[Federal Register Volume 73, Number 92 (Monday, May 12, 2008)]
[Rules and Regulations]
[Pages 26945-26947]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-10488]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AM40


Provision of Hospital Care and Medical Services During Certain 
Disasters or Emergencies

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) hereby establishes 
regulations regarding the provision of hospital care and medical 
services under the VA Emergency Preparedness Act of 2002, to 
individuals responding to, involved in, or otherwise affected by 
certain disasters or emergencies (including individuals who otherwise 
do not have VA eligibility for such care and services).

DATES: Effective Date: This final rule is effective May 12, 2008.

FOR FURTHER INFORMATION CONTACT: Tony A. Guagliardo, Director, Business 
Policy, Chief Business Office (163), Veterans Health Administration, 
Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 
20420 (202) 254-0406. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: This document amends VA medical regulations 
to implement provisions of Public Law 107-287, the VA Emergency 
Preparedness Act of 2002, regarding hospital care and medical services 
provided to individuals responding to, involved in, or otherwise 
affected by certain disasters or emergencies (including individuals who 
otherwise do not have VA eligibility for such care and services).
    This final rule adopts, without change, the provisions of the 
corresponding proposed rule published in the Federal Register on July 
12, 2007 (72 FR 38042), based on the rationale set forth in the 
proposed rule and this document. The proposed rule provided for a 60-
day comment period which ended September 10, 2007. We received comments 
from three individuals. The comments are discussed below.
    One commenter merely expressed agreement with the provisions of the 
proposed rule.
    A second commenter asserted that free care should be provided by 
the Federal government to anyone who needs it when a disaster occurs. 
We made no changes based on this comment. As proposed and under this 
final rule at Sec.  17.86(e), individuals who receive hospital care or 
medical services under the emergency provisions are responsible for the 
cost of the hospital care or medical services when charges are mandated 
by Federal law (including applicable appropriation acts) or when the 
cost of care or services is not reimbursed by other-than-VA Federal 
departments or agencies. This is intended to help ensure that funding 
will be available to VA for hospital care and medical services for 
veterans eligible for such care and services and in some instances is 
required by Federal law.
    A third commenter expressed support for the proposed rule changes. 
The commenter also expressed views concerning how VA should prepare for 
and act in response to disasters. Those statements concern matters not 
within the scope of this rulemaking. Accordingly, we made no changes 
based on this comment.

Administrative Procedure Act

    Pursuant to 5 U.S.C. 553(d), we find that there is good cause to 
dispense with a 30-day delay in the effective date of this rule. We 
find that delay in its effective date would be contrary to the public 
interest. A disaster or emergency requiring the use of this rule could 
occur at any time and it is in the public interest that we have in 
place regulations to implement the emergency program under 38 U.S.C. 
1785, in compliance with the provisions of section 205 of division I of 
Public Law 110-161, the Consolidated Appropriations Act, 2008, if and 
when the need arises. Further, we find that this rule's provisions are 
not ones for which members of the public would need a delay in 
effective date to prepare for the changes made by the rule.

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 given year. This rule will have no such effect on 
State, local, and tribal governments, or the private sector.

Paperwork Reduction Act of 1995

    This document contains no provisions constituting a collection of 
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).

Executive Order 12866

    Executive Order 12866 directs agencies to assess all costs and 
benefits

[[Page 26946]]

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, and other 
advantages; distributive impacts; and equity). The Executive Order 
classifies a ``significant regulatory action,'' requiring review by the 
Office of Management and Budget (OMB) unless OMB waives such review, as 
any regulatory action that is likely to result in a rule that may: (1) 
Have an annual effect on the economy of $100 million or more or 
adversely affect in a material way the economy, a sector of the 
economy, productivity, competition, jobs, the environment, public 
health or safety, or State, local, or tribal governments or 
communities; (2) create a serious inconsistency or otherwise interfere 
with an action taken or planned by another agency; (3) materially alter 
the budgetary impact of entitlements, grants, user fees, or loan 
programs or the rights and obligations of recipients thereof; or (4) 
raise novel legal or policy issues arising out of legal mandates, the 
President's priorities, or the principles set forth in the Executive 
Order.
    The economic, interagency, budgetary, legal, and policy 
implications of this final rule have been examined and it has been 
determined to be a significant regulatory action under the Executive 
Order because it is likely to result in a rule that may raise novel 
legal or policy issues arising out of legal mandates, the President's 
priorities, or the principles set forth in the Executive Order.

Regulatory Flexibility Act

    The Secretary hereby certifies that this final rule will not have a 
significant economic impact on a substantial number of small entities 
as they are defined in the Regulatory Flexibility Act. In addition to 
affecting individuals, this document will affect mainly large insurance 
companies. Further, where small entities are involved, they will not be 
impacted significantly since an inconsequential portion of their 
business will be with VA. Accordingly, pursuant to 5 U.S.C. 605(b), 
this final rule is exempt from the initial and final regulatory 
flexibility analysis requirements of sections 603 and 604.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance numbers and titles for 
the programs affected by this document are 64.005, Grants to States for 
the Construction of State Homes; 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.

    Approved: February 5, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.

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For the reasons set forth in the preamble, the Department of Veterans 
Affairs amends 38 CFR part 17 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, and as noted in specific 
sections.


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2. Add an undesignated center heading and Sec.  17.86 to read as 
follows:

Care During Certain Disasters and Emergencies


Sec.  17.86  Provision of hospital care and medical services during 
certain disasters and emergencies under 38 U.S.C. 1785.

    (a) This section sets forth regulations regarding the provision of 
hospital care and medical services under 38 U.S.C. 1785.
    (b) During and immediately following a disaster or emergency 
referred to in paragraph (c) of this section, VA under 38 U.S.C. 1785 
may furnish hospital care and medical services to individuals 
(including those who otherwise do not have VA eligibility for such care 
and services) responding to, involved in, or otherwise affected by that 
disaster or emergency.
    (c) For purposes of this section, a disaster or emergency means:
    (1) A major disaster or emergency declared by the President under 
the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 
U.S.C. 5121 et seq.) (Stafford Act); or
    (2) A disaster or emergency in which the National Disaster Medical 
System established pursuant to section 2811(b) of the Public Health 
Service Act (42 U.S.C. 300hh-11(b)) is activated either by the 
Secretary of Health and Human Services under paragraph (3)(A) of that 
section or as otherwise authorized by law.
    (d) For purposes of paragraph (b) of this section, the terms 
hospital care and medical services have the meanings given such terms 
by 38 U.S.C. 1701(5) and 1701(6).
    (e) Unless the cost of care is charged at rates agreed upon in a 
sharing agreement as described in Sec.  17.102(e), the cost of hospital 
care and medical services provided under this section to an officer or 
employee of a department or agency of the United States (other than VA) 
or to a member of the Armed Forces shall be calculated in accordance 
with the provisions of Sec.  17.102(c) and (h). Other individuals who 
receive hospital care or medical services under this section are 
responsible for the cost of the hospital care or medical services when 
charges are mandated by Federal law (including applicable appropriation 
acts) or when the cost of care or services is not reimbursed by other-
than-VA Federal departments or agencies. When individuals are 
responsible under this section for the cost of hospital care or medical 
services, VA will bill in the amounts calculated in accordance with the 
provisions of Sec.  17.102(h), without applying the exception provided 
in the first paragraph of Sec.  17.102.
    (f) VA may furnish care and services under this section to a 
veteran without regard to whether that individual is enrolled in the VA 
healthcare system under 38 U.S.C. 1705 and Sec.  17.36 of this part.

    (Authority: 38 U.S.C. 501, 1785)


Sec.  17.102  [Amended]

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3. Amend Sec.  17.102 by:
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a. In paragraph (b)(1), removing ``Sec.  17.43(c)(1)'' and adding, in 
its place, ``Sec.  17.43(b)(1)''.
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b. In the first sentence of paragraph (h), adding ``Sec.  17.86 and 
under'' after ``charges under''; removing ``Cost Distribution Report'' 
and adding, in its place, ``Monthly Program Cost Report (MPCR)''; and 
removing ``and outpatient visit'' and adding, in its place, ``, and 
actual basic costs and rates for outpatient care visits or 
prescriptions filled''.
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c. In the fifth sentence of paragraph (h), removing ``Cost Distribution

[[Page 26947]]

Report'' and adding, in its place, ``MPCR''.

[FR Doc. E8-10488 Filed 5-9-08; 8:45 am]
BILLING CODE 8320-01-P