[Federal Register Volume 84, Number 43 (Tuesday, March 5, 2019)]
[Rules and Regulations]
[Pages 7813-7815]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-03747]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AQ34
Update: Enrollment--Provision of Hospital and Outpatient Care to
Medal of Honor Veterans
AGENCY: Department of Veterans Affairs
ACTION: Final rule.
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SUMMARY: The Department of Veterans Affairs (VA) is amending its
medical regulations governing eligibility for VA health care and
copayment requirements to conform to recent statutory changes. VA is
changing its enrollment criteria to move Medal of Honor recipients from
priority category three to priority category one, and exempting
recipients of the Medal of Honor from copayments for inpatient care,
outpatient care, medications, and extended care services.
DATES: This final rule is effective on March 5, 2019.
FOR FURTHER INFORMATION CONTACT: Stacey Echols Sr., CP, FAC-P/PM,
Business Policy, VHA Member Services; 810 Vermont Avenue NW,
Washington, DC 20420; (404) 828-5281. (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION:
Enrollment Eligibility
Section 1705 of title 38, United States Code (38 U.S.C. 1705),
requires VA to implement a national enrollment system to manage the
delivery of its health care services and also contains priority
categories for determining eligibility for enrollment in VA's health
care system. In its original enactment, section 1705 did not include
receipt of the Medal of Honor as a criterion for eligibility in a
priority category. See Public Law 104-262 (October 9, 1996). In 2010,
Congress amended section 1705 by adding Medal of Honor recipients to
priority category three. See Public Law 111-163 (May 5, 2010). VA has
implemented section 1705 in regulation at 38 Code of Federal
Regulations (CFR) 17.36.
In the Jeff Miller and Richard Blumenthal Veterans Health Care and
Benefits Improvement Act of 2016, Congress elevated Medal of Honor
recipients' health care enrollment eligibility from priority category
three to priority category one. Public Law (Pub. L.) 114-315 (December
16, 2016).
This final rulemaking updates 38 CFR 17.36 to reflect the current
statutory requirement that VA place Medal of Honor recipients in
priority category one. VA therefore is removing award of the Medal of
Honor as a criterion from paragraph (b)(3) and inserting it as a
criterion in paragraph (b)(1).
Copayments
Several sections in Chapter 17 of title 38, U.S.C. require VA to
collect copayments from certain veterans for various types of care and
medication. Section 1710 of 38 U.S.C., for example, directs VA to
provide hospital care and medical services to numerous categories of
veterans, and requires VA to charge certain categories of veterans
copayments for the care and services provided. Section 1710B allows VA
to furnish extended care services to certain categories of veterans,
including several categories who are not required to pay copayments.
Section 1722A requires VA to charge copayments for medications,
excepting several categories of veterans who are not required to pay
copayments. While Public Law 111-163 added Medal of Honor awardees to
Priority Group 3, it did not exempt these veterans from VA copayment
requirements.
Section 603 of Public Law 114-315 amended 38 U.S.C. 1710(a)(2)(D),
1710B(c)(2), and 1722A(a)(3) to afford Medal of Honor recipients
specific exemptions to the copayments required for hospital care and
medical services, extended care services, and medications. VA has
regulated copayments for the aforementioned benefits at 38 CFR 17.108,
17.110, and 17.111. This final rulemaking adds Sec. Sec.
17.108(d)(13), 17.110(c)(11), and 17.111(f)(10) to reflect the
statutory changes exempting Medal of Honor recipients from copayments
for the
[[Page 7814]]
listed health care services and medications.
Administrative Procedure Act
This final rule implements the specific requirements mandated by
Public Law 114-315 that VA place Medal of Honor recipients into
priority category one for purposes of enrollment eligibility and exempt
those veterans from certain copayments. Accordingly, because this rule
simply incorporates current statutory requirements, VA finds there is
good cause to exempt this rule from the prior notice-and-comment and
delayed-effective-date requirements, in accordance with 5 U.S.C.
553(b)(B) and 5 U.S.C. 553(d)(3).
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
Although 38 CFR 17.36 contains provisions constituting collections
of information under the Paperwork Reduction Act of 1995 (44 U.S.C.
3501-3521), no new or proposed revised collections of information are
associated with this final rule. The information collection
requirements for Sec. 17.36 are currently approved by the Office of
Management and Budget (OMB) and have been assigned OMB control number
2900-0091.
Regulatory Flexibility Act
The Regulatory Flexibility Act, 5 U.S.C. 601-612, is not applicable
to this rulemaking because notice of proposed rulemaking is not
required. 5 U.S.C. 601(2), 603(a), 604(a). In any event, the Secretary
hereby certifies that this rule does not have a significant economic
impact on a substantial number of small entities as they are defined in
the Regulatory Flexibility Act. This rule directly affects only
individuals and does not directly affect small entities. Therefore,
pursuant to 5 U.S.C. 605(b), this rulemaking is exempt from the initial
and final regulatory flexibility analysis requirements of 5 U.S.C. 603
and 604.
Executive Order 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). 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 the Executive Order.
The economic, interagency, budgetary, legal, and policy
implications of this rule have been examined, and it has been
determined not to be 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 Fiscal Year to Date.'' This rule is not
an E.O. 13771 regulatory action because this rule is not significant
under E.O. 12866.
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 the expenditure by
State, local, and tribal governments, in the aggregate, or by the
private sector, of $100 million or more (adjusted annually for
inflation) in any one year. This final rule will have no such effect on
State, local, and tribal governments, or on the private sector.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic Assistance numbers and titles for
the programs affected by this document are 64.007, Blind Rehabilitation
Centers; 64.008, Veterans Domiciliary Care; 64.009, Veterans Medical
Care Benefits; 64.010, Veterans Nursing Home Care; 64.011, Veterans
Dental Care; 64.012, Veterans Prescription Service; 64.013, Veterans
Prosthetic Appliances; 64.014, Veterans State Domiciliary Care; 64.015,
Veterans State Nursing Home Care; 64.018, Sharing Specialized Medical
Resources; 64.019, Veterans Rehabilitation Alcohol and Drug Dependence;
64.022, Veterans Home Based Primary Care; and 64.024, VA Homeless
Providers Grant and Per Diem Program.
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug abuse, 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, Reporting and recordkeeping requirements,
Travel and transportation expenses, Veterans.
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 February 26, 2019, for publication.
Dated: February 26, 2019.
Consuela Benjamin,
Regulations Development Coordinator, Office of Regulation Policy &
Management, Office of the Secretary, Department of Veterans Affairs.
For the reasons stated in the preamble, Department of Veterans
Affairs amends 38 CFR part 17 as follows:
[[Page 7815]]
PART 17--MEDICAL
0
1. The authority citation for part 17 continues to read in part as
follows:
Authority: 38 U.S.C. 501, and as noted in specific sections.
* * * * *
0
2. Amend Sec. 17.36 by revising paragraphs (b)(1) and (3) to reads as
follows:
Sec. 17.36 Enrollment--provision of hospital and outpatient care to
veterans.
* * * * *
(b) * * *
(1) Veterans with a singular or combined rating of 50 percent or
greater based on one or more service-connected disabilities or
unemployability; and veterans awarded the Medal of Honor.
* * * * *
(3) Veterans who are former prisoners of war; veterans awarded the
Purple Heart; veterans with a singular or combined rating of 10 percent
or 20 percent based on one or more service-connected disabilities;
veterans who were discharged or released from active military service
for a disability incurred or aggravated in the line of duty; veterans
who receive disability compensation under 38 U.S.C. 1151; veterans
whose entitlement to disability compensation is suspended pursuant to
38 U.S.C. 1151, but only to the extent that such veterans' continuing
eligibility for that care is provided for in the judgment or settlement
described in 38 U.S.C. 1151; veterans whose entitlement to disability
compensation is suspended because of the receipt of military retired
pay; and veterans receiving compensation at the 10 percent rating level
based on multiple noncompensable service-connected disabilities that
clearly interfere with normal employability.
* * * * *
0
3. Amend Sec. 17.108 by adding paragraph (d)(13) to read as follows:
Sec. 17.108 Copayments for inpatient hospital care and outpatient
medical care.
* * * * *
(d) * * *
(13) A veteran who was awarded the Medal of Honor.
* * * * *
0
4. Amend Sec. 17.110 by adding paragraph (c)(11) to read as follows:
Sec. 17.110 Copayments for medications.
* * * * *
(c) * * *
(11) Medication for a veteran who was awarded the Medal of Honor.
* * * * *
0
5. Amend Sec. 17.111 by adding paragraph (f)(10) to read as follows:
Sec. 17.111 Copayments for extended care services.
* * * * *
(f) * * *
(10) A veteran who was awarded the Medal of Honor.
* * * * *
[FR Doc. 2019-03747 Filed 3-4-19; 8:45 am]
BILLING CODE 8320-01-P