[Federal Register Volume 85, Number 35 (Friday, February 21, 2020)]
[Proposed Rules]
[Pages 10118-10120]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-03432]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Parts 17 and 70

RIN 2900-AQ44


VHA Claims and Appeals Modernization

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its 
regulations concerning its claims and appeals process governing various 
programs administrated by the Veterans Health Administration (VHA). The 
Veterans Appeals Improvement and Modernization Act of 2017 (AMA) 
amended the procedures applicable to administrative review and appeal 
of VA decisions on claims for benefits, creating a new, modernized 
review system. This rulemaking proposes amendments to sunset certain 
VHA regulations which are inconsistent with AMA.

DATES: Comments must be received on or before April 21, 2020.

FOR FURTHER INFORMATION CONTACT: Erik Shepherd, Program Specialist, 
Office of Regulatory and Administrative Affairs, Department of Veterans 
Affairs, 810 Vermont Ave. NW, Washington, DC 20420, (202) 461-9596 
(This is not a toll-free number.).

ADDRESSES: Written comments may be submitted through 
www.Regulations.gov; by mail or hand-delivery to Director, Office of 
Regulation Policy and Management (00REG), Department of Veterans 
Affairs, 810 Vermont Avenue NW, Room 1064, Washington, DC 20420; or by 
fax to (202) 273-9026. Comments should indicate that they are submitted 
in response to [RIN 2900-AQ44 VHA Appeals Modernization.] Copies of 
comments received will be available for public inspection in the Office 
of Regulation Policy and Management, Room 1064, between the hours of 
8:00 a.m. and 4:30 p.m., Monday through Friday (except holidays). 
Please call (202) 461-4902 for an appointment. (This is not a toll-free 
number.) In addition, during the comment period, comments may be viewed 
online through the Federal Docket Management System (FDMS) at 
www.Regulations.gov.

SUPPLEMENTARY INFORMATION: Public Law 115-55, the Veterans Appeals 
Improvement and Modernization Act of 2017 (AMA), changes the processes 
by which veterans seek review of VA benefits decisions. VA has 
implemented the AMA in a rulemaking that is generally applicable to 
benefits administered throughout VA, to include benefits administered 
by the Veterans Health Administration (VHA). VA Claims and Appeals 
Modernization, 84 FR 138, 172 (Jan. 18, 2019). That rulemaking 
specifically provides, ``unless otherwise specified in this final rule, 
VA amends its regulations applicable to all claims processed under

[[Page 10119]]

the new review system, which generally applies where an initial VA 
decision on a claim is provided on or after the effective date or where 
a claimant has elected to opt into the new review system under 
established procedures.'' 84 FR 138.
    However, the VA Claims and Appeals Modernization regulatory 
amendments did not explicitly revise or remove VHA specific regulations 
which are inconsistent with AMA. In this rulemaking, VA proposes to 
sunset multiple VHA regulations that are inconsistent with the AMA and 
the VA Claim and Appeals Modernization regulatory amendments. Because 
the AMA and VA's January 2019 regulations apply to VHA, these proposed 
conforming changes to part 17 will not change the procedures VHA 
currently follows under the AMA.
    First, the authority to reconsider a VHA decision, which is 
established under VHA's regulations at 38 CFR 17.133, 17.276, 17.904, 
and 17.1006 and 38 CFR 70.40, is inconsistent with the specific 
differentiated lanes for seeking review of a VA decision that are 
established by AMA and implemented in the VA Claims and Appeals 
Modernization regulatory amendments, particularly the closed record 
requirement for higher level review. To conform VHA's regulations to 
the procedures applicable under AMA and implementing regulations, VA 
proposes to amend Sec. Sec.  17.133, 17.276, 17.904, 17.1006, and 70.40 
to make clear that VHA reconsideration is available only in legacy 
claims, as defined in Part 3 and 20 of this title.
    Similarly, VHA proposes to revise 38 CFR 17.132 regarding appeals 
of VHA decisions on certain requests for payment or reimbursement for 
care rendered in the community. Section 17.132 affords only one avenue 
for disputing a VA decision regarding payment or reimbursement, appeal 
to the Board of Veterans' Appeals. For payment requests covered by AMA 
and implementing regulations, this is inconsistent with the three 
distinct lanes established by that law. Thus, VHA proposes to revise 
Sec.  17.132 to clarify that it will apply only to payment decisions 
made for legacy claims as described above.

Paperwork Reduction Act

    This final rule contains no provisions constituting a collection of 
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).

Regulatory Flexibility Act

    The Secretary hereby certifies that this proposed rule would 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 proposed rule only affects procedures regarding 
the appeals process; it does not affect the cost of filing an appeal 
nor any amount duly owed to a small entity. Therefore, pursuant to 5 
U.S.C. 605(b), the initial and final regulatory flexibility analysis 
requirements of 5 U.S.C. 603 and 604 do not apply.

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 promoting flexibility. 
The Office of Information and Regulatory Affairs has determined that 
this rule is 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 FYTD.
    This rule is not expected to be subject to the requirements of 
Executive Order 13771 because this rulemaking is expected to result 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 proposed rule would 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 64.009--Veterans Medical 
Care Benefits; 64.039--CHAMPVA.

List of Subjects in 38 CFR Parts 17 and 70

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
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, Philippines, Reporting 
and recordkeeping requirements, Scholarships and fellowships, 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. Pamela 
Powers, Chief of Staff, Department of Veterans Affairs, approved this 
document on January 10, 2020, for publication.

Consuela Benjamin,
Regulations Development Coordinator, Office of Regulation Policy & 
Management, Office of the Secretary, Department of Veterans Affairs.

    For the reasons set out in the preamble, VA proposes to amend 38 
CFR parts 17 and 70 as set forth below:

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.
* * * * *
0
2. Amend Sec.  17.132 by:
0
a. Designating the text as paragraph (b); and
0
b. Adding paragraph (a).
    The addition to read as follows:


Sec.  17.132   Appeals.

    (a) This section applies only to legacy claims.
* * * * *
0
3. Amend Sec.  17.133 by revising paragraph (a) to read as follows:


Sec.  17.133  Procedures.

    (a) Scope. This section sets forth reconsideration procedures 
regarding claims for benefits administered by the Veterans Health 
Administration (VHA).

[[Page 10120]]

This section applies only to legacy claims.
* * * * *
0
4. Amend Sec.  17.276 by:
0
a. Designating the text as paragraph (b); and
0
b. Adding paragraph (a).
    The addition to read as follows:


Sec.  17.276  Appeal/Review Process

    (a) This section applies only to legacy claims.
* * * * *
0
5. Amend Sec.  17.904 by:
0
a. Designating the text as paragraph (b); and
0
b. Adding paragraph (a).
    The addition to read as follows:


Sec.  17.904  Review and Appeal Process

    (a) This section applies only to legacy claims.
* * * * *


Sec.  17.1006  [Amended].

0
6. Amend Sec.  17.1006 by removing the words ``reconsideration and'' 
from the last sentence.

PART 70--VETERANS TRANSPORTATION PROGRAMS

0
1. The authority citation for part 70 continues to read as follows:

    Authority: 38 U.S.C. 101, 111, 111A, 501, 1701, 1714, 1720, 
1728, 1782, 1783, and E.O. 11302, 31 FR 11741, 3 CFR, 1966-1970 
Comp., p. 578, unless otherwise noted.

0
2. Amend Sec.  70.40 by:
0
a. Designating the text as paragraph (b); and
0
b. Adding paragraph (a).
    The addition to read as follows:


Sec.  70.40  Administrative Procedures

    (a) This section applies only to legacy claims.
* * * * *
[FR Doc. 2020-03432 Filed 2-20-20; 8:45 am]
 BILLING CODE 8320-01-P