[Federal Register Volume 83, Number 126 (Friday, June 29, 2018)]
[Notices]
[Pages 30819-30821]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-13951]


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DEPARTMENT OF VETERANS AFFAIRS


Announcement for Public Meeting Regarding Health Care Access 
Standards

AGENCY: Department of Veterans Affairs.

ACTION: Announcement of public meeting.

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SUMMARY: The Department of Veterans Affairs (VA) is holding a public 
meeting to seek information from pertinent entities relating to 
implementation of 1703B of title 38, United States Code, as added by 
section 104(a) of the John S. McCain III, Daniel K. Akaka, and Samuel 
R. Johnson VA Maintaining Internal Systems and Strengthening Integrated 
Outside Networks (MISSION) Act of 2018 (the VA MISSION Act) which 
directs VA to establish access standards for furnishing hospital care, 
medical services, and extended care services to covered veterans for 
purposes of the Veterans Community Care Program. In establishing these 
access standards, VA is required to consult with all pertinent Federal, 
private sector, and non-governmental entities. VA requests information 
from the public regarding the development of these access standards, 
including but not limited to information on the use of access standards 
for the design of health plan provider networks, referrals from network 
providers to out-of-network providers, the appeals process for 
exemptions from benefit limits to out-of-network providers, the 
existence of standards for appointment wait times, the use of travel 
distance for establishing service areas, the development or use of 
guidelines to

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refer patients to out of network providers, and the measurement of 
performance against federal and state regulatory standards. Responses 
to this notice will support industry research and VA's development of 
access standards.

DATES: VA will hold the public meeting on July 13, 2018, in Arlington, 
VA. The meeting will start at 9:00 a.m. and conclude on or before 5:00 
p.m. Check-in will begin at 8:00 a.m.

ADDRESSES: The meeting will be held at the VHA National Conference 
Center at 2011 Crystal Drive, Arlington, VA 22202. This facility is 
accessible to individuals with disabilities.
    * In-person attendance will be limited to 50 individuals. Advanced 
registration for individuals and groups is strongly encouraged (see 
registration instructions below). For listening purposes only (phone 
lines will be muted), the meeting will be available via audio which can 
be accessed by dialing 1-800-767-1750 access code 21398.
    Please submit all written comments no later than Monday, July 30, 
by any of the following methods:
     Federal Rulemaking Portal: Go to http://www.regulations.gov. Follow the online instructions for submitting 
comments.
     Mail, Hand Delivery, Courier: Postmarked no later than 
July 30, 2018, to: Director of Regulations Management (00REG), 
Department of Veterans Affairs, 810 Vermont Ave. NW, Room 1063B, 
Washington, DC 20420.
    Note: Copies of comments received will be available for public 
inspection in the Office of Regulation Policy and Management, Room 
1063B, between the hours of 8:00 a.m. and 4:30 p.m., Monday through 
Friday (except Federal Holidays). Please call (202) 461-4902 (this is 
not a toll-free number) for an appointment.
     Fax: (202) 273-9026, ATTENTION: Director of Regulations 
Management (00REG). All submissions must include the agency name and 
docket number. Note that all comments received will be posted and can 
be viewed online through the Federal Docket Management System at http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Christina Hosenfeld, Management 
Analyst, Office of the Deputy Under Secretary for Health for Community 
Care, Veterans Health Administration, Department of Veterans Affairs, 
810 Vermont Avenue NW, Washington, DC 20420, (202) 461-4112. This is 
not a toll free number.

SUPPLEMENTARY INFORMATION: The John S. McCain III, Daniel K. Akaka, and 
Samuel R. Johnson VA Maintaining Internal Systems and Strengthening 
Integrated Outside Networks Act of 2018, Public Law 115-182, (the VA 
MISSION Act) created a new 1703B in title 38, United States Code 
(U.S.C.), that contains requirements for VA to facilitate the 
establishment and use of access standards. Section 1703B(c) 
specifically requires VA to consult with all pertinent Federal 
entities, entities in the private sector, and other nongovernmental 
entities in establishing access standards. This public meeting serves 
as one of the means for VA to consult with these groups and entities. 
We note that VA has published a request for information in the Federal 
Register in order to provide these groups and entities an opportunity 
to provide additional information. The request for information 
mentioned above can be found in www.regulations.gov under the title of 
``Notice of Request for Information Regarding Health Care Access 
Standards.'' Comments should indicate that they are submitted in 
response to ``Notice of Request for Information Regarding Health Care 
Access Standards.'' VA will use the statements and testimonials 
presented at the public hearing to help determine the access standards 
in compliance with the VA MISSION Act. VA will then submit a report, no 
later than March 3, 2019, as required by section 1703B(d)(1), detailing 
the access standards to the appropriate committees of Congress. The 
access standards will ultimately be published in the Federal Register 
and will be made available on a VA internet website.
    In order to submit a report to Congress detailing the access 
standards by March 3, 2019, VA must expedite this consultation, which 
will be foundational to the process of determining the access 
standards.
    Registration: In-person attendance and participation in this 
meeting is limited to 50 individuals. VA has the right to refuse 
registration for in-person attendance once the maximum capacity of 50 
individuals has been reached. Individuals interested in attending in-
person should request registration by emailing Krinessa Pinkett at 
[email protected]. A confirmation message will be provided within 
1-2 business days after a request has been received, and individuals 
will be notified via email by July 9, 2017, confirming their attendance 
in-person. Attendees wanting to offer oral comments, testimonies, and/
or technical remarks should indicate their intentions upon 
registration.
    Individual registration: VA encourages individual registrations for 
those not affiliated with or representing a group, association, or 
organization.
    Group registration: Identification of the name of the group, 
association, or organization should be indicated in your registration 
request. Due to the meeting location's maximum capacity, VA may limit 
the size of a group's registration to allow receipt of comments, 
testimonies, and/or technical remarks from a broad, diverse group of 
stakeholders. Oral comments, testimonies, and/or technical remarks may 
be limited from a group, association or organization with more than two 
(2) individuals representing the same group, association, or 
organization. Efforts will be made to accommodate all attendees who 
wish to attend in-person. However, VA will give priority for in-person 
attendance to pertinent Federal, private sector, and non-governmental 
entities who request registration before July 5, 4:00 p.m. ET, and wish 
to provide oral comments, testimonies, and/or technical remarks. Please 
provide the number and names of people your organization would like to 
send in-person, and VA will accommodate as space allows; organizations 
should list names in the order of importance of their attendance to 
ensure that VA allows admission for the right representatives. The 
length of time allotted for attendees to provide oral comments, 
testimonies and/or technical remarks during the meeting may be subject 
to the number of in-person attendees, and to ensure ample time is 
allotted to those registered attendees. There will be no opportunity 
for audio-visual presentations during the meeting. Written comments 
will be accepted by those attending in-person (see above instructions 
for submitting written comments).
    Audio (for listening purposes only): Limited to the first 200 
participants, on a first come, first served basis. Advanced 
registration is not required. Audio attendees will not be allowed to 
offer oral comments, testimonies, and/or technical remarks as the phone 
line will be muted. Written comments will be accepted from those 
participating via audio (see above instructions for submitting written 
comments).
    Note: VA will conduct the public meeting informally, and technical 
rules of evidence will not apply. VA will arrange for a written 
transcript of the meeting and keep the official record open for 15 days 
after the meeting to allow submission of supplemental information. You 
may make arrangements for copies of the transcript directly with the 
reporter, and the transcript will also be posted in the docket of the 
rule as part of the official

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record when the rule is published. Should it be necessary to cancel the 
meeting due to inclement weather or other emergencies, VA will take 
available measures to notify registered participants.

Agenda

08:00-09:00 Arrival/Check-In
09:00-12:00 Morning Public Meeting Session
12:00-13:00 Lunch Break (Note: Meals will not be provided by VA.)
13:00-17:00 Afternoon Public Meeting Session
17:00 Adjourn

Public Meeting Topics

    Pursuant to section 1703B(c) of title 38, U.S.C., as added by 
section 104(a) of Public Law 115-182, (the VA MISSION Act), VA requests 
information that will assist in developing the access standards 
required by section 1703B(a)(1). This includes information regarding 
the development of these access standards, including but not limited to 
information on the use of access standards for the design of health 
plan provider networks, referrals from network providers to out-of-
network providers, the appeals process for exemptions from benefit 
limits to out-of-network providers, the existence of standards for 
appointment wait times, the use of travel distance for establishing 
service areas, the development or use of guidelines to refer patients 
to out of system providers, and the measurement of performance against 
regulatory standards.
    Specifically, VA requests information from health plans and systems 
related to the below:
    1. Do health plans use internal access standards for the design of 
provider networks and the application of in network/out of network 
benefits that are more stringent than regulatory standards (time or 
distance of travel, appointment wait times, provider/member ratios)? If 
so, what are these internal standards? How does the health plan measure 
performance against regulatory and internal access standards? How does 
the health plan respond to findings when access standards are not being 
met? Are current regulatory access standards cost-effective while 
maintaining quality standards? Do health plans have a process to handle 
routine requests from members or referring providers for exemptions to 
benefit limits when members seek out of network care or a lower tier 
provider?
    2. Do health plans allow for appeals by providers or members to 
request exemptions from benefit limits related to out of network care 
or care by a lower tier provider? Is external review allowed for such 
appeals?
    3. What are health plan practices regarding internal, regulatory, 
and/or accreditation standards for appointment wait times, including 
variance by specialty or type of service? How does the health plan use 
travel distance or time and/or provider-to-population ratios in 
deciding which geographic areas to consider as primary or secondary 
service areas?
    4. Are clinicians within the health system given guidelines or 
rules on when to refer patients to out of system providers? For 
example, are clinicians encouraged to refer out of system if in-system 
wait times are longer than standard, travel time or distance to an in-
system provider is too long, the patient's ability to travel is 
compromised or the frequency of treatment makes travel to an in-network 
provider difficult?

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 25, 2018, for publication.

    Dated: June 25, 2018.
Jeffrey M. Martin,
Impact Analyst, Office of Regulation Policy & Management, Office of the 
Secretary, Department of Veterans Affairs.
[FR Doc. 2018-13951 Filed 6-28-18; 8:45 am]
 BILLING CODE 8320-01-P