Proposed Rule2024-28999
Updates to Waiver of Charges for Copayments
Primary source
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Published
December 17, 2024
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) proposes to amend its medical regulations to allow VA to initiate a waiver request for debt accumulated from health care copayments on behalf of veterans in certain circumstances and to remove the requirement that veterans submit VA Form 5655 when seeking a waiver of copayment debt.
Full Text
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<title>Federal Register, Volume 89 Issue 242 (Tuesday, December 17, 2024)</title>
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[Federal Register Volume 89, Number 242 (Tuesday, December 17, 2024)]
[Proposed Rules]
[Pages 102031-102034]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-28999]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AS25
Updates to Waiver of Charges for Copayments
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 allow VA to initiate a waiver request for debt
accumulated from health care copayments on behalf of veterans in
certain circumstances and to remove the requirement that veterans
submit VA Form 5655 when seeking a waiver of copayment debt.
DATES: Comments must be received on or before February 18, 2025.
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
<a href="http://www.regulations.gov">www.regulations.gov</a> as soon as possible after they have been received.
VA will not post public comments on <a href="http://www.regulations.gov">www.regulations.gov</a> that make
threats to individuals or institutions or suggest that the commenter
will take actions to harm an 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
[[Page 102032]]
received after the comment period's closing date is considered late and
will not be considered in the final rulemaking. In accordance with the
Providing Accountability Through Transparency Act of 2023, a plain
language summary (not more than 100 words in length) of this proposed
rule is available at <a href="http://www.regulations.gov">www.regulations.gov</a>, under RIN 2900-AS25.
FOR FURTHER INFORMATION CONTACT: Andrew Patrick, Executive Director,
Revenue Operations, Office of Finance, (104RO), Veterans Health
Administration, Department of Veterans Affairs, 810 Vermont Ave. NW,
Washington DC 20420, (202) 809-3030. (This is not a toll-free telephone
number.)
SUPPLEMENTARY INFORMATION:
Authority and Background
Section 1710 of title 38, United States Code (U.S.C.) requires VA
to furnish hospital care and medical services, and authorizes VA to
provide nursing home care, that VA determines to be needed for eligible
veterans. Section 1710 authorizes VA to provide such care only when the
veteran agrees to pay the applicable copayment. 38 U.S.C. 1710(f)(1)
and (g)(1). Additionally, section 1722A establishes that VA must
require a copayment from certain veterans for medications. VA has set
forth copayment requirements for inpatient hospital care and outpatient
medical care in Sec. 17.108 of title 38, Code of Federal Regulations
(CFR), copayment requirements for medication in Sec. 17.110,
copayments for extended care services in Sec. 17.111, and copayments
for urgent care at Sec. 17.4600. These types of medical copayments are
generally referred to as ``copayments'' throughout this rulemaking.
Under 31 U.S.C. 3711(a)(1), Federal agencies are required to ``try
to collect a claim of the United States Government for money or
property arising out of the activities of, or referred to, the
agency,'' which means that VA must attempt to collect amounts owed by
veterans to VA, including debts arising from copayments. However, VA is
authorized to waive recovery of payments or overpayments of benefits,
including copayments, when recovery would be against equity and good
conscience and an application for relief is made within 180 days from
the date of notification of the indebtedness by VA. 38 U.S.C.
5302(a)(1). VA has regulated the waiver of debts arising from medical
copayments in 38 CFR 17.105(c). VA has also regulated the process for
waiver applications in 38 CFR 1.963(b), the process to request a
hearing in Sec. 1.966(a), and the application of the ``equity and good
conscience'' standard in Sec. Sec. 1.965 and 1.966(a).
Explained in more detail below, VA proposes to amend Sec.
17.105(c) to: remove the requirement to submit a particular form when
requesting a waiver of charges for copayments; add the ability for VA
to initiate waiver requests on behalf of veterans; update VA staff
position titles; and clarify the applicability of other regulations
related to appeals of VA decisions on the waiver of copayments. These
changes would provide clarity within the regulation, be consistent with
the statutory authority for collection of copayments and waiver of
copayments, reflect the current position title used by VA, and update
cross-references to other regulatory sections.
We note at the outset that current Sec. 17.105(c) references only
claimants, not veterans. In the proposed changes to Sec. 17.105(c)
discussed below, we would include references to both claimants and
veterans. We would maintain the existing references to claimants when
discussing the process for anyone other than VA to initiate a waiver
request for charges of copayments, and we would use the word veteran
when discussing the process whereby VA would initiate a request for
waiver on behalf of a veteran.
Changes to 38 CFR 17.105(c)
In this rulemaking we propose to amend 38 CFR 17.105(c) related to
waivers for copayments. We would first restructure current Sec.
17.105(c) by breaking the single paragraph into proposed subparagraphs
(c)(1) through (5), which would retain the majority of the language in
current paragraph (c), but the further subparagraphs would make the
proposed substantive and technical changes clearer.
The first sentence of current Sec. 17.105(c) introduces the
process for requesting a waiver of charges for copayments and states
that ``[if] the debt represents charges for outpatient medical care,
inpatient hospital care, medication or extended care services
copayments made under Sec. Sec. 17.108, 17.110, 17.111, or 17.4600,
the claimant must request a waiver by submitting VA Form 5655
(Financial Status Report) to the Consolidated Patient Account Center
(CPAC) Chief Financial Officer.'' We would retain this sentence as a
standalone proposed Sec. 17.105(c), with the following revisions.
We would first add the phrase ``urgent care'' to the list of debts
from charges for care authorized to be waived. Current Sec. 17.105(c)
does not include the phrase urgent care but does include reference to
Sec. 17.4600, which addresses copayments for urgent care. Therefore,
to ensure a complete and parallel listing of all applicable care types,
we would add the phrase ``urgent care'' to qualify Sec. 17.4600.
We would then add language in proposed Sec. 17.105(c) to establish
that VA may initiate a waiver request in addition to a ``claimant.''
This change would be necessary because VA recognizes that situations
may arise where it would be more equitable and efficient for VA staff
to initiate waiver requests on behalf of veterans. We would not propose
to list specific situations in which VA may initiate a waiver, so that
VA may retain greater flexibility in assessing what we believe would be
novel circumstances. However, one example for when VA might initiate a
waiver request would be in cases of VA error, particularly when large
groups of veterans are impacted by the same VA error or errors.
Proposed Sec. 17.105(c) would remove the requirement in current
Sec. 17.105(c) that claimants must submit VA Form 5655 to request a
waiver of charges of copayments. VA Form 5655 is a two-page form that
requires each claimant provide detailed information regarding monthly
expenses, debts, and other financial information. VA now finds that
this level of specificity can be burdensome to the claimant and is
often more information than VA requires to make a waiver determination.
VA would still regulate other criteria for submission of waiver
requests, but the requirement would be moved to proposed Sec.
17.105(c)(1).
Lastly, proposed Sec. 17.105(c) would move the requirement that
the form be sent to the Chief Financial Officer to Sec.
17.105(c)(1)(ii), and in that provision, change the position title from
``Chief Financial Officer'' to ``Chief Fiscal Officer'' to reflect the
current position title. This is merely a technical change and would not
change the process to submit a waiver or to whom the request is
submitted.
For the reasons stated above, proposed Sec. 17.105(c) would read:
``Of charges for copayments. If the debt represents charges for
outpatient medical care, inpatient hospital care, medication, extended
care services, or urgent care copayments made under Sec. Sec. 17.108,
17.110, 17.111, or 17.4600, either a claimant or VA may initiate a
waiver request.''
Proposed Sec. 17.105(c)(1) would establish requirements for
claimants to submit requests for waiver of charges of copayments.
Proposed paragraph (c)(1) would establish introductory language to
state ``[i]f the claimant requests a
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waiver, the claimant must:'' where proposed subparagraphs (c)(1)(i)-
(iv) would establish the specific criteria for a waiver request.
The criteria in proposed paragraphs (c)(1)(i), (ii), and (iv) would
remain the same as those listed in current Sec. 17.105(c), with the
exceptions of the requirement to submit VA Form 5655 and changing the
title of the CPAC Chief Financial Officer to the Chief Fiscal Officer.
Proposed Sec. 17.105(c)(1)(i) would establish that claimants must
make the request within the time period provided in Sec. 1.963(b) of
this chapter. This is identical to the submission timeframe in current
Sec. 17.105(c) as VA finds it is still sufficient for purposes of
waiver requests for copayments.
Proposed Sec. 17.105(c)(1)(ii) would establish that claimants
submit the request for waiver in writing to the Consolidated Patient
Account Center (CPAC) Chief Fiscal Officer. We reiterate that removing
the requirement for every claimant to submit VA Form 5655 would reduce
burden for most claimants and eliminate requests for information that
is not relevant for VA to determine whether to grant waiver requests.
Therefore, as we would no longer be requiring a certain form, we would
state that the request must be in writing in accordance with Sec. Sec.
1.911(c)(2), 1.912(c)(2) and 1.912a(c)(2). As discussed below, the
proposed removal of the requirement to submit VA Form 5655 would not
prevent VA from requesting VA Form 5655, or other information, from a
claimant after submission of the initial waiver request if, in the
course determining whether a waiver will be granted, VA determines more
information is needed to make a waiver determination.
To ensure that VA has the information required to make
determinations related to waiver requests, proposed Sec.
17.105(c)(1)(iii) would state that claimants must provide any
additional information that VA may request to determine whether the
waiver request will be granted. This requirement is not expressly
stated in current Sec. 17.105(c), but is consistent with VA practice.
Proposed Sec. 17.105(c)(1)(iv) would direct claimants to request a
hearing under Sec. 1.966(a) of this chapter if a hearing is desired.
This requirement is identical to what is stated in current Sec.
17.105(c), as VA finds it is still sufficient for purposes of waiver
requests for copayments.
Proposed Sec. 17.105(c)(2) would establish requirements for VA to
submit requests for waivers on behalf of veterans. VA believes that in
certain circumstances it would be beneficial to veterans and VA if VA
were permitted to submit requests for waivers on behalf of veterans.
Proposed paragraph (c)(2) would provide that when VA requests a waiver
on behalf of a veteran, VA would meet the criteria further outlined in
proposed paragraphs (c)(2)(i)-(iv). The criteria in proposed Sec.
17.105(c)(2)(i)-(iii) would essentially mirror the criteria required of
claimants under proposed (c)(1)(i), (ii), and (iv). The waiver request
requirements in proposed Sec. 17.105(c)(2)(i)-(iii) are again
substantively the same as those stated in current Sec. 17.105(c), with
the exceptions of the requirement to submit a particular VA form, and
the change in title of the CPAC Chief Financial Officer to the Chief
Fiscal Officer.
Proposed Sec. 17.105(c)(2)(i) would state that VA must make the
request within the time period provided in Sec. 1.963(b) of this
chapter, and proposed paragraph (c)(2)(ii) would direct VA to submit
the waiver request to the designated CPAC Chief Fiscal Officer. Both of
these requirements are consistent with what is stated in current Sec.
17.105(c) and proposed paragraphs (c)(1)(i) and (c)(1)(ii), in terms of
requirements for claimants' submission of waiver requests.
Proposed Sec. 17.105(c)(2)(iii) would establish that VA must
notify the veteran in writing that a request has been made on their
behalf and that the veteran may request a hearing pursuant to Sec.
1.966(a). The proposed requirement that VA notify the veteran when a
waiver request has been initiated on their behalf is not in current
Sec. 17.105(c) because the process for VA to do so is newly proposed
in this rulemaking. However, VA would ensure that the veteran is
notified, in writing, so that way veterans are aware that VA has
initiated a waiver request for the debt and that the veteran has the
right to a hearing on the request under Sec. 1.966(a).
Proposed Sec. 17.105(c)(2)(iv) would state that VA may request any
additional information from the veteran that may be required to
determine whether the waiver will be granted. Although this requirement
is also not stated in current Sec. 17.105(c), it reflects current VA
practice, and it is included in proposed Sec. 17.105(c)(1)(iii) as
applicable to claimants who request a waiver. It is necessary to ensure
VA has sufficient information by which to determine whether or not a
waiver request should be granted.
Proposed Sec. 17.105(c)(3) would state that the CPAC Chief Fiscal
Officer may extend the time period to submit a waiver request if the
Chairperson of the Committee on Waivers and Compromises could do so
under Sec. 1.963(b) of this chapter. This language would be consistent
with current Sec. 17.105(c), except that proposed paragraph (c)(3)
uses the term ``waiver request'' instead of the term ``claim.'' Using
the term ``waiver request'' would be consistent with the terminology
used in part 1 of Title 38, CFR, and referenced throughout this
rulemaking, while not substantively changing the meaning of the
provision.
Proposed Sec. 17.105(c)(4) would contain the standard of review
for waiver requests, and would state that the CPAC Chief Fiscal Officer
will apply the ``equity and good conscience'' standard in accordance
with Sec. Sec. 1.965 and 1.966(a) of this chapter, and may waive all
or part of the claimant's debts. This language would be identical to
that in current Sec. 17.105(c).
Lastly, proposed Sec. 17.105(c)(5) would establish that a decision
by the CPAC Chief Fiscal Officer under this provision is final (except
that the decision may be reversed or modified based on new and material
evidence, fraud, a change in law or interpretation of law, or clear and
unmistakable error shown by the evidence in the file at the time of the
prior decision, as provided in Sec. 1.969 of this chapter) and may be
appealed in accordance with 38 CFR parts 19 and 20 as applicable. This
language would be consistent with current Sec. 17.105(c), except that
proposed paragraph (c)(5) would include the words ``as applicable'' to
more clearly qualify that either or both 38 CFR parts 19 and 20 may
apply for purposes of appealing VA's decisions related to waiver
requests.
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
[[Page 102034]]
18, 2011 (Improving Regulation and Regulatory Review). The Office of
Information and Regulatory Affairs has determined that this rule 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 (RFA)
The Secretary hereby certifies that this proposed rule would or 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). The factual basis for this certification is that this
proposed rule impacts only VA staff and veterans, and thus no small
entities will be affected. 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 (PRA)
Although this proposed rule contains a collection of information
under the provisions of the Paperwork Reduction Act of 1995 (44 U.S.C.
3501-3521), there are no provisions associated with this rulemaking
constituting any new collection of information or any revisions to the
current collection of information. The collection of information for 38
CFR 17.105(c) is currently approved by the Office of Management and
Budget (OMB) and has a valid OMB control number of 2900-0165.
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Claims, Health care,
Veterans.
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, signed and approved
this document on December 5, 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,
Regulation 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 proposes to amend 38 CFR part 17 as set forth below:
PART 17--MEDICAL
0
1. The 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. 17.105 by revising paragraph (c) to read as follows:
Sec. 17.105 Waivers
* * * * *
(c) Of charges for copayments. If the debt represents charges for
outpatient medical care, inpatient hospital care, medication, extended
care services, or urgent care copayments made under Sec. Sec. 17.108,
17.110, 17.111, or 17.4600, either a claimant or VA may initiate a
waiver request.
(1) If the claimant requests the waiver, the claimant must:
(i) Make the request within the time period provided in Sec.
1.963(b) of this chapter.
(ii) Submit the request in writing to the Consolidated Patient
Account Center (CPAC) Chief Fiscal Officer.
(iii) Provide any additional information that VA may request to
determine whether the waiver will be granted.
(iv) Request a hearing under Sec. 1.966(a) of this chapter if a
hearing is desired.
(2) If VA requests a waiver on behalf of a veteran, VA will:
(i) Make the request within the time period provided in Sec.
1.963(b) of this chapter.
(ii) Submit the request in writing to the designated CPAC Chief
Fiscal Officer.
(iii) Notify the veteran in writing that a waiver request has been
made on the veteran's behalf and that the veteran may request a hearing
pursuant to Sec. 1.966(a).
(iv) Request any additional information from the veteran that may
be required to determine whether the waiver will be granted.
(3) The CPAC Chief Fiscal Officer may extend the time period to
submit a waiver request if the Chairperson of the Committee on Waivers
and Compromises could do so under Sec. 1.963(b) of this chapter.
(4) The CPAC Chief Fiscal Officer will apply the ``equity and good
conscience'' standard in accordance with Sec. Sec. 1.965 and 1.966(a)
of this chapter, and may waive all or part of the claimant's debts.
(5) A decision by the CPAC Chief Fiscal Officer under this
provision is final (except that the decision may be reversed or
modified based on new and material evidence, fraud, a change in law or
interpretation of law, or clear and unmistakable error shown by the
evidence in the file at the time of the prior decision, as provided in
Sec. 1.969 of this chapter) and may be appealed in accordance with 38
CFR parts 19 and 20, as applicable.
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[FR Doc. 2024-28999 Filed 12-16-24; 8:45 am]
BILLING CODE 8320-01-P
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