[Federal Register Volume 70, Number 83 (Monday, May 2, 2005)]
[Rules and Regulations]
[Pages 22595-22596]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-8729]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AM11


Elimination of Copayment for Smoking Cessation Counseling

AGENCY: Department of Veterans Affairs.

ACTION: Interim final rule.

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SUMMARY: This interim final rule amends the Department of Veterans 
Affairs (VA) medical regulations concerning copayments for inpatient 
hospital care and outpatient medical care. This rule designates smoking 
cessation counseling (individual and group sessions) as a service that 
is not subject to copayment requirements. The intended effect of this 
interim final rule is to increase participation in smoking cessation 
counseling by removing the copayment barrier.

DATES: Effective Date: May 2, 2005. Comments must be received on or 
before July 1, 2005.

ADDRESSES: Written comments may be submitted by: Mail or hand-delivery 
to Director, Regulations Management (00REG1), Department of Veterans 
Affairs, 810 Vermont Ave., NW., Room 1068, Washington, DC 20420; fax to 
(202) 273-9026; e-mail to [email protected]; or, through http://www.Regulations.gov. Comments should indicate that they are submitted 
in response to ``RIN 2900-AM11.'' All comments received will be 
available for public inspection in the Office of Regulation Policy and 
Management, Room 1063B, between the hours of 8 a.m. and 4:30 p.m., 
Monday through Friday (except holidays). Please call (202) 273-9515 for 
an appointment.

FOR FURTHER INFORMATION CONTACT: Eileen P. Downey, Program Analyst, 
Policy Development, Chief Business Office (16), (202) 254-0347 or Dr. 
Kim Hamlet-Berry, Director, Public Health National Prevention Program, 
Veterans Health Administration, 810 Vermont Avenue NW., Washington, DC 
20420, (202) 273-8929. (These are not toll-free numbers).

SUPPLEMENTARY INFORMATION: Smoking is the leading preventable cause of 
morbidity and mortality in the United States, with a 43 percent higher 
prevalence of smoking among veterans than in the comparable general 
population, based on age- and gender-comparisons. Many veterans, 
particularly WWII and Korean War era veterans began smoking in the 
military as cigarettes were routinely provided as part of K-rations. 
Veterans who receive their health care in the VA represent the 
subgroups that have the highest prevalence of smoking, notably 
individuals from lower socioeconomic levels, substance abuse 
populations, and individuals with psychiatric disorders. The prevalence 
of smoking has continued to be very high among these groups despite 
substantial decreases in smoking in the general population.
    The prevalence of smoking among VA's population is costly. In 2003, 
the Veterans Health Administration (VHA) conducted an analysis of the 
costs and benefits of the current copayment for smoking cessation. The 
analysis revealed that smoking-related illnesses account for up to 
23.81 percent of total health care costs in VA. Treatment of smoking 
and prevention of smoking-related illnesses is likely to continue to be 
a public health priority for VA in the future. The 2003 Department of 
Defense Survey of health-related behaviors among active military 
personnel noted the first increase in rates of smoking since 1980, with 
rates at or approaching the prevalence of smoking in VA populations.
    Smoking cessation is effective and has been cited in medical 
literature as the gold standard for cost-effectiveness among medical/
preventive interventions, second only to routine immunizations of 
children. Significant medical literature suggests the copayments can 
serve as a barrier to accessing counseling for smoking cessation. Both 
the 2000 U.S. Public Health Service Guidelines on Smoking Cessation and 
the Centers for Disease Control and Prevention Task Force on Community 
Preventive Services strongly recommend reduction or elimination of out-
of-pocket expenses for smoking cessation services.
    Given the clinical challenges facing the VA population, the cost of 
smoking-related illness, the effectiveness of

[[Page 22596]]

smoking cessation counseling, and the current relatively low 
participation levels in VA smoking cessation services, VA seeks to 
reduce barriers to the utilization of evidence-based smoking cessation 
counseling services. This interim final rule will advance that goal by 
eliminating the copayment requirement for smoking cessation counseling.

Administrative Procedure Act

    Pursuant to 5 U.S.C. 553, we find that we have good cause to 
dispense with advance notice and comment on this rule because of the 
urgent need for its implementation and the unlikelihood, given the fact 
that it grants an exemption from the copayment requirement, of 
encountering opposition from the public. The practice of smoking can 
lead to extremely debilitating disease and, possibly, death. In the 
time required to subject this rule to traditional notice and comment 
procedures, individuals who smoke incur a risk of contracting or 
exacerbating disease, or of dying, because they might be deterred by 
reason of the copayment requirement from participating in the program. 
Accordingly, we find that these significant health concerns render 
delay for notice and comment procedures impracticable and contrary to 
the public interest. Further, because this rule is beneficial to the 
public and is unlikely to generate adverse comments, we find that prior 
notice and opportunity to comment are unnecessary. Because of the need 
to reduce barriers to participating in combating this public health 
emergency, because the rule grants an exemption or relieves a 
restriction, and for the above reasons, we also find that it is 
unnecessary to delay the effective date of the rule by 30 days.

Regulatory Flexibility Act

    The Secretary hereby certifies that this interim final 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. The provisions of this interim final rule would not 
directly affect any small entities. Only individuals could be directly 
affected. Accordingly, pursuant to 5 U.S.C. 605(b), this interim final 
rule is exempt from the initial and final regulatory flexibility 
analyses requirements of sections 603 and 604.

Executive Order 12866

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

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 64.024.

Paperwork Reduction Act

    This document does not contain new provisions constituting a 
collection of information under the Paperwork Reduction Act (44 U.S.C. 
3501-3521).

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 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 (adjusted annually for 
inflation) in any given year. This interim final rule will have no such 
effect on State, local, or tribal governments, or the private sector.

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: December 17, 2004.
Anthony J. Principi,
Secretary of Veterans Affairs.

0
For the reasons set out in the preamble, 38 CFR Part 17 is amended as 
follows:

PART 17--MEDICAL

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

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


0
2. Section 17.108 is amended by:
0
A. In paragraph (e) (11), removing ``and'' from the end of the 
paragraph.
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B. Redesignating paragraph (e) (12) as (e) (13).
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C. Adding new paragraph (e) (12).
    The addition reads as follows:


Sec.  17.108  Copayments for inpatient hospital care and outpatient 
medical care.

* * * * *
    (e) * * *
    (12) Smoking cessation counseling (individual and group); and
* * * * *
[FR Doc. 05-8729 Filed 4-29-05; 8:45 am]
BILLING CODE 8320-01-P