[Federal Register Volume 79, Number 229 (Friday, November 28, 2014)]
[Proposed Rules]
[Pages 70941-70942]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-27230]



  Federal Register / Vol. 79, No. 229 / Friday, November 28, 2014 / 
Proposed Rules  

[[Page 70941]]


-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP10


Exempting Mental Health Peer Support Services From Copayments

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY: The Department of Veterans Affairs (VA) is proposing to amend 
its regulation that sets forth the VA services that are not subject to 
copayment requirements for inpatient hospital care or outpatient 
medical care. Specifically, the regulation would be amended to exempt 
mental health peer support services from having any required copayment. 
This would remove a barrier that may have previously discouraged 
veterans from choosing to use mental health peer support services as a 
viable care option. VA believes that mental health peer support 
services are a valuable resource for veterans with mental health 
conditions and wants to ensure that veterans take full advantage of all 
resources available to them.

DATES: Written comments must be received on or before January 27, 2015.

ADDRESSES: Written comments may be submitted through 
www.Regulations.gov; by mail or hand-delivery to the Director, 
Regulation Policy and Management (02REG), Department of Veterans 
Affairs, 810 Vermont Ave. NW., Room 1068, Washington, DC 20420; or by 
fax to (202) 273-9026. Comments should indicate that they are submitted 
in response to ``RIN 2900-AP10--Exempting Mental Health Peer Support 
Services from Copayments.'' Copies of comments received will be 
available for public inspection in the Office of Regulation Policy and 
Management, Room 1068, between the hours of 8 a.m. and 4:30 p.m. Monday 
through Friday (except holidays). Please call (202) 461-4902 for an 
appointment. (This is not a toll-free number.) In addition, during the 
comment period, comments may be viewed online through the Federal 
Docket Management System (FDMS) at www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Kristin J. Cunningham, Director 
Business Policy, Chief Business Office (10NB6), Veterans Health 
Administration, Department of Veterans Affairs, 810 Vermont Ave. NW., 
Washington, DC 20420; (202) 382-2508. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: Peer support services are provided as part 
of the medical care available to veterans under 38 U.S.C. 1710, 
specifically as part of mental health care services. Under 38 U.S.C. 
7401 and 7402, VA has the authority to appoint peer specialists. A peer 
specialist is a veteran ``who has recovered or is recovering from a 
mental health condition'' and is certified to provide peer support 
services. 38 U.S.C. 7402(b)(13). This certification may be obtained 
from a VA approved not-for-profit entity or a State approved process. 
These specialists are appointed by VA to provide veteran support 
services by relating to the veterans through their own personal 
experiences in recovering from mental illness. VA uses peer support 
services to help veterans with mental illness to successfully engage in 
their treatment through sharing experiences, encouragement, and 
instilling a sense of hope and skill building to promote recovery. 
Section 4 of Executive Order 13625, dated August 31, 2012, ordered VA 
to expand mental health staffing by hiring and training 800 peer-to-
peer counselors to ``empower veterans to support other veterans and 
help meet mental health care needs.'' 77 FR 54784, Sept. 5, 2012.
    VA now proposes to exempt mental health peer support services from 
the copayment requirement set forth in 38 CFR 17.108. Unless otherwise 
exempt, Veterans are currently required to pay a copayment of fifteen 
dollars for mental health peer support services. Under 38 U.S.C. 
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 by regulation.'' VA has interpreted 
section 1710(g)(1) to mean that VA has the discretion to establish the 
applicable copayment amount in regulation, even if such amount is zero. 
Generally, VA calculates the amount of a copayment based on the type of 
medical care provided and the resources needed to provide such care. In 
addition, VA may exempt certain care from copayment requirements in an 
effort to make health care more accessible to veterans, or to encourage 
veterans to become more actively involved in their medical care, and 
thereby improve health care outcomes (which, in turn, lowers overall 
health care costs). VA proposes to make mental health peer support 
services exempt from copayments in order to make such services more 
accessible to veterans and encourage veterans' use of such services. 
Veterans value the dynamic of peer support services because they can 
relate to other veterans through shared experiences, but because such 
services are currently subject to copayments, they may be less 
attractive to veterans who could benefit from them. VA proposes to make 
peer support services exempt from copayments by amending 38 CFR 17.108 
to add a new paragraph (e)(17) to include mental health peer support 
services as services that are exempt from copayment requirements. The 
removal of the copayment would eliminate a potential barrier that could 
discourage veterans from using mental health peer support services as 
part of their mental health care. We would also make minor technical 
corrections to Sec.  17.108(e).

Administrative Procedure Act

    Concurrent with this proposed rule, we also are publishing a 
separate, substantively identical direct final rule in this Federal 
Register. See RIN 2900-AP11. The simultaneous publication of these 
documents will speed notice and comment rulemaking under section 553 of 
the Administrative Procedure Act (5 U.S.C. 553) should we have to 
withdraw the direct final rule due to receipt of significant adverse 
comments.
    For purposes of the direct final rulemaking, a significant adverse 
comment is one that explains why the rule would be inappropriate, 
including challenges to the rule's underlying premise or approach, or 
why it would be ineffective or unacceptable without change. If 
significant adverse comments are received, VA will publish a document 
acknowledging receipt of significant adverse comments in the Federal 
Register and withdrawing the direct final rule.
    Under direct final rule procedures, unless significant adverse 
comments are received within the comment period, the regulation will 
become effective on the date specified in RIN 2900-AP11. After the 
close of the comment period, VA will publish a document in the Federal 
Register indicating that no adverse comments were received and 
confirming the date on which the final rule will become effective. VA 
will also publish a document withdrawing this proposed rule.
    In the event the direct final rule is withdrawn because of 
significant adverse comments, VA can proceed with the rulemaking by 
addressing the comments received and publishing a final rule. The 
comment period for the proposed rule runs concurrently with that of the 
direct final rule. Any comment received under the direct final rule 
will be treated as a comment regarding the proposed rule. VA will 
consider such comment in developing a subsequent final rule. Likewise, 
significant adverse comments submitted to the proposed rule will be 
considered

[[Page 70942]]

as comments regarding the direct final rule.

Effect of Rulemaking

    The Code of Federal Regulations, as proposed to be revised by this 
proposed rulemaking, would represent the exclusive legal authority on 
this subject. No contrary rules or procedures would be authorized. All 
VA guidance would be read to conform with this rulemaking if possible 
or, if not possible, such guidance would be superseded by this 
rulemaking.

Paperwork Reduction Act

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

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 directly affect only 
individuals and would not directly affect any small entities. 
Therefore, pursuant to 5 U.S.C. 605(b), this rulemaking is exempt from 
the initial and final regulatory flexibility analysis requirements of 5 
U.S.C. 603 and 604.

Executive Orders 12866 and 13563

    Executive Orders 12866 and 13563 direct 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) emphasizes the importance of quantifying both costs and 
benefits, reducing costs, harmonizing rules, and promoting flexibility. 
Executive Order 12866 (Regulatory Planning and Review) defines 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 this Executive Order.''
    The economic, interagency, budgetary, legal, and policy 
implications of this proposed rule have been examined, and it has been 
determined not to be a significant regulatory action under Executive 
Order 12866. VA's impact analysis can be found as a supporting document 
at http://www.regulations.gov, usually within 48 hours after the 
rulemaking document is published. Additionally, a copy of the 
rulemaking and its impact analysis are available on VA's Web site at 
http://www.va.gov/orpm, by following the link for VA Regulations 
Published From FY 2004 Through Fiscal Year to Date.

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 1 year. This proposed rule would have no such effect 
on State, local, and tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance numbers and titles for 
the programs affected by this document are 64.008, Veterans Domiciliary 
Care; 64.009, Veterans Medical Care Benefits; 64.010, Veterans Nursing 
Home Care; 64.019, Veterans Rehabilitation Alcohol and Drug Dependence; 
64.022, Veterans Home Based Primary Care; and 64.024, VA Homeless 
Providers Grant and Per Diem Program.

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. Jose D. 
Riojas, Chief of Staff, Department of Veterans Affairs, approved this 
document on October 31, 2014, for publication.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, 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: November 13, 2014.
William F. Russo,
Acting Director, Office of Regulation Policy & Management, Office of 
the General Counsel, U.S. Department of Veterans Affairs.

    For the reasons set out in the preamble, VA proposes to amend 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. Amend Sec.  17.108 by:
0
a. In paragraph (e)(4), removing ``.'' and adding in its place ``;''.
0
b. In paragraph (e)(14), removing ``and'' immediately after ``;''.
0
c. In paragraph (e)(15), removing ``.'' and adding in its place ``;''.
0
d. In paragraph (e)(16), removing ``.'' and adding in its place ``; 
and''.
0
e. Adding a new paragraph (e)(17) to read as follows:


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

* * * * *
    (e) * * *
    (17) Mental health peer support services.
* * * * *
[FR Doc. 2014-27230 Filed 11-26-14; 8:45 am]
BILLING CODE 8320-01-P