[Federal Register Volume 86, Number 20 (Tuesday, February 2, 2021)]
[Notices]
[Pages 7921-7923]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-02138]


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DEPARTMENT OF VETERANS AFFAIRS


Draft Criteria for Section 203 of the VA MISSION Act of 2018

AGENCY: Department of Veterans Affairs.

ACTION: Notice and request for comment.

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SUMMARY:  The Secretary of Department of Veterans Affairs (VA) is 
responsible for establishing a procedure for making recommendations in 
reviewing assets and infrastructure. This notice provides the selection 
criteria to guide this process in order to meet this this 
responsibility.

ADDRESSES:  Written comments may be submitted through 
www.regulations.gov. Comments should indicate that they are submitted 
in response to ``Notice of Intent and request for comments.'' During 
the comment period, comments may also be viewed online through the 
Federal Docket Management System at www.regulations.gov.

DATES:  Comments must be received on or before May 1, 2021.

FOR FURTHER INFORMATION CONTACT:  Valerie Mattison Brown, Chief 
Strategy Officer, Veterans Health Administration, Department of 
Veterans Affairs, 810 Vermont Avenue NW, Washington DC 20420, (202) 
461-7100 or [email protected].

SUPPLEMENTARY INFORMATION:  Section 1703C of 38 U.S.C., as added by 
Section 203 of the John S. McCain III, Daniel K. Akaka, and Samuel R. 
Johnson VA Maintaining Internal Systems and Strengthening Integrated 
Outside Networks (MISSION) Act of 2018 requires VA to establish 
criteria to be used in assessing and making recommendations regarding 
the modernization or realignment of facilities of the Veterans Health 
Administration (VHA) under the subtitle Selection Criteria. In 2019, 
VHA began working with various stakeholders and experts to identify 
factors to be considered in developing the criteria. VHA solicited 
feedback from Veterans Service Organizations, Veteran Engagement Boards 
and a wide range of interdisciplinary VA leaders. Six criteria and 
associated sub-criteria were developed through these robust 
engagements. VHA proposes to use these criteria to evaluate potential 
market opportunities for submission to the Asset and Infrastructure 
Review Commission.

Foreword

    VA is honored to deliver excellent health care for the more than 9 
million Veterans who entrust us with their care and is proud to serve 
as the backstop to the Nation's health care system. VA was in the midst 
of a tremendous transformation before the COVID-19 pandemic, working to 
empower Veterans with more excellent choices while modernizing our 
systems to enable an optimal experience of care and services. As the 
impacts of this unprecedented public health challenge have moved across 
the Nation and the globe, we have continued to demonstrate the strength 
of our nationwide, integrated system, positioning VA at the leading 
edge of U.S. health care on behalf of those we serve. We have employed 
each of our four missions--health care, education, research and 
emergency response--to lead the Nation forward beside our interagency 
and strategic partners. Each of these missions will be a vital element 
of the next step in our transformation journey: Designing the future of 
VA around the Veterans we serve.
    VA works each day to serve and honor America's Veterans and seeks 
to ensure each individual Veteran feels they are cared for uniquely, 
wherever they are and however they need. As Veteran needs, preferences 
and demographics shift over the coming decades, decisions about health 
care delivery and infrastructure need to be made by the Secretary to 
ensure Veterans can continue to access a sustainable, flexible and 
high-quality health care system well into the future. In line with our 
missions, VA proposes the following set of criteria for making 
decisions on health care improvement, as required by Section 203 of the 
MISSION Act of 2018. The criteria are designed to keep Veterans' needs 
at the center of the decision-making process,

[[Page 7922]]

assuring that each Veteran can receive the care they have earned and 
deserve.

Criteria

    VA is conducting Market Assessments to design high-performing 
networks of care to provide high quality, readily accessible cost-
effective care through VHA, Federal partners, academic affiliates and 
other private sector providers. This design provides VA with the 
ability to plan for the continuing evolution of Veteran health care, 
incorporating major trends and events in the national and global health 
ecosystem (e.g., the COVID-19 pandemic and telehealth). Each assessment 
will create opportunities to position the VA health care system to 
increase health equity, enhance Veteran experience, account for social 
determinants and serve as the coordinator of health care provided by 
VA. Through thoughtful and constructive engagements with internal and 
external stakeholders, the following criteria were developed for the 
evaluation of VHA realignment and modernization opportunities.
    The Secretary will use the criteria to make recommendations to the 
Asset and Infrastructure Review (AIR) Commission, established by the 
MISSION Act for the modernization and realignment of VHA facilities and 
to improve Veteran access to high-quality health care across the 
country. Recommendations submitted to the AIR Commission will focus on 
creating Veteran-centric outcomes that retain or improve health care 
services for Veterans through the most equitable modalities and through 
services and locations that most benefit those we serve. The 
recommendations will then go through the AIR Commission review process 
as outlined in the MISSION Act.
    Each criterion begins with a commitment statement, outlining VA's 
philosophy and commitment to current and future Veterans, followed by 
the criterion statement, sub-criteria and explanatory statement:

Veterans' Need for Care & Services (Demand)

    Commitment Statement: VA is committed to providing Veterans the 
full range of care and services needed and desired throughout their 
lifetimes, to include preventive, acute and chronic care. These 
services will be carefully balanced to meet Veterans' needs and 
preferences. We intend to ensure Veterans receive the personalized care 
they have earned. We will do this by matching the services and support 
they may need with our ability to provide those services in a timely 
manner, through VA's direct care system, through our Community Care 
Network and through government, academic and strategic partners.
    Demand Criterion: The recommendation aligns VA's high performing 
network resources to effectively meet the future health care demand of 
the Veteran enrollee population.
    Demand Sub-Criteria:
    The recommendation:
    [cir] Aligns the quality and delivery of care and services with 
projected Veteran demand across demographics and geography;
    [cir] Retains or improves VA's ability to meet projected demand;
    [cir] Considers health equity (i.e., demographics);
    [cir] Reflects consideration of factors underpinning observed 
utilization patterns (e.g., rurality and other social determinants of 
health); and
    [cir] Incorporates trends in the evolution of U.S. health care.
    When applying the `demand' criterion, VA will consider how a 
recommendation will impact VA's ability to meet the needs of Veterans 
in the future. VA will consider what Veterans may need through 
understanding the services that Veterans have accessed in the past and 
are projected to need and prefer in the future. VA will also consider 
how and where Veterans wish to receive services, including in 
ambulatory settings, hospitals, in the community, through telehealth, 
and through innovative models and modalities.

Accessibility of Care for Veterans (Access)

    Commitment Statement: We intend to provide Veterans with an 
accessible, whole health experience, with services thoughtfully 
designed to meet their needs. We will do this by making the services 
and support Veterans need accessible through locations, models and 
modalities that most benefit them and match their needs and 
preferences.
    Access Criterion: The recommendation maintains or improves Veteran 
access to care.
    Access Sub-Criteria:
    The recommendation:
    [cir] Aligns VA points of care and services with projected Veteran 
need across demographics and geography;
    [cir] Retains or improves Veterans' ability to access VA care;
    [cir] Ensures Veterans are provided a range of health care options 
and the opportunity to choose care they trust, based on their 
preferences, throughout their lifetime;
    [cir] Enables VA to serve as the coordinator of each Veteran's 
health care whether provided within or beyond VA;
    [cir] Considers health equity (i.e., demographics);
    [cir] Reflects consideration of factors underpinning observed 
access patterns (e.g., rurality and other social determinants of 
health); and
    [cir] Incorporates trends in the evolution of U.S. health care.
    When applying the `access' criterion, VA will consider how a 
recommendation will impact the convenience of care provided to Veterans 
in the future. Key components of access include the time it takes to 
receive care and the barriers and accelerators to receiving care, such 
as distance or availability of technology.

Impact on Mission

    Commitment Statement: VA is committed to delivering best-in-class 
care throughout Veterans' lifetimes. This means positioning the VA 
health care system at the leading edge of the health care industry in 
education, research and national emergency preparedness.
    Impact on Mission Criterion: The recommendation provides for VA's 
second, third and fourth statutory missions of education, research and 
emergency preparedness.
    Impact on Mission Sub-Criteria:
    The recommendation:
    [cir] Aligns resources to VA's education, research and emergency 
preparedness missions across demographics and geography;
    [cir] Education: Maintains or augments VA's ability to execute its 
education mission;
    [cir] Research: Maintains or augments VA's ability to execute its 
research mission;
    [cir] Emergency Preparedness: Maintains or augments VA's ability to 
execute its emergency preparedness mission;
    [cir] Considers health equity (i.e., demographics);
    [cir] Reflects consideration of factors underpinning observed 
mission impacts of education, research and emergency preparedness 
efforts (e.g., rurality and other social determinants of health; and
    [cir] Incorporates trends in the evolution of U.S. health care.
    The `impact on mission' criterion allows VA to consider how a 
recommendation will impact our ability to execute our statutory 
missions of education, research and emergency preparedness in support 
of Veterans and the nation.

[[Page 7923]]

Providing the Highest Quality Whole Health Care (Quality)

    Commitment Statement: VA is committed to providing Veterans with a 
high-quality, whole health care system that delivers an excellent 
experience of care and optimal health outcomes. VA will deliver the 
same high quality, evidence-based standards of care regardless of 
where, or by which modality, their care is received.
    Quality Criterion: The recommendation considers the quality and 
delivery of health care services available to Veterans, including the 
experience, safety and appropriateness of care.
    Quality Sub-Criteria:
    The recommendation:
    [cir] Ensures the highest possible quality of care across 
demographics and geography;
    [cir] Promotes recruitment of top clinical and non-clinical talent;
    [cir] Maintains or enhances Veteran experience;
    [cir] Considers health equity (i.e., demographics);
    [cir] Reflects consideration of factors underpinning observed 
quality patterns (e.g., rurality and other social determinants of 
health); and
    [cir] Incorporates trends in the evolution of U.S. health care.
    When applying the `quality' criterion, VA will consider how a 
recommendation will impact the quality of care for Veterans. Quality in 
health care is measured through metrics and ratings assessed by federal 
and commercial health care entities. VA will consider the care needs 
and preferences of Veterans in order to provide optimal experience, 
safety, and outcomes.

Effective Use of Resources for Veteran Care (Cost Effectiveness)

    Commitment Statement: VA is committed to optimizing our health care 
system through the effective use and sharing of resources, including 
staffing, space, infrastructure and funding, with the goal of providing 
Veterans with the best health care and outcomes. We will actively and 
mindfully manage our resources, allowing us to provide services and 
support that effectively match Veterans' needs and preferences while 
putting their health and empowerment at the center of system design.
    Cost Effectiveness Criterion: The recommendation provides a cost-
effective means by which to provide Veterans with modern health care.
    Cost Effectiveness Sub-Criteria:
    The recommendation:
    [cir] Reflects stewardship of taxpayer dollars by optimizing 
investments and resources for Veterans;
    [cir] Recognizes potential savings or efficiencies that may free 
resources for more impactful investment for Veterans;
    [cir] Considers the value of Veteran and employee experience, 
innovation, and other intangible elements of value;
    [cir] Considers health equity (i.e., demographics);
    [cir] Reflects consideration of factors underpinning observed cost 
patterns (e.g., rurality and other social determinants of health); and
    [cir] Incorporates trends in the evolution of U.S. health care.
    When applying the `cost effectiveness' criterion, VA will consider 
whether a recommendation optimizes funding for Veteran care.

Ensuring a Safe Environment of Care (Sustainability)

    Commitment Statement: VA is committed to providing Veterans a safe 
and welcoming environment of care. Our goal is for Veterans to feel 
safe physically, mentally, socially and emotionally when in our care. 
We commit to providing standard and complementary types of care for our 
unique Veteran population in an equitable and inclusive environment. We 
will do this by ensuring points of care are modern and inviting, with 
an expert workforce and care options designed to meet them where they 
are in their health journey.
    Sustainability Criterion: The recommendation creates a sustainable 
health care delivery system for Veterans.
    Sustainability Sub-Criteria:
    The recommendation:
    [cir] Aligns investment in care and services with Veteran need 
across demographics and geography;
    [cir] Reflects stewardship of taxpayer dollars by creating a 
sustainable infrastructure system for Veterans;
    [cir] Enables recruitment and retention of top clinical and non-
clinical talent;
    [cir] Considers health equity (i.e., demographics);
    [cir] Reflects consideration of factors underpinning observed 
access patterns (e.g., rurality and other social determinants of 
health); and
    [cir] Incorporates trends in the evolution of U.S. health care.
    When applying the `sustainability' criterion, VA will consider how 
a recommendation impacts our ability to offer Veterans a welcoming and 
safe care environment that meets modern health care standards and 
ensures sustainability for future generations of Veterans.
Signing Authority
    Dat P. Tran, Acting Secretary of Veterans Affairs, approved this 
document on January 26, 2021, 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.

Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of 
the Secretary, Department of Veterans Affairs.
[FR Doc. 2021-02138 Filed 2-1-21; 8:45 am]
BILLING CODE 8320-01-P