[Federal Register Volume 80, Number 202 (Tuesday, October 20, 2015)]
[Proposed Rules]
[Pages 63480-63482]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-26606]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP37


Removing Net Worth Requirement From Health Care Enrollment

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: This rulemaking proposes to remove the regulatory provision 
regarding consideration by the Department of Veterans Affairs (VA) of 
the net worth of a veteran's assets as a factor in determining the 
veteran's eligibility for lower-cost VA health care. Prior to January 
1, 2015, VA considered both the net worth of a veteran's assets and the 
veteran's annual income when determining a veteran's eligibility. 
Because of that, certain veterans who would have been eligible for VA 
health care based on their annual income alone were ineligible for care 
because the net value of their assets was too high, or they were placed 
in a less favorable eligibility category. Reporting asset information 
imposed a significant paperwork burden on veterans, and VA dedicated 
significant administrative resources to verifying reported information. 
VA changed its policy to improve access to health care to lower-income 
veterans and remove the reporting burden from veterans by discontinuing 
collection of asset information. This rulemaking would amend the 
regulation to remove the reference to VA's discretionary statutory 
authority to consider net worth.

DATES: Comment Date: Comments must be received on or before December 
21, 2015.

ADDRESSES: Written comments may be submitted through 
www.Regulations.gov; by mail or hand-delivery to Director, Regulation 
Policy and Management (02REG), Department of Veterans Affairs, 810 
Vermont Avenue 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-AP37--Removing Net Worth Requirement from Health Care 
Enrollment.'' 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 www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Kristin J. Cunningham, Director, 
Business Policy, Chief Business Office, (10NB6), 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 proposes to amend VA's 
regulations governing enrollment in the VA health care system by 
removing the regulatory provision restating VA's discretionary 
authority to consider the net worth of a veteran's assets when 
determining eligibility for lower-cost health care.
    Pursuant to 38 U.S.C. 1705, VA has established a health care 
enrollment system with implementing regulations at 38 CFR 17.36. When 
veterans apply for health care benefits, VA assigns a priority category 
that reflects the basis for that veteran's eligibility, such as whether 
the veteran has been rated as having a service-connected disability or 
would be unable to defray the costs of necessary expenses because of 
low income. The veteran is placed in the highest priority category 
possible. These categories are described in Sec.  17.36(b). Priority 
categories are used by VA to determine which veterans are eligible to 
enroll in the VA health care system, which VA does on an annual basis, 
in accordance with Sec.  17.36(c). The priority category is also used 
to determine the amount of copayments veterans must pay to receive VA 
medical benefits. Veterans who are not eligible for enrollment in 
priority categories 1 through 4 but who are unable to defray the 
expenses of necessary care under 38 U.S.C. 1722(a) are placed in 
priority category 5. 38 CFR 17.36(b)(5). This rulemaking would affect a 
regulatory provision related to that category. Veterans are considered 
to be unable to defray the costs of necessary care if they have a low 
annual income, qualify for VA pension benefits, or meet other criteria 
under 38 U.S.C. 1722(a) and 38 CFR 17.47(d). VA has the authority to 
use net worth asset values to determine whether a veteran is unable to 
defray the cost of care at 38 U.S.C. 1722(d)(1), but this authority is 
not mandatory; i.e., VA is not required to consider the value of the 
estate of a veteran for this purpose. 38 U.S.C. 1722(d)(1) 
(``Notwithstanding the attributable income of a veteran,'' VA may 
determine that such veteran is not eligible ``if the corpus of the 
estate of the veteran is such that under all the circumstances it is 
reasonable that some

[[Page 63481]]

part of the corpus of the estate of the veteran be consumed for the 
veteran's maintenance'').
    In 2013, VA informed the public of its intent to discontinue annual 
financial assessment reporting by veterans. 78 FR 64065 (Oct. 25, 
2013), 78 FR 79564 (Dec. 30, 2013). VA notified the public that it 
would no longer request annual financial assessments from veterans 
enrolled in income-based priority categories, and would only request 
financial assessments for the initial health care enrollment process. 
Because we received no adverse responses to those notices and for the 
reasons that follow, as VA announced in March 2015, VA used its 
discretion under 38 U.S.C. 1722(d)(1) to cease consideration of the net 
worth of veterans' assets to determine whether they are able to defray 
the expenses of necessary care and qualify for inclusion in priority 
category 5, effective January 1, 2015. To avoid potential confusion, 
this rulemaking would remove the regulatory provision referencing VA's 
discretionary authority to consider net worth for purposes of priority 
category 5.
    By eliminating consideration of the net worth of a veteran's assets 
for purposes of health care enrollment, more veterans would qualify for 
VA health care in a higher priority category, improving access and 
affordability of health care for many lower-income veterans. VA 
estimates that in the first year of implementation of this policy, 
53,000 veterans would be moved to category 5 from a lower priority 
category and would be able to make lower copayments for VA care. Over 
five years, VA expects that 135,000 veterans who previously were 
ineligible would be able to enroll in the VA health care system because 
of this change. This change also reduces administrative burdens for 
veterans and VA. The burden on veterans to supply asset information to 
VA on an annual basis was considerable. In contrast, the burden is much 
lower for veterans to provide only an initial report of annual income 
during the enrollment process and future verification only in those 
cases where VA identifies a change to the veteran's income that would 
result in a change to the veteran's priority group status. In past 
years, VA had expended significant resources on verifying the reported 
figures because asset values are subjective and difficult to verify. 
Through established practices with the Internal Revenue Service and 
Social Security Administration, VA can verify veterans' reported annual 
income far more efficiently than reported assets. Therefore, this 
policy has eliminated the significant burden on veterans to report the 
worth of their assets, and also eliminated the need for VA to use 
resources to verify that information.
    In light of the preceding discussion, we propose to remove Sec.  
17.47(d)(5) in its entirety and renumber current Sec.  17.47(d)(6) as 
Sec.  17.47(d)(5). Current paragraph (d)(5) restates VA's discretionary 
statutory authority to use the value of a veteran's estate to determine 
whether he is able to defray the costs of care. By removing the 
regulatory restatement of VA's discretionary statutory authority to 
consider a veteran's net worth, VA removes language in the regulation 
that could be perceived as inconsistent with the policy change, which 
is favorable to veterans.

Effect of Rulemaking

    The Code of Federal Regulations, as proposed to be revised by this 
proposed rulemaking, represents the exclusive legal authority on this 
subject. No contrary rules or procedures would be authorized. All 
existing or subsequent 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 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 regulatory action 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 one 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 64.007, Blind Rehabilitation 
Centers; 64.008, Veterans Domiciliary Care; 64.009, Veterans Medical 
Care Benefits; 64.010, Veterans Nursing Home Care;

[[Page 63482]]

64.011, Veterans Dental Care; 64.012, Veterans Prescription Service; 
64.013, Veterans Prosthetic Appliances; 64.014, Veterans State 
Domiciliary Care; 64.015, Veterans State Nursing Home Care; 64.018, 
Sharing Specialized Medical Resources; 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. Robert L. 
Nabors II, Chief of Staff, Department of Veterans Affairs, approved 
this document on October 9. 2015, for publication.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, 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, Reporting and recordkeeping requirements, 
Travel and transportation expenses, Veterans.

    Dated: October 15, 2015,
William F. Russo,
Director, Office of Regulation Policy & Management, Office of the 
General Counsel, Department of Veterans Affairs.

    For the reasons stated in the preamble, the Department of Veterans 
Affairs 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.


Sec.  17.47  [Amended]

0
2. Amend Sec.  17.47 by removing paragraph (d)(5) and redesignating 
paragraph (d)(6) as new paragraph (d)(5).

[FR Doc. 2015-26606 Filed 10-19-15; 8:45 am]
 BILLING CODE 8320-01-P