Notice2021-24571
Announcement for Public Meeting Regarding Health Care Access Standards for Veteran Community Care Program
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 15, 2021
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) is holding a public meeting to seek information from pertinent entities 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. Specifically, VA requests information, including but not limited to the following: 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 217 (Monday, November 15, 2021)</title>
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[Federal Register Volume 86, Number 217 (Monday, November 15, 2021)]
[Notices]
[Pages 63105-63107]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-24571]
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DEPARTMENT OF VETERANS AFFAIRS
Announcement for Public Meeting Regarding Health Care Access
Standards for Veteran Community Care Program
AGENCY: Department of Veterans Affairs.
ACTION: Announcement of public meeting.
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SUMMARY: The Department of Veterans Affairs (VA) is holding a public
meeting to seek information from pertinent entities 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. Specifically, VA requests
information, including but not limited to the following: 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: VA will hold the public meeting virtually on December 1, 2021.
The meeting will start at 8:30 a.m. Eastern Time (ET) and conclude at
or before 4:30 p.m. ET.
ADDRESSES: The meeting will be held virtually and recorded on the Adobe
Connect platform. Attendance will be limited to 750 individuals.
Advanced registration for a maximum capacity of 30 individuals and
groups who wish to offer oral comments, testimonies, and/or technical
remarks is required (see registration instructions below). For
listening purposes only (lines will be muted), the meeting will be
available and can be accessed at the following web link: <a href="https://vacctraining.adobeconnect.com/public-meeting-for-va-health-care-access-standards/">https://vacctraining.adobeconnect.com/public-meeting-for-va-health-care-access-standards/</a>.
VA also published a request for information (RFI) regarding health
care access standards on November 4, 2021. Per the RFI, please submit
all written comments no later than December 6, 2021. Written comments
may be submitted through <a href="http://www.regulations.gov">http://www.regulations.gov</a>. Comments should
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indicate that they are submitted in response to ``Notice of Request for
Information Regarding Health Care Access Standards.'' During the
comment period, comments may be viewed online through the Federal
Docket Management System at <a href="http://www.regulations.gov">www.regulations.gov</a>.
FOR FURTHER INFORMATION CONTACT: Natalie Frey, Management Analyst,
Office of the Assistant Under Secretary for Health for Community Care,
Veterans Health Administration, Department of Veterans Affairs, 810
Vermont Avenue NW, Washington, DC 20420; telephone: 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 (MISSION Act), Public Law 115-
182, (the VA MISSION Act) added section 1703B to title 38, United
States Code (U.S.C.), which required VA to establish access standards
for furnishing hospital care, medical services, or extended care
services to covered veterans under the Veterans Community Care Program.
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, private sector, and other
nongovernmental 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. This
public meeting serves as one of the means for VA to consult with these
entities. As noted above, VA has published an RFI in the Federal
Register to provide these entities another opportunity to provide
additional information. This RFI can be found at <a href="http://www.regulations.gov">www.regulations.gov</a>
under the title ``Notice of Request for Information Regarding Health
Care Access Standards.'' VA will use the statements and testimonials
presented at the public meeting 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).
Registration: Overall attendance in this meeting is limited to 750
individuals and overall capacity for those providing oral comments,
testimonies, and/or technical remarks will be limited to 30
individuals. Individuals wanting to offer oral comments, testimonies,
and/or technical remarks must request registration by emailing Natalie
Frey at <a href="/cdn-cgi/l/email-protection#f3bd9287929f9a96ddb581968ab38592dd949c85"><span class="__cf_email__" data-cfemail="fdb39c899c919498d3bb8f9884bd8b9cd39a928b">[email protected]</span></a> by November 22, 2021. A message confirming
that the request has been received will be sent within 2 business days,
and individuals will be notified via email by November 26, 2021,
confirming their registration and attendance. VA has the right to
refuse registration for providing oral comments, testimonies, and/or
technical remarks once the maximum capacity of 30 individuals has been
reached.
Individual Registration: VA encourages individual registrations for
those not affiliated with or representing a group, association, or
organization.
Group Registration: Identification of the name of the group,
association, or organization should be indicated in your registration
request. Due to the meeting's maximum capacity for those providing oral
comments, testimonies, and/or technical remarks at 30 individuals, VA
may limit the number of registrants from a single group to two
individuals representing the same group to allow receipt of comments,
testimonies, and/or technical remarks from a broader, more diverse
group of stakeholders. Efforts will be made to accommodate all
registrants who wish to attend. However, VA will give priority to
pertinent Federal, private sector, and non-governmental entities who
request registration before November 22, 2021, 4:00 p.m. ET. Please
provide the names of people your organization would like to attend, and
VA will accommodate as capacity allows; organizations should list names
in the order of importance of their attendance to ensure that VA allows
admission for the preferred representatives. The length of time
allotted for attendees to provide oral comments, testimonies, and/or
technical remarks during the meeting may be subject to the number of
attendees and to ensure ample time is allotted to those registered
attendees. There will be no opportunity for audio-visual presentations
during the meeting. Written comments will be accepted by those
registered (see above instructions for submitting written comments).
Audio (for listening purposes only): Attending the live audio of
the meeting is limited to the first 750 participants on a first-come,
first-served basis. Advance registration is not required. Audio
attendees will not be allowed to offer oral comments, testimonies, and/
or technical remarks, as the audio line will be muted. Written comments
will be accepted from those participating via audio (see above
instructions for submitting written comments). Please note this meeting
will be recorded.
Note: VA will conduct the public meeting informally, and
technical rules of evidence will not apply. VA will arrange for
written minutes of the meeting to be posted in the docket of the
RFI. Should it be necessary to cancel the meeting due to an
emergency, VA will take available measures to notify registered
participants.
Agenda
08:30-12:00 Morning Public Meeting Session
12:00-13:00 Lunch Break
13:00-16:30 Afternoon Public Meeting Session
16:30 Adjourn
Public Meeting Topics
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 the following:
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 following: 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 (e.g., time
or distance of travel, appointment wait times, provider/member ratios)?
If so, what are these internal standards? Has the Coronavirus Disease
2019 (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
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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 29, 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.
Consuela Benjamin,
Regulations Development Coordinator, Office of Regulation Policy &
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2021-24571 Filed 11-12-21; 8:45 am]
BILLING CODE 8320-01-P
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