[Federal Register Volume 85, Number 158 (Friday, August 14, 2020)]
[Notices]
[Pages 49720-49721]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-17764]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0823]


Agency Information Collection Activity: Expanded Access to Non-VA 
Care Through the MISSION Act: Veterans Community Care Program

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: Veterans Health Administration, Department of Veterans Affairs 
(VA), is announcing an opportunity for public comment on the proposed 
collection of certain information by the agency. Under the Paperwork 
Reduction Act (PRA) of 1995, Federal agencies are required to publish 
notice in the Federal Register concerning each proposed collection of 
information, including each proposed extension of a currently approved 
collection, and allow 60 days for public comment in response to the 
notice.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before October 13, 2020.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at www.Regulations.gov 
or to Brian McCarthy, Office of Regulatory and Administrative Affairs 
(10B4), Department of Veterans Affairs, 810 Vermont Avenue NW, 
Washington, DC 20420 or email to [email protected]. Please refer 
to ``OMB Control No. 2900-0823'' in any correspondence. During the 
comment period, comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Brian McCarthy at (202) 615-9241.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995, Federal agencies must 
obtain approval from the Office of Management and Budget (OMB) for each 
collection of information they conduct or sponsor. This request for 
comment is being made pursuant to Section 3506(c)(2)(A) of the PRA.
    With respect to the following collection of information, VHA 
invites comments on: (1) Whether the proposed collection of information 
is necessary for the proper performance of VHA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VHA's estimate of the burden of the proposed collection of 
information; (3) ways to enhance the quality, utility, and clarity of 
the information to be collected; and (4) ways to minimize the burden of 
the collection of information on respondents, including through the use 
of automated collection techniques or the use of other forms of 
information technology.
    Authority: Public Law 104-13; 44 U.S.C. 3501-3521.
    Title: Expanded Access to Non-VA Care through the MISSION Act: 
Veterans Community Care Program, VA Forms 10-10143, 10-10143a, 10-
10143b, 10-10143c, 10-10143e, 10-10143f and 10-10143g.
    OMB Control Number: 2900-0823.
    Type of Review: Revision and extension of a currently approved 
collection.
    Abstract: Section 101 of the VA Maintaining Internal Systems and 
Strengthening Integrated Outside Networks (MISSION) Act of 2018 
requires VA to implement the Veterans Community Care Program to furnish 
care in the community to covered Veterans through eligible entities and 
providers, under circumstances as further prescribed in the MISSION 
Act. VA currently collects information that will be required to 
implement the Veterans Community Care Program (VCCP) under the Veterans 
Choice Program, through an OMB approved collection 2900-0823.
    OMB Collection 2900-0823 now includes VA Form 10-10143, Election to 
Receive Authorized Non-VA Care and Selection of Provider for the 
Veterans Community Care Program; VA Form 10-10143a, Veterans Community 
Care Health Insurance Certification; VA Form 10-10143b, Submission of 
Medical Record Information under the Veterans Community Care Program; 
VA Form 10-10143c, Submission of Information on Credentials and 
Licenses by Eligible Entities and Providers; and VA Form 10-10143e, 
Secondary Authorization Request for VA Community Care. In addition, two 
new forms that received emergency PRA clearances from OMB in 2020 are 
included in 2900-0823: VA Form 10-10143f, Community Care Document Cover 
Sheet; and VA Form 10-10143g, Non-VA Hospital Emergency Notification.
    VA seeks to update OMB collection 2900-0823 to implement the 
Veterans Community Care Program by updating the title of VA forms and 
any associated statutory citations to be consistent with the new 
program and the MISSION Act, by adding a new cover sheet to use when 
submitting documentation from providers of non-VA emergent care, by 
adding a new 72-hour notification form to be used when a Veteran 
receives emergent care from a non-VA provider, and by updating burden 
hours to account for estimated increased use of

[[Page 49721]]

community care under the new program.
    This collection of information is required to properly adjudicate 
and implement the requirements of the MISSION Act.
    a. VA Form 10-10143 will collect Veteran information on whether 
covered Veterans would elect to receive authorized care under the 
Veterans Community Care Program (VCCP) if certain conditions are met, 
as required by 38 U.S.C. 1703(d)(3). This form also will allow a 
covered Veteran to specify a particular non-VA entity or provider.
    b. VA Form 10-10143a will collect other health insurance 
information from covered Veterans who elect to participate in the VCCP, 
as required by 38 U.S.C. 1705A. This information also is required by 38 
U.S.C. 1703(j), which requires VA to recover or collect reasonable 
charges for community care that is furnished from a health care plan 
contract described in 38 U.S.C. 1729.
    c. VA Form 10-10143b will collect health records of covered 
Veterans from non-VA health care entities and providers for care 
authorized under the VCCP, as required by 38 U.S.C. 1703(a)(2)(A), 
which requires VA to establish a mechanism to receive medical records 
from non-VA providers. A copy of all medical and dental records 
(including but not limited to images, test results, and notes or other 
records of what care was provided and why) related to a Veteran's care 
provided under the VCCP must be submitted to VA, including any claims 
for payment for the furnishing of such care.
    d. VA Form 10-10143c will collect information from non-VA entities 
and providers concerning relevant credentials and licenses as required 
for such entities or providers to furnish care and services generally. 
This information is authorized by section 133 of the MISSION Act, which 
requires VA to establish competency standards for non-VA providers, as 
well as 38 U.S.C. 1703C(a)(1), which requires VA to establish certain 
standards of quality for furnishing care and services (including 
through non-VA providers).
    e. VA Form 10-10143e will collect secondary authorization requests 
from non-VA entities and providers to furnish care and services in 
addition to or supporting the original authorization for care. This 
information is required by 38 U.S.C. 1703(a)(3), which establishes that 
a covered Veteran may only receive care or services under the VCCP upon 
VA's authorization of such care or services.
    f. VA Form 10-10143f will allow for the submission of paper 
documents in support of a non-VA provider claim for emergency care 
rendered in the community when not accompanied by a paper Health Care 
Claim form. This Community Care Document Cover Sheet will be used 
exclusively for the submission of medical documentation for 
unauthorized emergent services for patients otherwise covered by VA.
    g. VA Form 10-10143g will be used to provide 72-hour notification 
to VA when a Veteran receives emergent care from a non-VA provider. 
This form should be completed by the non-VA provider within 72 hours of 
the beginning of treatment.

VA Form 10-10143

    Affected Public: Individuals or households.
    Estimated Annual Burden: 610,833 hours.
    Estimated Average Burden per Respondent: 10 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 3,665,000.

VA Form 10-10143a

    Affected Public: Individuals or households.
    Estimated Annual Burden: 610,833 hours.
    Estimated Average Burden per Respondent: 10 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 3,665,000.

VA Form 10-10143b

    Affected Public: Private Sector.
    Estimated Annual Burden: 1,039,332 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Average of 34 times annually.
    Estimated Number of Respondents: 366,823.

VA Form 10-10143c

    Affected Public: Private Sector.
    Estimated Annual Burden: 10,190 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 122,274.

VA Form 10-10143e

    Affected Public: Private Sector.
    Estimated Annual Burden: 611,372 hours.
    Estimated Average Burden per Respondent: 20 minutes.
    Frequency of Response: Average of 5 times annually.
    Estimated Number of Respondents: 366,823.

VA Form 10-10143f

    Affected Public: Private Sector.
    Estimated Annual Burden: 41,667 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 500,000.

VA Form 10-10143g

    Affected Public: Private Sector.
    Estimated Annual Burden: 83,333 hours.
    Estimated Average Burden per Respondent: 10 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 500,000.

    By direction of the Secretary.
Danny S. Green,
VA Clearance Officer, Office of Quality, Performance and Risk (OQPR). 
Department of Veterans Affairs.
[FR Doc. 2020-17764 Filed 8-13-20; 8:45 am]
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