Rule2024-16601
Center for Innovation for Care and Payment Update
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
July 29, 2024
Effective
July 29, 2024
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) amends its medical regulations governing the Center for Innovation for Care and Payment. This final rule is making several technical revisions to revise the organizational alignment of the Center for Innovation for Care and Payment and to revise where evaluation results are posted for public review for the pilot programs.
Full Text
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<title>Federal Register, Volume 89 Issue 145 (Monday, July 29, 2024)</title>
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[Federal Register Volume 89, Number 145 (Monday, July 29, 2024)]
[Rules and Regulations]
[Pages 60825-60827]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-16601]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AR18
Center for Innovation for Care and Payment Update
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: The Department of Veterans Affairs (VA) amends its medical
regulations governing the Center for Innovation for Care and Payment.
This final rule is making several technical revisions to revise the
organizational alignment of the Center for Innovation for Care and
Payment and to revise where evaluation results are posted for public
review for the pilot programs.
DATES: This rule is effective July 29, 2024.
FOR FURTHER INFORMATION CONTACT: David Au, Executive Director, VHA
[[Page 60826]]
Center for Care and Payment Innovation (14HIL3), 810 Vermont Ave. NW,
Washington, DC 20420. (202-461-7002). (This is not a toll-free
telephone number.)
SUPPLEMENTARY INFORMATION: On June 6, 2018, section 152 of Public Law
115-182, the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson
VA Maintaining Internal Systems and Strengthening Integrated Outside
Networks Act of 2018 (the MISSION Act), amended title 38 of the United
States Code (U.S.C.) by adding a new section 1703E. This new section
established the Center for Innovation for Care and Payment (the Center)
and authorized the conduct of pilot programs designed to develop
innovative approaches to testing payment and care models to reduce
expenditures while preserving or enhancing the quality of care
furnished by VA.
On October 25, 2019, VA published a final rule implementing section
1703E in title 38, Code of Federal Regulations (CFR) 17.450. See 84
Federal Register (FR) 57327. This new regulation, which became
effective on November 25, 2019, established the parameters for the
Center in its conduct of pilot programs. These parameters included, but
were not limited to, geographic location decisions, limitations on the
number of pilot programs to be operated at the same time, VA's
evaluation and reporting on the pilot programs, and when VA may expand,
modify, and terminate pilot programs.
As explained in more detail below, we now amend Sec. 17.450 by
making several technical revisions. VA is not making any substantive
edits to the content of Sec. 17.450.
38 CFR 17.450(a)(2)
Current paragraph (a) of Sec. 17.450 sets forth the purpose and
organization of the Center. Paragraph (a)(2) provides that the Center
will not operate within any specific administration within VA but
rather will operate in VA's corporate portfolio, to ensure the limited
number of concurrent pilot programs under Sec. 17.450 are not
redundant of or conflicted by ongoing innovation efforts within any
specific administration. We explained in the proposed rule for Sec.
17.450 that the Center will be operationally independent from any of
VA's three administrations and will be responsible for collaborating
across VA to develop and implement pilot programs under this section.
84 FR 36508 (July 29, 2019). As further explained in proposed
paragraphs (a)(2) and (3), being operationally independent referred to
the decision-making authority of the Center regarding the strategic,
procedural, and tactical aspects of managing the pilot programs under
this section. Id. However, we received public comments indicating that
the proposed language was unclear. See 84 FR 57328-57329 (October 25,
2019). We thus eliminated the reference to and definition of
operational independence in proposed paragraph (a)(2) and redesignated
paragraph (a)(3) to paragraph (a)(2), which is the language in current
38 CFR 17.450(a)(2). We further clarified in the final rule that the
Center is part of VA and acts at the direction of the Secretary, so it
is not ``independent'' from VA. 84 FR 57329.
Consistent with paragraph (a)(2), the Center had operated under
VA's Office of Enterprise Integration (OEI), which is a VA corporate
level office, since November 25, 2019.
However, since April 5, 2021, the Center has operated under the
Office of Discovery, Education, and Affiliate Networks (DEAN) under the
Veterans Health Administration (VHA). The Center moved from OEI to DEAN
to align these pilot programs with other established, complementary
innovation programs that are health-care focused initiatives within VHA
and to enable more efficient and effective oversight and execution of
all pilot programming which enhances care and service delivery for
veterans. As a result, this move has facilitated more efficient daily
operations, while continuing to maintain Department-wide connections
across VA. More specifically, this move has allowed the Center to
leverage the well-established practices of advancing innovation through
the VA innovation lifecycle developed and maintained by DEAN and the
Office of Healthcare Innovation and Learning (HIL) while still
permitting VA to ensure that the pilots managed by the Center are not
redundant of or conflict with ongoing innovation efforts within VA;
DEAN and HIL have several existing partnerships with programs across VA
and have established connections to ensure feedback is considered and
integrated into pilot-programming decision-making. This has been
achieved through formal governance and through structured
collaborations with programs across VA's three administrations (that
is, health, benefits, and memorial affairs). This facilitates cross-
agency communication, prevents redundant or conflicting efforts, and
ensures pilots drive transformational change across VA.
Because the organizational alignment of the Center has moved from
VA's corporate portfolio to VHA, we now amend Sec. 17.450(a)(2) to
reflect that change. However, in order to avoid amending Sec.
17.450(a)(2) in the future in the event that the name of the office
under which the Center will operate changes, we will not add the name
of DEAN and will instead state in Sec. 17.450(a)(2) that the Center
for Innovation for Care and Payment will operate within the Veterans
Health Administration. We are also making a technical edit to the last
part of Sec. 17.450(a)(2), which currently states in part that
concurrent pilot programs under Sec. 17.450 are not redundant of or
conflicted by ongoing innovation efforts within any specific
administration. We are removing the phrase ``conflicted by'' and
replacing it with ``conflicting with'' for clarity. This edit will not
change the meaning of the text.
38 CFR 17.450(g)
Current Sec. 17.450(g) establishes evaluation and reporting
provisions related to the Center. This paragraph states that VA will
evaluate each pilot program operated under this section and report its
findings. Such evaluations may be based on quantitative data,
qualitative data, or both; and whenever appropriate, evaluations will
include a survey of participants or beneficiaries to determine their
satisfaction with the pilot program. This paragraph further states that
VA will make the evaluation results available to the public on the VA
Innovation Center website on the schedule identified in VA's proposal
for the pilot program. As part of this rulemaking, we are revising the
last sentence of paragraph (g) to state that VA will make the
evaluation results available to the public on a VA website on the
schedule identified in VA's proposal for the pilot program. We
reference a VA website instead of the VA Innovation Center website
because the specific name of the website and sub-pages for pilot
programs vary, and referencing a VA website provides consistency and
avoids the potential need for additional regulatory updates; we believe
that the broader identification of a VA website in the regulation will
allow VA to more accurately and consistently identify the location of
the website where the evaluation results for the relevant pilot program
will be published. The website will still be identified on the schedule
in the proposal for such pilot program.
Administrative Procedure Act
This final rule will neither amend the substantive content of the
regulations cited nor have a substantive impact on the public. We are
merely providing technical revisions to revise the
[[Page 60827]]
organizational alignment of the Center for Innovation for Care and
Payment and to revise the location of the website where evaluation
results are posted for public review for the pilot programs.
Consequently, this rule is exempt from the notice-and-comment and
delayed-effective-date requirements as a rule of agency organization,
procedure, or practice pursuant to section 553(b)(A) in Title 5 of
United States Code.
Executive Orders 12866, 13563 and 14094
Executive Order 12866 (Regulatory Planning and Review) directs
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. Executive Order 14094 (Executive Order on
Modernizing Regulatory Review) supplements and reaffirms the
principles, structures, and definitions governing contemporary
regulatory review established in Executive Order 12866 of September 30,
1993 (Regulatory Planning and Review), and Executive Order 13563 of
January 18, 2011 (Improving Regulation and Regulatory Review). The
Office of Information and Regulatory Affairs has determined that this
rulemaking is not a significant regulatory action under Executive Order
12866, as amended by Executive Order 14094. 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 Regulatory Flexibility Act, 5 U.S.C. 601-612, is not applicable
to this rulemaking because notice of proposed rulemaking is not
required. 5 U.S.C. 601(2), 603(a), 604(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.
Paperwork Reduction Act
This final rule contains no provisions constituting a collection of
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).
Congressional Review Act
Pursuant to Subtitle E of the Small Business Regulatory Enforcement
Fairness Act of 1996 (known as the Congressional Review Act) (5 U.S.C.
801 et seq.), the Office of Information and Regulatory Affairs
designated this rule as not satisfying the criteria under 5 U.S.C.
804(2).
Assistance Listing
The Assistance Listing numbers and titles for the programs affected
by this document are as follows: 64.007, Blind Rehabilitation Centers;
64.008, Veterans Domiciliary Care; 64.009, Veterans Medical Care
Benefits; 64.010, Veterans Nursing Home Care; 64.011, Veterans Dental
Care; 64.012, Veterans Prescription Service; 64.013, Veterans
Prosthetic Appliances; 64.014, Veterans State Domiciliary Care; 64.015,
Veterans State Nursing Home Care; 64.016, Veterans State Hospital Care;
64.018, Sharing Specialized Medical Resources; 64.019, Veterans
Rehabilitation Alcohol and Drug Dependence; and 64.022, Veterans Home
Based Primary Care.
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 23, 2024, 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.
For the reasons stated in the preamble, the Department of Veterans
Affairs amends 38 CFR part 17 as set forth below:
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.
0
2. Amend Sec. 17.450 by revising paragraphs (a)(2) and (g) to read as
follows:
Sec. 17.450 Center for Innovation for Care and Payment.
(a) * * *
(2) The Center for Innovation for Care and Payment will operate
within the Veterans Health Administration, which will ensure that the
limited number of concurrent pilots under this section are not
redundant of or conflicting with ongoing innovation efforts within any
specific administration.
* * * * *
(g) Evaluation and reporting. VA will evaluate each pilot program
operated under this section and report its findings. Evaluations may be
based on quantitative data, qualitative data, or both. Whenever
appropriate, evaluations will include a survey of participants or
beneficiaries to determine their satisfaction with the pilot program.
VA will make the evaluation results available to the public on a VA
website on the schedule identified in VA's proposal for the pilot
program.
* * * * *
[FR Doc. 2024-16601 Filed 7-26-24; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on July 29, 2024.
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