[Federal Register Volume 80, Number 80 (Monday, April 27, 2015)]
[Rules and Regulations]
[Pages 23239-23241]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-09633]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Parts 1 and 17

RIN 2900-AP17


Updating Certain Delegations of Authority in VA Medical 
Regulations

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) is making technical 
amendments to its medical regulations by updating certain delegations 
of authority to be consistent with the statutory authority that 
established the Consolidated Patient Account Centers (CPACs). VA is, 
through this final rule, specifying delegations of authority for the 
collection of debts owed VA to the Chief Financial Officers of the 
CPACs.

DATES: Effective date: This final rule is effective April 27, 2015.

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

SUPPLEMENTARY INFORMATION: This rulemaking amends VA's regulations in 
title 38 Code of Federal Regulations (CFR) that delegate authority for 
the collection of debts owed to VA for medical care or services 
provided or furnished to a veteran for a nonservice-connected 
disability to the Fiscal Officer or the Chief of the Fiscal Activity at 
the VA medical facility responsible for the collection of the debt or 
the station where the debt occurred. Consistent with the requirements 
of 38 U.S.C. 1729B, VA established seven Consolidated Patient Account 
Centers (CPACs), whose function is to centralize the billing and 
collection activities of VA medical facilities related to medical care 
(commonly referred to as ``revenue activity''). Creation of the CPACs 
has allowed VA to uniformly address revenue activities and improve 
service to veterans.
    This rulemaking amends our regulations to be consistent with 38 
U.S.C. 1729B, which required VA to establish the CPACs, and current 
practice to specify that, for medical care revenue activities, the 
responsibility for collection of a medical debt belongs to the CPAC, 
rather than the Fiscal Officer or Chief of the Fiscal Activity at the 
medical facility or station. We also are clarifying that the Chief of 
the Fiscal Activity of a VA facility or the Chief of the Fiscal 
Activity of the station where the debt occurred is no longer the 
responsible individual for the fiscal activities of such facility or 
station because these fiscal activities fall under the purview of the 
Chief Financial Officer of the corresponding CPAC. This rulemaking 
amends Sec. Sec.  1.956(a)(2)(iv), 17.103(a), 17.104(a), and 17.105(c).
    Current Sec.  1.956(a)(2)(iv) states that fiscal officers at VA 
medical facilities are authorized to waive veterans' debts arising from 
medical care copayments (Sec.  17.105(c)). Consistent with 38 U.S.C. 
1729B and under current practice, the CPACs are responsible for waiving 
debts related to medical care copayments, not the individual VA medical 
facilities. We are amending Sec.  1.956(a)(2)(iv) to clarify that the 
Chief Financial Officer of the Consolidated Patient Account Center is 
authorized to waive veterans' debts arising from medical care 
copayments (Sec.  17.105(c).
    Current Sec.  17.103(a) states that compromise offers for debts of 
charges made under Sec.  17.101(a) shall be referred to the Chief of 
the Fiscal activity of the facility for application of the collection 
standards in Sec.  1.900 et seq. The reference to Sec.  17.101(a) is 
incorrect. A veteran is not responsible for charges billed to an 
insurance company under the methodology in Sec.  17.101. Only the 
General Counsel and those authorized to act for the General Counsel 
have the authority to compromise or waive a claim arising under 38 
U.S.C. 1729 and 38 CFR 17.101. The application of the collection 
standards in Sec.  1.900 et seq. are primarily focused on benefit debt, 
including copayment debt and employee debt. The reference to Sec.  
17.101(a) was added in error by a final rule published by VA in 1996, 
61 FR 21964. The correct reference in Sec.  17.103(a) should be to the 
copayment provisions of Sec. Sec.  17.108, 17.110 or 17.111. 
Accordingly, we are amending paragraph (a), introductory text, by 
removing the references made to the debt that represents charges made 
under Sec.  17.101(a), and the Chief of the Fiscal activity of the 
facility to refer instead to the debt representing charges made

[[Page 23240]]

under Sec. Sec.  17.108, 17.110 or 17.111, and the Chief Financial 
Officer of the Consolidated Patient Account Center (CPAC) to make the 
statement in line with the authorizing statute for the CPAC. We are 
also amending the heading of Sec.  17.103(a) to refer to the ``Chief 
Financial Officers of the Consolidated Patient Account Centers'' in 
order to correctly state the individual who is responsible for the 
financial activities of paragraph (a). We are also amending Sec.  
17.103(a)(2), which uses the term ``field station.'' As we have stated 
in this rulemaking, the CPAC is now in charge of activities that were 
previously done in a field facility. We are, therefore, removing the 
term ``a field station'' in paragraph (a)(2) and adding, in its place, 
``the CPAC.'' We are making a similar amendment in Sec.  17.104(a), 
which states that questions concerning suspension or termination of 
collection action shall be referred to the Chief of the Fiscal activity 
of the station for application of the collection standards in Sec.  
1.900 et seq. Specifically, we are amending paragraph (a) by removing 
the reference to Sec.  17.101(a) and (b). As previously stated in this 
rulemaking, these references are incorrect because the veteran is not 
responsible for charges under Sec.  17.101; rather, the veteran is 
responsible for charges under Sec. Sec.  17.108, 17.110 or 17.111. We 
are also amending the term ``Chief of the Fiscal activity of the 
station'' and replacing it with ``Chief Financial Officer of the 
Consolidated Patient Account Center.''
    Paragraph (c) of Sec.  17.105 states that the Fiscal Officer at a 
VA medical facility where all or part of the debt was incurred will 
receive claims for waivers, and that the Fiscal Officer may also extend 
the time period for submitting said waiver. Paragraph (c) also states 
that a decision rendered by the Fiscal Officer under this provision is 
final. In an effort to maintain consistency, we are removing the words 
``Fiscal Officer at a VA medical facility where all or part of the debt 
was incurred'' and replacing them with ``the Consolidated Patient 
Account Center (CPAC) Chief Financial Officer.'' We are also removing 
the term ``Fiscal Officer'' and replacing the term with ``CPAC Chief 
Financial Officer'' every time it appears. We are making these changes 
because the CPACs are now in charge of processing waivers of debts of 
charges for copayments.

Administrative Procedure Act

    The Secretary of Veterans Affairs finds that there is good cause 
under 5 U.S.C. 553(b)(B) and (d)(3) to dispense with the opportunity 
for notice and public comment and good cause to publish this rule with 
an immediate effective date. This final rule merely revises VA's 
regulations so that they align with recent statutory amendments and 
corrects a citation that was added in error by a prior rulemaking. 
These are technical revisions only. Therefore, compliance with the 
notice-and-comment and delayed effective date requirements of 5 U.S.C. 
553 is unnecessary.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as revised by this 
final rulemaking, represents VA's implementation of its legal authority 
on this subject. Other than future amendments to this regulation or 
governing statutes, no contrary guidance or procedures are authorized. 
All existing or subsequent VA guidance must be read to conform with 
this rulemaking if possible or, if not possible, such guidance is 
superseded by this rulemaking.

Paperwork Reduction Act

    This final 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 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, 5 U.S.C. 601-
612. This final rule directly affects only individuals and will not 
directly affect 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 final 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 FYTD.

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 one year. This final rule will 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 program numbers and 
titles for this rule are as follows: 64.008, Veterans Domiciliary Care; 
64.009, Veterans Medical Care Benefits; 64.010, Veterans Nursing Home 
Care; and 64.018, Sharing Specialized Medical Resources.

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

[[Page 23241]]

D. Riojas, Chief of Staff, Department of Veterans Affairs, approved 
this document on April 16, 2015, for publication.

List of Subjects

38 CFR Part 1

    Administrative practice and procedure, Archives and records, 
Cemeteries, Claims, Courts, Crime, Flags, Freedom of information, 
Government contracts, Government employees, Government property, 
Infants and children, Inventions and patents, Parking Penalties, 
Privacy Reporting and recordkeeping requirements, Seals and insignia, 
Security measures, Wages.

38 CFR Part 17

    Administrative practice and procedure, Claims, Health care, Health 
facilities, Health records, Nursing homes, Reporting and recordkeeping 
requirements, Veterans.

    Approved: April 21, 2015.
Michael Shores,
Chief Impact Analyst, Office of Regulation Policy & Management, Office 
of the General Counsel, Department of Veterans Affairs.
    For the reasons set forth in the preamble, we amend 38 CFR parts 1 
and 17 as follows:

PART 1--GENERAL PROVISIONS

0
1. The authority citation for part 1 continues to read as follows:


    Authority:  38 U.S.C. 501(a), and as noted in specific sections.


0
2. Revise Sec.  1.956(a)(2)(iv) to read as follows:


Sec.  1.956  Jurisdiction.

    (a) * * *
    (2) * * *
    (iv) The Chief Financial Officer of the Consolidated Patient 
Account Center is authorized to waive veterans' debts arising from 
medical care copayments (Sec.  17.105(c) of this chapter).
* * * * *

PART 17--MEDICAL

0
3. The authority citation for part 17 continues to read as follows:


    Authority:  38 U.S.C. 501, and as noted in specific sections.


Sec.  17.103  [Amended]

0
4. Amend Sec.  17.103 by:
0
a. In the heading of paragraph (a), removing the term ``Chiefs of 
Fiscal activities'' and adding, in its place, ``Chief Financial 
Officers of the Consolidated Patient Account Centers''.
0
b. In paragraph (a) introductory text, removing ``If the debt 
represents charges made under Sec.  17.101(a), the compromise offer 
shall be referred to the Chief of the Fiscal activity of the facility'' 
and adding, in its place, ``If the debt represents charges made under 
Sec. Sec.  17.108, 17.110, or 17.111, the compromise offer shall be 
referred to the Chief Financial Officer of the Consolidated Patient 
Account Center (CPAC)''.
0
c. In paragraph (a)(2), removing the term ``a field station'' and 
adding, in its place, ``the CPAC''.


Sec.  17.104  [Amended]

0
5. Amend Sec.  17.104 by removing from paragraph (a) ``If the debt 
represents charges made under Sec.  17.101 (a) or (b) questions 
concerning suspension or termination of collection action shall be 
referred to the Chief of the Fiscal activity of the station'' and 
adding, in its place, ``If the debt represents charges made under 
Sec. Sec.  17.108, 17.110, or 17.111 questions concerning suspension or 
termination of collection action shall be referred to the Chief 
Financial Officer of the Consolidated Patient Account Center''.

0
6. Revise Sec.  17.105(c) to read as follows:


Sec.  17.105  Waivers.

* * * * *
    (c) Of charges for copayments. If the debt represents charges for 
outpatient medical care, inpatient hospital care, medication or 
extended care services copayments made under Sec. Sec.  17.108, 17.110, 
or 17.111, the claimant must request a waiver by submitting VA Form 
5655 (Financial Status Report) to the Consolidated Patient Account 
Center (CPAC) Chief Financial Officer. The claimant must submit this 
form within the time period provided in Sec.  1.963(b) of this chapter 
and may request a hearing under Sec.  1.966(a) of this chapter. The 
CPAC Chief Financial Officer may extend the time period for submitting 
a claim if the Chairperson of the Committee on Waivers and Compromises 
could do so under Sec.  1.963(b) of this chapter. The CPAC Chief 
Financial Officer will apply the standard ``equity and good 
conscience'' in accordance with Sec. Sec.  1.965 and 1.966(a) of this 
chapter, and may waive all or part of the claimant's debts. A decision 
by the CPAC Chief Financial Officer under this provision is final 
(except that the decision may be reversed or modified based on new and 
material evidence, fraud, a change in law or interpretation of law, or 
clear and unmistakable error shown by the evidence in the file at the 
time of the prior decision as provided in Sec.  1.969 of this chapter) 
and may be appealed in accordance with 38 CFR parts 19 and 20.
* * * * *
[FR Doc. 2015-09633 Filed 4-24-15; 8:45 am]
 BILLING CODE 8320-01-P