[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]
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