[Federal Register Volume 86, Number 194 (Tuesday, October 12, 2021)]
[Rules and Regulations]
[Pages 56646-56652]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-22131]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AQ74


Educational Assistance for Certain Former Members of the Armed 
Forces

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) is amending its 
regulations that govern scholarships to certain health care 
professionals. This rulemaking implements the mandates of the 
Consolidated Appropriations Act 2018 by establishing a pilot program to 
provide educational assistance to certain former members of the Armed 
Forces for education and training leading to a degree as a physician 
assistant.

DATES: This rule is effective November 12, 2021.

FOR FURTHER INFORMATION CONTACT: Scot Burroughs, Executive Director 
Physician Assistant Services, 810 Vermont Avenue NW, Washington DC 
20420, (319) 333-2845. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: On July 27, 2020, VA published a proposed 
rule in the Federal Register (85 FR 45135) that would establish a pilot 
program to provide educational assistance to certain former members of 
the Armed Forces for education and training leading to a degree as a 
physician assistant, the Educational Assistance for Certain Former 
Members of the Armed Forces (EACFMAF) program. VA provided a 60-day 
comment period, which ended on September 25, 2020. VA received 21 
comments on the proposed rule.
    Section 246 of Public Law 115-141, the Consolidated Appropriations 
Act, 2018 (March 23, 2018), established the authority for the EACFMAF. 
See also 38 United States Code (U.S.C.) 7601 Note (2018) Physician 
Assistant Education and Training Pilot Program for Former Members of 
the Armed Forces. This pilot program provides an opportunity for 
veterans who possess medical experience gained while in the military;

[[Page 56647]]

a certificate, undergraduate degree, or post baccalaureate training in 
a science relating to health care; or participated in the delivery of 
health care services or related medical services, to further their 
medical education and become a physician assistant (PA) providing 
medical care to fellow veterans. The EACFMAF would increase access to 
VA health care by utilizing a veteran workforce that has received 
training as a PA in the Armed Forces. Section 246 of Public Law 115-141 
sets forth the eligibility criteria, the types of available funding, 
established an agreement to be met by the participants, as well as the 
consequences for a breach in such agreement. This final rule 
establishes the regulations needed to carry out the EACFMAF. 
Immediately following title 38 of the Code of Federal Regulations (CFR) 
17.531, we are adding a new undesignated center heading titled 
Educational Assistance for Certain Former Members of the Armed Forces 
and new Sec. Sec.  17.535 through 17.539.

General Comments in Support of the Proposed Rule

    Several commenters who were in favor of the rule stated that the 
EACFMAF is an excellent way to support our veterans and it would 
provide jobs for veterans with medical or military health experience 
and would also become vested stakeholders as contributing employees. 
Several commenters similarly stated that they strongly supported the 
promoting of opportunities for veterans to transition into the PA 
profession by providing educational assistance. A commenter also added 
that the program is critical in maintaining a strong health care 
workforce for the VA, staffed with people that are not only highly 
trained, but that have had the experience of serving in the military. 
Several commenters stated that having veteran PAs would increase 
patient satisfaction as well as patient health care and will benefit VA 
as the participants would have intimate knowledge of veteran issues and 
understand better what the veteran patient is going through. A 
commenter similarly stated that PAs with former military service gave 
the best quality of care, explained the care the veteran would receive 
in terms the veterans could readily understand, and had the needed 
insight of what the veteran was going through to help such veterans 
make an informed decision about their medical care. Another commenter 
stated that this program is a great way to provide additional training 
to already highly qualified individuals which will lead to a degree and 
a VA career as a physician assistant.
    Another commenter was in favor of the rule and stated that the 
EACFMAF will offer participants peace of mind in not having to worry 
about tuition, books, and other expenses while in school and allow the 
participants to concentrate their efforts in finishing their studies. A 
commenter similarly stated that the EACFMAF will help reduce the number 
of homeless veterans by ensuring that they maintain a steady cash flow 
for their necessities. The commenter added that the concept of paying 
back all the money that participants receive in the EACFMAF in case 
they fail the classes sounds fair and will make the participants more 
responsible in completing their studies. Another commenter agrees in 
that the proposed rule specified up front the repayment requirements.
    One commenter stated that the EACFMAF would be a perfect fit for a 
veteran who served as a medic in a war zone. The commenter added that 
they would love to be part of the program. Another commenter added that 
this is a much-needed scholarship program and that it would improve 
access to care for veterans. Lastly, the commenter stated that if the 
EACFMAF should become permanent it would be a direct line of PAs to 
seek employment in VA.
    A commenter stated that other Federal agencies have recently waived 
requirements for doctors to perform certain intake, vaccination, or 
other medical procedures under the COVID-19 pandemic and having 
increased numbers of PAs would save doctors' time as well as increase 
the availability of health care services, which include examinations, 
interviewing, and telemedicine procedures. The commenter added that 
they are aware that veterans often have to travel long distances 
because of the lack of available physicians in the VA medical facility 
nearest them, and having PA's available could provide a benefit to 
these veterans seeking medical care from VA, including through 
telemedicine. We are not making any changes based on these comments.

Sec.  17.536 Eligibility

    Military and training requirements. Several commenters suggested 
that VA not limit the eligibility for the EACFMAF to individuals who 
have medical or military health experience gained while serving in the 
military. The commenters stated that there are many servicemembers who 
decide to pursue a PA degree after leaving the military and should not 
be limited to what their jobs were in the service. The commenter 
suggested that the eligibility criteria for the EACFMAF be that the 
servicemember gets accepted into PA school and not be limited to what 
their previous job was in the service. Another commenter stated that 
medical experience as a corpsman or medic may provide priority, but not 
exclusivity for application to the EACFMAF.
    We note that the eligibility criteria for the EACFMAF is set forth 
in section 246(b) of the Consolidated Appropriations Act, 2018. The 
applicant has to meet one of these criteria by law in order to qualify 
for the EACFMAF; VA does not have any flexibility on amending the 
criteria in the regulation. The second criteria in proposed Sec.  
17.536(a) is that the individual has received a certificate, associate 
degree, baccalaureate degree, master's degree, or post baccalaureate 
training in a science relating to health care. The veteran does not 
have to meet this criteria while in military service. This criteria can 
be met once the veteran is discharged from service. As we have stated 
in this rulemaking, the purpose EACFMAF is to provide an opportunity to 
veterans to further their medical education and become a PA providing 
medical care to fellow veterans. Based on the comments in the previous 
paragraph, we are clarifying the regulation text to state that in order 
to qualify for the EACFMAF, a claimant must meet one of the eligibility 
criteria.
    Several commenters were in favor of the rule, but suggested that VA 
remove the stipulation that the applicants must have a science related 
degree. A commenter added that PA schools require prerequisite science 
and math courses to be completed prior to the application process and 
this requirement is not needed in this proposal, and that the 
applicants do not need a science degree to enter PA school, but are 
required to demonstrate the ability to handle science related courses. 
The commenter indicated that the proposed rule has the potential of 
removing worthy veteran applicants from consideration because they do 
not have a science related degree. The commenter also stated that 
science majors are not the only individuals who make excellent clinical 
providers. Another commenter similarly stated that the requirement for 
a degree in health care, biology, physiology, etc. is also not required 
if the individual has been accepted into a PA education program, and 
that this requirement should merely give priority to individuals with a 
health care related degree and not exclude other individuals with other 
types of degrees.
    VA notes that the second eligibility requirement in section 246 of 
the Consolidated Appropriations Act, 2018

[[Page 56648]]

states that one of the eligibility requirements is that the individual 
has received a certificate, associate degree, baccalaureate degree, 
master's degree, or postbaccalaureate training in a science relating to 
health care. We agree with the commenter in that the statutory 
requirement in section 246 would prevent PAs that graduate from an ARC-
PA program and pass the National Commission on Certification of 
Physician Assistants (NCCPA), from participating in the EACFMAF because 
the PA does not have health science undergraduate degree. The 
legislative history of the EACFMAF shows that this program, including 
its eligibility requirements, is based on an earlier house bill H.R. 
3794, 114th Congress, ``Grow Our Own Directive: Physician Assistant 
Employment and Education Act of 2016''. The House Subcommittee on 
Health held a hearing on several bills, including H.R. 3794 on April 
20, 2016, and the bill was referred to the full House after markup. 
House Report 114-710 (September 6, 2016). While there are minor 
differences between H.R. 3794 and enacted section 246 of the 
Consolidated Appropriations Act, 2018, the eligibility requirements 
remained unchanged. VA does not have the authority to change 
eligibility requirements for this pilot program absent a change in the 
law.
    However, VA notes that if the veteran otherwise meets one of the 
other two eligibility criteria, such veteran may be eligible to 
participate in the EACFMAF: That the veteran has medical or military 
health experience gained while serving as a member of the Armed Forces, 
or has participated in the delivery of health care services or related 
medical services, including participation in military training relating 
to the identification, evaluation, treatment, and prevention of disease 
and disorders. VA has other scholarship programs for participants to 
receive financial assistance for their health care education, including 
as a PA, such as the Health Professional Scholarship Program, found at 
38 CFR 17.600-17.612. Individuals who do not meet the eligibility 
criteria for the EACFMAF, may apply for these other scholarship 
programs if they otherwise meet the eligibility criteria for such 
scholarship programs. However, these other programs and their 
eligibility criteria are beyond the scope of the proposed rule. We are 
not making any changes based on these comments.
    School and Individual requirements. Another commenter was in favor 
of the rule, but requested that the requirement in proposed Sec.  
17.536(b)(1) be amended to include students who are enrolled or 
accepted for enrollment in an accredited school located in a State as 
part-time students. The commenter indicated that veterans could have 
families and other job requirements that would limit their ability to 
attend school as a full-time student. The commenter added that if VA 
allowed participants of the EACFMAF to be enrolled part-time and 
provide a longer time frame to complete their degree, more veterans 
would have the opportunity to apply for the scholarship and complete 
their degree.
    VA understands that some students may not be able to attend school 
on a full-time basis. Proposed Sec.  17.536(b)(1) states that to be 
eligible for the EACFMAF, an applicant must be unconditionally accepted 
for enrollment or be enrolled as a full-time student in an accredited 
school located in a State. These school requirements are in alignment 
with similar VA scholarship programs. See 38 CFR 17.602. Allowing 
enrollment on a less than full-time basis will not meet the needs of 
the EACFMAF, which is a pilot program that will expire unless renewed 
in five years. As such, we proposed only to provide financial 
assistance for one to three years under proposed Sec.  17.536(b) and we 
do not believe that education to become a PA or related professional 
can be completed on a less than full-time basis prior to the pilot 
expiring. We are not making any changes based on this comment.

Sec.  17.537 Award Procedures

    Priority. A commenter was in favor of the proposed rule, but 
requested that proposed Sec.  17.537(a)(3) be removed because it 
unfairly favors States that already have adequate PA populations in 
urban areas and consequently draws viable candidates away from rural 
locations where their services and expertise are more acutely needed. 
The commenter also stated that Sec.  17.537(a)(3) goes against the 
agency's core values of commitment and advocacy by giving priority to 
eligible individuals who agree to be employed as physician assistants 
in a VA medical facility that is in a State with a per capita 
population of veterans of more than five percent. The commenter stated 
that while VA has the best intentions, the proposed section fails to 
consider that PA shortages prevalently continue predominantly along an 
urban-rural dichotomy, and that over 84 percent of PAs already provide 
services in an urban market. The commenter indicated that dedicating 
future PAs to the States with the largest per capita of veterans in the 
U.S., such as California, Texas, and Florida, all of which boast large 
urban populations, therefore ignores the larger problem that veterans 
in rural areas are in need of more support. The commenter recommends 
that VA remove Sec.  17.537(a)(3) because the previous subsection 
already achieves VA's goal of providing more support to medically 
underserved facilities without providing an unnecessary limitation.
    VA agrees that PAs are needed to serve in medically underserved 
populations. However, we do not agree that Sec.  17.537(a)(3) provides 
an unnecessary limitation or that it unfairly favors States that 
already have adequate PA populations in urban areas. Read in its 
entirety, proposed Sec.  17.537(a)(3) priority is not limited to the 
sole factor of veteran population. Rather, it states that VA will give 
priority to eligible individuals who agree to be employed as physician 
assistants in a VA medical facility that: (1) Is located in a community 
that is designated as a medically underserved population as defined by 
42 U.S.C. 254b(b)(3)(A); (2) Is designated by VA as a medically 
underserved facility; and (3) Is in a State with a per capita 
population of veterans of more than five percent, according to the 
National Center for Veterans Analysis and Statistics and the United 
States Census Bureau. Proposed Sec.  17.537(a)(3) is also a requirement 
established under section 246(d)(2) of the Consolidated Appropriations 
Act, 2018, which is meant to allow VA to provide health care to a State 
with a per capita population of veterans of more than five percent, but 
is not meant to be exclusive of an urban population. All other 
conditions in Sec.  17.537(a) must also be met, which includes 
medically underserved communities and VA medical facilities. VA intends 
to utilize the EACFMAF to expand health care services in VA medical 
facilities where recruitment and retention of PAs is difficult due to 
the location of the VA medical facility. In addition, establishing the 
five percent requirement allows VA to serve a larger number of veterans 
in communities that would otherwise benefit from increased health care 
professionals. We are not making any changes based on this comment.

Sec.  17.538 Agreement and Obligated Service

    Obligated service--General. A commenter stated that if there was 
not an employment vacancy for a PA at a VA medical facility that is 
located in the vicinity of the participant's residence within 90 days 
after the date that the participant completes their education, then the 
90 day requirement should be extended to 180 days for such individual.

[[Page 56649]]

    We stated in proposed Sec.  17.538(b)(1) that the obligated service 
would begin on the date on which the eligible individual begins full-
time permanent employment with VA as a clinical practice employee as a 
physician assistant, but no later than 90 days after the date that the 
eligible individual completes a master's degree in physician assistant 
studies or similar master's degree or the date the eligible individual 
becomes licensed in a State and certified as required by the Secretary, 
whichever is later. VA has been successful in placing participants of 
similar scholarship programs into full-time VA employment within an 
even shorter 60-day time frame. See 38 CFR 17.607(b). In addition, the 
participant must be willing to relocate to another geographic location 
to carry out their service obligation. We are not making any changes 
based on this comment.
    A commenter stated that the fulltime service requirement to begin 
within 90 days after completion of the PA degree assumes that VA will 
have full time permanent positions available. The commenter suggested 
that the requirement should be that an individual will undertake at 
least 50 percent time employment on a fulltime or temporary basis, in 
order to give the maximum flexibility to both the individual and the 
VA. The commenter added that VA hospitals may have limited hiring 
ability and may not wish to hire full time permanent employees, but 
could still benefit from having more physician assistants.
    VA currently has PA vacancies nationwide, especially in VA medical 
facility located in communities that are designated as medically 
underserved under 42 U.S.C. 245b(b)(3)(A) and those VA medical 
facilities that VA has determined as medically underserved. In 
addition, VA anticipates the need for PA's will remain, particularly in 
the medically underserved areas. Under proposed Sec.  17.538(a)(3) a 
participant agrees to be employed as a full-time clinical practice 
employee in VA as a physician assistant for a period of obligated 
service for one calendar year for each school year or part thereof for 
which the EACFMAF was awarded, but for no less than three years. The 
full-time employment requirement is also similar to other VA 
scholarship programs. Reducing the service to anything other than full 
time would defeat the purpose of the EACFMAF. We are not making any 
changes based on this comment.
    One commenter stated that Sec.  17.538(b)(1) does not provide 
enough flexibility to account for unforeseeable delays in attaining 
certification as it does not account for possible extenuating 
circumstances outside of an individual's control. The commenter added 
that the COVID-19 pandemic has clearly demonstrated that unforeseen 
events can arise, which can delay intended plans indefinitely, and that 
there is arguably a lack of compassion in a provision that can cause an 
individual to be in breach of their contract when they are not at fault 
because of major outside influences. The commenter suggests that VA 
consider extending the length of time before an individual is in breach 
to one year and revise the consequence of failing to acquire licensure 
or certification due to unforeseen circumstances by placing the 
participant under review, subject to breach if the failure was due to 
the individual's actions.
    We stated in the proposed rule that section 246 of the Consolidated 
Appropriations Act, 2018 does not establish a time frame for when an 
eligible individual will repay the amount of damages when such eligible 
individual breaches their terms of agreement, and that proposed Sec.  
17.539(b) would mirror the repayment period language from similar 
scholarship programs. See 38 U.S.C. 7617(c)(2) and 38 CFR 17.610(c). We 
stated in part in proposed Sec.  17.538(b)(1) that VA will actively 
assist and monitor eligible individuals to ensure State licenses and 
certificates are obtained in a minimal amount of time following 
graduation. We also stated that if an eligible individual fails to 
obtain his or her degree, or fails to become licensed in a State or 
become certified no later than 180 days after receiving the degree, the 
eligible individual is considered to be in breach of the acceptance 
agreement. Participants of similar VA scholarship programs have been 
successfully able to obtain the required certification within the 180-
day time frame, and we believe that will be the case in EACFMAF as 
well. However, we are aware that there may be instances where the 
participant of the EACFMAF may not be able to obtain their 
certification due to unforeseen circumstances such as the COVID-19 
National Emergency. VA's engagement in assisting and monitoring the 
eligible individuals obtain their State license and certificates will 
alert VA of any potential unforeseen circumstance. VA will examine 
these unforeseen circumstances as they arise on a case by case basis 
and may provide general guidance to all participants if the unforeseen 
circumstance affects all participants. We are not making any changes 
based on this comment.
    Location and position of obligated service. One commenter was in 
favor of the rule, but stated that more clarity is needed regarding 
exactly which VA medical facilities are considered to be given 
preference under the criteria set forth in the rule. The commenter 
added that the proposed regulation text is vague and subject to changes 
based on classification of various sites, for which the criteria is 
unclear.
    We agree with the commenter in that the proposed rule did not 
specify how VA would alert potential participants of VA locations that 
have vacancies. We, therefore, revise Sec.  17.538(b)(2) as proposed to 
state that VA will publish a list of VA medical facilities where the 
participants may perform their period of obligated service in a notice 
in the Federal Register on a yearly basis. Participants of the EACFMAF 
may select their preference for service from this list to serve the 
period of obligated service, however, VA reserves the right to make the 
final decision on location. By providing this list of vacancies, 
prospective participants will know prior to applying for the program 
the VA medical facilities that will have vacancies in which the 
participants of the EACFMAF may perform their period of obligated 
service.
    Several commenters stated that students receiving EACFMAF should, 
at the very least, have relocation costs reimbursed if their assigned 
facility is outside the area of their current residence or have the 
participant agree before their service begins where their term is to be 
served, and commit via contract. These commenters asserted that these 
changes would reduce financial hardship for students with families with 
already limited resources and lessen the burden of a mandated move.
    We stated in the proposed rule that VA reserves the right to make 
final decisions on the location and position of the obligated service. 
We also stated that an eligible individual who receives an EACFMAF must 
be willing to relocate to another geographic location to carry out 
their service obligation. This language is consistent with similar 
scholarship programs. See 38 CFR 17.607(d). We appreciate that 
relocation expenses can be burdensome to some applicants. However, 
paying relocation expenses to a participant of the EACFMAF would reduce 
the amount of funds available for the program. In addition, Public Law 
115-141 section 246 does not give VA specific authority to pay 
relocation expenses. We are not

[[Page 56650]]

making any changes based on this comment.
    One commenter disagreed with the statement in the proposed rule's 
Supplementary Section where VA stated that several branches of the 
Armed Forces train individuals to perform the duties of a physician 
assistant without the required educational training. The commenter 
stated that corpsman and medics are very highly trained and provide 
exceptional medical care to their fellow servicemembers but they are 
not trained perform to the duties of a PA, and that the training is 
extensive but one cannot be called a PA without going through PA 
school.
    We agree with the commenter that being trained in potential PA 
duties does not equate with being a PA, and that is exactly the 
function of the EACFMAF, to allow an individual without formal PA 
training to receive such training. We stated in the proposed rule that 
the EACFMAF would allow such individuals the opportunity to complete 
their education and training in order to be employed by VA as a 
physician assistant. We are not making any changes based on this 
comment.

Technical Edit

    We are making one technical edit to Sec.  17.536(b)(4). Proposed 
Sec.  17.536(b)(4) stated that an applicant must submit an application 
to participate in the Scholarship Program together with a signed 
contract. We are amending the term ``contract'' to now state 
``agreement'' to be consistent in the use of the term as stated in 
Sec.  17.538. We are not making any changes to the meaning of Sec.  
17.536(b)(4).
    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 the changes described in this final rule.

Paperwork Reduction Act

    The Paperwork Reduction Act of 1995 (44 U.S.C. 3507(d)) requires 
that VA consider the impact of paperwork and other information 
collection burdens imposed on the public. According to the 1995 
amendments to the Paperwork Reduction Act (5 CFR 1320.8(b)(2)(vi)), an 
agency may not collect or sponsor the collection of information, nor 
may it impose an information collection requirement unless it displays 
a currently valid Office of Management and Budget (OMB) control number. 
This final rule includes provisions constituting an amendment of an 
existing collection of information under the Paperwork Reduction Act of 
1995 that require approval by the OMB. The existing OMB control number 
that will be amended by this action is 2900-0793. Accordingly, under 44 
U.S.C. 3507(d), VA has submitted a copy of this rulemaking action to 
OMB for review.
    OMB assigns control numbers to collections of information it 
approves. VA may not conduct or sponsor, and a person is not required 
to respond to, a collection of information unless it displays a 
currently valid OMB control number. Proposed 38 CFR 17.538 contains a 
collection of information under the Paperwork Reduction Act of 1995. If 
OMB does not approve the collection of information as requested, VA 
will immediately remove the provision containing a collection of 
information or take such other action as is directed by OMB.
    The amended proposed collection of information is comprised of an 
agreement between VA and the eligible individual who accepts funding 
for the Educational Assistance for Certain Former Members of the Armed 
Forces (EACFMAF).
    VA estimates there will be 100 veteran applicants per year, which 
will require them to complete an application package. This application 
package is comprised of the application itself, academic verification, 
evaluation & recommendation, and an addendum to the application. VA 
estimates it will take an applicant 3.7 hours to complete the 
application package, for a total PRA cost of $10,061.02 (100 applicants 
x 3.7 hrs. x $27.07 \1\).
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    \1\ For the proposed collection of information, VA used general 
wage data from the May 2020 Bureau of Labor Statistics (BLS) 
website, https://www.bls.gov/oes/current/oes_nat.htm, VA used the 
BLS wage code of ``00-0000 All Occupations, which has a mean hourly 
wage/salary workers of $27.07.
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    Additionally, there will be further collections for applicants 
selected for the program. VA intends to select 25 Veterans for the 
scholarship each year. Those selected to receive the scholarship will 
be required to fill out agreements for the scholarship, a mobility 
agreement, an offer response, notice of change/annual academic report, 
notice of approaching graduation, education program completion, request 
for deferment for advanced education, and an annual VA employment/
deferment verification. VA estimates it will take 1.75 hours to 
complete the acceptance package, for a total PRA cost of $ 1,184.31 (25 
applicants x 1.75 hrs. x $27.07 \2\). VA estimates the total annual 
burden cost to all respondents to be $11,245.33 ($10,061.02 for the 
application + $1,184.31 acceptance package).
---------------------------------------------------------------------------

    \2\ For the proposed collection of information, VA used general 
wage data from the May 2020 Bureau of Labor Statistics (BLS) 
website, https://www.bls.gov/oes/current/oes_nat.htm, VA used the 
BLS wage code of ``00-0000 All Occupations, which has a mean hourly 
wage/salary workers of $27.07.
---------------------------------------------------------------------------

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 rulemaking does not change VA's policy regarding small 
businesses, does not have an economic impact to individual businesses, 
and there are no increased or decreased costs to small business 
entities. On this basis, the final rule will not have an economic 
impact on a substantial number of small entities as they are defined in 
the Regulatory Flexibility Act, 5 U.S.C. 601-612. 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 and 13563

    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 not a significant regulatory action under Executive Order 
12866. The Regulatory Impact Analysis associated with this rulemaking 
can be found as a supporting document at www.regulations.gov.

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.

[[Page 56651]]

Congressional Review Act

    Pursuant to the Congressional Review Act (5 U.S.C. 801 et seq.), 
the Office of Information and Regulatory Affairs designated this rule 
as not a major rule, as defined by 5 U.S.C. 804(2).

Catalog of Federal Domestic Assistance

    There are no Catalog of Federal Domestic Assistance numbers and 
titles for this rule.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Health care, Health 
facilities, Health professions, Scholarships and fellowships.

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved this 
document on October 4, 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.

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

    For the reasons set forth in the preamble, we are amending 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.
* * * * *
    Sections 17.535 through 17.539 are also issued under Public Law 
115-141, sec. 246.
* * * * *

0
2. Add an undesignated center heading and Sec. Sec.  17.535 through 
17.539 immediately following Sec.  17.531 to read as follows.

Sec.
* * * * *

Educational Assistance for Certain Former Members of the Armed 
Forces

17.535 Purpose.
17.536 Eligibility.
17.537 Award procedures.
17.538 Agreement and obligated service.
17.539 Failure to comply with terms and conditions of agreement.
* * * * *


Sec.  17.535   Purpose.

    The purpose of Sec. Sec.  17.535 through 17.539 is to establish the 
Educational Assistance for Certain Former Members of the Armed Forces 
(EACFMAF). The EACFMAF will provide a scholarship to certain former 
members of the Armed Forces for the education and training leading to 
employment as a VA physician assistant.


Sec.  17.536   Eligibility.

    (a) Military and Training requirements. An individual is eligible 
to participate in the EACFMAF if such individual is a former member of 
the Armed Forces who was discharged or released therefrom under 
conditions other than dishonorable and meets one of the following 
criteria:
    (1) Has medical or military health experience gained while serving 
as a member of the Armed Forces;
    (2) Has received a certificate, associate degree, baccalaureate 
degree, master's degree, or post baccalaureate training in a science 
relating to health care; or
    (3) Has participated in the delivery of health care services or 
related medical services, including participation in military training 
relating to the identification, evaluation, treatment, and prevention 
of disease and disorders.
    (b) School and Individual requirements. To be eligible for the 
EACFMAF, an applicant must:
    (1) Be unconditionally accepted for enrollment or be enrolled as a 
full-time student in an accredited school located in a State;
    (2) Be pursuing a degree leading to employment as a physician 
assistant;
    (3) Be a citizen of the United States; and
    (4) Submit an application to participate in the Scholarship Program 
together with a signed agreement as specified in Sec.  17.538.


Sec.  17.537   Award procedures.

    (a) Priority. In awarding EACFMAF, VA will give priority to 
eligible individuals who agree to be employed as physician assistants 
in a VA medical facility that:
    (1) Is located in a community that is designated as a medically 
underserved population under 42 U.S.C. 254b(b)(3)(A);
    (2) Is designated by VA as a medically underserved facility; and
    (3) Is in a State with a per capita population of veterans of more 
than five percent, according to the National Center for Veterans 
Analysis and Statistics and the United States Census Bureau.
    (b) Amount of funds. VA will provide a scholarship to individuals 
who participate in the EACFMAF to cover the costs of such individuals 
obtaining a master's degree in physician assistant studies or similar 
master's degree for a period of one to three years. All such payments 
to scholarship participants are exempt from Federal taxation. The 
payments will consist of:
    (1) Tuition and required fees;
    (2) Other educational expenses, including books and laboratory 
equipment.


Sec.  17.538   Agreement and obligated service.

    (a) Agreement. Each eligible individual who accepts funds from the 
EACFMAF will enter into an agreement with VA where the eligible 
individual agrees to the following:
    (1) Maintain enrollment, attendance, and acceptable level of 
academic standing as defined by the school;
    (2) Complete a master's degree in physician assistant studies or 
similar master's degree; and
    (3) Be employed as a full-time clinical practice employee in VA as 
a physician assistant for a period of obligated service for one 
calendar year for each school year or part thereof for which the 
EACFMAF was awarded, but for no less than three years.
    (b) Obligated service--(1) General. An eligible individual's 
obligated service will begin on the date on which the eligible 
individual begins full-time permanent employment with VA as a clinical 
practice employee as a physician assistant, but no later than 90 days 
after the date that the eligible individual completes a master's degree 
in physician assistant studies or similar master's degree, or the date 
the eligible individual becomes licensed in a State and certified as 
required by the Secretary, whichever is later. VA will actively assist 
and monitor eligible individuals to ensure State licenses and 
certificates are obtained in a minimal amount of time following 
graduation. If an eligible individual fails to obtain his or her 
degree, or fails to become licensed in a State or become certified no 
later than 180 days after receiving the degree, the eligible individual 
is considered to be in breach of the acceptance agreement.
    (2) Location and position of obligated service. VA will publish a 
list of VA medical facilities where the participants may perform their 
period of obligated service in a notice in the Federal Register on a 
yearly basis. Participants of the EACFMAF may select their preference 
for service from this list to serve the period of obligated service. VA 
reserves the right to make final decisions on the location and position 
of the obligated service. An eligible individual who receives an 
EACFMAF must be willing to relocate to another geographic location to 
carry out their service obligation.


(The Office of Management and Budget has approved the information 
collection

[[Page 56652]]

requirements in this section under control number 2900-0793.)


Sec.  17.539   Failure to comply with terms and conditions of 
agreement.

    (a) Participant fails to satisfy terms of agreement. If an eligible 
individual who accepts funding for the EACFMAF fails to satisfy the 
terms of agreement, the United States is entitled to recover damages in 
an amount equal to the total amount of EACFMAF funding paid or is 
payable to or on behalf of the individual, reduced by the total number 
of obligated service days the individual has already served minus the 
total number of days in the individual's period of obligated service.
    (b) Repayment period. The eligible individual will pay the amount 
of damages that the United States is entitled to recover under this 
section in full to the United States no later than one year after the 
date of the breach of the agreement.

[FR Doc. 2021-22131 Filed 10-8-21; 8:45 am]
BILLING CODE 8320-01-P