[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