[Federal Register Volume 83, Number 228 (Tuesday, November 27, 2018)]
[Notices]
[Pages 60966-60968]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-25763]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Program of Comprehensive Assistance for Family Caregivers 
(PCAFC)

AGENCY: Department of Veterans Affairs.

ACTION: Request for information.

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SUMMARY: The Department of Veterans Affairs (VA) is requesting 
information regarding its Program of Comprehensive Assistance for 
Family Caregivers (PCAFC). This notice requests information and 
comments from interested parties on certain requirements of the John S. 
McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining 
Internal Systems and Strengthening Integrated Outside Networks Act of 
2018 or the VA MISSION Act of 2018 related to PCAFC.

DATES: Comments are due by December 12, 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 (this is not a toll-free number). Comments should 
indicate that they are submitted in response to ``Notice of Request for 
Information on the Department of Veterans Affairs Program of 
Comprehensive Assistance for Family Caregivers (PCAFC).'' 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 Avenue 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 for an 
appointment (this is not a toll-free number). During the comment 
period, comments may also be viewed online through the Federal Docket 
Management System at www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Margaret Kabat, National Director, 
Caregiver Support Program (10P4C), Veterans Health Administration, 
Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 
20420, (202) 461-6780 (this is not a toll-free number), 
[email protected].

SUPPLEMENTARY INFORMATION: The Program of Comprehensive Assistance for 
Family Caregivers (PCAFC) was established by title I of Public Law 
(Pub. L.) 111-163, Caregivers and Veterans Omnibus Health Services Act 
of 2010, and is codified in section 1720G(a) of title 38 of the United 
States Code (U.S.C.). VA has been administering PCAFC continuously 
since May 5, 2011, and has implemented this program through its 
regulations in Part 71 of title 38 of the Code of Federal Regulations 
(CFR). Through PCAFC, VA provides family caregivers of eligible 
veterans and servicemembers (as defined in 38 CFR 71.20) certain 
benefits, such as training, respite care, counseling, technical 
support, beneficiary travel (to attend required caregiver training and 
for an eligible veteran's medical appointments), a monthly stipend 
payment, and access to health care (if qualified) through the Civilian 
Health and Medical Program of the Department of Veterans Affairs 
(CHAMPVA) 38 U.S.C. 1720G(a)(3), 38 CFR 71.40. For the purposes of this 
notice, the term veteran includes servicemembers who apply for or 
participate in PCAFC.
    PCAFC is currently available to family caregivers of eligible 
veterans who incurred or aggravated a serious injury (including 
traumatic brain injury, psychological trauma, or other mental disorder) 
in the line of duty in the active military, naval, or air service on or 
after September 11, 2001. 38 U.S.C. 1720G(a)(2)(B). On June 6, 2018, 
the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA 
Maintaining Internal Systems and Strengthening Integrated Outside 
Networks Act of 2018 or the VA MISSION Act of 2018 (``MISSION Act''), 
Public Law 115-182, was signed into law. Section 161 of the MISSION Act 
amended 38 U.S.C. 1720G to expand eligibility for PCAFC to family 
caregivers of eligible veterans who incurred or aggravated a serious 
injury in the line of duty before September 11, 2001, establish new 
benefits for designated primary family caregivers of eligible veterans, 
and make other changes affecting program eligibility and VA's 
evaluation of PCAFC applications. The expansion of PCFAC to family 
caregivers of eligible veterans who incurred or aggravated a serious 
injury in the line of duty before September 11, 2001, will occur in two 
phases, the first of which will begin when VA certifies to Congress 
that it has fully implemented a required information technology system. 
During the 2-year period beginning on the date of such certification to 
Congress, PCAFC will be expanded to include family caregivers of 
eligible veterans who have a serious injury (including traumatic brain 
injury, psychological trauma, or other mental disorder) incurred or 
aggravated in the line of duty in the active military, naval, or air 
service on or before May 7, 1975. Two years after the date of 
submission of the certification to Congress, PCAFC will be expanded to 
family caregivers of all eligible veterans who have a serious injury 
(including traumatic brain injury, psychological trauma, or other 
mental disorder) incurred or aggravated in the line of duty in the 
active military, naval, or air service, regardless of when the serious 
injury occurred.
    We are issuing this notice to solicit input on changes to the 
program required by the MISSION Act, as further explained below. This 
notice and request for information serves as a means for VA to consult 
with key stakeholders on how to define and implement changes made to 
the program by the MISSION Act. After

[[Page 60967]]

receipt of this information, we will use the information to inform any 
changes to this program and its implementing regulations.
    This notice and request for information has a comment period of 15 
days, during which individuals, groups, and entities may reply to the 
questions presented below. VA believes that 15 days is sufficient to 
provide comments, as the individuals, groups, and entities interested 
in this program likely have information and opinions readily available 
or can quickly compile and submit such information. Commenters are 
encouraged to provide complete but concise responses to the questions 
outlined below. Please note that VA will not respond to comments or 
other questions regarding policy plans, decisions, or issues regarding 
this notice. VA may choose to contact individual commenters, and such 
communications would only serve to further clarify their written 
comments.
    To implement changes to PCAFC consistent with, and pursuant to, the 
MISSION Act, we are seeking information on the following topics and 
issues:

Need for Personal Care Services

    In addition to expanding PCAFC to eligible veterans who served 
before September 11, 2001 (subject to the timeline discussed above), 
section 161 of the MISSION Act amended the eligibility criteria in 38 
U.S.C. 1720G to add an additional basis upon which a veteran can be 
deemed in need of personal care services. Previously, to be eligible 
for PCAFC, a veteran had to be in need of personal care services 
because of (1) an inability to perform one or more activities of daily 
living, (2) a need for supervision or protection based on symptoms or 
residuals of neurological or other impairment or injury, or (3) such 
other matters as the Secretary considers appropriate. The MISSION Act 
amended this section to include ``a need for regular or extensive 
instruction or supervision without which the ability of the veteran to 
function in daily life would be seriously impaired'' as another basis 
upon which a veteran could be deemed in need of personal care services. 
See 38 U.S.C. 1720G(a)(2)(C)(iii), as amended by Public Law 115-182, 
section 161(a)(2).
    Relatedly, the MISSION Act also modified the definition of personal 
care services to include ``supervision or protection based on symptoms 
of residuals of neurological or other impairment or injury,'' and 
``regular or extensive instruction or supervision without which the 
ability of the veteran to function in daily life would be seriously 
impaired.'' See 38 U.S.C. 1720G(d)(4), as amended by Public Law 115-
182, section 161(b). In its regulations, VA has defined ``personal care 
services'' as care or assistance of another person necessary to support 
the eligible veteran's health and well-being, and perform personal 
functions required in everyday living ensuring the eligible veteran 
remains safe from hazards or dangers incident to his or her daily 
environment. See, 38 CFR 71.15.
    VA is seeking public input on how to define this need for regular 
or extensive instruction or supervision, how to assess whether the 
veteran's ability to function in daily life would be seriously 
impaired, and whether and how to change ``personal care services'' as 
defined in VA's regulations.

Legal and Financial Services

    The MISSION Act also expands upon the benefits available to each 
family caregiver designated as the primary provider of personal care 
services for an eligible veteran to include: (1) Financial planning 
services relating to the needs of injured veterans and their 
caregivers, and (2) legal services, including legal advice and 
consultation, relating to the needs of injured veterans and their 
caregivers. See 38 U.S.C. 1720G(a)(3)(A)(ii)(VI), as amended by Public 
Law 115-182, section 161(a)(3). VA is seeking public comment on how to 
define and deliver such additional services.

Request for Information

    Through this notice, we are soliciting information on certain 
changes made to PCAFC by the MISSION Act. We ask respondents to address 
the following questions, where possible, in the context of the 
discussion in this document. Commenters do not need to address every 
question and should focus on those that relate to their expertise or 
perspectives. To the extent possible, please clearly indicate which 
question(s) you address in your response. As previously mentioned, 
responses to this request will inform our updates to PCAFC.
    Accordingly, we request comments on the following:
    1. How should VA define ``a need for regular or extensive 
instruction or supervision'' in the new 38 U.S.C. 1720G(a)(2)(C)(iii)?
    a. Should this be based upon frequency of intervention needed by 
the veteran or level of complexity of intervention? Should this be 
based upon the impact to the veteran if such instruction or supervision 
is not provided? If so, how should this be measured?
    b. What constitutes ``regular'' instruction or supervision?
    c. What constitutes ``extensive'' instruction or supervision?
    2. How does ``a need for regular or extensive instruction or 
supervision without which the ability of the veteran to function in 
daily life would be seriously impaired'' differ from ``a need for 
supervision or protection based on symptoms of residuals of 
neurological or other impairment or injury?''
    a. How should VA define and assess ``a need for supervision or 
protection based on symptoms of residuals of neurological or other 
impairment or injury''?
    b. Are there established standards VA should model?
    3. How should VA assess whether the ability of the veteran to 
function in daily life would be seriously impaired without regular or 
extensive instruction or supervision?
    a. Are there existing tools or assessments that could be used?
    b. How should ``seriously impaired'' be defined?
    i. For example, should there be a standard of time in which a 
veteran is expected to be able to function without the need for a 
caregiver, and once that period of time is exceeded, a need for a 
caregiver is required due to the impairment of the veteran? Is there a 
minimum period of time lapse that a veteran should be expected to be 
able to function and upon exceeding that time, might meet this 
eligibility criterion?
    ii. Are there standards that should or could be used to determine 
when a veteran's ability to function in daily life is considered 
seriously impaired without regular or extensive instruction or 
supervision?
    iii. How should ``ability to function in daily life'' be defined?
    4. What specific financial planning services relating to the needs 
of injured veterans and their caregivers should be made available to 
primary family caregivers under the new 38 U.S.C. 
1720G(a)(3)(A)(ii)(VI)(aa)?
    a. Should entities provide these services for free?
    b. Are there specific financial planning services that should be 
excluded?
    c. How should these services be made available and/or delivered? 
Should these be provided in person, online, and/or via telephone?
    d. Should there be a limit as to how many times a primary family 
caregiver has access to these services? If yes, should it be an annual 
limit or lifetime limit? Should it be limited by some other measure?
    e. What types of private organizations provide these services?

[[Page 60968]]

    i. What services do they provide?
    ii. How are the services provided?
    iii. Do these organizations provide these services for free?
    iv. Do these organizations contract with other entities to provide 
these services? Do these organizations receive grants to provide these 
services?
    f. What other Federal/state/local agencies offer these services?
    i. What services do they provide?
    ii. How are the services provided?
    iii. Do these agencies provide these services for free?
    iv. Do these agencies contract with other entities to provide these 
services? Do these agencies receive grants to provide these services?
    5. What specific legal services relating to the needs of injured 
veterans and their caregivers should be made available to primary 
family caregivers under the new 38 U.S.C. 1720G(a)(3)(A)(ii)(VI)(bb)?
    a. Should entities provide these services for free?
    b. Are there specific legal services that should be excluded?
    c. How should these services be made available? Should these be 
provided in person, online, and/or via telephone?
    d. Should there be a limit as to how many times a primary family 
caregiver has access to these services? If yes, should it be an annual 
limit or lifetime limit? Should it be limited by some other measure?
    e. What types of private organizations provide these services?
    i. What services do they provide?
    ii. How are the services provided?
    iii. Do these organizations provide these services for free?
    iv. Do these organizations contract with other entities to provide 
these services? Do these organizations receive grants to provide these 
services?
    f. What other Federal/state/local agencies offer these services?
    i. What services do they provide?
    ii. How are the services provided?
    iii. Do these agencies provide these services for free?
    iv. Do these agencies contract with other entities to provide these 
services? Do these organizations receive grants to provide these 
services?

Paperwork Reduction Act

    This request for information constitutes a general solicitation of 
public comments as stated in the implementing regulations of the 
Paperwork Reduction Act of 1995 at 5 CFR 1320.3(h)(4). Therefore, this 
request for information does not impose information collection 
requirements (i.e., reporting, recordkeeping or third-party disclosure 
requirements). Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).

Signing Authority

    The Secretary of Veterans Affairs 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. 
Wilkie, Secretary, Department of Veterans Affairs, approved this 
document on November 19, 2018, for publication.

    Dated: November 19, 2018.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of 
the Secretary, Department of Veterans Affairs.
[FR Doc. 2018-25763 Filed 11-26-18; 8:45 am]
 BILLING CODE 8320-01-P