Notice2021-24041
Notice of Request for Information Regarding Health Care Access Standards
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
November 4, 2021
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) is requesting information from the public to inform VA's review of access standards for furnishing hospital care, medical services and extended care services to covered veterans, for purposes of the Veterans Community Care Program (VCCP). Specifically, VA requests information regarding access standards, including but not limited to, information regarding health plans on the use of access standards for the design of health plan provider networks; referrals from network providers to out-of- network providers; the appeals process for exemptions from benefit limits to out-of-network providers; and the measurement of performance against Federal or State regulatory standards. Further, VA is requesting input on Veterans' experience with the access standards established in 2019.
Full Text
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<title>Federal Register, Volume 86 Issue 211 (Thursday, November 4, 2021)</title>
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[Federal Register Volume 86, Number 211 (Thursday, November 4, 2021)]
[Notices]
[Pages 60970-60971]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-24041]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information Regarding Health Care Access
Standards
AGENCY: Department of Veterans Affairs.
ACTION: Request for information.
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SUMMARY: The Department of Veterans Affairs (VA) is requesting
information from the public to inform VA's review of access standards
for furnishing hospital care, medical services and extended care
services to covered veterans, for purposes of the Veterans Community
Care Program (VCCP). Specifically, VA requests information regarding
access standards, including but not limited to, information regarding
health plans on the use of access standards for the design of health
plan provider networks; referrals from network providers to out-of-
network providers; the appeals process for exemptions from benefit
limits to out-of-network providers; and the measurement of performance
against Federal or State regulatory standards. Further, VA is
requesting input on Veterans' experience with the access standards
established in 2019.
DATES: Comments must be received on or before December 6, 2021.
ADDRESSES: Comments may be submitted through <a href="http://www.regulations.gov">www.regulations.gov</a>.
Comments should indicate that they are submitted in response to
``Notice of Request for Information Regarding Health Care Access
Standards.''
FOR FURTHER INFORMATION CONTACT: Natalie Frey, Management Analyst,
Office of the Assistant Under Secretary for Health, Office of Community
Care, Veterans Health Administration, Department of Veterans Affairs,
810 Vermont Avenue NW, Washington, DC 20420; 720-429-9171. This is not
a toll-free number.
SUPPLEMENTARY INFORMATION: 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, (VA
MISSION Act of 2018) added section 1703B to title 38, United States
Code, which required VA to establish access standards for furnishing
hospital care, medical services or extended care services to covered
Veterans under VCCP. VA established these access standards through
rulemaking on June 6, 2019, at 38 CFR 17.4040. Section 1703B(c)
specifically requires VA to consult with all pertinent Federal
entities, entities in the private sector
[[Page 60971]]
and other non-governmental entities in establishing access standards.
Section 1703B(e) requires VA, not later than 3 years after the date on
which VA establishes access standards, and not less frequently than
once every 3 years thereafter, to conduct a review of the established
access standards and submit to the appropriate committees of Congress a
report on the findings and any modification to the access standards. In
reviewing these access standards, VA is choosing to consult with
pertinent Federal, private sector and non-governmental entities. VA
will use the comments received to help review the access standards
established in June 2019. VA will then submit a report (in June 2022),
as required by section 1703B(e)(2). Responses to this notice will
support industry research and VA's evaluation of access standards.
This notice is a request for information only. Commenters are
encouraged to provide complete, but concise responses to the questions
outlined below. VA may choose to contact individual commenters, and
such communications would serve to further clarify their written
comments.
Request for Information: VA requests information that will assist
in reviewing the access standards, as required by section 1703B. This
includes information regarding access standards, including but not
limited to, information with regard to health plans on the use of
access standards for the design of health plan provider networks;
referrals from network providers to out-of-network providers; the
appeals process for exemptions from benefit limits to out-of-network
providers; and the measurement of performance against Federal or State
regulatory standards. Regarding health systems, VA requests information
from the public including, but not limited to, the existence of
standards for appointment wait times; the use of travel distance for
establishing service areas; the development or use of guidelines to
refer patients to out-of-system providers; the utilization of virtual
health services; and the measurement of performance against Federal or
State regulatory standards. VA's specific requests for information are
as follows:
1. Do health plans use internal access standards for the design of
provider networks and the application of in-network/out-of-network
benefits that are more stringent than regulatory standards (time or
distance of travel, appointment wait times, provider/member ratios)? If
so, what are these internal standards? Has the COVID-19 pandemic
affected established access standards? How does the health plan measure
performance against regulatory and internal access standards? How does
the health plan respond to findings when access standards are not being
met? Are current regulatory access standards cost-effective while
maintaining quality standards? Do health plans have a process to handle
routine requests from members or to refer providers for exemptions to
benefit limits when members seek out-of-network care or a lower tier
provider?
2. Do health plans allow for appeals, by providers or members, to
request exemptions from benefit limits related to out-of-network care
or care by a lower tier provider? Is external review allowed for such
appeals?
3. What are health plan practices regarding internal, regulatory
and/or accreditation standards for appointment wait times, including
variance by specialty or type of service? How does the health plan use
travel distance or time, and/or provider-to-population ratios, in
deciding which geographic areas to consider as primary or secondary
service areas? How do health plans use financial modeling/impact to
inform established access standards?
4. What virtual health services (e.g., telehealth and telephonic)
do health systems provide? Are virtual health services used to ensure
compliance with established access standards?
5. Are clinicians within the health system given guidelines or
rules on when to refer patients to out-of-system providers? For
example, are clinicians encouraged to refer out-of-system if in-system
wait times are longer than standard; travel time or distance to an in-
system provider is too long; the patient's ability to travel is
compromised; or the frequency of treatment makes travel to an in-
network provider difficult?
6. What are Veterans' experiences with, and feedback on, the VA
access standards established in 2019?
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved this
document on October 6, 2021, 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.
Michael P. Shores,
Director, Office of Regulation Policy & Management, Office of General
Counsel, Department of Veterans Affairs.
[FR Doc. 2021-24041 Filed 11-3-21; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on November 4, 2021.
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