[Federal Register Volume 84, Number 101 (Friday, May 24, 2019)]
[Rules and Regulations]
[Pages 24032-24034]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-10869]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP37


Removing Net Worth Requirement From Health Care Enrollment

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) is removing the 
regulatory provisions regarding the veteran's net worth as a factor in 
determining the veteran's eligibility for VA health care. Prior to 
January 1, 2015, VA considered a veteran's net worth and annual income 
when determining a veteran's assignment to an enrollment priority group 
for VA health care. Reporting net worth information imposed a 
significant burden on veterans and VA dedicated substantial 
administrative resources to verify the reported information. VA changed 
its policy regarding net worth reporting in order to improve access to 
VA health care to lower-income veterans and to remove the reporting 
burden from veterans by discontinuing collection of net worth 
information. As VA no longer considers net worth in making eligibility 
determinations, this final rule amends the regulation to remove 
reference to VA's discretionary statutory authority to consider a 
veteran's net worth as a factor in determining eligibility for VA 
health care. Because of the net worth reporting requirement, certain 
veterans who would have been eligible to receive VA health care based 
on their annual income were ineligible for such care, or they were 
placed in a lower priority category, because their net worth was too 
high.

DATES: The final rule is effective June 24, 2019.

FOR FURTHER INFORMATION CONTACT: Ralph Weishaar, Director, Program 
Administration, Member Services, (10NF), Department of Veterans 
Affairs, 810 Vermont Avenue NW, Washington, DC 20420; (202) 382-2508. 
(This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: In a document published in the Federal 
Register on October 20, 2015 (80 FR 63480), VA proposed to amend its 
regulations that govern enrollment in the VA health care system by 
removing the regulatory provision that restates VA's discretionary 
authority to consider the veteran's net worth when determining 
eligibility for lower-cost health care. VA provided a 60-day comment 
period, which ended on December 21, 2015. We received thirteen (13) 
comments on the proposed rule. Pursuant to 38 U.S.C. 1705, VA 
established a health care enrollment system with implementing 
regulations at 38 CFR 17.36. When veterans apply for VA health care 
benefits, VA assigns a priority category that reflects the basis for 
that veteran's eligibility, such as whether the veteran was rated as 
having a service-connected disability or would be unable to defray the 
costs of necessary expenses because of low income. Veterans are placed 
in the highest priority category they are eligible for based on the 
criteria described in Sec.  17.36(b). Veterans who do not meet the 
requirements of priority categories 1 through 4, and are determined to 
be unable to defray the expenses of necessary care under 38 U.S.C. 
1722(a) are placed in priority category 5. See 38 CFR 17.36(b)(5). This 
rulemaking affects a regulatory provision related to priority category 
5.

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Veterans are considered unable to defray the costs of necessary care if 
they have a low annual income, qualify for VA pension benefits, or 
otherwise meet the criteria set forth in 38 U.S.C. 1722(a) and 38 CFR 
17.47(d). VA has the authority to use a veteran's net worth to 
determine whether the veteran is unable to defray the cost of health 
care at 38 U.S.C. 1722(d)(1), but this authority is discretionary.
    In 2013, VA informed the public of its intent to discontinue annual 
income and asset information reporting by veterans. See 78 FR 64065 
(Oct. 25, 2013) and 78 FR 79564 (Dec. 30, 2013). VA did not receive any 
adverse response to those notices. With this in mind, VA has determined 
that it is appropriate to cease consideration of the veteran's net 
worth in determining whether they are able to defray the expenses of 
necessary health care and qualify for inclusion in priority category 5 
effective January 1, 2015.
    By eliminating consideration of the veteran's net worth for 
purposes of health care enrollment, more veterans have qualified for VA 
health care in a higher priority category, which has improved access 
and affordability of VA health care for many lower-income veterans. 
This change reduced administrative burdens for veterans and VA. By 
eliminating the requirement to have veterans report net worth 
information VA will be able to use established practices with the 
Internal Revenue Service and Social Security Administration to verify 
veterans' reported annual income far more efficiently. Since this 
process can be done without requiring a collection of information with 
the Veteran, this policy has eliminated the significant burden on 
veterans to report their net worth, and it also eliminated the need for 
VA to use resources to verify that information.
    For these reasons, we are removing Sec.  17.47(d)(5) in its 
entirety and renumbering current Sec.  17.47(d)(6) as Sec.  
17.47(d)(5). Current paragraph (d)(5) restates VA's discretionary 
statutory authority to use the veteran's net worth to determine whether 
he is able to defray the costs of health care. By removing the 
regulatory restatement of VA's discretionary statutory authority to 
consider a veteran's net worth, VA removed language in the regulation 
that will be perceived as inconsistent with the policy change. The 
amendments in this rulemaking are consistent with current VA policy and 
help ensure our regulations are not interpreted more narrowly than VA 
intends.
    Nine (9) commenters agreed with the change in rulemaking. One 
commenter stated that ``all vets deserve the care they rightly earned. 
Net worth has nothing to do with it.'' Two (2) of these commenters 
``agree[d] with the decision to remove the net worth requirement for 
veterans seeking health care through the VA'' and ``believe[d] removing 
the wording that gives VA discretionary authority and replacing it with 
wording that leaves out financial status discrimination against 
Veterans is a good idea.'' Additionally, two (2) other of these 
commenters remarked ``the role of this rule is to more properly and 
efficiently administer the health care of veterans'' and that the rule 
``is fair, cost-effective, and supports VA's main mission of caring 
about Veterans.'' We thank the commenters for supporting the rule and 
make no edits based on these comments.
    Four (4) others disagreed or appeared to misunderstand the 
proposal. The comments ranged from requesting that VA ``not take away 
the insurance promised to our veterans'' to ``they served their time/
retired & went on to a higher paying career, does not mean they don't 
deserve equal benefits.'' Two (2) commenters expressed concerns 
regarding the costs VA would incur implementing this rulemaking. 
Shifting veterans previously classified in categories 7 and 8 to 
category 5 does not increase the cost of care. Veterans shifting from 
categories 7 and 8 to category 5 merely collapses the categories 
administratively for more effective management and tracking. This shift 
merely reclassifies the veterans. We recognize that it is reasonable to 
expect an uptick in expenditures when collapsing categories in this 
manner, especially when more veterans will occupy the same category. 
However, VA expects that it will see a decrease in collections of 
$55,873,000 from 2015-2019 for categories 7 and 8. The authority to 
consider net worth in making these determinations is discretionary. In 
weighing all factors, including the economic impact of this change, VA 
has decided this amendment is best for VA and veterans. Therefore, VA 
makes no changes based on this comment. Some questioned why VA 
requested the income and net worth of veterans. These responses may 
have come from a misunderstanding of the intent of the rule. The intent 
of the rule is to eliminate the net worth reporting burden for veterans 
who seek VA health care. VA makes no edits based on these comments. 
Based on the rationale set forth in the Supplementary Information to 
the proposed rule and in this final rule, VA is adopting the proposed 
rule with no changes.

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, this final rule contains provisions constituting a 
collection of information, at 38 CFR 17.47, under the provisions of the 
Paperwork Reduction Act (44 U.S.C. 3501 et seq.), no new or revised 
collections of information are associated with this final rule. The 
information collection requirements for 38 CFR 17.47(d)(5) are 
currently approved by the Office of Management and Budget (OMB) and 
have been assigned OMB control number 2900-0091. On November 24, 2014 
and prior to publication of the proposed rule associated with this 
final regulation, VA revised the Information Collection Request (ICR) 
to remove the net worth information collection from VA form 10-10EZ, in 
accordance with the Paperwork Reduction Act of 1995.

Regulatory Flexibility Act

    The Secretary hereby certifies that this final rule will not have a 
significant economic impact on a substantial number of small entities 
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. This final rule will directly affect only individuals and would 
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 Orders 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

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promoting flexibility. Executive Order 12866 (Regulatory Planning and 
Review) defines a ``significant regulatory action,'' which requires 
review by the Office of Management and Budget (OMB), 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 this Executive Order.''
    VA has examined the economic, interagency, budgetary, legal, and 
policy implications of this regulatory action and determined that the 
action is a significant regulatory action because it is likely to 
result in a rule that may raise novel legal or policy issues arising 
out of legal mandates, the President's priorities, or the principles 
set forth in this Executive Order. 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 FYTD. This rule is not subject to the 
requirements of E.O. 13771 because this rule results in no more than de 
minimis costs.

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, 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. Robert L. 
Wilkie, Secretary, Department of Veterans Affairs, approved this 
document on May 20, 2019, for publication.

    Dated: May 21, 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, the Department of Veterans 
Affairs amends 38 CFR part 17 as follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501, and as noted in specific sections.


Sec.  17.47   [Amended]

0
2. Amend Sec.  17.47 by removing paragraph (d)(5) and the authority 
citation immediately following paragraph (d)(5) and re-designating 
paragraph (d)(6) as new paragraph (d)(5).

[FR Doc. 2019-10869 Filed 5-23-19; 8:45 am]
 BILLING CODE 8320-01-P