[Federal Register Volume 85, Number 136 (Wednesday, July 15, 2020)]
[Rules and Regulations]
[Pages 42724-42726]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-14341]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
Update To Access Standards Drive Time Calculations
AGENCY: Department of Veterans Affairs.
ACTION: Guidance.
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SUMMARY: This Department of Veterans Affairs (VA) document provides
additional information regarding VA's calculation of average drive
times for purposes of eligibility determinations for covered veterans
to access community care through the Veterans Community Care Program.
DATES: Effective August 14, 2020.
FOR FURTHER INFORMATION CONTACT: Joseph Duran, Office of Community Care
(10D), Veterans Health Administration (VHA), Department of Veterans
Affairs, Ptarmigan at Cherry Creek, Denver, CO 80209;
[email protected]; 303-370-1637 (this is not a toll-free number).
SUPPLEMENTARY INFORMATION: On June 5, 2019, VA published a final rule
at 84 FR 26278 to promulgate 38 CFR 17.4000-17.4040 to implement the
Veterans Community Care Program established by section 101 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 (MISSION Act), Public Law 115-182.
Section 17.4040 established access standards for purposes of making
eligibility determinations under the Veterans Community Care Program
under Sec. 17.4010(a)(4). For primary care, mental health care, and
non-institutional extended care services, eligibility is established if
VA cannot schedule an appointment for the covered veteran with a VA
health care
[[Page 42725]]
provider for the required care or service: (i) Within 30 minutes
average driving time of the veteran's residence; and (ii) Within 20
days of the date of request unless a later date has been agreed to by
the veteran in consultation with the VA health care provider. For
specialty care, eligibility is established if VA cannot schedule an
appointment for the covered veteran with a VA health care provider for
the required care or service: (i) Within 60 minutes average driving
time of the veteran's residence; and (ii) Within 28 days of the date of
request unless a later date has been agreed to by the veteran in
consultation with the VA health care provider. VA noted in Sec.
17.4040(b) that to calculate average driving time from the veteran's
residence in paragraph (a) of the section, VA would use geographic
information system software.
In the preamble to the final rule, VA explained that it was not
detailing in regulation a specific methodology for calculating average
drive time because it was more veteran-centric to maintain operational
flexibility to refine and improve VA's average drive-time calculations
in response to experience, feedback and changing real-world conditions.
See 84 FR 26278, 26299. This final rule further stated that as VA
gained more experience with administering the Veterans Community Care
Program and received feedback from veterans regarding their experience
with the program, VA anticipated refining the tool to calculate average
drive times as well as VA systems to improve our consideration of
actual conditions that affect travel to receive care and services and
to provide more information to veterans regarding calculation of
average drive times. See 84 FR 26278, 26301. This notice serves to
inform the public that VA is will change the geographic information
system software used to the calculate average drive times under Sec.
17.4040.
Description of Changes in Calculating Average Drive Times: As
described in the final rule establishing the Veterans Community Care
Program (84 FR 26278), VA uses a variety of factors, including
distance, route options, and speed limits to calculate the average
drive time between the veteran's residence (as noted in VA's enrollment
system) and VA facilities that offer the type of care needed by the
Veteran. The calculation is similar to the calculations used in popular
commercial mapping software used for point-to-point driving directions
and estimated travel times. The calculated average is used to determine
whether the veteran is eligible for community care based on drive time.
The final rule also stated that, in response to comments that requested
clarification on how VA will calculate average drive times, that some
detailed information regarding average drive time calculations and
algorithms is proprietary, and VA was unable to disclose the full
method used to make the calculations. See 84 FR 26278, 26300.
VA recognized the concerns voiced by veterans and members of the
public at the time we launched the Veterans Community Care Program
regarding how we calculate average drive time and whether we are making
the best estimates of average drive times. This notice about planned
refinements is the result of VA's efforts to continue improving how we
calculate this important component of eligibility.
VA is refining the average drive-time calculations in the online
Decision Support Tool (DST) to improve eligibility determination
results and response times based on feedback received from veterans and
VA staff regarding their experiences with the Veterans Community Care
Program since its implementation on June 6, 2019.
Effective August 14, 2020, VA will use a new geographic information
system within DST. Under the new system, VA will determine drive times
between two addresses by developing ``service areas'' around all VA
facilities, which are bands surrounding the facility that reflect drive
times in ranges of 10-minute increments, starting with 0-10 minutes,
going up to 81-90 minutes. The applicable drive-time standards depend
on the type of care being requested (i.e., the veteran can get needed
care within 30 minutes' average drive time for primary care, mental
health care and extended care services under Sec. 17.4040(a)(1)(i) or
within 60 minutes for specialty care services under Sec.
17.4040(a)(2)(i)). Users of the system will get an estimate of the
drive time between the veteran's residence and the VA facility in a 10-
minute range under the bands, instead of a single-time estimate as in
the current system. Covered veterans whose residence address is within
a drive-time service area range that exceeds the drive-time standards
for the type of care being sought would be determined to be eligible
under Sec. 17.4010(a)(4).
The new system will use historical traffic patterns in all
searches. The system will calculate average drive times based on
historical traffic patterns on Wednesdays at 10 a.m. at the veteran's
local time for all searches. We have selected this time and day of the
week to reasonably approximate times that veterans would be traveling
for appointments, while working within the capabilities of the system
and the available data. Historical traffic data will be updated two to
three times per year to reflect changes in local travel patterns.
Veterans will benefit from this change in two ways. First, VA
believes the new system will better reflect the actual conditions that
affect the time it takes for veterans to travel to receive care and
services because of the way that historical traffic data will be used
and how average travel times will be calculated. Second, we can now
offer more information to veterans and the public regarding how VA will
calculate average drive times under this new system. While VA is
primarily making this change to improve eligibility determination
results and response times, it will also impact eligibility under the
access standards for some veterans. VA believes the result will be an
overall increase in eligibility.
We note that the average drive time is only one element of covered
veterans' eligibility for community care. Since VA established the
Veterans Community Care Program on June 6, 2019, covered veterans have
also been eligible for community care under other criteria (see 38 CFR
17.4010, Veteran Eligibility). For example, covered veterans who would
not be considered eligible for community care based solely on the
average drive time element of the designated access standard criterion
may still be eligible for community care if the veteran and his or her
VA provider agree that it is in the best medical interest of the
veteran to receive community care. We remain committed to ensuring that
covered veterans are referred to community care where it is in their
best medical interest, and veterans with concerns about whether they
should be referred to the community are always welcome to discuss their
options with their VA providers.
Although we are changing the method of calculating average drive
times in our DST tool, which may affect some individuals' eligibility,
this notice is not changing VA's designated drive time access standard
under Sec. 17.4040. The average drive times that establish eligibility
under the designated access standards criterion will remain the same
after VA updates the average drive-time calculation tool.
VA continues to believe it is more veteran-centric to maintain the
operational flexibility to refine and improve VA's calculations in
response to experience, feedback and changing real-world conditions,
rather than to detail in regulation a specific
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methodology or considerations that could constrain VA's ability to
improve the calculation of average drive times in the future. For that
reason, we will continue to update the public through documents in the
Federal Register about any changes to how we calculate average drive
times for the Veterans Community Care Program.
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. Brooks D.
Tucker, Acting Chief of Staff, Department of Veterans Affairs, approved
this document on June 23, 2020 for publication.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
the Secretary, Department of Veterans Affairs.
[FR Doc. 2020-14341 Filed 7-14-20; 8:45 am]
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