Proposed Rule2024-31494
Exempting Whole Health Well-Being Services From Copayment
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 3, 2025
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) proposes to revise its medical regulations to exempt Whole Health well-being services from the copayment requirements for inpatient hospital care and outpatient medical care. These Whole Health well-being services, which consist of Whole Health education and skill-building programs and complementary and integrative health well-being services, are provided to Veterans within the VA Whole Health System of Care to improve Veterans' overall health and well-being.
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<title>Federal Register, Volume 90 Issue 2 (Friday, January 3, 2025)</title>
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[Federal Register Volume 90, Number 2 (Friday, January 3, 2025)]
[Proposed Rules]
[Pages 279-282]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-31494]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AS23
Exempting Whole Health Well-Being Services From Copayment
AGENCY: Department of Veterans Affairs
ACTION: Proposed rule
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SUMMARY: The Department of Veterans Affairs (VA) proposes to revise its
medical regulations to exempt Whole Health well-being services from the
copayment requirements for inpatient hospital care and outpatient
medical care. These Whole Health well-being services, which consist of
Whole Health education and skill-building programs and complementary
and integrative health well-being services, are provided to Veterans
within the VA Whole Health System of Care to improve Veterans' overall
health and well-being.
DATES: Comments must be received on or before March 4, 2025.
ADDRESSES: Comments may be submitted through <a href="http://www.regulations.gov">www.regulations.gov</a>.
Except as provided herein, 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
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<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://Regulations.gov">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; however, we will post 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. 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-AS23.
FOR FURTHER INFORMATION CONTACT: Kavitha Reddy, Associate Director,
Employee Whole Health, Veterans Health Administration, Department of
Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, 314-312-
8126. (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION:
Authority
Section 1710 of title 38 United States Code (U.S.C.) requires VA to
furnish hospital care and medical services that VA determines to be
needed for eligible Veterans. Section 1701(6) defines medical services
as examination, treatment, and rehabilitative services, as well as
other specifically listed services. VA implemented the statutory
requirements through 38 Code of Federal Regulations (CFR) 17.38,
frequently referred to as the Medical Benefits Package. Under section
1710(g)(1), VA may not furnish medical services to certain Veterans
unless the Veteran agrees to pay ``the applicable amount or amounts
established by the Secretary [of VA] by regulation.'' VA has
interpreted section 1710(g)(1) to mean that VA may establish in
regulation the amount of a copayment, even if that amount is zero,
meaning that VA effectively has the authority to exempt certain care
from copayment requirements. VA has set forth copayment requirements
for inpatient hospital care, outpatient medical care, and urgent care
in 38 CFR 17.108.
Generally, 38 CFR 17.108 sets forth requirements regarding
copayments for inpatient hospital care and outpatient medical care
provided to Veterans by VA. 38 CFR 17.108(b) and (c). Services not
subject to copayments are listed in 38 CFR 17.108(e). VA has long
acknowledged that copayments can deter Veterans from obtaining certain
services and be a barrier to participation in a program promoted by VA.
Therefore, to encourage Veterans to become more actively involved in
their medical care, thereby improving health care outcomes and, in
turn, lowering overall health care costs, VA has exempted certain
services from the copayment requirements. There are currently multiple
copayment exemptions listed in Sec. 17.108(e) such as weight
management counseling and publicly announced VA public health
initiatives (for example, health fairs) or outpatient visits solely
consisting of preventative screening and immunizations to encourage
such behavior. In this rulemaking, VA proposes to add an additional
copayment exemption for Whole Health well-being services to encourage
Veterans to be more actively involved in their health care and further
use these important services.
Whole Health Well-Being Services and the Whole Health System of Care
Whole Health well-being services, which are services that focus on
the overall well-being of the Veteran independent of treatment for a
specific medical condition or diagnosis, are an important aspect of the
Whole Health System of Care. The Whole Health System of Care is care
that supports the Veteran's health and well-being in line with what
matters most to the Veteran. The Whole Health System of Care engages
and empowers Veterans to prioritize a healthy lifestyle--including
mental, emotional, functional, spiritual, social, and community
aspects--equipping them to take charge of their health and well-being
by addressing lifestyle and environmental root causes of chronic
disease. This approach has improved Veterans' perceptions of health
care, increased their engagement in health care and self-care, and
improved their life's meaning and purpose.
One component of the Whole Health System of Care focuses on the
overall well-being of the Veteran that is independent of treatment of a
specific medical condition or diagnosis to equip each Veteran to better
manage their own health. The well-being component includes various
services that are centered around what matters most to the Veteran and
their health and well-being goals. Whole Health well-being services are
provided to Veterans alongside conventional health care to promote,
preserve, and restore health. All Whole Health well-being services
provided by VA are in line with accepted standards of medical practice,
serve to increase Veterans' access to care, and currently are
authorized and provided to Veterans as part of the medical benefits
package under 38 CFR 17.38. Whole Health well-being services include
Whole Health education and skill-building programs and complementary
and integrative health well-being services, both of which are discussed
in further detail herein.
VA determined it is necessary to exempt these Whole Health well-
being services from copayment to remove a barrier that may discourage
Veterans from proactively engaging in the Whole Health System of Care
and to further encourage Veterans to better manage their health and
improve their overall well-being. Whole Health well-being services do
not generally require the expertise of a licensed clinical provider or
specialty care provider as these approaches are not used for treatment
of a specific condition or diagnosis but rather to support health and
overall well-being. A Veteran's participation in Whole Health well-
being services can initiate a cascade of health benefits that result
from a Veteran's conscious, committed participation in promoting,
restoring, and preserving the Veteran's own health. Exempting Whole
Health well-being services would encourage Veterans to proactively take
advantage of well-being services to improve their overall well-being.
Copayment Exemption for Whole Health Well-Being Services
In this rulemaking, we propose to amend 38 CFR 17.108 by adding new
paragraph (e)(20) to exempt Whole Health well-being services from
copayment requirements. New paragraph (e)(20) of section 17.108 would
provide that ``the following Whole Health well-being services'' would
be exempt from copayment requirements. As mentioned previously, Whole
Health well-being services consist of Whole Health education and skill-
building programs as well as complementary and integrative health well-
being services. Proposed paragraphs (e)(20)(i) and (ii) would then
describe these two categories of well-being services that would be
exempt from copayment.
In addition, we would make two minor technical edits to maintain
proper punctuation throughout the list of copayment exempt services in
Sec. 17.108(e). We would remove ``and'' at the end of current
paragraph (17); we would remove the period at the end of paragraph (18)
and in its place insert a semicolon; and we would remove the period at
the end of paragraph (19) and
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in its place insert a semicolon followed by ``and.'' These changes
would ensure that new paragraph (20) would properly complete the list
of currently exempt services in Sec. 17.108(e).
Whole Health Education and Skill-Building Programs
Proposed Sec. 17.108(e)(20)(i) would describe ``Whole Health
education and skill-building programs.'' Whole Health education and
skill-building programs would be defined as the services that educate,
instruct, and empower Veterans to understand and implement the
principles and practices of Whole Health. VA would use this definition
for Whole Health education and skill-building programs because it would
succinctly describe this category of Whole Health-focused programs and
would be consistent with how Whole Health education and skill-building
programs are provided to Veterans within VA. Whole Health education and
skill-building programs have a Whole Health-focused curriculum,
contribute to the overall well-being of the Veteran, and may be offered
individually or in a group setting. Whole Health education and skill-
building programs generally address Whole Health principles, promote
well-being approaches, and focus on helping a Veteran meet their health
and well-being goals. Such programs are developed in partnership with
the Veterans Health Administration Office of Patient Centered Care and
Cultural Transformation.
The following sentence would then provide a non-exhaustive list of
the categories of programs that would be included as Whole Health
education and skill-building programs. The list would include Whole
Health coaching, Whole Health partner sessions, and Whole Health
education and skill-building courses. The list of these categories of
programs would be consistent with how Whole Health education and skill-
building programs currently are provided to Veterans within VA. VA
believes that a non-exhaustive list would be most beneficial because
these categories would adequately capture any approved Whole Health
education and skill-building programs available within the Whole Health
System of Care. However, as the VA Whole Health System of Care becomes
more firmly established as the model for how VA provides health care,
VA is developing, improving, and expanding Whole Health education and
skill-building programs continuously with an openness to innovation and
iterative improvement based on Veteran feedback and evidence.
Therefore, a non-exhaustive list would provide VA with the flexibility
it needs to continue to provide Whole Health education and skill-
building programs that meet the needs of Veterans and improve Veterans'
overall well-being.
Whole Health coaching is a Veteran-centered process that
facilitates and empowers Veterans to develop and achieve their self-
determined health and well-being goals. In Whole Health coaching, the
coach supports Veterans in mobilizing their internal strengths and
external resources to develop strategies for making sustainable,
healthy lifestyle behavior changes that support improved health and
well-being. Whole Health coaching includes connecting health and well-
being goals to what matters most to the Veteran and following up on
actions needed to achieve these values-based goals. Whole Health
coaches work in close collaboration with interdisciplinary staff and
teams throughout VA medical facilities to enhance well-being and assist
with management of chronic disease. This type of interprofessional,
team-based care is important for high quality, Veteran-centered Whole
Health care.
In Whole Health partnering, a Whole Health partner facilitates
individual and group sessions where Veterans learn about the Whole
Health approach and identify their meaning and purpose. They work in
collaboration with staff and teams, further supporting
interprofessional, team-based delivery of health care. Veterans then
can reflect on their personal well-being and create health and well-
being goals centered around what matters most to them for their quality
of life. Whole Health partners welcome Veterans into the Whole Health
System of Care, have knowledge of internal and external Whole Health
System of Care resources, help Veterans navigate the Whole Health
System of Care, and connect Veterans to the best options to support
their overall health and well-being. Whole Health partners` often
conduct introductory sessions to orient Veterans to Whole Health and
assist them in filling out elements of their personal health plan.
Whole Health education and skill-building courses are courses that
generally address Whole Health principles, promote well-being
approaches, and focus on helping the Veteran meet health and well-being
goals. Current offerings within VA provide education on the concept of
Whole Health, Whole Health coaching, Whole Health partnering, and how
Veterans can take charge of their life and health.
Complementary and Integrative Health Well-Being Services
Proposed Sec. 17.108(e)(20)(ii) would describe the complementary
and integrative health well-being services that would be exempt from
copayment requirements. Like proposed paragraph (i), proposed paragraph
(ii) would first define complementary and integrative health well-being
services. Complementary and integrative health well-being services
would be defined as the services that promote health, well-being, and
self-care independent of treatment of a specific medical condition or
diagnosis. In general, complementary and integrative health services
are a group of diverse services and practices not broadly considered to
be part of conventional health care, but often used in conjunction with
conventional health care. Complementary and integrative health services
are used in the Whole Health System of Care as they place importance on
the relationship between the practitioner and patient and focus on the
whole person.
The following sentence then would provide a non-exhaustive list of
the types of services that would be included as complementary and
integrative health well-being services. The services would be guided
imagery, meditation, Tai Chi/Qigong, and yoga for well-being, which
would be consistent with how complementary and integrative health well-
being services currently are provided within VA. We believe listing
these types of services in regulation would adequately capture the
current complementary and integrative health well-being services
available within the Whole Health System of Care. Like Whole Health
education and skill-building programs in proposed paragraph (i), we
would use a non-exhaustive list to provide flexibility to VA to
continue to evaluate the efficacy of additional complementary and
integrative health well-being approaches that would meet the needs of
Veterans and improve Veterans' overall well-being.
Guided imagery is the practice of using a series of multi-sensory
images designed to trigger specific changes in an individual's
physiology, emotions, or mental state for the purpose of increasing an
individual's healing response or causing unconscious change. Guided
imagery may be performed by a complementary and integrative health
provider in an individual or group clinical setting.
Meditation is the defined practice or technique (often arising from
a contemplative tradition) that primarily
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focuses on training an individual's attention regulation processes with
the intent of cultivating general mental well-being and/or specific
capacities such as concentration, compassion, or insight. The focus of
meditation is on training attentional processes rather than
specifically targeting a change in mental content.
Tai Chi is the mind-body exercise rooted in the Asian traditions of
martial arts, Chinese medicine, and philosophy that combines slow-
flowing intentional movements with breathing, awareness, and
visualization. Tai Chi enhances relaxation, vitality, focus, posture,
balance, strength, flexibility, and mood.
Qigong is the ancient Chinese healing art (like Tai Chi) with a
focus on cultivating the body's vital energy or ``qi.'' Qigong involves
the coordination of breath, posture, awareness, visualization, and
focused movements and may be practiced as a stationary or moving
meditation.
Yoga is the mind-body practice rooted in ancient Indian philosophy
that typically combines physical postures, breathing techniques,
meditation or relaxation, and discussion on applications to daily life.
There are many different yoga styles ranging from gentle to physically
demanding practices. Yoga for well-being is the practice of yoga to
advance an individual's general sense of well-being. Yoga for well-
being is often practiced in a group setting and focuses on general
health, stress reduction, fitness, and/or community.
Executive Orders 12866, 13563, and 14094
Executive Order 12866 (Regulatory Planning and Review; September
30, 1993) 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; January 18,
2011) emphasizes the importance of quantifying both costs and benefits,
reducing costs, harmonizing rules, and promoting flexibility. Executive
Order 14094 (Modernizing Regulatory Review; April 6, 2023) supplements
and reaffirms the principles, structures, and definitions governing
contemporary regulatory review established in Executive Order 12866 and
Executive Order 13563. 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 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 proposed rule would exempt certain health care
services from copayment. This proposed rule would not cause a
significant economic impact on small entities because it is limited to
copayments that would be received by VA directly from Veterans.
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 contains no provisions constituting a collection
of information under the provisions of the Paperwork Reduction Act of
1995 (44 U.S.C. 3501-3521).
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Drug abuse, Government contracts, Health care, Health
facilities, Health professions, Mental health programs, Nursing homes,
Reporting and recordkeeping requirements, Veterans.
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, signed and approved
this document on December 18, 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 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. 17.108 by revising paragraphs (e)(17) through (19) and
adding paragraph (e)(20) to read as follows:
Sec. 17.108 Copayments for inpatient hospital care and outpatient
medical care.
* * * * *
(e) * * *
(17) Mental health peer support services;
(18) An outpatient care visit solely for education on the use of
opioid antagonists to reverse the effects of overdoses of specific
medications or substances;
(19) Emergent suicide care as authorized under 38 CFR 17.1200-
17.1230; and
(20) The following Whole Health well-being services:
(i) Whole Health education and skill-building programs. The
programs that educate, instruct, and empower Veterans to understand and
implement the principles and practices of Whole Health. Whole Health
education and skill-building programs may include, but are not limited
to, Whole Health coaching, Whole Health partner sessions, and Whole
Health education and skill-building courses.
(ii) Complementary and integrative health well-being services. The
services that promote health, well-being, and self-care independent of
treatment of a specific medical condition or diagnosis. Complementary
and integrative health well-being services may include, but are not
limited to, guided imagery, meditation, Tai Chi/Qigong, and yoga for
well-being.
* * * * *
[FR Doc. 2024-31494 Filed 1-2-25; 8:45 am]
BILLING CODE 8320-01-P
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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.