[Federal Register Volume 67, Number 196 (Wednesday, October 9, 2002)]
[Rules and Regulations]
[Pages 62887-62889]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-25491]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AK38


Enrollment--Provision of Hospital and Outpatient Care to Veterans

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: VA's medical regulations captioned ``Enrollment--Provision of 
Hospital and Outpatient Care to Veterans'' implement a national 
enrollment system to manage the delivery of inpatient hospital care and 
outpatient medical care. Prior to October 1, 2002, veterans were 
eligible to be enrolled based on seven priority categories. In this 
final rule we add veterans awarded the Purple Heart to priority 
category 3 to implement new statutory requirements. We also delete the 
copayment provisions from priority category 4 to clarify statutory 
requirements. In addition, we divide priority category 7 into two new 
priority categories (7 and 8) to implement new statutory requirements, 
using the subpriorities for former category 7 for these new categories. 
Further, we state principles for placing veterans in enrollment 
categories to help ensure clarity and fairness in making priority 
category determinations. Finally, we change the VA officials who can 
make enrollment decisions and provide an additional address for sending 
a request for voluntary disenrollment.

DATES: Effective Date: November 8, 2002.

FOR FURTHER INFORMATION CONTACT: Amy Hertz, Office of Policy and 
Planning (105D), at (202) 273-8934 or Roscoe Butler, Chief Policy & 
Operations, Health Administration Service (10C3), at (202) 273-8302. 
These individuals are in the Veterans Health Administration of the 
Department of Veterans Affairs, and are located at 810 Vermont Avenue, 
NW., Washington, DC 20420.

SUPPLEMENTARY INFORMATION: In a document published in the Federal 
Register on July 23, 2002 (67 FR 48078), the Department of Veterans 
Affairs proposed to amend its enrollment regulations that manage the 
delivery of inpatient hospital care and outpatient medical care. We 
requested comments for a 30-day period that ended August 22, 2002, to 
allow for a final rule to be established in time to allow the VA 
Secretary to have as many options as possible concerning the provision 
of health care services to veterans in fiscal year 2003. We received no 
comments. Based on the rationale set forth in the proposed rule, we are 
adopting the proposed rule as a final rule.

Unfunded Mandates

    The Unfunded Mandates Reform Act requires, at 2 U.S.C. 1532, that 
agencies prepare an assessment of anticipated costs and benefits before 
developing any rule that may result in an expenditure by State, local, 
or tribal governments, in the aggregate, or by the private sector of 
$100 million or more in any given year. This rule would have no 
consequential effect on State, local, or tribal governments.

Paperwork Reduction Act

    This document contains no provisions constituting a collection of 
information under the Paperwork Reduction Act (44 U.S.C. 3501-3520).

Executive Order 12866

    This document has been reviewed by the Office of Management and 
Budget under Executive Order 12866.

Regulatory Flexibility Act

    The Secretary hereby certifies that this regulatory amendment will 
not have a significant economic impact on a substantial number of small 
entities as they are defined in the Regulatory Flexibility Act (RFA), 5 
U.S.C. 601-612. This amendment would not directly affect any small 
entities. Only individuals could be directly affected. Therefore, 
pursuant to 5 U.S.C. 605(b), this amendment is exempt from the initial 
and final regulatory flexibility analysis requirements of sections 603 
and 604.

Catalog of Federal Domestic Assistance Numbers

    The Catalog of Federal Domestic Assistance numbers for the 
programs affected by this document are 64.005, 64.007, 64.008, 
64.009, 64.010, 64.011, 64.012, 64.013, 64.014, 64.015, 64.016, 
64.018, 64.019, 64.022, and 64.025.

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.

    Approved: September 18, 2002.
Anthony J. Principi,
Secretary of Veterans Affairs.

    For the reasons set out in the preamble, 38 CFR part 17 is amended 
as set forth below:

PART 17--MEDICAL

    1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501, 1721, unless otherwise noted.


    2. Section 17.36 is amended by:
    A. Removing ``Chief Network Officer'' wherever it appears and 
adding, in its place, ``Deputy Under Secretary for Health for 
Operations and Management

[[Page 62888]]

or Chief, Health Administration Service or equivalent official at a VA 
medical facility, or Director, Health Eligibility Center''.
    B. Revising paragraphs (a)(2), (b)(4), and (b)(7).
    C. In paragraph (b)(3), removing ``prisoners of war;'' and adding, 
in its place, ``prisoners of war; veterans awarded the Purple Heart;''
    D. Adding a new paragraph (b)(8).
    E. Revising paragraph (d)(1); removing ``Note to Paragraph 
(d)(1)''; and redesignating paragraphs (d)(3) through (d)(5) as 
paragraphs (d)(4) through (d)(6), respectively.
    F. Adding a new paragraph (d)(3).
    G. Revising newly redesignated paragraphs (d)(5) introductory text; 
and (d)(5)(i).
    H. In newly redesignated paragraph (d)(5)(iii), removing ``priority 
category 5;'' and adding, in its place, ``priority category 5 or 
priority category 7;''.
    I. In paragraph (f), removing ``[insert actual photocopy of VA Form 
10-10EZ]''.
    J. Revising the authority at the end of the section.
    The revisions and additions read as follows:


Sec.  17.36  Enrollment--provision of hospital and outpatient care to 
veterans.

    (a) * * *
    (2) Except as provided in paragraph (a)(3) of this section, a 
veteran enrolled under this section and who, if required by law to do 
so, has agreed to make any applicable copayment is eligible for VA 
hospital and outpatient care as provided in the ``medical benefits 
package'' set forth in Sec.  17.38.
* * * * *
    (b) * * *
    (4) Veterans who receive increased pension based on their need for 
regular aid and attendance or by reason of being permanently housebound 
and other veterans who are determined to be catastrophically disabled 
by the Chief of Staff (or equivalent clinical official) at the VA 
facility where they were examined.
* * * * *
    (7) Veterans who agree to pay to the United States the applicable 
copayment determined under 38 U.S.C. 1710(f) and 1710(g) if their 
income for the previous year constitutes ``low income'' under the 
geographical income limits established by the U.S. Department of 
Housing and Urban Development for the fiscal year that ended on 
September 30 of the previous calendar year. For purposes of this 
paragraph, VA will determine the income of veterans (to include the 
income of their spouses and dependents) using the rules in Sec. Sec.  
3.271, 3.272, 3.273, and 3.276. After determining the veterans' income 
and the number of persons in the veterans' family (including only the 
spouse and dependent children), VA will compare their income with the 
current applicable ``low-income'' income limit for the public housing 
and section 8 programs in their area that the U.S. Department of 
Housing and Urban Development publishes pursuant to 42 U.S.C. 
1437a(b)(2). If the veteran's income is below the applicable ``low-
income'' income limits for the area in which the veteran resides, the 
veteran will be considered to have ``low income'' for purposes of this 
paragraph. To avoid a hardship to a veteran, VA may use the projected 
income for the current year of the veteran, spouse, and dependent 
children if the projected income is below the ``low income'' income 
limit referenced above. This category is further prioritized into the 
following subcategories:
    (i) Noncompensable zero percent service-connected veterans; and
    (ii) All other priority category 7 veterans.
    (8) Veterans not included in priority category 4 or 7, who are 
eligible for care only if they agree to pay to the United States the 
applicable copayment determined under 38 U.S.C. 1710(f) and 1710(g). 
This category is further prioritized into the following subcategories:
    (i) Noncompensable zero percent service-connected veterans; and
    (ii) All other priority category 8 veterans.
* * * * *
    (d) Enrollment and disenrollment process--(1) Application for 
enrollment. A veteran may apply to be enrolled in the VA healthcare 
system at any time. A veteran who wishes to be enrolled must apply by 
submitting a VA Form 10-10EZ to a VA medical facility. Veterans 
applying based on inclusion in priority categories 1, 2, 3, 6, and 8 do 
not need to complete section II, but must complete the rest of the 
form. Veterans applying based on inclusion in priority category 4 
because of their need for regular aid and attendance or by being 
permanently housebound need not complete section II, but must complete 
the rest of the form. Veterans applying based on inclusion in priority 
category 4 because they are catastrophically disabled need not complete 
section II, but must complete the rest of the form, if: they agree to 
pay to the United States the applicable copayment determined under 38 
U.S.C. 1710(f) and 1710(g); they are a veteran of the Mexican border 
period or of World War I or a veteran with a 0 percent service-
connected disability who is nevertheless compensated; their 
catastrophic disability is a disorder associated with exposure to a 
toxic substance or radiation, or with service in the Southwest Asia 
theater of operations during the Gulf War as provided in 38 U.S.C. 
1710(e); or their catastrophic disability is an illness associated with 
service in combat in a war after the Gulf War or during a period of 
hostility after November 11, 1998, as provided in 38 U.S.C. 1710(e). 
All other veterans applying based on inclusion in priority category 4 
because they are catastrophically disabled must complete the entire 
form. Veterans applying based on inclusion in priority category 5 must 
complete the entire form. Veterans applying based on inclusion in 
priority category 7 must complete the entire form except for section 
IIE. VA form 10-10EZ is set forth in paragraph (f) of this section and 
is available from VA medical facilities.
* * * * *
    (3) Placement in enrollment categories.
    (i) Veterans will be placed in priority categories whether or not 
veterans in that category are eligible to be enrolled.
    (ii) A veteran will be placed in the highest priority category or 
categories for which the veteran qualifies.
    (iii) A veteran may be placed in only one priority category, except 
that a veteran placed in priority category 6 based on a specified 
disorder or illness will also be placed in priority category 7 or 
priority category 8, as applicable, if the veteran has previously 
agreed to pay the applicable copayment, for all matters not covered by 
priority category 6.
    (iv) A veteran who had been enrolled based on inclusion in priority 
category 5 and became no longer eligible for inclusion in priority 
category 5 due to failure to submit to VA a current VA Form 10-10EZ 
will be changed automatically to enrollment based on inclusion in 
priority category 6 or 8 (or more than one of these categories if the 
previous principle applies), as applicable, and be considered 
continuously enrolled. To meet the criteria for priority category 5, a 
veteran must be eligible for priority category 5 based on the 
information submitted to VA in a current VA Form 10-10EZ. To be 
current, after VA has sent a form 10-10EZ to the veteran at the 
veteran's last known address, the veteran must return the completed 
form (including signature) to the address on the return envelope within 
60 days from the date VA sent the form to the veteran.

[[Page 62889]]

    (v) Veterans will be disenrolled, and reenrolled, in the order of 
the priority categories listed with veterans in priority category 1 
being the last to be disenrolled and the first to be reenrolled. 
Similarly, within priority categories 7 and 8, veterans will be 
disenrolled, and reenrolled, in the order of the priority subcategories 
listed with veterans in subcategory (i) being the last to be 
disenrolled and first to be reenrolled.
* * * * *
    (5) Disenrollment. A veteran enrolled in the VA health care system 
under paragraph (d)(2) or (d)(4) of this section will be disenrolled 
only if:
    (i) The veteran submits to a VA medical center or the VA Health 
Eligibility Center, 1644 Tullie Circle, Atlanta, Georgia 30329, a 
signed document stating that the veteran no longer wishes to be 
enrolled; or
* * * * *
(Authority: 38 U.S.C 101, 501, 1521, 1701, 1705, 1710, 1721, 1722).

[FR Doc. 02-25491 Filed 10-8-02; 8:45 am]
BILLING CODE 8320-01-P