[Federal Register Volume 86, Number 211 (Thursday, November 4, 2021)]
[Notices]
[Pages 60970-60971]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-24041]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information Regarding Health Care Access 
Standards

AGENCY: Department of Veterans Affairs.

ACTION: Request for information.

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SUMMARY: The Department of Veterans Affairs (VA) is requesting 
information from the public to inform VA's review of access standards 
for furnishing hospital care, medical services and extended care 
services to covered veterans, for purposes of the Veterans Community 
Care Program (VCCP). Specifically, VA requests information regarding 
access standards, including but not limited to, information regarding 
health plans on the use of access standards for the design of health 
plan provider networks; referrals from network providers to out-of-
network providers; the appeals process for exemptions from benefit 
limits to out-of-network providers; and the measurement of performance 
against Federal or State regulatory standards. Further, VA is 
requesting input on Veterans' experience with the access standards 
established in 2019.

DATES: Comments must be received on or before December 6, 2021.

ADDRESSES: Comments may be submitted through www.regulations.gov. 
Comments should indicate that they are submitted in response to 
``Notice of Request for Information Regarding Health Care Access 
Standards.''

FOR FURTHER INFORMATION CONTACT: Natalie Frey, Management Analyst, 
Office of the Assistant Under Secretary for Health, Office of Community 
Care, Veterans Health Administration, Department of Veterans Affairs, 
810 Vermont Avenue NW, Washington, DC 20420; 720-429-9171. This is not 
a toll-free number.

SUPPLEMENTARY INFORMATION: The John S. McCain III, Daniel K. Akaka, and 
Samuel R. Johnson VA Maintaining Internal Systems and Strengthening 
Integrated Outside Networks Act of 2018, Public Law 115-182, (VA 
MISSION Act of 2018) added section 1703B to title 38, United States 
Code, which required VA to establish access standards for furnishing 
hospital care, medical services or extended care services to covered 
Veterans under VCCP. VA established these access standards through 
rulemaking on June 6, 2019, at 38 CFR 17.4040. Section 1703B(c) 
specifically requires VA to consult with all pertinent Federal 
entities, entities in the private sector

[[Page 60971]]

and other non-governmental entities in establishing access standards. 
Section 1703B(e) requires VA, not later than 3 years after the date on 
which VA establishes access standards, and not less frequently than 
once every 3 years thereafter, to conduct a review of the established 
access standards and submit to the appropriate committees of Congress a 
report on the findings and any modification to the access standards. In 
reviewing these access standards, VA is choosing to consult with 
pertinent Federal, private sector and non-governmental entities. VA 
will use the comments received to help review the access standards 
established in June 2019. VA will then submit a report (in June 2022), 
as required by section 1703B(e)(2). Responses to this notice will 
support industry research and VA's evaluation of access standards.
    This notice is a request for information only. Commenters are 
encouraged to provide complete, but concise responses to the questions 
outlined below. VA may choose to contact individual commenters, and 
such communications would serve to further clarify their written 
comments.
    Request for Information: VA requests information that will assist 
in reviewing the access standards, as required by section 1703B. This 
includes information regarding access standards, including but not 
limited to, information with regard to health plans on the use of 
access standards for the design of health plan provider networks; 
referrals from network providers to out-of-network providers; the 
appeals process for exemptions from benefit limits to out-of-network 
providers; and the measurement of performance against Federal or State 
regulatory standards. Regarding health systems, VA requests information 
from the public including, but not limited to, the existence of 
standards for appointment wait times; the use of travel distance for 
establishing service areas; the development or use of guidelines to 
refer patients to out-of-system providers; the utilization of virtual 
health services; and the measurement of performance against Federal or 
State regulatory standards. VA's specific requests for information are 
as follows:
    1. Do health plans use internal access standards for the design of 
provider networks and the application of in-network/out-of-network 
benefits that are more stringent than regulatory standards (time or 
distance of travel, appointment wait times, provider/member ratios)? If 
so, what are these internal standards? Has the COVID-19 pandemic 
affected established access standards? How does the health plan measure 
performance against regulatory and internal access standards? How does 
the health plan respond to findings when access standards are not being 
met? Are current regulatory access standards cost-effective while 
maintaining quality standards? Do health plans have a process to handle 
routine requests from members or to refer providers for exemptions to 
benefit limits when members seek out-of-network care or a lower tier 
provider?
    2. Do health plans allow for appeals, by providers or members, to 
request exemptions from benefit limits related to out-of-network care 
or care by a lower tier provider? Is external review allowed for such 
appeals?
    3. What are health plan practices regarding internal, regulatory 
and/or accreditation standards for appointment wait times, including 
variance by specialty or type of service? How does the health plan use 
travel distance or time, and/or provider-to-population ratios, in 
deciding which geographic areas to consider as primary or secondary 
service areas? How do health plans use financial modeling/impact to 
inform established access standards?
    4. What virtual health services (e.g., telehealth and telephonic) 
do health systems provide? Are virtual health services used to ensure 
compliance with established access standards?
    5. Are clinicians within the health system given guidelines or 
rules on when to refer patients to out-of-system providers? For 
example, are clinicians encouraged to refer out-of-system if in-system 
wait times are longer than standard; travel time or distance to an in-
system provider is too long; the patient's ability to travel is 
compromised; or the frequency of treatment makes travel to an in-
network provider difficult?
    6. What are Veterans' experiences with, and feedback on, the VA 
access standards established in 2019?

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved this 
document on October 6, 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.

Michael P. Shores,
Director, Office of Regulation Policy & Management, Office of General 
Counsel, Department of Veterans Affairs.
[FR Doc. 2021-24041 Filed 11-3-21; 8:45 am]
BILLING CODE 8320-01-P