA develops qualifications for hearing aid specialists appointed to
positions in VHA, and how VA utilizes any such specialists in VHA
facilities, are outside the scope of this rulemaking and implicate no
issues bearing on the contents of the interim final rule.
The same commenter also urged VA to prioritize delivery of hearing-
related health care services to veterans, both in VHA facilities and
through ``the Community Care Program,'' a phrase that we interpret to
be a reference to the Veterans Community Care Program (VCCP)
established by section 101 of the MISSION Act (codified as amended at
38 U.S.C. 1703). The matters raised in this comment, including whether
and to what extent VA can and does prioritize the provision of certain
types of hospital care, medical services, and extended care services in
VHA facilities or through the VCCP, are matters outside the scope of
this rulemaking. Moreover, to the extent the commenter is concerned
about VA electing to adopt regulatory parameters that restrict VA's
ability to provide hearing-related health care services through VCAs,
we note that the interim final rule contains no such elective
restrictions. The interim final rule authorizes VA to use VCAs to
obtain any of the types of hospital care, medical services, and
extended care services permitted by the underlying statutory authority,
38 U.S.C. 1703A.
The commenter also recommended that VA use licensed hearing aid
specialists and audiologists to provide hearing aid evaluations,
hearing aid fittings, and related services when veterans are receiving
such services through ``the Community Care Program,'' a phrase that, as
previously noted, we interpret to be a reference to the VCCP. The
matters raised in this comment, including whether and to what extent
certain specific types of providers furnish the care and services that
VA obtains for covered veterans through the VCCP, are matters outside
the scope of this rulemaking. Moreover, to the extent the commenter is
concerned about VA electing to adopt regulatory parameters that
restrict VA's ability to use VCAs to obtain care and services furnished
by licensed hearing aid specialists and audiologists, we note that the
interim final rule contains no such elective restrictions. For example,
the certification process set forth in Sec. 17.4110 of the interim
final rule contains no requirements or approval criteria that would
fundamentally preclude VA from granting certification to licensed
hearing aid specialists and audiologists or that are any more
restrictive with regard to those types of providers than they are for
any other type of provider or entity seeking certification.
In addition to providing the general comments described above, the
same commenter also suggested two changes to the text of the interim
final rule. First, the commenter suggested that VA replace the term
``medical'' in Sec. 17.4110(b)(1)(i) with the term ``health care'' so
that the licensure documentation requirement in that subparagraph
encompasses health care professionals other than physicians. In
response, we clarify that the requirement in that subparagraph to
provide documentation of ``applicable medical licenses'' does not
preclude health care professionals other than physicians from applying
for and receiving certification under Sec. 17.4110. If the applicant
does not possess a medical license, then there are no ``applicable
medical licenses'' of which the applicant must submit documentation
under that subparagraph. Moreover, we also note that under Sec.
17.4110(b)(1)(ii), VA can require applicants to submit documentation of
relevant licenses other than medical licenses. Consequently, because
the result apparently sought by the commenter--VA's certification
process accommodating the submission of documentation of licenses from
health care professionals other than physicians--is already provided
for in the existing language of the interim final rule, VA does not
adopt the change recommended in this comment. The commenter also
indicated that the payment rate parameters set forth in Sec.
17.4120(a)-(b) of the interim final rule, which are expressly tied to
Medicare payment models, should be revised to allow for the
establishment of fee schedules for services that are not within the
scope of those Medicare-related parameters, such as hearing tests for
the provision of hearing aids and related hearing aid services. In
response, VA notes that the payment rate parameters set forth in Sec.
17.4120 of the interim final rule already permit the very result that
the commenter is seeking. Under Sec. 17.4120, the rates paid by VA for
hospital care, medical services, or extended care services furnished
pursuant to a VCA are the rates set forth in the price terms of that
specific VCA, and, when the Medicare-related parameters set forth in
Sec. 17.4120(a)-(b) do not apply to the care or services at issue, VA
is permitted to establish the payment rates for such care or services
based on a fee schedule or some other formulation that is unrelated to
Medicare payment rates and methodologies. Given that the result sought
by the commenter is already permitted under the existing language of
the interim final rule, VA makes no changes based on this comment.
[[Page 50859]]
A commenter that operates a psychiatric facility raised multiple
issues. First, the commenter noted that veterans often face specialized
mental health needs, including ``combat related'' needs such as those
resulting from post-traumatic stress disorder (PTSD) or traumatic brain
injury (TBI). In light of VA's specialized experience in those clinical
areas, the commenter urged VA to share its knowledge of ``combat
related illnesses'' with mental health providers and indicated that VA
should require mental health providers furnishing care pursuant to VCAs
to be adequately trained to handle mental health needs that are unique
to or more frequently experienced by veterans. In this regard, the
commenter specifically recommended that the certification process in
Sec. 17.4110 of the interim final rule should require special training
in the area of mental health. We interpret this recommendation to mean
that such training should be required solely for mental health
providers and should pertain to those clinical areas for which VA has
special expertise, including PTSD and TBI. In response, we note that VA
agrees that it is critical for veterans to receive competent care from
qualified non-VA providers and that VA can contribute to that result in
certain instances by providing training and/or education to non-VA
providers in clinical areas for which VA has special expertise,
including PTSD and TBI. In this regard, we note that VA will take a
number of actions that will result in the provision of relevant
training and education to non-VA providers furnishing care and services
authorized pursuant to VCAs. For example, in accordance with section
133 of the MISSION Act (codified at 38 U.S.C. 1701 note), VA
established competency standards and requirements, including training
requirements, for the provision of care by non-VA providers in clinical
areas for which VA has special expertise, including PTSD and TBI. Such
requirements apply to providers furnishing care and services pursuant
to VCAs. Also, in accordance with section 123 of the MISSION Act
(codified at 38 U.S.C. 1701 note), VA established a program to provide
continuing medical education to non-VA medical professionals furnishing
care to VA beneficiaries, including pursuant to VCAs. Moreover, VA
provides appropriate oversight of care and services furnished pursuant
to VCAs as VA administers those agreements. For example, VA established
and imposed quality standards in accordance with 38 U.S.C. 1703C and
monitors and assess the quality of the care and services provided
pursuant to VCAs in accordance with 38 U.S.C. 1703A(g). However, adding
specific training requirements to the certification process in Sec.
17.4110 through the regulation process, as opposed through the VCA
agreements themselves, would not be an appropriate means of
establishing such training requirements and ensuring that non-VA
providers fulfill the appropriate training requirements prior to
furnishing mental health care that VA obtains through VCAs in clinical
areas for which VA has special expertise, including PTSD and TBI.
Training requirements for mental health providers furnishing care and
services pursuant to VCAs may need to be changed over time, potentially
quickly in certain instances, for reasons including developments in
clinical practice or new legal requirements with which VA must comply.
So, establishing training requirements in the terms of VCAs, rather
than in the certification process set forth in the final rule resulting
from this rulemaking, will ensure VA retains the flexibility to more
quickly and efficiently adjust those training requirements as
appropriate based on evolving circumstances and requirements. For the
foregoing reasons, we do not adopt the commenter's recommendation to
add a training requirement to the certification process set forth in
Sec. 17.4110 of the interim final rule.
The same commenter also provided recommendations regarding the
authority set forth in Sec. 17.4020(d) of the interim final rule,
which authorizes VA to establish payment rates exceeding the applicable
Medicare-based limitations in Sec. 17.4120(a)-(b) when VA determines
that it is not practicable to limit payment to those rates.
Specifically, the commenter recommended that the authority to make the
determinations referenced in Sec. 17.4120(d) should be delegated to
officials at individual VHA medical facilities and should not be
subject to an overly burdensome justification and approval process. In
response, VA notes that although the authority to generate
determinations referenced in Sec. 17.4120(d) of the interim final rule
is delegated to officials at individual VHA medical facilities, that
authority is circumscribed by a requirement that each such
determination must be approved by VHA's national Office of Community
Care. This centralized oversight by the Office of Community Care is
intended to enhance the effectiveness and integrity of VA's use of
VCAs, as well as the entire VCCP, by bringing that office's resources,
data, and enterprise-wide view of VCAs and the VCCP to bear in a manner
that will promote consistency and quality in how VA interprets and
applies the impracticability standard in Sec. 17.4120(d) of the
interim final rule and that will ensure VA is appropriately assessing
and accounting for the potential impacts, if any, of such
determinations on the VCCP more broadly. Consequently, VA does not make
any changes to the interim final rule based on these comments.
The same commenter also indicated that the non-VA entities and
providers furnishing care pursuant to VCAs need to be adequately
compensated on a timely basis for their services. In response, we note
that VA agrees with this comment and will work to ensure timely
payments for care and services obtained pursuant to VCAs, as required
by 38 U.S.C. 1703D. All VCAs contain payment terms that require VA to
make payment in accordance with the timeframes required by statute, so
it would serve no relevant purpose to add those same payment timeliness
requirements to this final rule. Consequently, we do not make any
changes to the interim final rule based on this comment.
The same commenter also asserted that VA must develop and partner
with a network of dedicated providers and that service-disabled veteran
owned small businesses (SDVOSB), veteran owned small businesses (VOSB),
and prior VA clinicians should be given priority. The comment indicated
that the reasons for recommending that VA prioritize utilization of
SDVOSBs and VOSBs include that veterans (which we presume refers to the
veteran owners of those businesses) have shared military experience
that improves the efficacy of counseling services provided to fellow
veterans and that such veteran owners are highly motivated, dedicated,
and willing to make sacrifices to help their fellow veterans. As it
pertains to the subject matter of this rulemaking, VCAs, we interpret
this comment recommending that VA give ``priority'' to SDVOSBs, VOSBs,
and prior VA clinicians to mean that when VA is obtaining needed
hospital care, medical services, or extended care services for a
veteran through a VCA, in accordance with the legal criteria for doing
so,\4\ two or more VCAs are feasibly available for that purpose, and
one or more of those feasibly available VCAs was entered into with an
entity that's an SDVOSB or a VOSB or with a provider that's a prior
[[Page 50860]]
VA clinician, that VA should automatically obtain the needed care or
services through one of the VCAs entered into with the entities and
providers in those classes in lieu of using any other VCAs that are
feasibly available. In response, we note that when the needed care or
services at issue are being obtained through the VCCP, the veteran is
legally permitted to select the eligible entity or provider from which
the veteran receives such care or services.\5\ So, implementing the
commenter's recommendation would not be legally feasible in that
context if the veteran opts to select the eligible entity or provider.
Moreover, if and when VA finds itself in the position of selecting from
among multiple VCAs that are feasibly available for purposes of
obtaining needed care or services, VA's determination of the
appropriate VCA to utilize will be driven by clinical considerations,
including those bearing on ensuring VA obtains timely and quality care
and services most appropriate to the specific needs of the beneficiary.
In some instances, the involvement of veterans or prior VA clinicians
in the delivery of care and services by certain entities and providers
could prove relevant to such individualized and clinically driven
determinations. However, selecting the VCA that VA will use based upon
whether the VCA was entered into with an SDVOSB, a VOSB, or a prior VA
clinician, rather than based upon a holistic and individualized
assessment of all relevant clinical considerations, including those
bearing on ensuring VA obtains timely and quality care and services
most appropriate to the specific needs of the veteran, could result in
adverse consequences, including worse health outcomes, for the veteran.
Consequently, we decline to adopt such an approach, and, for the
foregoing reasons, we make no changes to the interim final rule based
on this comment.
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\4\ As previously noted, the circumstances when VA is legally
authorized to use VCAs to obtain hospital care, medical services, or
extended care services are specified in 38 U.S.C. 1703A(a) and in
Sec. 17.4115(a) of the interim final rule.
\5\ See 38 U.S.C. 1703(g)(2) (``[VA] shall not prioritize
providers in a tier over providers in any other tier in a manner
that limits the choice of a covered veteran in selecting a health
care provider specified in subsection (c) for receipt of hospital
care, medical services, or extended care services under [the
VCCP]''); 38 CFR 17.4030 (``[a] covered veteran may specify a
particular eligible entity or provider'').
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Administrative Procedure Act
VA has considered all relevant input and information contained in
the comments submitted in response to the interim final rule (84 FR
21668) and, for the reasons set forth in the foregoing responses to
those comments, has concluded that no changes to the interim final rule
are warranted. Accordingly, based upon the authorities and reasons set
forth in the interim final rule (84 FR 21668), as supplemented by the
additional reasons provided in this document in response to comments
received, VA is adopting the provisions of the interim final rule as a
final rule with no substantive changes.
Paperwork Reduction Act
The Paperwork Reduction Act of 1995 (44 U.S.C. 3507) requires that
VA consider the impact of paperwork and other information collection
burdens imposed on the public. Except for emergency approvals under 44
U.S.C. 3507(j), VA may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays
a currently valid OMB control number. The interim final rule included
provisions constituting new collections of information under the
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521) that require
approval by the Office of Management and Budget (OMB) (the provisions
in the interim final rule are Sec. Sec. 17.4110, 17.4130, and
17.4135). Accordingly, under 44 U.S.C. 3507(d), VA submitted a copy of
the interim final rule to OMB for review, and VA requested that OMB
approve the collections of information on an emergency basis. VA did
not receive any comments on the collections of information contained in
the interim final rule. OMB approved the collections of information
under control number 2900-0872.
Regulatory Flexibility Act
The Secretary hereby certifies that this rule will not have a
significant economic impact on a substantial number of small entities
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
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 and 13563
Executive Orders 12866 and 13563 direct agencies to assess the
costs and benefits of available regulatory alternatives and, when
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, and other advantages; distributive impacts;
and equity). Executive Order 13563 (Improving Regulation and Regulatory
Review) emphasizes the importance of quantifying both costs and
benefits, reducing costs, harmonizing rules, and promoting flexibility.
OMB's Office of Information and Regulatory Affairs (OIRA) has
determined that this rule is not a significant regulatory action under
Executive Order 12866. The Regulatory Impact Analysis associated with
this rulemaking can be found as a supporting document at
<a href="http://www.regulations.gov">www.regulations.gov</a>.
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.
1532, that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in the expenditure by
State, local, and tribal governments, in the aggregate, or by the
private sector, of $100 million or more (adjusted annually for
inflation) in any one year. This final rule will have no such effect on
State, local, and tribal governments, or on the private sector.
Congressional Review Act
Pursuant to the Congressional Review Act (5 U.S.C. 801 et seq.),
OIRA designated this rule as not a major rule, as defined by 5 U.S.C.
804(2).
Catalog of Federal Domestic Assistance
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; and 64.018, Sharing Specialized Medical
Resources.
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
Denis McDonough, Secretary of Veterans Affairs, approved this
document on July 27, 2021, and authorized the undersigned to sign and
submit the document to the Office of the Federal Register for
publication
[[Page 50861]]
electronically as an official document of the Department of Veterans
Affairs.
Michael P. Shores,
Director, Office of Regulation Policy & Management, Office of General
Counsel, Department of Veterans Affairs.
Accordingly, the interim final rule amending 38 CFR part 17, which
was published at 84 FR 21668 on May 14, 2019, is adopted as final with
the following technical amendments:
PART 17--MEDICAL
0
1. The general authority citation for part 17 continues to read as
follows:
Authority: 38 U.S.C. 501, and as noted in specific sections
* * * * *
Sec. Sec. 17.4110, 17.4130, and 17.4135 [Amended]
0
2. In Sec. Sec. 17.4110, 17.4130, and 17.4135, remove the OMB
statement ``(The information collection requirements have been
submitted to the Office of Management and Budget (OMB) and are pending
OMB approval.)'' and add in its place ``(Office of Management and
Budget approved the collection of information under control number
2900-0872.)''.
[FR Doc. 2021-19470 Filed 9-10-21; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on September 13, 2021.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.