[Federal Register Volume 80, Number 101 (Wednesday, May 27, 2015)]
[Proposed Rules]
[Pages 30190-30200]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-12724]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 70
RIN 2900-AO92
Veterans Transportation Service
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its
medical regulations concerning the transportation of persons for the
purposes of examination, treatment, and care. Public Law 112-260, as
amended, authorized VA to carry out a program to transport any person
to or from a VA facility or other place, among other things, for the
purpose of examination, treatment, or care. This authority expires on
December 31, 2015. These regulations would provide guidelines for
veterans and the public regarding VA's Veterans Transportation Service
(VTS).
DATES: Comment Date: Comments must be received on or before July 27,
2015.
ADDRESSES: Written comments may be submitted through http://www.regulations.gov; by mail or hand-delivery to 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-AO92-Veterans Transportation Service.'' Copies of
comments received will be available for public inspection in the Office
of Regulation Policy and Management, Room 1068, between the hours of
8:00 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 http://www.regulations.gov.
FOR FURTHER INFORMATION CONTACT: David Riley, Director, Veterans
Transportation Program, Chief Business Office (10NB2G), 2957 Clairmont
Rd., Atlanta, GA 30329-1647, (404) 828-5601. (This is not a toll-free
number.)
SUPPLEMENTARY INFORMATION:
Executive Summary: Purpose of This Regulatory Action: We would
create new regulations concerning the Veterans Transportation Service
(VTS), a program where the Department of Veterans Affairs (VA) directly
transports veterans and other persons to or from VA or VA-authorized
facilities for the purposes of examination, treatment, or care.
Specifically, these regulations would define which persons are
eligible, how they may apply for transportation benefits, and how VA
would provide transportation, including such limitations as are
necessary for the safe and effective operation of the program.
Summary of the Major Provisions of this Regulatory Action: This
proposed rule would--
Modify VA's existing transportation regulations by
including new content specific to VA's direct transportation of
veterans and other persons for the purposes of examination, treatment,
or care.
Define key terms used throughout the regulation. These
terms would include attendant, which would be similar to the term used
in VA's beneficiary travel program and refer to a person who is
required to aid or assist another person; guest, which would be a
person whose presence is not medically required; scheduled visit,
[[Page 30191]]
which would be an appointment arranged prior to a person's appearance
at a VA or VA-authorized facility; and unscheduled visit, which would
be a visit that was not recorded in VA's scheduling system prior to the
visit.
Define eligible persons, which would include enrolled and
non-enrolled veterans; servicemembers; prospective and approved family
caregivers; attendants; persons receiving counseling, training, or
mental health services; beneficiaries of the Civilian Health and
Medical Program of the Department of Veterans Affairs (CHAMPVA); and
guests. The regulation would also define limitations on eligibility,
such as if the person's behavior has jeopardized or could jeopardize
the health or safety of others, or could interfere with the safe
transportation of persons. The regulations also would limit access so
that only one person may accompany a veteran or servicemember unless a
VA clinician determines that more than one person should attend the
visit. The regulation also would provide some restrictions for persons
under the age of 18.
Identify and describe the types of transportation
authorized under VTS, including door-to-door service, travel to and
from designated locations, service between VA facilities, and travel to
and from other locations.
Explain the process for arranging transportation services
and how VA would determine which persons can travel if demand for VTS
services exceeds supply.
Costs and Benefits: As further detailed in the Regulatory Impact
Analysis, which can be found as a supporting document at http://www.regulations.gov and is 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,'' the proposed rule would
expand access to transportation options for veterans and other persons.
Increasing transportation options should allow more veterans and other
beneficiaries to access VA health care services and reduce demand for
travel reimbursement under the beneficiary travel program.
General Discussion: In section 202 of the Dignified Burial and
Other Veterans' Benefits Improvement Act of 2012 (the Act), Public Law
112-260, 126 Stat. 2417 (2013), as amended by Public Law 113-59, 127
Stat. 658 (2013) and Public Law 113-175, 128 Stat. 1901 (2014),
Congress codified a new statute, 38 U.S.C. 111A, which authorizes the
Department of Veterans Affairs (VA), until December 31, 2015, to
transport any person to or from a VA facility or other place in
connection with vocational rehabilitation, counseling required by
chapters 34 or 35 of title 38, U.S.C., or for the purpose of
examination, treatment, or care. Vocational rehabilitation is
authorized by chapter 31 of title 38, U.S.C., and assists veterans with
service-connected disabilities in preparing for, finding, and keeping
suitable employment. Chapters 34 and 35 of title 38, U.S.C., authorize
education benefits for eligible veterans and their survivors and
dependents. Vocational rehabilitation and the education benefits
provided under chapters 34 and 35 are administered by the Veterans
Benefits Administration (VBA), and are not typically provided at VA
health care facilities. Moreover, almost all VA health care facilities
administer transportation programs in the form of beneficiary travel
payments, and many have already begun addressing transportation service
issues by developing infrastructure or identifying the travel needs of
their patients as a result of this authority. Consequently, VA is
limiting this rulemaking to health care access (meaning any hospital
care or medical services under the medical benefits package in 38 CFR
17.38), and we do not include transportation for vocational
rehabilitation or education benefits under chapters 34 and 35. VA has
promulgated regulations in part 70 of 38 CFR governing transportation
benefits for travel to health care facilities, and this rulemaking is
consistent with those existing rules. We would use the term ``VA
facility'' rather than the more specific ``VA health care facility'' in
this regulation because the term ``VA facility'' is already a defined
term in 38 CFR 70.2 that refers to health care facilities.
We propose organizing these regulations in 38 CFR part 70, which
also contains regulations governing the Veterans Health
Administration's (VHA) beneficiary travel program, so that eligible
persons and members of the public who are interested in VA
transportation benefits could find all relevant information in one
location in VA's regulations. Accordingly, we would amend the title for
part 70 to read, ``Veterans Transportation Programs,'' to indicate that
it contains regulations related to more than one transportation
program. Under this heading, there would be two subheadings. The first
would identify a new subpart for the current part 70 regulations
related to beneficiary travel (Sec. Sec. 70.1-70.50). This subheading
would read, ``Subpart A-Beneficiary Travel and Special Mode
Transportation under 38 U.S.C. 111.'' The second subheading, ``Subpart
B-Veterans Transportation Service under 38 U.S.C. 111A,'' would contain
the regulations promulgated by this proposed rule. We also would modify
the list of authorities for part 70 to include 38 U.S.C. 111A.
This rulemaking is intended to cover only those transportation
services provided to eligible persons by the Veterans Transportation
Service (VTS) pursuant to 38 U.S.C. 111A. The Veterans Transportation
Service is a program where VA transports eligible persons to and from
VA or VA-authorized health care facilities and other locations for the
purpose of examination, treatment or care. The current regulations
governing the beneficiary travel program, located at Sec. Sec. 70.1
through 70.50, contain numerous references to part 70. For example,
Sec. 70.1(a) states that ``[t]his part [i.e., part 70] provides a
mechanism under 38 U.S.C. 111 for the Veterans Health Administration
(VHA) to make payments for travel expenses,'' and Sec. 70.1(b) states
that part 70 does not cover payment for certain other specified
transportation. Section 70.2 provides definitions applicable to all of
part 70. Because we are organizing the VTS regulations under part 70,
these part 70 references and definitions also apply to the VTS program.
We have carefully reviewed part 70 and believe that all of the
references are appropriate and will not create confusion. For example,
the definitions in Sec. 70.2 generally are consistent with the
proposed VTS regulations that would be promulgated with this
rulemaking, with one exception as noted below. Also, the references in
Sec. Sec. 70.1 and 70.10 clearly refer to beneficiary travel, and VTS
is not part of the beneficiary travel program. We are not revising the
beneficiary travel regulations at this time. Commenters who identify
confusing or contrary sections in part 70 are encouraged to provide
comments to this rulemaking. We are currently reviewing the other
regulations in part 70 and will make appropriate revisions in a future
action. We do not intend to make any changes to the beneficiary travel
program as a result of this rulemaking, and this rulemaking should not
be interpreted to modify the current beneficiary travel regulations in
any way.
70.70 Purpose and Definitions
Paragraph (a) of Sec. 70.70 states that this subpart would apply
to VTS, a program that transports eligible persons to or from a VA or
VA-authorized facility or other place for the purpose of
[[Page 30192]]
examination, treatment, or care. A VA-authorized health care facility
is defined in Sec. 70.2 as a non-VA health care facility where VA has
approved care for an eligible beneficiary at VA expense. Travel to such
facilities would be covered under VTS as it currently is under the
beneficiary travel program.
In Sec. 70.70(b), we would set forth definitions applicable to
VTS. The definition of ``attendant'' for purposes of VTS would include,
but not be limited to, the definition used in 38 CFR 70.2. Under Sec.
70.2, an attendant is ``an individual traveling with a beneficiary who
is eligible for beneficiary travel and requires the aid and/or physical
assistance of another person.'' Because VTS is intended to support a
broader population, VA is not limiting attendants for purposes of VTS
to only those persons who are eligible for beneficiary travel. Thus,
for purposes of VTS, an attendant also would mean an individual
traveling with a veteran or servicemember who is eligible for VTS and
requires the aid and/or assistance of another person. This definition
would ensure that VA may transport attendants through VTS for all
veterans and servicemembers who are eligible for VTS on their own.
We would define an ``eligible person'' as one described in Sec.
70.71, which would define categories of eligible persons in detail.
We would define a ``guest'' as any individual the veteran or
servicemember would like to have accompany him or her to an appointment
but whose presence is not medically required. Some examples of guests
who might be asked to attend would be a general caregiver (that is, not
a Family Caregiver, which is described later and in regulations at 38
CFR part 71) who provides supervision or other basic support or a
friend who can provide emotional support during an appointment.
We also would define ``scheduled visit'' and ``unscheduled visit.''
A scheduled visit would mean that a VA beneficiary had an appointment
that was made before she or he appeared at a VA or VA-authorized
facility, or that a VA beneficiary was specifically authorized to
appear at such facility on the date of the visit in order to obtain
examination, treatment, or care. Examples of scheduled visits include:
Regular appointments for examination, treatment, or care; visits to
undergo laboratory work; or doctor-recommended visits to clinics with
open hours. This definition would be consistent with common usage of
the term in the health care community. An unscheduled visit would be
when a veteran travels to a VA or VA-authorized facility for purposes
of examination, treatment, or care not recorded in VA's scheduling
system prior to the veteran's visit. An unscheduled visit is commonly
made for mental health visits, counseling sessions, or other types of
clinical interventions, such as weight management counseling or smoking
cessation. These visits need not be for an appointment with a VA
clinician; for example, a veteran may be traveling to attend a peer-led
counseling session. These definitions would allow VA to ensure veterans
are able to travel using VTS for the full array of services we provide.
70.71 Eligibility
Section 70.71 would define the categories of persons eligible for
transportation services under this authority. Eligibility for VTS would
be broader than eligibility for the beneficiary travel program for a
number of reasons. First, 38 U.S.C. 111A authorizes VA to provide
transportation to ``any person'' to or from a VA facility or other
place, among other things, for the purpose of examination, treatment,
or care. In other provisions of title 38, U.S.C., the term person is
defined as being broader than the term veteran. For example, in 38
U.S.C. 1708(b), persons eligible for temporary lodging in a Fisher
House or other appropriate facility include veterans, family members,
and others who accompany a veteran and provide the equivalent of
familial support within that definition. We interpret the broad term
``any person'' to authorize VA to provide VTS to the widest possible
range of individuals, including former members of the Armed Forces,
family members, and other beneficiaries. In addition, veterans may be
eligible for VTS whether they are enrolled in VA's health care system
or not.
VA also would include additional persons as eligible for VTS
because 38 U.S.C. 111A does not require VA to provide direct
transportation to specific types of persons, as the law did for
beneficiary travel payments in 38 U.S.C. 111(b). Moreover, VTS has a
negligible marginal cost for each new user of the service compared to
beneficiary travel recipients. VTS is designed to provide
transportation to several people at once using a single vehicle, and
provided that vehicles are not full, adding one more passenger results
in extremely small cost increases for VA.
Furthermore the purpose of 38 U.S.C. 111A is to expand
transportation options for persons who receive certain benefits from
VA. During the House of Representatives' consideration of the bill, the
Chairman of the Veterans' Affairs Committee described the intent of
this provision as being to complement, and not replace, existing
programs that offer transportation assistance to veterans. See 158
Cong. Rec. H7445 (Dec. 30, 2012). This regulation would achieve that
goal. Consequently, we would interpret the term ``any person'' in 38
U.S.C. 111A more broadly than the same term in 38 U.S.C. 111.
Paragraph (a) of Sec. 70.71 would define all persons eligible for
beneficiary travel as also being eligible for VTS benefits. This
definition would be consistent with the statutory authorities for VTS
and the beneficiary travel program. Specifically, the language in 38
U.S.C. 111(a) that authorizes VA to make beneficiary travel payments is
the same as the language in 38 U.S.C. 111A in terms of the purpose for
the travel. Thus, VA is interpreting 38 U.S.C. 111A as authorizing VTS
benefits to the categories of persons eligible for beneficiary travel
payments under Sec. 70.10.
Because some individuals will be eligible for transportation
benefits under both VTS and the beneficiary travel program, paragraph
(a) would prohibit beneficiaries from claiming more than one type of
transportation benefit for the same travel. Essentially, this provision
would prohibit a beneficiary from receiving direct transportation
services through VTS under subpart B of part 70 while also filing a
claim for mileage reimbursement or special mode transportation under
VA's beneficiary travel program in subpart A of part 70 for the same
travel. However, participation in VTS would not prevent a person
eligible for beneficiary travel from receiving benefits under that
program for travel expenses actually incurred. For example, if veterans
eligible for mileage reimbursement under the beneficiary travel program
drove from their residences to a designated location where they boarded
a van that took them to a VA facility, these veterans would receive
mileage reimbursement for their travel from their residences to the
designated location and back, but would not be eligible for
reimbursement for the portion of the trip provided by VA. This would be
consistent with VA's requirements in regulations at Sec. 70.30(a) that
VA will pay for beneficiary travel by an eligible beneficiary when
travel expenses are actually incurred.
Enrolled veterans would be eligible under paragraph (b) if they are
traveling for a scheduled visit or urgent care; for retrieval,
adjustment, or training
[[Page 30193]]
concerning medications or prosthetic appliances; to acquire and become
adjusted to a service dog provided pursuant to 38 CFR 17.148; for an
unscheduled visit; or to participate and attend other events or
functions for the purposes of examination, treatment, or care. Some of
these visits are recorded in the files of the specific clinical
practice or service line but may not be recorded as a clinical
encounter in VA's scheduling package. Veterans may travel to other
events or functions, such as Stand Downs for homeless veterans and
special events like the Wheelchair Games and the Summer and Winter
Sports Clinics, when VA has clinically determined that the event or
function is for the purpose of examination, treatment, or care.
VA staff would work to ensure appropriate accommodations are made
for veterans traveling with a service animal.
Urgent care may also qualify as an unscheduled visit; however,
veterans with emergent care needs should call 911. VTS is not equipped
to provide the level of care and services that veterans in a medical
emergency require.
Veterans who are not enrolled in VA's health care system also would
be eligible for transportation by VTS under paragraph (c) if they are
travelling for an unscheduled or walk-in visit. This type of visit will
often result from direct interaction with a VA employee or a
solicitation by VA to apply for enrollment or other health care
benefits for which the person is eligible, but a veteran could choose
to come to VA independently. Establishing this category would ensure
that VA is able to transport veterans seeking enrollment in the VA
health care system or access to other veterans' benefits (such as for
compensation and pension) and those who qualify for VA assistance (such
as homeless veterans) but who are not currently in VA's health care
system. Veterans, whether they are enrolled or not, also would be
eligible if they are traveling for a medical examination related to a
claim for compensation or pension benefits from the Veterans Benefits
Administration. Veterans who are not enrolled also would be allowed to
travel to other events or functions VA has clinically determined are
for the purpose of examination, treatment, or care.
Paragraph (d) would establish eligibility for active duty
servicemembers and members of the National Guard or Reserve traveling
to a VA or VA-authorized facility for the purpose of examination,
treatment, or care; for a compensation and pension examination; or to
enroll or otherwise receive benefits for which they are eligible from a
VA or VA-authorized facility. In many locations across the country,
active duty personnel receive health care from a VA facility pursuant
to a sharing agreement or other arrangement. In other cases,
servicemembers may be in the process of transitioning from the Armed
Forces to the VA system. Including these individuals would facilitate
the delivery of health care and improve access for persons
transitioning from military service.
Paragraph (e) would authorize VA to transport prospective and
designated Family Caregivers under 38 CFR 71.25. Family caregivers
could travel either to receive their own benefits or to accompany the
veteran or servicemember to whom they are furnishing caregiver
services. Under paragraph (j)(2) of this section, only one person,
whether an attendant, Family Caregiver, or guest would be able to
travel at a time for the care of an eligible veteran or servicemember,
unless a VA clinician determines that more than one Family Caregiver
should be present when services are provided to the eligible veteran or
servicemember. This limitation is intended to ensure that eligible
veterans and servicemembers have the support of their family caregivers
and allow for training and education of Family Caregivers, while still
ensuring other veterans and servicemembers are able to access
transportation services. The Family Caregiver would not need to travel
with the eligible veteran or servicemember. For example, an eligible
veteran or servicemember may be receiving inpatient care, and the
Family Caregiver may need to travel back and forth to the facility
several times during the patient's admission.
Family Caregivers also would be able to travel for receipt of
benefits made available to them under the Family Caregivers Program in
part 71. When traveling in connection with the examination, treatment,
or care of a veteran or servicemember, the Family Caregiver is
essentially traveling as an attendant, and VA may limit the number of
attendants who can accompany a veteran or servicemember. VA would limit
travel to one Family Caregiver per veteran or servicemember at a time
when the Family Caregiver is accompanying the veteran or servicemember
in the interest of ensuring that veterans or servicemembers have
sufficient access to VTS for their own health care needs. This
limitation also would apply when a Family Caregiver is traveling
without an eligible veteran or servicemember but in connection with the
examination, treatment, or care of an eligible veteran or
servicemember. In both circumstances, if a VA clinician determined that
more than one Family Caregiver should travel in connection with the
examination, treatment, or care of a veteran or servicemember, all of
the Family Caregivers requested by the clinician would be able to
travel. If the Family Caregiver were traveling for benefits available
under the Family Caregivers Program, he or she would be able to travel
independent of the veteran or servicemember, and the limitation of only
one Family Caregiver per trip would no longer apply. Specifically,
prospective Family Caregivers would be able to travel for an initial
mandatory assessment and training under 38 CFR 71.25(c)-(d), and Family
Caregivers would be able to travel for benefits in 38 CFR 71.40(b),
which includes general caregiver benefits; continuing instruction,
preparation, or training related to the care of the veteran or
servicemember; ongoing technical support in a timely manner; and
counseling, training, or mental health services as described in 38 CFR
71.50 and 71.40(b)(5). Family Caregivers also would be able to travel
if they were designated as Primary Family Caregivers and were seeking
benefits in 38 CFR 71.40(c)(1) or (2), which includes all of the Family
Caregiver benefits just described and respite care. VA also would
provide transportation to a VA facility if the Primary Family Caregiver
is eligible under 38 CFR 71.40(c)(3) to receive health care under the
Civilian Health and Medical Program of the Department of Veterans
Affairs (CHAMPVA) and if such care is being delivered at a VA facility
under the CHAMPVA Inhouse Treatment Initiative (CITI). CITI is an
initiative through which VA provides eligible non-veterans with care in
VA facilities. Although this program is not available at every
facility, extending transportation to these individuals would result in
no additional expenditure of resources while providing greater access
to health care.
Paragraph (f) would authorize VA to transport an attendant. For
purposes of VTS, an attendant, as defined in Sec. 70.70(b), would have
the meaning set forth in Sec. 70.2 and also mean an individual
traveling with a veteran or servicemember who is eligible for travel
under VTS and requires the aid and/or assistance of another person.
Such travel would be permitted when it is in connection with the
examination, treatment, or care of any enrolled or non-enrolled veteran
or servicemember.
[[Page 30194]]
Paragraph (g) would authorize VA to transport persons receiving
counseling, training, or mental health services under 38 U.S.C. 1782
and 38 CFR 71.50. Under these authorities, VA provides consultation,
professional counseling, marriage and family counseling, training, and
mental health services to family members of veterans when necessary in
connection with the treatment of a disability (both service-connected
and non-service connected) for which the veteran is receiving treatment
through VA. These services are offered as an extension to the care
provided for veterans, and access to these services by family members
can be improved by offering direct transportation services to them. For
purposes of 38 CFR 71.50, the term ``family member'' means ``(1) A
person related to the veteran by birth or marriage who lives with the
veteran or has regular personal contact with the veteran; (2) The
veteran's legal guardian or surrogate; (3) A Primary or Secondary
Family Caregiver or a General Caregiver; or (4) The individual in whose
household the veteran has certified an intention to live.'' 38 CFR
71.50(b). The terms ``primary family caregiver,'' ``secondary family
caregiver,'' and ``general caregiver'' are defined and described in
Sec. Sec. 71.25 and 71.30. Under 38 CFR 71.50(c), VA may provide
referral services for family members who cannot be provided benefits
under that section because their need is not necessary in connection
with the treatment of the veteran. VA would not provide VTS services to
aid these family members in following up on these referrals because by
definition it lacks authority to provide care to these persons.
Paragraph (h) would authorize VA to transport certain CHAMPVA
beneficiaries, specifically those eligible for and receiving care
through CITI. CHAMPVA beneficiaries are the spouses or dependents of
certain veterans, or as noted previously, the designated Primary Family
Caregiver of an eligible veteran. Few CHAMPVA beneficiaries receive
care at VA facilities through this program, but including them as
eligible persons for VTS will help ensure access to health care. VA
would not extend transportation services under this authority to allow
transportation to non-VA facilities for CHAMPVA beneficiaries because
these persons could receive care at a number of different locations,
and providing transportation to these various facilities would be too
costly and time-consuming, ultimately depriving veterans and
servicemembers of transportation resources. VA Mobility Managers or
other designated personnel could assist CHAMPVA beneficiaries receiving
care at non-VA facilities in accessing other resources to travel for
their care. Throughout the regulation, we refer to the ``facility
director or designee'' as the responsible official; in almost all
cases, this would be the facility's Mobility Manager.
Paragraph (i) would authorize VA to transport a guest of a veteran
or servicemember who is traveling for the purpose of examination,
treatment, or care. Section 70.70(b) includes a definition of the word
guest. A guest would be a person who accompanies an eligible person but
who is not providing necessary clinical support. In contrast, an
attendant would be someone who has been determined to be clinically
needed to aid and assist another person. Including these individuals is
important to the care and treatment of veterans because it can provide
comfort to the veteran during the clinical encounter and can assist
with the veteran's care after the veteran has returned home by either
training the guest or supporting the veteran's recollection of the
provider's instructions. Transporting one additional individual on a
vehicle represents only a marginal cost to VA and can provide a
significant benefit to the veteran. However, guests would be
transported only as resources permit. Consequently, if a veteran
requested transportation for a guest, VA could decline to transport
that person if it could not accommodate all veterans, servicemembers,
Family Caregivers, attendants, and other CHAMPVA beneficiaries who have
requested transportation services. VA Mobility Managers or other
designated personnel would provide referrals to other non-VA
transportation resources for guests in such a scenario. VA believes
this limitation is important because it would allow VA to transport
others for the benefit of the veteran, without compromising access for
veterans, servicemembers, Family Caregivers, attendants, or other
CHAMPVA beneficiaries.
Paragraph (j) would define limitations on eligibility. Under
paragraph (j)(1), VA would have the authority to restrict access to VTS
when VA has determined that transporting a person has jeopardized or
could jeopardize the health or safety of other eligible users of VTS or
VA staff. A person may also be ineligible if the person's behavior has
interfered or could interfere with the safe transportation of eligible
persons to or from a VA facility or other place. Decisions to limit
access under this paragraph would be made after considering, for
example, the nature of the risk to other VTS users and VA staff, the
individual's particular circumstances, and any prior decisions to
restrict access to VTS. This provision is intended to balance an
otherwise eligible individual's need for VTS services and the safety
and well-being of veterans, other VTS users, and VA employees.
Paragraph (j)(2) would limit the number of Family Caregivers,
attendants, or guests that may travel with an eligible person on a
given trip. Unless otherwise indicated by a VA clinician, a veteran or
servicemember would not be able to be accompanied by more than one
Family Caregiver, one attendant, or one guest per trip. This limitation
is intended to preserve transportation resources for veterans and
servicemembers, while allowing flexibility to ensure that patient needs
are appropriately satisfied. However, more than one Family Caregiver
may travel for receipt of his or her own benefits under Sec.
70.71(e)(1) or (e)(2)(ii).
Finally, paragraph (j)(3) would provide conditions under which a
person under the age of 18 may accompany another person using VTS.
Specifically, a parent or legal guardian would have to consent to the
transportation, and the facility director or designee would have to
consent to the transportation as well. The facility director or
designee would consider the special transportation needs of the child,
if any; the ability to transport the child safely using the available
resources; the availability of services at the facility to accommodate
the needs of the child; the appropriateness of transporting the child;
and any other relevant factors. Applying these criteria, a facility
director or designee may not consent to the transport of a child for
several reasons. For example, if the person is an infant or small
child, he or she may require a special car seat or other restraining
device to ensure safe transportation. VA transportation of children
would not be available if State law required the use of a child
restraint, such as a child safety seat or booster seat. This limitation
would be specifically noted in this paragraph, due to the potential
dangers and liabilities that could result from improper use of a
child's car seat or use of an improper child's car seat.
Children could be accompanying another person using VTS because
child care services could not be arranged. VA notes that a limited
number of VA facilities offer child care services through a pilot
program authorized by Public Law 111-163, 124 Stat. 1130 (2010), the
Caregivers and Veterans
[[Page 30195]]
Omnibus Health Services Act of 2010. VA also could consider any other
relevant factors on a case-by-case basis when making these
determinations. VA does not provide benefits through CITI to persons
under the age of 18, and as a result, this section would not address
their eligibility.
70.72 Types of Transportation
Under 38 CFR 70.72, VTS would be operated in one or more of the
following types: Door-to-door service, designated location service,
service between VA facilities, and other locations.
Door-to-door service, as defined in paragraph (a), would consist of
transporting an eligible person between a VA or VA-authorized facility
and his or her residence or place where the person is staying. The
eligible person could select a location other than his or her residence
or place where the person is staying, but the selection of any other
location would be subject to the approval of the facility director or
designee assessing whether such a location is financially favorable to
VA. The focus of this type of transportation is transporting the
eligible person between a VA or VA-authorized facility and his or her
home. This arrangement is the most patient-centered option and can
allow VA to make multiple stops along the way to ensure as many persons
are transported for care as possible. This type of transportation is
likely to be particularly effective when persons are geographically
concentrated in one location, as well as for persons with limited
mobility or other disabilities, such as visual impairment, that would
make transportation for health care services more difficult. VA could
use this type of transportation to transport a patient who is being
discharged from inpatient care and requests door-to-door service on an
unscheduled basis. This is designed to ensure that veterans who have
received inpatient care and may not have another means of returning
home can do so safely.
The default location for transportation would be the eligible
person's residence or place where the person is staying, as it is with
other VA transportation programs, most notably the beneficiary travel
program. Under VTS, VA could transport persons from another location
when such transportation is financially favorable to VA. For example,
if a veteran lives in a remote area but works in an urban center and
requests transportation from his or place of employment to a VA medical
facility, VA could approve the requested transportation even though the
departure location is the person's place of employment as it would
require fewer miles driven and fewer resources used by VA.
Determinations regarding financial favorability to the Department are
currently made for VA's beneficiary travel program under Sec.
70.30(b)(8), and.VA would apply these same criteria in the context of
VTS.
VA could also identify designated locations in communities from
which it would transport eligible persons on a scheduled basis to VA or
VA-authorized health care facilities and to which they would be
transported under paragraph (b). This type of transportation moves
eligible persons between VA or VA-authorized facilities and designated
locations in the community. Veterans or other eligible persons wishing
to ensure transport should contact the facility's Mobility Manager or
other designated personnel using the process described in Sec. 70.73
to reserve a seat on the vehicle. Decisions regarding reservations and
allocation of seats when demand for transportation services exceeds
supply would be made in accordance with established guidelines and
criteria, as discussed in Sec. 70.73, but eligible persons generally
would be accommodated on a first come, first served basis. VA intends
that designated locations generally would be identified based upon
convenience of access for persons and the consent of the property
owner. In some communities, a private shopping complex might be the
best location for persons to meet for transportation services, and in
such a situation, the VA facility would need to agree with the property
owner on the use of the property. Alternatively, a military base or a
VA Regional Office may be ideally located, in which case such an
agreement would not be necessary, provided the eligible VTS users
otherwise have access to the area.
Under paragraph (c), VA could transport eligible persons between VA
or VA-authorized health care facilities either on a scheduled or
unscheduled basis. An eligible person may need to travel from one VA
building to another within a single VA campus for scheduled or
unscheduled visits, for example, or a VA facility may wish to transport
a veteran to another VA or VA-authorized facility for care that cannot
be provided at one location but that could be accommodated at another.
Any persons requiring emergency care that could be accommodated at the
facility would be transported by ambulance (not a VTS vehicle) to the
nearest VA or non-VA medical facility capable of delivering the
required care. Payment of the ambulance costs would be determined in
accordance with existing regulations in part 70. As indicated above,
paragraph (c) also would authorize transportation from one building to
another on a single VA campus. This is intended to ensure eligible
veterans and other health care beneficiaries can safely access
treatment and services.
Finally, under paragraph (d), VA could transport eligible persons
to and/or from a VA or VA-authorized facility or other locations. This
type of transportation would allow VA to move eligible persons from one
location to another when a VA clinician has determined that such
transport is needed to promote, preserve, or restore the health of the
individual and is in accord with generally accepted standards of
medical practice as defined in Sec. 17.38(b). This is consistent with
38 U.S.C. 111A, which requires that transportation be for the purpose
of examination, treatment or care, and with VA's standards for the
delivery of care in the medical benefits package in 38 CFR 17.38(b).
Eligible persons could be transported from their home to another
location, or from a VA or VA-authorized facility to another location,
to promote, preserve, or restore the health of the individual. For
example, blind or visually impaired veterans often need assistance in
learning or updating navigation skills, and clinicians in VA's Blind
Rehabilitation Center provide this support. Other transportation, such
as day trips for nursing home patients or trips to retreat settings for
persons undergoing counseling, could also be undertaken using VTS
because the transportation would be considered treatment or care,
authorized by chapter 17 of title 38. Travel under paragraph (d) would
be permissible only for veterans and servicemembers and any attendants
because the basis for transportation is to promote, preserve, or
restore the health of an individual seeking or receiving VA care. VA
could also transport a CHAMPVA beneficiary receiving health care
benefits under the CITI program.
70.73 Arranging Transportation Services
Eligible persons should contact the facility director or designee,
in many cases the Mobility Manager, at the VA facility that is
providing or authorizing the examination, treatment, or care for which
the person is traveling to request transportation services. Persons
could make a reservation by requesting transportation and providing the
necessary information, including their name, the basis for the
eligibility for transportation (as defined in Sec. 70.71), the name of
the veteran or
[[Page 30196]]
servicemember they are accompanying (if applicable), the time of the
appointment (if known), the location from and to which they will
require transportation, any special needs that must be accommodated to
allow for transportation (e.g., wheelchair, oxygen tank, service or
guide dog), and other relevant information.
Under paragraph (b), persons could travel without a reservation if
they were being discharged from an inpatient setting or were traveling
for an unscheduled visit pursuant to a recommendation by an attending
VA clinician. Eligible persons could also travel without a reservation
from one VA or VA-authorized facility to another, such as when a
patient needs transportation from one building on campus to another.
Eligible persons, whether requesting scheduled or unscheduled
transport, would have to provide the necessary information described
above. This information is needed to ensure a proper accounting of the
program and to identify unmet transportation needs within the eligible
population.
Generally, transportation services under this authority would be
provided on a first come, first served basis. However, paragraph (c)
states that, when there are more requests for transportation than
available resources, VA could prioritize the provision of
transportation services using several criteria. These criteria are not
listed in order of importance or consideration, and decisions would be
made based on the totality of the circumstances so that no one factor
is determinative. Requests made first in time generally would be
prioritized over later requests, but VA could consider the clinical
needs of each patient, the inability of a person to transport him or
herself, the eligibility of a person for other transportation services
and benefits, the availability of other transportation services, and
the Department's ability to maximize the use of available resources.
Under paragraph (c)(1), VA also could prioritize according to the
eligibility bases for those seeking transportation services. Within
this criterion, there would be a hierarchy: Enrolled veterans would
receive first priority, followed, in order, by non-enrolled veterans;
servicemembers; Family Caregivers; persons receiving counseling,
training, or mental health services under 38 U.S.C. 1782 and 38 CFR
71.50; CHAMPVA beneficiaries participating in the CITI program; and
guests. VA realizes that some veterans are eligible for examination,
treatment, care, or other services without enrolling. However, as a
general practice, VA encourages veterans who seek care to enroll, so we
believe the population of unenrolled veterans who would be affected by
this hierarchy would be quite small. Based on past experience, VA
anticipates the vast majority of eligible veterans would be enrolled
but VA wishes to ensure that unenrolled veterans who have not
previously come to VA for care or benefits have access to
transportation to do so. VA understands that some eligible veterans may
nonetheless choose to not enroll for various reasons, and we note that
an unenrolled veteran who would be eligible for care notwithstanding
his or her enrollment likely would receive priority after consideration
of other criteria included here, including the clinical needs of the
patient, the inability of the person to transport him or herself, and
the availability of other transportation services.
If a veteran or servicemember requires an attendant and is provided
transportation through VTS, VA would provide transportation to the
attendant as well because by definition, the veteran would be unable to
travel without the aid of the attendant. This hierarchy reflects VA's
core mission, to provide health care for veterans. Family Caregivers
travel for purposes related to a veteran's or servicemember's
conditions, and consequently would be prioritized next. Similarly,
persons receiving counseling, training, or mental health services under
38 U.S.C. 1782 and 38 CFR 71.50 are receiving these benefits as an
extension of care for veterans. CHAMPVA beneficiaries participating in
the CITI program are traveling for their own health care conditions and
independent of a veteran's care, and consequently would follow.
Finally, guests would be accommodated on an ``as available'' basis.
Persons who are eligible under more than one designation (e.g., a
veteran serves as a Family Caregiver for another veteran) would be
considered based on the highest priority category applicable to that
trip. For example, CHAMPVA beneficiaries participating in the CITI
program traveling for their own benefits would qualify only under that
designation, but if they were traveling to assist an eligible veteran
or servicemember for that person's appointment, they would be traveling
as an attendant. Similarly, if a Family Caregiver is also a veteran and
is traveling for his or her own medical care, he or she would be
traveling as a veteran. VA's Mobility Managers or other designated
personnel would work with those seeking to arrange transportation
services to determine the proper basis for eligibility.
VA could also consider other criteria. These criteria would allow
VA to ensure those with the greatest need are able to access these
services. For example, an enrolled veteran in need of urgent care could
be given priority over an enrolled veteran in need of non-urgent care.
VA facilities also could make decisions to maximize the use of
available resources. For example, if a group of veterans located in the
same area request transportation and one veteran in another area
several hours away also requests transportation, VA could choose to
serve the similarly located veterans using VTS to ensure maximum access
to its facilities and health care, and assist the remote veteran with
finding transportation alternatives.
VA would endeavor to maintain a greater supply of transportation
slots than demand in all locations, but in cases where demand exceeds
supply, VA Mobility Managers or other designated personnel at each
facility would be responsible for informing persons whose
transportation request cannot be accommodated by VTS that VA would not
be able to transport them as requested. The Mobility Managers or other
designated personnel would be responsible for assisting eligible
persons with alternative transportation options.
Effect of Rulemaking
Title 38 of the Code of Federal Regulations, as proposed to be
revised by this proposed rulemaking, would represent 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 on this subject 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 includes a collection of information under the
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521) that requires
approval by the Office of Management and Budget (OMB). Accordingly,
under 44 U.S.C. 3507(d), VA has submitted a copy of this rulemaking to
OMB for review.
OMB assigns a control number for each collection of information it
approves. VA may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a
currently valid OMB control number. Section 70.73 contains a collection
of information under the
[[Page 30197]]
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521). If OMB does not
approve the collection of information as requested, VA will immediately
remove the provisions containing a collection of information or take
such other action as is directed by OMB.
Comments on the collection of information contained in this
proposed rule should be submitted to the Office of Management and
Budget, Attention: Desk Officer for the Department of Veterans Affairs,
Office of Information and Regulatory Affairs, Washington, DC 20503,
with copies sent by mail or hand delivery to the Director, Regulation
Policy and Management (02REG), Department of Veterans Affairs, 810
Vermont Avenue NW., Room 1068, Washington, DC 20420; fax to (202) 273-
9026; or through www.Regulations.gov. Comments should indicate that
they are submitted in response to ``RIN 2900-AO92-Veterans
Transportation Service.''
OMB is required to make a decision concerning the collections of
information contained in this rule between 30 and 60 days after
publication of this document in the Federal Register. Therefore, a
comment to OMB is best assured of having its full effect if OMB
receives it within 30 days of publication. This does not affect the
deadline for the public to comment on the rule.
VA considers comments by the public on proposed collections of
information in--
Evaluating whether the proposed collections of information
are necessary for the proper performance of the functions of VA,
including whether the information will have practical utility;
Evaluating the accuracy of VA's estimate of the burden of
the proposed collections of information, including the validity of the
methodology and assumptions used;
Enhancing the quality, usefulness, and clarity of the
information to be collected; and
Minimizing the burden of the collections of information on
those who are to respond, including through the use of appropriate
automated, electronic, mechanical, or other technological collection
techniques or other forms of information technology, e.g., permitting
electronic submission of responses.
The amendments to title 38 CFR part 70 contain collections of
information under the Paperwork Reduction Act of 1995 for which we are
requesting approval by OMB. These collections of information are
described immediately following this paragraph, under their respective
titles.
Title: Veterans Transportation Service.
Summary of collection of information: Section 70.73 would require
eligible persons requesting transportation services from VA to provide
their name, the basis of their eligibility (veteran, servicemember,
Family Caregiver, attendant, CITI beneficiary, or guest), the name of
the veteran or servicemember they are accompanying (if applicable), the
time of the appointment (if known), the location of the person's
arrival or departure, any special needs that must be accommodated to
allow for transportation (e.g., wheelchair, oxygen tank, service or
guide dog), and other relevant information.
Description of the need for information and proposed use of
information: The information is needed to ensure that only eligible
persons are receiving VTS benefits, and to ensure the integrity of
related transportation programs such as beneficiary travel. It is also
necessary to measure and evaluate VTS to determine the effectiveness
and need for the program, especially as it relates to the possibility
of eligible persons also being eligible for beneficiary travel
benefits. This information is also needed to ensure the safety of
veterans in the event of an accident or other problem in the operation
of the vehicle, and to ensure VA is prepared to assist the person in
entering, exiting, and riding in the vehicle safely. VA may use this
information to identify trends in usage of transportation services and
make decisions on the allocation of resources to maximize benefits to
the eligible population.
Description of likely respondents: Eligible persons seeking
transportation services from VA.
Estimated number of respondents per year: 100,872 eligible persons.
Estimated frequency of responses per month: 3.32 times per month.
Estimated average burden per response: 5 minutes.
Estimated total annual reporting and recordkeeping burden: 334,895
hours.
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 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 regulatory action have been examined, and it has
been determined not to be a significant regulatory action. 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 proposed rule would have no such
effect on State, local, and tribal governments, or on the private
sector.
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 authorize VA to transport
eligible persons to and from VA or VA-authorized health care
[[Page 30198]]
facilities for the purposes of examination, treatment, or care. The
proposed rule would affect individuals and have no impact on 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 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 as follows: 64.007, Blind
Rehabilitation Centers; 64.009, Veterans Medical Care Benefits; 64.010,
Veterans Nursing Home Care; 64.011, Veterans Dental Care; 64.013,
Veterans Prosthetic Appliances; 64.018, Sharing Specialized Medical
Resources; 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. Jose D.
Riojas, Chief of Staff, Department of Veterans Affairs, approved this
document on January 9, 2015, for publication.
List of Subjects in 38 CFR Part 70
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: May 21, 2015 .
Michael Shores,
Chief Impact Analyst, Office of Regulation Policy & Management, Office
of the General Counsel, U.S. Department of Veterans Affairs.
For the reasons set forth in the preamble, VA proposes to amend 38
CFR part 70 as follows:
PART 70--VETERANS TRANSPORTATION PROGRAMS
0
1. The authority citation for part 70 is revised to read as follows:
Authority: 38 U.S.C. 101, 111, 111A, 501, 1701, 1714, 1720,
1728, 1782, 1783, and E.O. 11302.
0
2. Revise the heading of part 70 to read as set forth above.
0
3. Add a heading for subpart A immediately before Sec. 70.1 to read as
follows:
Subpart A--Beneficiary Travel and Special Mode Transportation under
38 U.S.C. 111
0
4. Designate Sec. Sec. 70.1 through 70.50 as subpart A.
0
5. Add subpart B to read as follows:
Subpart B--Veterans Transportation Service under 38 U.S.C. 111A
Sec.
70.70 Purpose and definitions.
70.71 Eligibility.
70.72 Types of transportation.
70.73 Arranging transportation services.
Subpart B--Veterans Transportation Service under 38 U.S.C. 111A
Sec. 70.70 Purpose and definitions.
(a) Purpose. This subpart implements the Veterans Transportation
Service (VTS), through which VA transports eligible persons to or from
a VA or VA-authorized facility or other place for the purpose of
examination, treatment, or care.
(b) Definitions. For purposes of this subpart:
Attendant has the meaning set forth in Sec. 70.2, and also means
an individual traveling with a veteran or servicemember who is eligible
for travel under VTS and requires the aid and/or assistance of another
person.
Eligible person means a person described in Sec. 70.71.
Guest means any individual the veteran or servicemember would like
to have accompany him or her to an appointment but whose presence is
not medically required.
Scheduled visit means that a VA beneficiary had an appointment that
was made before she or he appeared at a VA, or VA-authorized, facility,
or that a VA beneficiary was specifically authorized to appear at such
facility on the date of the visit in order to obtain examination,
treatment, or care. Examples of scheduled visits include: regular
appointments for examination, treatment, or care; visits to undergo
laboratory work; or doctor-recommended visits to clinics with open
hours.
Unscheduled visit means a visit to a VA, or VA-authorized, facility
for purposes of examination, treatment, or care that was not recorded
in VA's scheduling system prior to the veteran's visit. For example, an
unscheduled visit may be for a simple check of a person's blood
pressure, for counseling, or for clinical intervention.
(Authority: 38 U.S.C. 111A, 501, 1714)
Sec. 70.71 Eligibility.
Except as provided in paragraph (j) of this section, VA facilities
may provide VTS benefits to the following:
(a) Persons eligible for beneficiary travel. All persons eligible
for beneficiary travel benefits in Sec. 70.10 are eligible for VTS
benefits (however, persons cannot claim benefits under both programs
for the same trip or portion of a trip).
(b) Enrolled veterans. Regardless of a veteran's eligibility for
beneficiary travel, VA may provide VTS to veterans enrolled in VA's
health care system who need transportation authorized under Sec. 70.72
for:
(1) A scheduled visit or urgent care;
(2) Retrieval of, adjustment of, or training concerning
medications, prosthetic appliances, or a service dog (as defined in 38
CFR 17.148);
(3) An unscheduled visit; or
(4) To participate and attend other events or functions, as
clinically determined by VA, for the purposes of examination,
treatment, or care.
(c) Non-enrolled veterans. VA may provide VTS to veterans not
enrolled in VA's health care system who need transportation authorized
under Sec. 70.72 for:
(1) A compensation and pension examination;
(2) An unscheduled or walk-in visit;
(3) To apply for enrollment or health care benefits; or
(4) To participate and attend other events or functions, as
clinically determined by VA, for the purposes of examination,
treatment, or care.
(d) Servicemembers. VA may provide VTS to a member of the Armed
Forces (including the National Guard or Reserve) traveling to a VA or
VA-authorized facility for VA hospital care or medical services,
including examination, treatment or care, a compensation and pension
examination, or to enroll or otherwise receive benefits for which they
are eligible.
(e) Prospective Family Caregivers and Family Caregivers. (1) VA may
provide VTS to a prospective Family Caregiver who has applied for
designation as a Family Caregiver under 38 CFR 71.25(a) when the travel
is for purposes of assessment and training under 38 CFR 71.25(c) and
(d).
(2) VA may provide VTS to a Family Caregiver (who is approved and
designated under 38 CFR 71.25) of veteran or servicemember described in
[[Page 30199]]
paragraphs (b) through (d) of this section to:
(i) Accompany or travel independently from a veteran or
servicemember for purposes of examination, treatment, or care of the
veteran or servicemember; or
(ii) Receive benefits under 38 CFR 71.40(b) or 71.40(c). For health
care benefits provided under 38 CFR 71.40(c)(3), Primary Family
Caregivers may travel using VTS for care only if it is provided at a VA
facility through the Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA) Inhouse Treatment Initiative
(CITI).
(f) Attendants. VA may provide VTS to an attendant of a veteran or
servicemember described in paragraphs (b) through (d) of this section.
(g) Persons receiving counseling, training, or mental health
services. VA may provide VTS to persons receiving counseling, training,
or mental health services under 38 U.S.C. 1782 and 38 CFR 71.50.
(h) CHAMPVA beneficiaries. VA may provide VTS to persons eligible
for health care under the Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA) under 38 CFR 17.270 through
17.278, provided that such care is being provided at a VA facility
through the CHAMPVA Inhouse Treatment Initiative (CITI).
(i) Guests. For each veteran described in paragraph (b) or (c) of
this section or member of the Armed Forces described in paragraph (d)
of this section, a guest may travel with the veteran or servicemember
provided resources are still available after providing services to
individuals identified in paragraphs (b) through (h) of this section.
(j) Limitations on eligibility. Notwithstanding an individual's
eligibility under this section:
(1) A person may be ineligible for transportation services if VA
determines the person's behavior has jeopardized or could jeopardize
the health or safety of other eligible users of VTS or VA staff, or
otherwise has interfered or could interfere with the safe
transportation of eligible persons to or from a VA facility or other
place.
(2) Only one person may travel with an eligible veteran or
servicemember as a Family Caregiver, attendant, or guest, unless a VA
clinician determines that more than one such person is needed or would
otherwise be beneficial to the examination, treatment, or care of the
eligible veteran or servicemember. Family Caregivers traveling for
benefits under paragraph (e)(1) or (e)(2)(ii) of this section are not
subject to this limitation.
(3) Persons under the age of 18 may accompany another person using
VTS with the consent of their parent or legal guardian and the medical
facility director or designee. VA transportation of children is not
available if State law requires the use of a child restraint, such as a
child safety seat or booster seat. In making determinations under this
provision, the medical facility director or designee will consider:
(i) The special transportation needs of the child, if any;
(ii) The ability to transport the child safely using the available
resources;
(iii) The availability of services at the facility to accommodate
the needs of the child;
(iv) The appropriateness of transporting the child; and
(v) Any other relevant factors.
(Authority: 38 U.S.C. 111A, 1714, 1720G, 1781, 1782, 501)
Sec. 70.72 Types of transportation.
The following types of transportation may be provided by VA
facilities through VTS:
(a) Door-to-door service. VA facilities may use VTS to transport,
on a scheduled or unscheduled basis, eligible persons between a VA or
VA-authorized facility and their residence or a place where the person
is staying. VA facilities may use VTS to transport eligible persons to
and from a VA or VA-authorized facility and another location identified
by the person when it is financially favorable to the government to do
so.
(b) Travel to and from designated locations. VA facilities may use
VTS to provide transportation between a VA or VA-authorized facility
and a designated location in the community on a scheduled basis.
(c) Service between VA facilities. VA facilities may use VTS to
provide scheduled or unscheduled transportation between VA or VA-
authorized health care facilities. This includes travel from one
building to another within a single VA campus.
(d) Other locations. VA facilities may use VTS to provide scheduled
or unscheduled transportation to and/or from a VA or VA-authorized
facility or other places when a VA clinician has determined that such
transportation of the veteran, servicemember, their attendant(s), or
CHAMPVA beneficiary receiving benefits through the CITI program would
be needed to promote, preserve, or restore the health of the individual
and is in accord with generally accepted standards of medical practice,
as defined in 38 CFR 17.38(b).
(Authority: 38 U.S.C. 111A, 501, 1718, 7301)
Sec. 70.73 Arranging transportation services.
(a) Requesting VTS. An eligible person may request transportation
services by contacting the facility director or designee at the VA
facility providing or authorizing the examination, treatment, or care
to be delivered. The person must provide the facility director or
designee with information necessary to arrange these services,
including the name of the person, the basis for eligibility, the name
of the veteran or servicemember they are accompanying (if applicable),
the time of the appointment (if known), the eligible person's departure
location and destination, any special needs that must be accommodated
to allow for transportation (e.g., wheelchair, oxygen tank, service or
guide dog), and other relevant information. Transportation services
generally will be provided on a first come, first served basis.
(b) Travel without a reservation. Eligible persons who have
provided the facility director or designee with the information
referred to in the previous paragraph may travel without a reservation
for the purpose of examination, treatment, or care when, for example:
(1) The person is being discharged from inpatient care;
(2) The person is traveling for an unscheduled visit, pursuant to a
recommendation for such a visit by an attending VA clinician; or
(3) The person is being transported to another VA or VA-authorized
facility.
(c) Determining priority for transportation. When the facility
director or designee determines there are insufficient resources to
transport all persons requesting transportation services, he or she
will assist any person denied VTS in identifying and accessing other
transportation options. VTS resources will be allocated using the
following criteria, which are to be assessed in the context of the
totality of the circumstances, so that no one factor is determinative:
(1) The eligible person's basis for eligibility. Enrolled veterans
will receive first priority, followed in order by non-enrolled
veterans; servicemembers; Family Caregivers; persons receiving
counseling, training, or mental health services under 38 U.S.C. 1782
and 38 CFR 71.50; CITI beneficiaries; and guests. Persons eligible
under more than one designation will be considered in the highest
priority category for which that trip permits. VA will provide
transportation to any attendant accompanying a veteran or servicemember
who is approved for transportation.
[[Page 30200]]
(2) First in time request.
(3) An eligible person's clinical need.
(4) An eligible person's inability to transport him or herself
(e.g., visual impairment, immobility, etc.).
(5) An eligible person's eligibility for other transportation
services or benefits.
(6) The availability of other transportation services (e.g., common
carriers, veterans' service organizations, etc.).
(7) The VA facility's ability to maximize the use of available
resources. (The Office of Management and Budget has approved the
information collection requirements in this section under control
number XXXX-XXXX.)
(Authority: 38 U.S.C. 111A, 501)
[FR Doc. 2015-12724 Filed 5-26-15; 8:45 am]
BILLING CODE 8320-01-P