[Federal Register Volume 76, Number 41 (Wednesday, March 2, 2011)]
[Rules and Regulations]
[Pages 11338-11339]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-4686]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AN41


Hospital and Outpatient Care for Veterans Released From 
Incarceration to Transitional Housing

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: This document affirms as final a proposed rule that amends the 
Department of Veterans Affairs (VA) medical regulations to authorize VA 
to provide hospital and outpatient care to a veteran in a program that 
provides temporary housing upon release from incarceration in a prison 
or jail. The final rule permits VA to work with these veterans while 
they are in these programs with the goal of continuing to work with 
them after their release, which will assist in preventing homelessness 
in this population of veterans.

DATES: This final rule is effective April 1, 2011.

FOR FURTHER INFORMATION CONTACT: James McGuire, Program Manager, 
Healthcare for Re-entry Veterans, Veterans Health Administration, 
Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 
20420, (202) 461-1591. (This is not a toll free number.)

SUPPLEMENTARY INFORMATION: Under 38 U.S.C. 1710(h), VA is not required 
``to furnish care to a veteran to whom another agency of Federal, 
State, or local government has a duty under law to provide care in an 
institution of such government.'' VA implemented this statute in 38 CFR 
17.38(c)(5). Generally, Sec.  17.38(c)(5) bars VA from providing 
``[h]ospital and outpatient care for a veteran who is either a patient 
or inmate in an institution of another government agency if that agency 
has a duty to give the care or services.'' Typically, government 
agencies have a duty to provide medical care to inmates who have been 
released from incarceration in a prison or jail to a temporary housing 
program (such as a community residential re-entry center or halfway 
house).
    This duty may exist even though the responsible government agency 
expects residents in these programs to arrange for their own medical 
care. Irrespective of whether a duty exists, however, VA wants to be 
able to provide hospital and outpatient care to eligible veterans in 
these programs. Under Sec.  17.38(c)(5), VA cannot provide care to 
veterans in these programs if the other government agency has a duty to 
provide the care unless that agency is willing to pay VA for the care 
by contract.
    In a proposed rule published May 12, 2010, we proposed to amend 
Sec.  17.38 to establish that the exclusion in paragraph (c)(5) does 
not apply to any veteran who is released from incarceration to a 
temporary housing program. We explained that this amendment is 
necessary to authorize VA hospital and outpatient care for these 
veterans who often require additional assistance in successfully 
transitioning from incarceration.
    VA wants to provide care to these veterans because VA has found 
that upon release from jail or prison these veterans are particularly 
at risk of not receiving adequate medical care, and in many cases 
become homeless, as a result of not receiving such care, after their 
release from temporary housing programs. Under 38 U.S.C. 2022(a), VA is 
charged with reaching out ``to veterans at risk of homelessness, 
including particularly veterans who are being discharged or released 
from institutions after * * * imprisonment.'' Outreach workers for the 
Veterans Health Administration report that veterans with acute or 
chronic medical or psychiatric problems who are treated while 
incarcerated, often have difficulty obtaining similar treatment during 
a transitional period. In particular, if mental health issues are not 
addressed during the transitional period, upon release, many of these 
veterans are rendered incapable of finding or maintaining appropriate 
housing.
    In addition to being an important component of VA's duty to attempt 
to prevent veterans from becoming homeless, establishing that the 
exclusion in 38 CFR 17.38(c)(5) does not apply to veterans who are 
residents in temporary housing programs offers potentially significant 
public benefits and will further the success of other VA policies. For 
example, section 20 of VHA Handbook 1160.01 specifically requires VA to 
``engage with veterans being released from prison in need of care.'' 
VHA Handbook 1160.01, section 20(a)(2). As significant numbers of 
veterans in these programs have difficulty obtaining medical treatment 
comparable to the treatment they received in prison, some begin to 
believe the only way they can obtain treatment is to violate the terms 
of their release and return to prison. A 2008 Urban Institute study of 
a large re-entry population cohort, found health care played a key role 
in the first months of community re-adjustment and reduced recidivism. 
Mallik-Kane, K, and Visher, C.A., Health and prisoner re-entry: How 
physical, mental, and substance abuse conditions shape the process of 
re-integration. Urban Institute Justice Policy Center: Washington, DC 
(2008). In particular, the study noted that access to medications for 
chronic health and mental health conditions is a low-cost powerful tool 
in preventing recidivism.
    We received three comments on the proposed rule. All of the 
comments support the substance of the proposed rule. One commenter 
recommended that VA add a number of services to its medical benefits 
package, and made strategic recommendations for VA housing programs. 
This rulemaking simply removes a bar that prevented veterans, who are 
released from incarceration into temporary housing, from receiving 
outpatient and hospital care under the medical benefits package. 
Because the commenter suggested that additional services be added to 
this package, we do not believe that these comments are within the 
scope of this rulemaking. However, to the extent that the commenter 
seeks to connect veterans to needed care and support services, we note 
that VA currently provides a number of programs that provide housing 
and other support services to veterans. Nothing prevents formerly 
incarcerated veterans from taking advantage of any of the programs for 
which they qualify.
    For the foregoing reasons, VA amends 38 CFR 17.38 to revise the 
exclusion in the VA medical benefits package for a veteran who is a 
patient or inmate in an institution of another government agency so 
that the exclusion does not apply to a veteran who is a resident of a 
temporary housing program. For purposes of this rule, a ``temporary 
housing program,'' includes community residential re-entry centers, 
halfway houses, and similar residential facilities.

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 an expenditure by 
state, local and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more

[[Page 11339]]

(adjusted annually for inflation) in any given year. This rule has no 
such effect on state, local and tribal governments, or on the private 
sector.

Executive Order 12866

    Executive Order 12866 directs agencies to assess all 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, 
and other advantages; distributive impacts; and equity). The Order 
classifies a ``significant regulatory action,'' requiring review by the 
Office of Management and Budget (OMB), as a 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, state, local, or tribal 
governments or communities; (2) create a serious inconsistency or 
otherwise interfere with an action planned or taken 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 rule have been examined, and it has been 
determined not to be a significant regulatory action under Executive 
Order 12866.

Paperwork Reduction Act

    This rule does not contain any collections of information under the 
Paperwork Reduction Act (44 U.S.C. 3501-3520).

Regulatory Flexibility Act

    The Secretary hereby certifies that this rule does 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 rule only affects individuals, not small entities. Therefore, 
pursuant to 5 U.S.C. 605(b), this 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 64.009, Veterans Medical 
Care Benefits; 64.011, Veterans Dental Care; 64.012, Veterans 
Prescription Service; 64.013, Veterans Prosthetic Appliances; 64.019, 
Veterans Rehabilitation Alcohol and Drug Dependence; and 64.022, 
Veterans Home Based Primary Care.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document 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. John R, 
Gingrich, Chief of Staff, approved this document on February 24, 2011 
for publication.

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.

    Dated: February 25, 2011.
William F. Russo,
Director, Regulations Management, Department of Veterans Affairs.
    For the reasons stated in the preamble, VA amends 38 CFR part 17 as 
follows:

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. Revise Sec.  17.38(c)(5) to read as follows:


Sec.  17.38  Medical benefits package.

* * * * *
    (c) * * *
    (5) Hospital and outpatient care for a veteran who is either a 
patient or inmate in an institution of another government agency if 
that agency has a duty to give the care or services. This exclusion 
does not apply to veterans who are released from incarceration in a 
prison or jail into a temporary housing program (such as a community 
residential re-entry center or halfway house).
* * * * *
[FR Doc. 2011-4686 Filed 3-1-11; 8:45 am]
BILLING CODE 8320-01-P