[Federal Register Volume 80, Number 245 (Tuesday, December 22, 2015)]
[Rules and Regulations]
[Pages 79483-79484]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-32098]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP34


Payment of Emergency Medication by VA

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) is amending its 
medical regulations that govern reimbursement of emergency treatment 
provided by non-VA medical care providers. VA is clarifying its 
regulations insofar as it involves the reimbursement of medications 
prescribed or provided to the veteran during the episode of non-VA 
emergency treatment.

DATES: This regulation is effective January 21, 2016.

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

SUPPLEMENTARY INFORMATION: VA is authorized under 38 U.S.C. 1725 to 
reimburse an eligible veteran (or the provider of the emergency 
treatment or another person or entity who paid such expenses on the 
veteran's behalf) for the reasonable value of emergency treatment 
furnished to the Veteran at a non-VA medical facility. Under 38 U.S.C. 
1728, VA is authorized to reimburse eligible veterans (or the provider 
of the emergency treatment or another person or entity who paid such 
expenses on the veteran's behalf) for the customary and usual charges 
of non-VA emergency treatment furnished to the veteran.
    Current VA regulations implementing 38 U.S.C. 1725 and 1728 each 
state that covered emergency treatment includes ``medication, including 
a short course of medication related to and necessary for the treatment 
of the emergency condition that is provided directly to the patient for 
use after the emergency condition is stabilized and the patient is 
discharged.'' See 38 CFR 17.120(b) and 17.1002. It is undisputed that 
medications directly provided to the veteran or administered to the 
veteran as part of the emergency treatment are covered. VA has 
determined that the language ``provided directly to the patient'' is 
vague inasmuch as it does not clearly indicate that it also extends to 
a short course of necessary medication provided to the veteran by way 
of a prescription that is written or called in to an outpatient or 
commercial pharmacy by the emergency non-VA provider with instructions 
to the veteran-patient to obtain and use the medication post-discharge, 
as directed.
    On July 27, 2015, we proposed to amend Sec. Sec.  17.120(b) and 
17.1002 to address this issue. See 80 FR 44318. We proposed amending 
Sec.  17.120(b) to clarify that VA reimburses the cost of a short 
course of medication prescribed for the veteran at the time that the 
veteran was receiving emergency treatment, by stating that emergency 
treatment includes ``a short course of medication related to and 
necessary for the treatment of the emergency condition that is provided 
directly to or prescribed for the patient for use after the emergency 
condition is stabilized and the patient is discharged.'' We proposed 
making a similar amendment to the introductory paragraph of Sec.  
17.1002. The proposed amendments in this rulemaking are consistent with 
current VA policy and help ensure our regulations are not interpreted 
more narrowly than VA intends.
    We provided a 60-day comment period, which ended on September 25, 
2015. We received 1 comment in support of the proposed rule. Based on 
the rationale set forth in the Supplementary Information to the 
proposed rule and in this final rule, VA is adopting the proposed rule 
as a final rule with no changes.

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,'' which requires 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

[[Page 79484]]

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 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 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; 64.011, Veterans 
Dental Care; 64.012, Veterans Prescription Service; 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 December 16, 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, Foreign relations, 
Government contracts, Grant programs--health, Grant programs--veterans, 
Health care, Health facilities, Health professions, Health records, 
Homeless, Incorporation by reference, 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: December 17, 2015.
William F. Russo
Director, Office of Regulation Policy & Management, Office of the 
General Counsel, Department of Veterans Affairs.

    For the reasons set forth in the preamble, VA amends 38 CFR part 17 
as follows:

PART 17--MEDICAL

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


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


Sec.  17.120  [Amended]

0
2. Amend the first sentence of Sec.  17.120(b) by adding ``or 
prescribed for'' immediately after ``provided directly to''.


Sec.  17.1002  [Amended]

0
3. Amend the introductory text of Sec.  17.1002 by adding ``or 
prescribed for'' immediately after ``provided directly to''.

[FR Doc. 2015-32098 Filed 12-21-15; 8:45 am]
 BILLING CODE 8320-01-P