[Federal Register Volume 83, Number 122 (Monday, June 25, 2018)]
[Rules and Regulations]
[Pages 29447-29449]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-13487]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP55


Medical Care in Foreign Countries and Filing for Reimbursement 
for Community Care Not Previously Authorized by VA

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) adopts as final, with 
no changes, a proposed rule amending its medical regulations related to 
hospital care and medical services in foreign countries. We simplified 
and clarified the scope of these regulations, address medical services 
provided to eligible veterans in the Republic of the Philippines, and 
removed provisions related to grants to the Republic of the Philippines 
that are no longer supported by statutory authority. VA also amends its 
medical regulations related to filing claims for reimbursement of 
medical expenses incurred for VA care not previously authorized. We 
provided a 60-day period to receive comments from the public on the 
proposed changes, and received no comments. VA adopts the proposed rule 
as final, with no changes.

DATES: This final rule is effective July 25, 2018.

FOR FURTHER INFORMATION CONTACT: Joseph Duran, Director, Policy and 
Planning, Office of Community Care (10D1A1), Veterans Health 
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, 
Washington, DC 20420, (303) 372-4629. (This is not a toll-free number) 
or [email protected].

SUPPLEMENTARY INFORMATION: Section 1724 of title 38 United States Code 
(U.S.C.) prohibits VA from furnishing hospital care or medical services 
outside any State except under specific circumstances. VA is authorized 
under 38 U.S.C. 1724(b)(1) to furnish care and services to an eligible 
veteran outside any State if VA ``determines that such care and 
services are needed for the treatment of a service-connected disability 
of the veteran or as part of a rehabilitation program under chapter 31 
of this title.'' VA furnishes health care to eligible veterans in the 
Republic of the Philippines under this authority. In addition, 38 
U.S.C. 1724(c) provides that ``within the limits'' of the Veterans 
Memorial Medical Center at Manila, Republic of the Philippines, VA may 
enter into contracts to furnish necessary hospital care to a veteran 
for any non-service-connected disability if such veteran is unable to 
defray the expenses of necessary hospital care. VA may also operate an 
outpatient clinic in the Republic of the Philippines to furnish 
necessary medical services to a veteran who has a service-connected 
disability. 38 U.S.C. 1724(e). Several sections of title 38 Code of 
Federal Regulations (CFR) part 17 address VA's authority to provide for 
hospital care and medical services for eligible veterans outside the 
United States, as well as submission of claims for reimbursement for 
services obtained from community care providers outside the United 
States.
    On January 31, 2018, VA proposed to revise or amend these 
regulations to consolidate similar content, clarify provisions, and 
ensure that these regulations reflect current VA practice and statutory 
authority. (83 FR 4454). We proposed simplifying language in Sec.  
17.35 to make it easier to understand, adding a new paragraph (b) to 
address hospital care and outpatient services provided to eligible 
veterans in the Republic of the Philippines as authorized in 38 U.S.C. 
1724, and paragraph (c) to provide guidance on which sections of part 
17 apply to claims for payment or reimbursement of services not 
previously authorized by the Foreign Medical Program. We proposed 
amending Sec.  17.125 which focuses on filing claims. We proposed 
stating that in those cases where VA payment for such services has not 
been authorized in advance, claims for payment for such health care 
services provided in a State should be submitted to the VA medical 
facility nearest to where those services were provided. We also 
proposed amending that section to provide specific guidance on where 
and how to file claims.
    We proposed removing Sec. Sec.  17.140 and 17.141 as the subject 
matter of delegation of authority would be covered by proposed 
revisions to Sec.  17.125. Finally, we proposed removing Sec. Sec.  
17.350 through 17.370 which addressed grants to the Republic of the 
Philippines, as our authority to provide these grants under 38 U.S.C. 
1732(b) has expired. VA still retains authority under 38 U.S.C. 1731 to 
assist the Republic of the Philippines in fulfilling its responsibility 
in providing medical care and treatment for Commonwealth Army veterans 
and new Philippine Scouts in need of such care and treatment for 
service-connected disabilities and non-service-connected disabilities 
under certain conditions.
    We provided a 60-day period to the public to comment on the 
proposed rule. The comment period closed April 2, 2018, and we received 
no comments. Based on the rationale set forth in the proposed rule and 
in this document, VA is adopting the provisions of 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 regulatory amendment 
does 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 rulemaking does not directly affect any small 
entities. Only VA beneficiaries and certain community care providers 
would be directly affected. Therefore, pursuant to 5 U.S.C. 605(b), 
this amendment is be exempt from the initial and final regulatory 
flexibility analysis requirements of sections 603 and 604.

Executive Orders 12866, 13563, and 13771

    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).

[[Page 29448]]

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.''
    VA has examined the economic, interagency, budgetary, legal, and 
policy implications of this regulatory action and determined that the 
action is not 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 website at 
http://www.va.gov/orpm by following the link for VA Regulations 
Published from FY 2004 through FYTD. [For information about 
economically significant regulations, see Impact Analysis Procedures 
guide on the 00REG intranet site.]
    Executive Order 13771 (Reducing Regulation and Controlling 
Regulatory Costs) requires an agency, unless prohibited by law, to 
identify at least two existing regulations to be repealed when the 
agency publicly proposes for notice and comment, or otherwise 
promulgates, a new regulation. In furtherance of this requirement, 
section 2(c) of E.O. 13771 requires that the new incremental costs 
associated with new regulations shall, to the extent permitted by law, 
be offset by the elimination of existing costs associated with at least 
two prior regulations. This final rule is not subject to the 
requirements of E.O. 13771 because there is no incremental cost 
associated with this rule.

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 expenditure by 
State, local, or tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any given year. This final rule has no such effect on 
State, local, or tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance program number and title 
for this rule are as follows: 64.008--Veterans Domiciliary Care; 
64.011--Veterans Dental Care; 64.012--Veterans Prescription Service; 
64.013--Veterans Prosthetic Appliances; 64.029--Purchase Care Program; 
64.040--VHA Inpatient Medicine; 64.041--VHA Outpatient Specialty Care; 
64.042--VHA Inpatient Surgery; 64.043--VHA Mental Health Residential; 
64.044--VHA Home Care; 64.045--VHA Outpatient Ancillary Services; 
64.046--VHA Inpatient Psychiatry; 64.047--VHA Primary Care; 64.048--VHA 
Mental Health clinics; and 64.050--VHA Diagnostic Care.

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, 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.

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. Jacquelyn 
Hayes-Byrd, Acting Chief of Staff, Department of Veterans Affairs, 
approved this document on June 19, 2018, for publication.

    Dated: June 19, 2018
Consuela Benjamin,
Regulation Development Coordinator, Office of Regulation Policy & 
Management, Office of the Secretary, Department of Veterans Affairs.

    For the reasons stated in the preamble, the Department of Veterans 
Affairs amends 38 CFR part 17 as follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 is amended by adding statutory 
authority citations for Sec. Sec.  17.35 and 17.125 in numerical order 
to read as follows:

    Authority:  38 U.S.C. 501, and as noted in specific sections.
    Section 17.35 is also issued under 38 U.S.C. 1724.
* * * * *
    Section 17.125 is also issued under 38 U.S.C. 7304.

* * * * *


0
2. Revise Sec.  17.35 to read as follows:


Sec.  17.35   Hospital care and outpatient services in foreign 
countries.

    (a) Under the VA Foreign Medical Program, VA may furnish hospital 
care and outpatient services to any veteran outside of the United 
States, without regard to the veteran's citizenship:
    (1) If necessary for treatment of a service-connected disability, 
or any disability associated with and held to be aggravating a service-
connected disability;
    (2) If the care and services are furnished to a veteran 
participating in a rehabilitation program under 38 U.S.C. chapter 31 
who requires care and services for the reasons enumerated in Sec.  
17.47(i)(2).
    (b) Under the Foreign Medical Program, the care and services 
authorized under paragraph (a) of this section are available in the 
Republic of the Philippines to a veteran who meets the requirements of 
paragraph (a) of this section. VA may also provide outpatient services 
to a veteran referenced in paragraph (a)(1) in the VA outpatient clinic 
in Manila for the treatment of such veteran's service-connected 
conditions within the limits of the clinic. Non-service connected 
conditions of a veteran who has a service-connected disability may be 
treated within the limits of the VA outpatient clinic in Manila.
    (c) Claims for payment or reimbursement for services not previously 
authorized by VA under this section are governed by Sec. Sec.  17.123-
17.127 and 17.129-17.132.

0
3. Revise Sec.  17.125 to read as follows:

[[Page 29449]]

Sec.  17.125   Where to file claims.

    Generally, VA must preauthorize VA payment for health care services 
provided in the community when such care is provided in a State as that 
term is defined in 38 U.S.C. 101(20).
    (a) Where VA payment for such services has not been authorized in 
advance, claims for payment for such health care services provided in a 
State should be submitted to the VA medical facility nearest to where 
those services were provided.
    (b) Claims for payment for hospital care and outpatient services 
authorized under Sec.  17.35(a) and provided in Canada must be 
submitted to Veterans Affairs Canada, Foreign Countries Operations 
Unit, 2323 Riverside Dr., 2nd Floor, Ottawa, Ontario, Canada K1A OP5.
    (c) All other claims for payment for hospital care and outpatient 
services authorized under Sec.  17.35(a) and provided outside a State 
must be submitted to the Foreign Medical Program, P.O. Box 469061, 
Denver, CO 80246-9061.


Sec.  17.140   [Removed]

0
4. Remove Sec.  17.140 and the undesignated center heading 
``Delegations of Authority'', immediately preceding it.


Sec.  17.141   [Removed]

0
5. Remove Sec.  17.141.

0
6. Add an undesignated center heading, ``Delegation of Authority'' 
immediately preceding Sec.  17.142.

0
7. Remove the undesignated center heading, ``Grants to the Republic of 
the Philippines'', immediately preceding Sec.  17.350.


Sec. Sec.  17.350-17.352, 17.355, 17.362-17.367, 17.369, and 17.370   
[Removed]

0
8. Remove Sec. Sec.  17.350 through 17.352, 17.355, 17.362 through 
17.367, 17.369, and 17.370.

[FR Doc. 2018-13487 Filed 6-22-18; 8:45 am]
 BILLING CODE 8320-01-P