Proposed Rule2023-00364
Copayment Exemption for Indian Veterans
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
January 12, 2023
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) proposes to amend its medical regulations to implement a statute exempting Indian and urban Indian veterans from copayment requirements for the receipt of hospital care or medical services, including the initial three urgent care visits in a calendar year, under laws administered by VA.
Full Text
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<title>Federal Register, Volume 88 Issue 8 (Thursday, January 12, 2023)</title>
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[Federal Register Volume 88, Number 8 (Thursday, January 12, 2023)]
[Proposed Rules]
[Pages 2038-2046]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-00364]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AR48
Copayment Exemption for Indian Veterans
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
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SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its
medical regulations to implement a statute exempting Indian and urban
Indian veterans from copayment requirements for the receipt of hospital
care or medical services, including the initial three urgent care
visits in a calendar year, under laws administered by VA.
DATES: Comments must be received on or before February 13, 2023.
ADDRESSES: Comments must be submitted through <a href="http://www.regulations.gov">www.regulations.gov</a>.
Except as provided below, comments received before the close of the
comment period will be available at <a href="http://www.regulations.gov">www.regulations.gov</a> for public
viewing, inspection, or copying, including any personally identifiable
or confidential business information that is included in a comment. We
post the comments received before the close of the comment period on
the following website as soon as possible after they have been
received: <a href="http://www.regulations.gov">http://www.regulations.gov</a>. VA will not post on
<a href="http://Regulations.gov">Regulations.gov</a> public comments that make threats to individuals or
institutions or suggest that the commenter will take actions to harm
the individual. VA encourages individuals not to submit duplicative
comments. We will post acceptable comments from multiple unique
commenters even if the content is identical or nearly identical to
other comments. Any public comment received after the comment period's
closing date is considered late and will not be considered in the final
rulemaking.
FOR FURTHER INFORMATION CONTACT: Mark Upton, Acting Deputy to the
Deputy Under Secretary for Health, Office of the Deputy Under Secretary
for Health (10A), 810 Vermont Avenue NW, Washington, DC 20420, 202-461-
7459. (This is not a toll-free telephone number.)
SUPPLEMENTARY INFORMATION: Pursuant to section 1730A of title 38,
United States Code (U.S.C.), catastrophically disabled veterans are
exempt from copayment for the receipt of hospital care or medical
services under laws administered by VA. On January 5, 2021, the
President signed into law the Johnny Isakson and David P. Roe, M.D.
Veterans Health Care and Benefits Improvement Act of 2020 (the
``Act''). Public Law 116-315. Section 3002 of the Act amended section
1730A to add a copayment exemption for veterans who are either Indian
or urban Indian, as those terms are defined in section 4 of the Indian
Health Care Improvement Act. This amendment to section 1730A took
effect one year after the date of enactment of the Act (that is, the
statutory amendment became effective on January 5, 2022). In accordance
with 38 U.S.C. 1730A, this rulemaking is using the terms Indian and
urban Indian as provided in 38 U.S.C. 1730A and as defined in 25 U.S.C.
1603(13) and (28). This rulemaking proposes to revise several VA
regulations concerning copayment exemptions to be consistent with the
amendment made to 38 U.S.C. 1730A by section 3002 of the Act.
Definitions of Indian and Urban Indian
As explained above, section 3002 of the Act defines Indian and
urban Indian based on those terms' definitions in section 4 of the
Indian Health Care Improvement Act for purposes of copayment exemption
under 38 U.S.C. 1730A. Section 4 of the Indian Health Care Improvement
Act is codified at 25 U.S.C. 1603, and the definitions for Indian and
urban Indian are located in paragraphs 13 and 28, respectively, of
section 1603.
Paragraph 13 of section 1603 defines the term Indians or Indian as
any person who is a member of an Indian tribe, as that term is further
defined in section 1603(14), except that, for the purpose of 25 U.S.C.
1612 and 1613, such terms
[[Page 2039]]
shall mean any individual who: (1) irrespective of whether he or she
lives on or near a reservation, is a member of a tribe, band, or other
organized group of Indians, including those tribes, bands, or groups
terminated since 1940 and those recognized now or in the future by the
State in which they reside, or who is a descendant, in the first or
second degree, of any such member; (2) is an Eskimo or Aleut or other
Alaska Native; (3) is considered by the Secretary of the Interior to be
an Indian for any purpose; or (4) is determined to be an Indian
pursuant to regulations promulgated by the Secretary of Health and
Human Services.
Section 1603(13) refers to members of an Indian tribe in the
definition of Indian. Section 1603(14) defines Indian tribe to mean any
Indian tribe, band, nation, or other organized group or community,
including any Alaska Native village or group or regional or village
corporation as defined in or established pursuant to the Alaska Native
Claims Settlement Act (85 Stat. 688) [43 U.S.C. 1601 et seq.], which is
recognized as eligible for the special programs and services provided
by the United States to Indians because of their status as Indians. For
purposes of this rulemaking, when VA uses the term Indian tribe in this
rulemaking, it is doing so to be consistent with, and to incorporate,
the definition of Indian tribe in section 1603(14).
Paragraph 28 of section 1603 defines the term urban Indian as any
individual who resides in an urban center (as such term is further
defined in section 1603(27)) and who meets at least one or more of the
four criteria in the definition of Indian in 25 U.S.C. 1603(13) (as
described above in a previous paragraph regarding the definition of
Indians or Indian).
For purposes of implementing the copayment exemption for Indian and
urban Indian veterans as required by 38 U.S.C. 1730A, VA is using the
definitions of Indian and urban Indian in 25 U.S.C. 1603(13) and (28).
Doing so ensures that VA is adhering to the statutory definitions
referenced in section 1730A and will allow VA to immediately implement
any changes made by Congress to those definitions without requiring
amendment to the definitions of Indian and urban Indian in VA's medical
regulations. As explained subsequently in this rulemaking, we propose
to revise Sec. Sec. 17.108, 17.110, 17.111 and 17.4600 of title 38,
Code of Federal Regulations (CFR) to include these definitions of
Indian and urban Indian under section 1603(13) and (28).
Documentation
In identifying ways in which VA could determine whether a veteran
meets the definition of Indian or urban Indian under 25 U.S.C. 1603(13)
and (28) for purposes of copayment exemption under 38 U.S.C. 1730A, VA
sought input and guidance from American Indian and Alaska Native tribal
governments and individuals who may be considered to meet the
definition of Indian and urban Indian under section 1730A. On April 1,
2021, VA published a Federal Register (FR) notice of a virtual tribal
consultation session scheduled for April 29, 2021, regarding
documentation that can be used by VA's health care system to identify
those veterans who are considered to meet the definition of the terms
Indian and urban Indian under section 1730A. See 86 FR 17267. The
Federal Register notice further explained that related written comments
may also be submitted to VA before May 29, 2021. Ninety-six
individuals, including representatives from American Indian and Alaska
Native tribal governments and veterans, attended the virtual
consultation session on April 29, 2021, and more than twenty attendees
provided feedback during the session. VA also received eighteen written
comments from various sources including American Indian and Alaska
Native tribal governments and American Indian and Alaska Native health
organizations.
The majority of the comments, including comments from American
Indian and Alaska Native tribal governments, supported submission of
documentation (e.g., tribal letter, tribal enrollment card, Certificate
of Degree of Indian Blood, enhanced tribal identification card, kinship
report). Some commenters supported veteran self-certification. Some
commenters recommended American Indian and Alaska Native tribal
governments determine the documentation VA should accept, rather than
VA determining the appropriate documentation. Other commenters
recommended VA adopt the same documentation requirements of the Indian
Health Service (IHS).
A recording of the April 29, 2021, virtual consultation session can
be found at: <a href="https://vacctraining.adobeconnect.com/pz8n69p0aov1/">https://vacctraining.adobeconnect.com/pz8n69p0aov1/</a>. The
written comments received from this notice are publicly available
online at <a href="http://www.regulations.gov">www.regulations.gov</a>.
Based on the feedback VA received from consultation that supported
requiring veterans submit documentation, VA proposes that, for purposes
of exempting from copayment veterans who meet the definition of the
terms Indian and urban Indian under section 1730A, VA will require
documentation from a veteran that they are an Indian or urban Indian as
those terms are defined in 25 U.S.C. 1603(13) and (28). VA proposes to
require documentation as this recognizes tribal sovereignty and
promotes the Nation-to-Nation relationship that exists between the
United States and tribal governments. As the vast majority of comments
from American Indian and Alaska Native tribal governments supported
documentation, requiring documentation would be consistent with the
preferences of tribal leaders. American Indian and Alaska Native tribal
governments recognize their members and provide individual members with
documentation to recognize that they are members of an American Indian
and Alaska Native tribe. This approach would acknowledge each tribal
government's right to determine their tribal membership and how best to
substantiate it.
Further, requiring veterans to submit documentation would also
align with how other Federal agencies, such as IHS, determine
eligibility for benefits or services. When determining eligibility for
benefits or service based on status as a member of an American Indian
or Alaska Native tribe, Federal agencies may accept documentation
issued by American Indian and Alaska Native tribal governments to
tribal members to show membership in the tribe. VA would defer to the
American Indian and Alaska Native tribal governments with respect to
the documentation showing who is a tribal member, as described later in
this discussion which, as noted above, is consistent with IHS
practices. While some commenters suggested American Indian and Alaska
Native tribal governments determine the documentation that is required
to meet the definitions of Indian and urban Indian under 25 U.S.C.
1603(13) and (28), part of VA's responsibility is to ensure that those
who are eligible for the copayment exemption under 38 U.S.C. 1730A
receive that benefit and that the documentation submitted meets the
definitions in the law. VA reiterates that it would defer to the
American Indian and Alaska Native tribal governments as to the
documentation that they provide to their members to submit to VA to
demonstrate they meet those definitions of Indian and urban Indian.
While some commenters supported self-attestation, VA believes that
self-attestation presents an unreasonable risk
[[Page 2040]]
that VA would provide the copayment exemption to veterans who do not
meet the legal definition of Indian or urban Indian under section
1603(13) and (28) as the definition of Indian and urban Indian under
section 1603(13) and (28) may be inaccurately interpreted by veterans.
This confusion and misunderstanding of whether a veteran would meet the
definition of Indian or urban Indian may result in good-faith but
mistaken self-attestations resulting in VA paying benefits to
individuals who are not eligible. Requiring documentation rather than
self-attestation would allow VA to ensure through audits that it is
fulfilling its duty to only exempt those veterans who are eligible
pursuant to section 1730A. For these reasons, VA believes documentation
would be appropriate to ensure that this copayment exemption is
administered only to veterans eligible for it under 38 U.S.C. 1730A.
Documentation VA proposes to accept to verify an individual meets
the definition of Indian or urban Indian under 25 U.S.C. 1603(13) and
(28) would be as follows:
(1) Documentation issued by a federally-recognized Indian tribe
that shows that a veteran is a member of the tribe;
(2) Documentation showing that the veteran, irrespective of whether
they live on or near a reservation, is a member of a tribe, band, or
other organized group of Indians terminated since 1940 and those
recognized now or in the future by the State in which they reside, or
who is a descendant, in the first or second degree, of any such member;
(3) Documentation showing that the veteran is an Eskimo or Aleut or
other Alaska Native;
(4) Documentation issued by the U.S. Department of the Interior
(DOI) showing that the veteran is considered by DOI to be an Indian for
any purpose;
(5) Documentation showing that the veteran is considered by the
U.S. Department of Health and Human Services (HHS) to be an Indian
under that Department's regulations;
(6) Documentation showing that the veteran resides in an urban
center and meets one or more of the following criteria:
(a) Irrespective of whether they live on or near a reservation, is
a member of a tribe, band, or other organized group of Indians,
including those tribes, bands, or groups terminated since 1940 and
those recognized now or in the future by the State in which they
reside, or who is a descendant, in the first or second degree, of any
such member;
(b) Is an Eskimo or Aleut or other Alaska Native;
(c) Is considered by DOI to be an Indian for any purpose; or
(d) Is considered by HHS to be an Indian under that Department's
regulations.
VA believes that all veterans who are Indian and urban Indian
pursuant to the definitions in 25 U.S.C. 1603(13) and (28) would be
able to obtain and submit to VA the documents listed above that are
applicable to their status in order to establish their status as Indian
or urban Indian. It is important to note that any documentation
submitted to VA would be safeguarded and protected consistent with all
applicable privacy and security laws.\1\ As American Indian and Alaska
Native tribal governments issue a variety of documents to demonstrate
an individual's membership in a federally-recognized Indian tribe, VA
would accept documentation issued by a federally-recognized Indian
tribe that shows that a veteran is a member of the tribe. This would
include, for example, cards issued by a federally-recognized Indian
tribe showing that the veteran is a member of that tribe or
documentation issued by a federally-recognized Indian tribe on tribal
letterhead that shows that a veteran is a member of the tribe.
Submission of such documentation would be required to show that a
veteran meets the definition of Indian in 25 U.S.C. 1603(13). VA notes
that as explained previously, VA proposes to use the definition of
Indian tribe in 25 U.S.C. 1603(14) for purposes of defining the term
Indian tribe.
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\1\ VA's privacy policy--www.va.gov/privacy-policy/.
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VA would accept documentation showing that the veteran,
irrespective of whether they live on or near a reservation, is a member
of a tribe, band, or other organized group of Indians terminated since
1940 and those recognized now or in the future by the State in which
they reside, or who is a descendant, in the first or second degree, of
any such member. Submission of such documentation would show that a
veteran meets the definition of Indian in 25 U.S.C. 1603(13),
specifically that the individual, irrespective of whether they live on
or near a reservation, is a member of a tribe, band, or other organized
group of Indians terminated since 1940 and those recognized now or in
the future by the State in which they reside, or who is a descendant,
in the first or second degree, of any such member. See 25 U.S.C.
1603(13)(A). This would include those veterans who are members of a
State-recognized Indian tribe or formerly federally-recognized Indian
tribe.
VA would accept documentation showing that the veteran is an Eskimo
or Aleut or other Alaska Native. Submission of such documentation would
show that a veteran meets the definition of Indian in 25 U.S.C.
1603(13), specifically that the individual is an Eskimo or Aleut or
other Alaska Native. See 25 U.S.C. 1603(13)(B).
DOI and HHS issue documentation that may show a veteran meets the
definition of Indian. Thus, VA would accept documentation issued by DOI
that shows that the veteran is considered by DOI to be an Indian for
any purpose. Submission of such documentation would show that a veteran
meets the definition of Indian in 25 U.S.C. 1603(13), specifically that
the individual is considered by the Secretary of Interior to be an
Indian for any purpose. See 25 U.S.C. 1603(13)(C). VA would also accept
documentation that shows that the veteran is considered by HHS to be an
Indian under that Department's regulations. Submission of such
documentation would show that a veteran meets the definition of Indian
in 25 U.S.C. 1603(13), specifically that the individual is determined
to be an Indian under regulations promulgated by the Secretary [of
HHS]. See 25 U.S.C. 1603(13)(D).
To be eligible for the copayment exemption under 38 U.S.C. 1730A,
veterans would also be able to submit documentation showing that they
reside in an urban center and meet one or more of the following
criteria: (a) Irrespective of whether they live on or near a
reservation, is a member of a tribe, band, or other organized group of
Indians, including those tribes, bands, or groups terminated since 1940
and those recognized now or in the future by the State in which they
reside, or who is a descendant, in the first or second degree, of any
such member; (b) Is an Eskimo or Aleut or other Alaska Native; (c) is
considered by DOI to be an Indian for any purpose; or (d) Is considered
by HHS to be an Indian under HHS regulations. Submission of such
documentation would show that a veteran meets the definition of urban
Indian in 25 U.S.C. 1603(28). As the definition of urban Indian in
section 1603(28) refers to and incorporates (A) through (D) of the
definition of Indian in section 1603(13), VA acknowledges that urban
Indians would be able to meet both the definition of Indian and urban
Indian and would be able to submit documentation that shows they meet
both of these definitions. However,
[[Page 2041]]
a veteran would only be required to submit documentation that show that
they meet one definition. VA believes the proposed list of
documentation to show a veteran meets the definition of Indian would
likely capture those who meet the definition of urban Indian. However,
to be consistent with 38 U.S.C. 1730A, VA would add a separate category
of documentation for those veterans that meet the definition of urban
Indian under section 1603(28). VA seeks input during the comment period
from Indian and urban Indian veterans and American Indian and Alaska
Native tribal governments on whether there is any other documentation
VA should consider including in this proposed list of documentation to
show that a veteran meets the definition of urban Indian.
This new copayment exemption would not be automatic; regardless of
whether a veteran is already enrolled in VA health care or is enrolling
in VA health care for the first time, the veteran would need to submit
documentation to VA. Until veterans submit documentation that confirms
that they meet the definition of the term Indian or urban Indian under
25 U.S.C. 1603(13) and (28), VA would be unable to exempt such veterans
from copayments. However, once the documentation is submitted and
processed, VA would exempt the veteran from copayments unless and until
they notify VA that they no longer meet the definition of Indian or
urban Indian under section 1603(13) and (28) or VA determines that the
veteran does not meet the definition of Indian or urban Indian as
defined in section 1603(13) and (28).
Covered Services
As previously discussed, 38 U.S.C. 1730A exempted those veterans
determined to be catastrophically disabled from copayments for hospital
care and medical services prior to the Act. Section 3002 of the Act
amended section 1730A to add veterans who meet the definition of the
terms Indian and urban Indian as covered veterans exempt from
copayments for hospital care and medical services. VA considers the
terms hospital care and medical services as defined in 38 U.S.C.
1701(5) and (6) and in 38 CFR 17.30(a).
The copayment exemptions for catastrophically disabled veterans, as
authorized under 38 U.S.C. 1730A, were implemented in 38 CFR 17.108,
17.110, and 17.111. Section 17.108 sets forth the copayments for
inpatient hospital care and outpatient medical care and exempts
catastrophically disabled veterans from copayments for such care.
Section 17.110 sets forth the copayments for medication provided by VA
on an outpatient basis (other than medication administered during
treatment) and exempts catastrophically disabled veterans from
copayments for such medication. Section 17.111 sets forth the
copayments for extended care services and exempts catastrophically
disabled veterans from copayments for adult day health care,
noninstitutional geriatric evaluation, and noninstitutional respite
care.
In addition to ``hospital care'' and ``medical services,'' veterans
exempted from copayments under section 1730A are also exempt from
copayments for at least two visits to qualifying non-Department
providers for urgent care in a year. See 38 U.S.C. 1725A(f)(1)(B).
However, VA has the authority to require copayments for this care for
such veterans after the second urgent care visit in a year. Id. VA has
exercised this authority and requires veterans otherwise exempt from
copayments, including veterans exempt pursuant to 38 U.S.C. 1730A, to
pay copayments for urgent care from qualifying non-Department providers
after the third urgent care visit in a calendar year. The copayments
for urgent care under 38 U.S.C. 1725A are established separately in
Sec. 17.4600(d).
VA utilizes the authority provided under section 1725A to require
copayments for all veterans, irrespective of their priority group in VA
enrollment, level of service-connected disability, or designation as
catastrophically disabled, after the first three visits in a calendar
year because the copayment is designed to encourage appropriate use of
the benefit. Collecting a copayment after the third visit helps ensure
that the urgent care benefit is utilized appropriately and is not being
used as a substitute for primary care. Copayments are a common feature
of health care, including VA health care, and are an important
mechanism for guiding behavior to ensure that patients receive care at
an appropriate location. The urgent care copayment is designed to
encourage all veterans to seek care from VA first, when VA can provide
the needed care, and to utilize urgent care when prompt treatment is
necessary to prevent the condition from becoming emergent. Urgent care
is considered to be a convenient option for care but is not intended to
be used as a substitute for traditional primary care that emphasizes
longitudinal management and care coordination.
As section 3002 of the Act amended 38 U.S.C. 1730A to include
veterans who meet the definition of the terms Indian and urban Indian
as copayment exempt, with no distinction between this new cohort and
those considered catastrophically disabled with regards to the care for
which these copayments are exempted, VA would interpret the copayment
exemption for veterans who meet the definition of the terms Indian and
urban Indian under section 1730A the same as VA has for
catastrophically disabled veterans. Thus, as explained later in this
discussion, VA proposes to amend 38 CFR 17.108, 17.110, and 17.111 to
include veterans who meet the definition of the terms Indian and urban
Indian as exempt from copayment for inpatient hospital care, outpatient
medical care, outpatient medications, adult day health care,
noninstitutional geriatric evaluation, and noninstitutional respite
care. However, these veterans would still be required to pay copayments
for domiciliary care, institutional respite care, institutional
geriatric evaluation, and nursing home care. Similarly, consistent with
how VA applies copayment exemptions for catastrophically disabled
veterans for urgent care visits, VA proposes to amend the urgent care
copayment regulation at Sec. 17.4600(d)(1) to include veterans who
meet the definition of the terms Indian and urban Indian to ensure that
these veterans are not charged a copayment until their fourth urgent
care visit.
The changes VA proposes to make to 38 CFR part 17 are explained in
more detail below in the section describing the regulations proposed to
be amended.
Retroactive Copayment Reimbursement
In order to allow time for veterans to learn about this new benefit
and submit to VA documentation that verifies they meet the definition
of Indian or urban Indian under 25 U.S.C. 1603(13) and (28), VA
proposes to reimburse Indian and urban Indian veterans for copayments
paid to VA for hospital care, medical services, and urgent care
provided on or after January 5, 2022, if they would have been exempt
from making such copayments if this regulation had been in effect. This
would also allow these veterans to be reimbursed for copayments that
were paid for such care provided on or after January 5, 2022,
irrespective of when this rulemaking is published and effective or when
these veterans submit their documentation for processing.
After a veteran submits to VA the required documentation, VA would
review the documentation to determine if the veteran meets the
definition of Indian or urban Indian in 25 U.S.C. 1603(13) and (28). If
the veteran meets the definition of Indian or urban Indian under 25
U.S.C. 1603(13) and (28), the veteran's record would be updated to
[[Page 2042]]
reflect their Indian or urban Indian status so that future copays are
not charged. VA would then process reimbursement payments for any
copayments that were paid for hospital care, medical services, and
urgent care provided on or after January 5, 2022. VA would not require
veterans to submit claims for reimbursement of copayments for such
care. However, veterans would not be prohibited from submitting claims
for reimbursement. If VA would be unable to determine the veteran meets
the definition of Indian or urban Indian as defined in 25 U.S.C.
1603(13) and (28) based on the submitted documentation, VA would notify
the veteran of such determination.
Regulations To Be Amended
As previously explained, VA has implemented regulations concerning
copayments for hospital care and medical services at 38 CFR 17.108,
17.110, 17.111, and 17.4600. In this rulemaking, VA proposes to amend
these regulations to align with the statutory requirement to exempt
from copayment veterans who are an Indian or urban Indian as those
terms are defined in section 4 of the Indian Health Care Improvement
Act.
Section 17.108
Copayments for inpatient hospital care and outpatient medical care
are established in 38 CFR 17.108. Paragraph (d) of Sec. 17.108 lists
categories of veterans who are not subject to the copayment
requirements of this section. VA proposes to amend Sec. 17.108(d) by
adding a new paragraph (14). Proposed paragraph (14) explains that a
veteran who meets the definition of Indian or urban Indian, as defined
in 25 U.S.C. 1603(13) and (28), would be exempt from copayment under
this section. In addition, it would include language explaining that
the exemption is applicable for care provided on or after January 5,
2022. This is consistent with 38 U.S.C. 1730A, as amended by section
3002 of the Act which exempts these veterans from copayments for care
received on or after January 5, 2022.
Proposed paragraph (14) would further inform veterans that to
demonstrate they meet the definition of Indian or urban Indian in 25
U.S.C. 1603(13) and (28), they must submit to VA any of the following
documentation: (i) documentation issued by a federally-recognized
Indian tribe that shows that the veteran is a member of the tribe; (ii)
documentation showing that the veteran, irrespective of whether they
live on or near a reservation, is a member of a tribe, band, or other
organized group of Indians terminated since 1940 and those recognized
now or in the future by the State in which they reside, or who is a
descendant, in the first or second degree, of any such member; (iii)
documentation showing that the veteran is an Eskimo or Aleut or other
Alaska Native; (iv) documentation issued by DOI showing that the
veteran is considered by DOI to be an Indian for any purpose; (v)
documentation showing that the veteran is considered by HHS to be an
Indian under that Department's regulations; or (vi) documentation
showing that the veteran resides in an urban center and meets one or
more of the following criteria: (A) irrespective of whether they live
on or near a reservation, is a member of a tribe, band, or other
organized group of Indians, including those tribes, bands, or groups
terminated since 1940 and those recognized now or in the future by the
State in which they reside, or who is a descendant, in the first or
second degree, of any such member; (B) is an Eskimo or Aleut or other
Alaska Native; (C) is considered by DOI to be an Indian for any
purpose; or (D) is considered by the HHS to be an Indian under that
Department's regulations.
VA also proposes to amend Sec. 17.108 by adding a new paragraph
(g) to explain that after VA determines the documentation submitted by
the veteran meets paragraph (d)(14) and updates the veteran's record to
reflect the veteran's status as an Indian or urban Indian, VA would
reimburse veterans exempt under paragraph (d)(14) of this section for
any copayments that were paid to VA for inpatient hospital care and
outpatient medical care provided on or after January 5, 2022, if they
would have been exempt from making such copayments if this regulation
had been in effect.
Section 17.110
Copayments for medications are established in 38 CFR 17.110.
Paragraph (c) of Sec. 17.110 lists medications that are not subject to
the copayment requirements of this section. Similar to the proposed
amendments to Sec. 17.108, VA proposes to amend Sec. 17.110(c) by
adding paragraph (13) to include as exempt from copayment under such
section a veteran who meets the definition of Indian or urban Indian,
as defined in 25 U.S.C. 1603(13) and (28), for medications provided on
or after January 5, 2022.
In addition, VA would include in proposed Sec. 17.110(c)(13) the
same language under Sec. 17.108(d)(14) to inform veterans that to
demonstrate they meet the definition of Indian or urban Indian in 25
U.S.C. 1603(13) and (28), the veteran must submit to VA any of the
following documentation: (i) documentation issued by a federally-
recognized Indian tribe that shows that the veteran is a member of the
tribe; (ii) documentation showing that the veteran, irrespective of
whether they live on or near a reservation, is a member of a tribe,
band, or other organized group of Indians terminated since 1940 and
those recognized now or in the future by the State in which they
reside, or who is a descendant, in the first or second degree, of any
such member; (iii) documentation showing that the veteran is an Eskimo
or Aleut or other Alaska Native; (iv) documentation issued by DOI
showing that the veteran is considered by DOI to be an Indian for any
purpose; (v) documentation showing that the veteran is considered by
HHS to be an Indian under that Department's regulations; or (vi)
documentation showing that the veteran resides in an urban center and
meets one or more of the following criteria: (A) irrespective of
whether they live on or near a reservation, is a member of a tribe,
band, or other organized group of Indians, including those tribes,
bands, or groups terminated since 1940 and those recognized now or in
the future by the State in which they reside, or who is a descendant,
in the first or second degree, of any such member; (B) is an Eskimo or
Aleut or other Alaska Native; (C) is considered by DOI to be an Indian
for any purpose; or (D) is considered by HHS to be an Indian under that
Department's regulations.
VA also proposes to add paragraph (d) to Sec. 17.110 to state that
after VA determines the documentation submitted by the veteran meets
paragraph (c)(13) and updates the veteran's record to reflect the
veteran's status as an Indian or urban Indian, VA would reimburse
veterans exempt under paragraph (c)(13) of this section for any
copayments that were paid to VA for medications provided on or after
January 5, 2022 if they would have been exempt from making such
copayments if this regulation had been in effect.
Section 17.111
Copayments for extended care services are established in Sec.
17.111. Section 17.111(f) lists categories of veterans and care that
are not subject to the copayment requirements of this section. While 38
U.S.C. 1730A only exempts Indian and urban Indian veterans from
copayments for hospital care and medical services, noninstitutional
extended care services are included in the definition of medical
[[Page 2043]]
services. 38 U.S.C. 1701(6)(E); 38 CFR 17.38(a)(1)(xi). Similar to the
proposed amendments to Sec. Sec. 17.108 and 17.110, VA proposes to add
a new paragraph (11) to Sec. 17.111(f) to include, as exempt from
copayment under such section, a veteran who meets the definition of
Indian or urban Indian, as defined in 25 U.S.C. 1603(13) and (28), for
adult day health care, noninstitutional respite care, and
noninstitutional geriatric evaluation provided on or after January 5,
2022.
VA also proposes to add language to inform veterans that to
demonstrate they meet the definition of Indian or urban Indian in 25
U.S.C. 1603(13) and (28), they must submit to VA any of the following
documentation: (i) documentation issued by a federally-recognized
Indian tribe that shows that the veteran is a member of the tribe; (ii)
documentation showing that the veteran, irrespective of whether they
live on or near a reservation, is a member of a tribe, band, or other
organized group of Indians terminated since 1940 and those recognized
now or in the future by the State in which they reside, or who is a
descendant, in the first or second degree, of any such member; (iii)
documentation showing that the veteran is an Eskimo or Aleut or other
Alaska Native; (iv) documentation issued by DOI showing that the
veteran is considered by DOI to be an Indian for any purpose; (v)
documentation showing that the veteran is considered by HHS to be an
Indian under that Department's regulations; or (vi) documentation
showing that the veteran resides in an urban center and meets one or
more of the following criteria: (A) irrespective of whether they live
on or near a reservation, is a member of a tribe, band, or other
organized group of Indians, including those tribes, bands, or groups
terminated since 1940 and those recognized now or in the future by the
State in which they reside, or who is a descendant, in the first or
second degree, of any such member; (B) is an Eskimo or Aleut or other
Alaska Native; (C) is considered by DOI to be an Indian for any
purpose; or (D) is considered by HHS to be an Indian under that
Department's regulations.
VA proposes to add a new paragraph (g) to 38 CFR 17.111 to explain
that after VA determines the documentation submitted by the veteran
meets paragraph (f)(11) and updates the veteran's record to reflect the
veteran's status as an Indian or urban Indian, VA would reimburse
veterans exempt under paragraph (f)(11) of this section for any
copayments that were paid to VA for adult day health care,
noninstitutional respite care, and noninstitutional geriatric
evaluation provided on or after January 5, 2022, if they would have
been exempt from making such copayments if this regulation had been in
effect.
Section 17.4600
VA also proposes to amend 38 CFR 17.4600 for purposes of urgent
care visits. Pursuant to 38 U.S.C. 1725A(f)(1)(B), an eligible veteran
not required to pay a copayment under title 38, U.S.C., may access
urgent care without a copayment for the first two visits in a calendar
year. For any additional visits, a copayment at an amount determined by
VA may be required. The implementing regulation for 38 U.S.C. 1725A is
38 CFR 17.4600. Section 17.4600(d)(1)(i) explains that certain veterans
are exempt from copayment for the first three urgent care visits in a
calendar year, but must pay a copayment after those first three visits.
VA has determined that a veteran who meets the definition of Indian or
urban Indian in 25 U.S.C. 1603(13) and (28), based on the documentation
the veteran has submitted, should not be required to pay a copayment
for the first three visits in a calendar year. This would be consistent
with how VA implements copayments for urgent care visits by
catastrophically disabled veterans. VA proposes to amend 38 CFR
17.4600(d)(1) by redesignating current paragraph (ii) as (iii) and
adding new paragraph (ii) to exempt from copayment the initial three
urgent care visits in a calendar year of a veteran who meets the
definition of Indian or urban Indian, as defined in 25 U.S.C. 1603(13)
and (28).
VA also proposes to add language to 38 CFR 17.4600(d)(1)(ii) to
inform veterans that to demonstrate that they meet the definition of
Indian or urban Indian in 25 U.S.C. 1603(13) and (28), they must submit
to VA any of the following documentation: (A) documentation issued by a
federally-recognized Indian tribe that shows that the veteran is a
member of the tribe; (B) documentation showing that the veteran,
irrespective of whether they live on or near a reservation, is a member
of a tribe, band, or other organized group of Indians terminated since
1940 and those recognized now or in the future by the State in which
they reside, or who is a descendant, in the first or second degree, of
any such member; (C) documentation showing that the veteran is an
Eskimo or Aleut or other Alaska Native; (D) documentation issued by DOI
showing that the veteran is considered by DOI to be an Indian for any
purpose; (E) documentation showing that the veteran is considered by
HHS to be an Indian under that Department's regulations; or (F)
documentation showing that the veteran resides in an urban center and
meets one or more of the following criteria: (1) irrespective of
whether they live on or near a reservation, is a member of a tribe,
band, or other organized group of Indians, including those tribes,
bands, or groups terminated since 1940 and those recognized now or in
the future by the State in which they reside, or who is a descendant,
in the first or second degree, of any such member; (2) is an Eskimo or
Aleut or other Alaska Native; (3) is a considered by DOI to be an
Indian for any purpose; or (4) is considered by HHS to be an Indian
under that Department's regulations.
VA also proposes to amend 38 CFR 17.4600(d)(2), which explains that
an eligible veteran who receives urgent care under Sec.
17.4600(b)(5)(iv) or urgent care consisting solely of an immunization
against influenza (flu shot) is not subject to a copayment under Sec.
17.4600(d)(1) and such a visit shall not count as a visit for purposes
of Sec. 17.4600(d)(1)(i). Because VA proposes to add new paragraph
(d)(1)(ii) which is similar to (d)(1)(i) in exempting certain eligible
veterans from copayment for the initial three urgent care visits in a
calendar year, VA also proposes to add paragraph (d)(1)(ii) so that
veterans who meet the definition of Indian or urban Indian, as defined
in 25 U.S.C. 1603(13) and (28) are treated the same for purposes of
paragraph (d)(2).
VA also proposes to add paragraph (d)(4) to Sec. 17.4600 to state
that after VA determines the documentation submitted by the veteran
meets Sec. 17.4600(d)(1)(ii) and updates the veteran's record to
reflect the veteran's status as an Indian or urban Indian, VA would
reimburse veterans exempt under paragraph (d)(1)(ii) of this section
for any copayments that were paid to VA for the first three visits for
urgent care in a calendar year provided on or after January 5, 2022 if
they would have been exempt from making such copayments if this
regulation had been in effect.
While there are veterans exempt from copayment under 38 CFR 17.108,
17.110, 17.111, and 17.4600 who have been assigned a specific Priority
Group (for example, catastrophically disabled veterans are in Priority
Group 4), section 3002 of the Act did not change VA's system for
enrolling veterans who meet the definition of Indian or urban Indian in
25 U.S.C. 1603(13) and (28) in the VA health care system and assigning
them to a Priority Group. VA is thus not proposing to make any changes
to the
[[Page 2044]]
Priority Groups as set forth in 38 CFR 17.36.
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.
The Office of Information and Regulatory Affairs has determined that
this proposed rule is 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>.
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). This rule would not cause a significant economic
impact on small entities since this exemption is limited to individual
veterans who VA determines to be Indian or urban Indian. 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.
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.
Paperwork Reduction Act
This proposed rule includes provisions constituting a new
collection 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). Accordingly, under 44 U.S.C. 3507(d), VA has submitted a
copy of this rulemaking action to OMB for review and approval.
OMB assigns control numbers to collection of information it
approves. 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. Sections 17.108, 17.110, 17.111,
and 17.4600 would require documentation be submitted by veterans to be
eligible for copayment exemption as an Indian or urban Indian. If OMB
does not approve the collection of information as requested, VA will
immediately remove the provisions containing the collection of
information or take such other action as is directed by OMB.
Comments on the new collection of information contained in this
rulemaking should be submitted through <a href="http://www.regulations.gov">www.regulations.gov</a>. Comments
should indicate that they are submitted in response to ``RIN 2900-AR48,
Copayment Exemption for Indian Veterans'' and should be sent within 30
days of publication of this rulemaking. The collection of information
associated with this rulemaking can be viewed at: <a href="http://www.reginfo.gov/public/do/PRAMain">www.reginfo.gov/public/do/PRAMain</a>.
OMB is required to make a decision concerning the collection of
information contained in this rulemaking between 30 and 60 days after
publication of this rulemaking in the Federal Register (FR). Therefore,
a comment to OMB is best assured of having its full effect if OMB
receives it within 30 days of publication. This does not affect the
deadline for the public to comment on the provisions of this
rulemaking.
The Department considers comments by the public on new collection
of information in--
<bullet> Evaluating whether the new collections of information are
necessary for the proper performance of the functions of the
Department, including whether the information will have practical
utility;
<bullet> Evaluating the accuracy of the Department's estimate of
the burden of the new collection of information, including the validity
of the methodology and assumptions used;
<bullet> Enhancing the quality, usefulness, and clarity of the
information to be collected; and
<bullet> Minimizing the burden of the collection of information on
those who are to respond, including through the use of appropriate
automated, electronic, mechanical, or other technological collection
techniques or other forms of information technology, e.g., permitting
electronic submission of responses.
The collection of information associated with this rulemaking
contained in 38 CFR 17.108, 17.110, 17,111, 17.4600 is described
immediately following this paragraph, under its respective title.
Title: Documentation of Indian or urban Indian status.
OMB Control No: 2900-XXXX (New/TBD).
CFR Provision: 38 CFR 17.108, 17.110, 17,111, 17.4600.
<bullet> Summary of collection of information: The new collection
of information in 38 CFR 17.108, 17.110, 17.111, and 17.4600 would
require veterans to submit certain documentation to VA as evidence that
they meet the definition of Indian or urban Indian as defined in 25
U.S.C. 1603(13) and (28).
<bullet> Description of need for information and proposed use of
information: The information will be used by VA to determine if a
veteran meets the definition of Indian or urban Indian as defined in 25
U.S.C. 1603(13) and (28) for purposes of exempting these veterans from
copayment for certain health care.
<bullet> Description of likely respondents: Veterans.
<bullet> Estimated number of respondents: 25,000.
<bullet> Estimated frequency of responses: One time.
<bullet> Estimated average burden per response: 15 minutes.
<bullet> Estimated total annual reporting and recordkeeping burden:
6,250 hours.
<bullet> Estimated cost to respondents per year: VA estimates the
annual cost to (respondents, etc.) to be $175,062.50. Using VA's
estimated annual number of Indian and urban Indian veterans applying
for copayment exemption, VA estimates the total information collection
burden cost to be $175,062.50 per year *. (6,250 burden hours for
respondents x (multiplied by) $28.01 per hour).
* To estimate the total information collection burden cost, VA used
the Bureau of Labor Statistics (BLS) mean hourly wage for hourly wage
for ``00-0000 All Occupations'' of $28.01 per hour. This information is
available at <a href="https://www.bls.gov/oes/current/oes.nat.htm">https://www.bls.gov/oes/current/oes.nat.htm</a>.
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, Government programs--
veterans, Health care, Health facilities, Health professions, Health
records, Homeless,
[[Page 2045]]
Medical and dental schools, Medical devices, Medical research, Mental
health programs, Nursing home care, Veterans.
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved this
document on December 28, 2022, 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.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
General Counsel, Department of Veterans Affairs.
For the reasons stated in the preamble, the Department of Veterans
Affairs proposes to amend 38 CFR part 17 as set forth below:
PART 17--MEDICAL
0
1. The authority citation for part 17 is amended by adding entries for
Sec. Sec. 17.111 and 17.4600 in numerical order to read in part as
follows:
Authority: 38 U.S.C. 501, and as noted in specific sections.
* * * * *
Section 17.111 is also issued under 38 U.S.C. 101(28), 501,
1701(7), 1703, 1710, 1710B, 1720B, 1720D, 1722A, and 1730A.
* * * * *
Section 17.4600 is also issued under 38 U.S.C. 1725A and 1730A.
* * * * *
0
2. Amend Sec. 17.108 by adding paragraphs (d)(14) and (g), and the
information collection control number to read as follows:
Sec. 17.108 Copayments for inpatient hospital care and outpatient
medical care.
* * * * *
(d) * * *
(14) A veteran who meets the definition of Indian or urban Indian,
as defined in 25 U.S.C. 1603(13) and (28), for inpatient hospital care
or outpatient medical care provided on or after January 5, 2022. To
demonstrate that they meet the definition of Indian or urban Indian,
the veteran must submit to VA any of the documentation listed in
paragraphs (d)(14)(i) through (vi) of this section:
(i) Documentation issued by a federally-recognized Indian tribe
that shows that the veteran is a member of the tribe;
(ii) Documentation showing that the veteran, irrespective of
whether they live on or near a reservation, is a member of a tribe,
band, or other organized group of Indians terminated since 1940 and
those recognized now or in the future by the State in which they
reside, or who is a descendant, in the first or second degree, of any
such member;
(iii) Documentation showing that the veteran is an Eskimo or Aleut
or other Alaska Native;
(iv) Documentation issued by the Department of Interior (DOI)
showing that the veteran considered by DOI to be an Indian for any
purpose;
(v) Documentation showing that the veteran is considered by the
Department of Health and Human Services (HHS) to be an Indian under
that Department's regulations; or
(vi) Documentation showing that the veteran resides in an urban
center and meets one or more of the following criteria:
(A) Irrespective of whether they live on or near a reservation, is
a member of a tribe, band, or other organized group of Indians,
including those tribes, bands, or groups terminated since 1940 and
those recognized now or in the future by the State in which they
reside, or who is a descendant, in the first or second degree, of any
such member;
(B) Is an Eskimo or Aleut or other Alaska Native;
(C) Is considered by the Department of Interior to be an Indian for
any purpose; or
(D) Is considered by HHS to be an Indian under that Department's
regulations.
* * * * *
(g) Retroactive copayment reimbursement. After VA determines that
the documentation submitted by the veteran meets the criteria in
paragraph (d)(14) of this section and VA updates the veteran's record
to reflect the veteran's status as an Indian or urban Indian, VA will
reimburse veterans exempt under paragraph (d)(14) for any copayments
that were paid to VA for inpatient hospital care and outpatient medical
care provided on or after January 5, 2022 if they would have been
exempt from making such copayments if this regulation had been in
effect.
(The Office of Management and Budget has approved the information
collection provisions in this section under control number 2900-TBD.)
0
3. Amend Sec. 17.110 by adding paragraphs (c)(13) and (d), and the
information collection control number to read as follows:
Sec. 17.110 Copayments for medication.
* * * * *
(c) * * *
(13) A veteran who meets the definition of Indian or urban Indian,
as defined in 25 U.S.C. 1603(13) and (28), for medications provided on
or after January 5, 2022. To demonstrate that they meet the definition
of Indian or urban Indian, the veteran must submit to VA any of the
documentation listed in paragraphs (c)(13)(i) through (vi) of this
section:
(i) Documentation issued by a federally-recognized Indian tribe
that shows that the veteran is a member of the tribe;
(i) Documentation showing that the veteran, irrespective of whether
they live on or near a reservation, is a member of a tribe, band, or
other organized group of Indians terminated since 1940 and those
recognized now or in the future by the State in which they reside, or
who is a descendant, in the first or second degree, of any such member;
(iii) Documentation showing that the veteran is an Eskimo or Aleut
or other Alaska Native;
(iv) Documentation issued by the Department of Interior (DOI)
showing that the veteran is considered by DOI to be an Indian for any
purpose;
(v) Documentation showing that the veteran is considered by the
Department of Health and Human Services (HHS) to be an Indian under
that Department's regulations; or
(vi) Documentation showing that the veteran resides in an urban
center and meets one or more of the following criteria:
(A) Irrespective of whether they live on or near a reservation, is
a member of a tribe, band, or other organized group of Indians,
including those tribes, bands, or groups terminated since 1940 and
those recognized now or in the future by the State in which they
reside, or who is a descendant, in the first or second degree, of any
such member;
(B) Is an Eskimo or Aleut or other Alaska Native;
(C) Is considered by DOI to be an Indian for any purpose; or
(D) Is considered by HHS to be an Indian under that Department's
regulations.
(d) Retroactive copayment reimbursement. After VA determines the
submitted documentation meets paragraph (c)(13) of this section and
updates the veteran's record to reflect the veteran's status as an
Indian or urban Indian, VA will reimburse veterans exempt under
paragraph (c)(13) for any copayments that were paid to VA for
medications provided on or after January 5, 2022, if they would have
been exempt from making such copayments if this regulation had been in
effect.
[[Page 2046]]
(The Office of Management and Budget has approved the information
collection provisions in this section under control number 2900-TBD.)
0
4. Amend Sec. 17.111 by adding paragraphs (f)(11) and (g), and the
information collection control number to read as follows:
Sec. 17.111 Copayments for extended care services.
* * * * *
(f) * * *
(11) A veteran who meets the definition of Indian or urban Indian,
as defined in 25 U.S.C. 1603(13) and (28), is exempt from copayments
for noninstitutional extended care including adult day health care,
noninstitutional respite care, and noninstitutional geriatric
evaluation provided on or after January 5, 2022. To demonstrate that
they meet the definition of Indian or urban Indian, the veteran must
submit to VA any of the documentation listed in paragraphs (f)(11)(i)
through (vi) of this section:
(i) Documentation issued by a federally-recognized Indian tribe
that shows that the veteran is a member of the tribe;
(ii) Documentation showing that the veteran, irrespective of
whether they live on or near a reservation, is a member of a tribe,
band, or other organized group of Indians terminated since 1940 and
those recognized now or in the future by the State in which they
reside, or who is a descendant, in the first or second degree, of any
such member;
(iii) Documentation showing that the veteran is an Eskimo or Aleut
or other Alaska Native;
(iv) Documentation issued by the Department of Interior (DOI)
showing that the veteran is considered by DOI to be an Indian for any
purpose;
(v) Documentation showing that the veteran is considered by the
Department of Health and Human Services (HHS) to be an Indian under
that Department's regulations; or
(vi) Documentation showing that the veteran resides in an urban
center and meets one or more of the following criteria:
(A) Irrespective of whether they live on or near a reservation, is
a member of a tribe, band, or other organized group of Indians,
including those tribes, bands, or groups terminated since 1940 and
those recognized now or in the future by the State in which they
reside, or who is a descendant, in the first or second degree, of any
such member;
(B) Is an Eskimo or Aleut or other Alaska Native;
(C) Is considered by DOI to be an Indian for any purpose; or
(D) Is considered by HHS to be an Indian under that Department's
regulations.
(g) Retroactive copayment reimbursement. After VA determines the
submitted documentation meets paragraph (f)(11) of this section and
updates the veteran's record to reflect the veteran's status as an
Indian or urban Indian, VA will reimburse veterans exempt under
paragraph (f)(11) for any copayments that were paid to VA for adult day
health care, non-institutional respite care, and non-institutional
geriatric evaluation provided on or after January 5, 2022, if they
would have been exempt from making such copayments if this regulation
had been in effect.
(The Office of Management and Budget has approved the information
collection provisions in this section under control number 2900-TBD.)
0
5. Amend Sec. 17.4600 by:
0
a. Redesignating paragraph (d)(1)(ii) as (d)(1)(iii);
0
b. Adding new paragraph (d)(1)(ii);
0
c. Revising paragraph (d)(2);
0
d. Adding paragraph (d)(4);
0
e. Adding the information collection control number.
The additions and revision read as follows:
Sec. 17.4600 Urgent Care.
* * * * *
(d) * * *
(1) * * *
(ii) After three visits in a calendar year if such eligible veteran
meets the definition of Indian or urban Indian, as defined in 25 U.S.C.
1603(13) and (28). To demonstrate that they meet the definition of
Indian or urban Indian, the veteran must submit to VA any of the
documentation listed in paragraphs (A) through (F):
(A) Documentation issued by a federally-recognized Indian tribe
that shows that the veteran is a member of the tribe;
(B) Documentation showing that the veteran, irrespective of whether
they live on or near a reservation, is a member of a tribe, band, or
other organized group of Indians terminated since 1940 and those
recognized now or in the future by the State in which they reside, or
who is a descendant, in the first or second degree, of any such member;
(C) Documentation showing that the veteran is an Eskimo or Aleut or
other Alaska Native;
(D) Documentation issued by the Department of Interior (DOI)
showing that the veteran is considered by DOI to be an Indian for any
purpose;
(E) Documentation showing that the veteran is considered by the
Department of Health and Human Services (HHS) to be an Indian under
that Department's regulations; or
(F) Documentation showing that the veteran resides in an urban
center and meets one or more of the following criteria:
(1) Irrespective of whether they live on or near a reservation, is
a member of a tribe, band, or other organized group of Indians,
including those tribes, bands, or groups terminated since 1940 and
those recognized now or in the future by the State in which they
reside, or who is a descendant, in the first or second degree, of any
such member;
(2) Is an Eskimo or Aleut or other Alaska Native;
(3) Is considered by DOI to be an Indian for any purpose; or
(4) Is considered by HHS to be an Indian under that Department's
regulations.
* * * * *
(2) An eligible veteran who receives urgent care under paragraph
(b)(5)(iv) of this section or urgent care consisting solely of an
immunization against influenza (flu shot) is not subject to copayment
under paragraph (d)(1) of this section and such a visit shall not count
as a visit for purposes of paragraph (d)(1)(i) or (ii) of this section.
* * * * *
(4) After VA determines the submitted documentation meets paragraph
(d)(1)(ii) of this section and updates the veteran's record to reflect
the veteran's status as an Indian or urban Indian, VA will reimburse
eligible veterans exempt under paragraph (d)(1)(ii) for any copayments
that were paid to VA for the first three visits for urgent care in a
calendar year provided on or after January 5, 2022, if they would have
been exempt from making such copayments if this regulation had been in
effect.
* * * * *
(The Office of Management and Budget has approved the information
collection provisions in this section under control number 2900-TBD.)
[FR Doc. 2023-00364 Filed 1-11-23; 8:45 am]
BILLING CODE 8320-01-P
</pre></body>
</html>Indexed from Federal Register on January 12, 2023.
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.