[Federal Register Volume 83, Number 126 (Friday, June 29, 2018)]
[Notices]
[Pages 30818-30819]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-13952]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information Regarding Health Care Access 
Standards

AGENCY: Department of Veterans Affairs.

ACTION: Request for information.

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SUMMARY: The Department of Veterans Affairs (VA) is requesting 
information to assist in implementing section 1703B of title 38, United 
States Code (U.S.C.), 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 with regard to health plans 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, and the 
measurement of performance against federal or state regulatory 
standards. With regard to health systems, VA requests information from 
the public including but not limited to 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 
federal or state regulatory standards. Responses to this notice will 
support industry research and VA's evaluation of access standards.

DATES: July 30, 2018.

ADDRESSES: Written comments may be submitted through http://www.regulations.gov; by mail or hand delivery to the Director, Office 
of Regulation Policy and Management (00REG), Department of Veterans 
Affairs, 810 Vermont Avenue NW, Room 1063B, Washington, DC 20420; or by 
fax to 202-273-9026. Comments should indicate that they are submitted 
in response to ``Notice of Request for Information Regarding Health 
Care Access Standards''. Copies of comments received will be available 
for public inspection in the Office of Regulation Policy and Management 
(00REG), Department of Veterans Affairs, 810 Vermont Ave. NW, Room 
1063B, Washington, DC 20420, 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. 
During the comment period, comments may also be viewed online through 
the Federal Docket Management System at www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Christina Hosenfeld, Management

[[Page 30819]]

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) creates a new 38 U.S.C. 1703B 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 notice 
and request for information serves as one of the means for VA to 
consult with these groups and entities. We note that VA will also hold 
a public hearing on Friday, July 13, 2018, to provide these groups and 
entities an opportunity to provide additional information. VA will use 
the comments it receives 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. Hence, this notice and request for information has a comment 
period of 30 days. VA believes that 30 days is sufficient to provide 
comments, as the groups and entities with expertise in access standards 
will likely have the information readily available or can quickly 
compile and submit such information.
    This notice is a request for information only. Commenters are 
encouraged to provide complete but concise responses to the questions 
outlined below. VA may choose to contact individual commenters, and 
such communications would serve to further clarify their written 
comments.
    Request for Information: VA requests information that will assist 
in developing the access standards required by the VA MISSION Act. This 
includes information regarding the development of these access 
standards, including but not limited to information, with regard to 
health plans, 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, and with respect to health systems, 
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. 2018-13952 Filed 6-28-18; 8:45 am]
 BILLING CODE 8320-01-P