[Federal Register Volume 86, Number 217 (Monday, November 15, 2021)]
[Notices]
[Pages 63105-63107]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-24571]


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DEPARTMENT OF VETERANS AFFAIRS


Announcement for Public Meeting Regarding Health Care Access 
Standards for Veteran Community Care Program

AGENCY: Department of Veterans Affairs.

ACTION: Announcement of public meeting.

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SUMMARY: The Department of Veterans Affairs (VA) is holding a public 
meeting to seek information from pertinent entities 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. Specifically, VA requests 
information, including but not limited to the following: 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: VA will hold the public meeting virtually on December 1, 2021. 
The meeting will start at 8:30 a.m. Eastern Time (ET) and conclude at 
or before 4:30 p.m. ET.

ADDRESSES: The meeting will be held virtually and recorded on the Adobe 
Connect platform. Attendance will be limited to 750 individuals. 
Advanced registration for a maximum capacity of 30 individuals and 
groups who wish to offer oral comments, testimonies, and/or technical 
remarks is required (see registration instructions below). For 
listening purposes only (lines will be muted), the meeting will be 
available and can be accessed at the following web link: https://vacctraining.adobeconnect.com/public-meeting-for-va-health-care-access-standards/.
    VA also published a request for information (RFI) regarding health 
care access standards on November 4, 2021. Per the RFI, please submit 
all written comments no later than December 6, 2021. Written comments 
may be submitted through http://www.regulations.gov. Comments should

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indicate that they are submitted in response to ``Notice of Request for 
Information Regarding Health Care Access Standards.'' During the 
comment period, comments may be viewed online through the Federal 
Docket Management System at www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Natalie Frey, Management Analyst, 
Office of the Assistant Under Secretary for Health for Community Care, 
Veterans Health Administration, Department of Veterans Affairs, 810 
Vermont Avenue NW, Washington, DC 20420; telephone: 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 (MISSION Act), Public Law 115-
182, (the VA MISSION Act) added section 1703B to title 38, United 
States Code (U.S.C.), which required VA to establish access standards 
for furnishing hospital care, medical services, or extended care 
services to covered veterans under the Veterans Community Care Program. 
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, private sector, and other 
nongovernmental 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. This 
public meeting serves as one of the means for VA to consult with these 
entities. As noted above, VA has published an RFI in the Federal 
Register to provide these entities another opportunity to provide 
additional information. This RFI can be found at www.regulations.gov 
under the title ``Notice of Request for Information Regarding Health 
Care Access Standards.'' VA will use the statements and testimonials 
presented at the public meeting 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).
    Registration: Overall attendance in this meeting is limited to 750 
individuals and overall capacity for those providing oral comments, 
testimonies, and/or technical remarks will be limited to 30 
individuals. Individuals wanting to offer oral comments, testimonies, 
and/or technical remarks must request registration by emailing Natalie 
Frey at [email protected] by November 22, 2021. A message confirming 
that the request has been received will be sent within 2 business days, 
and individuals will be notified via email by November 26, 2021, 
confirming their registration and attendance. VA has the right to 
refuse registration for providing oral comments, testimonies, and/or 
technical remarks once the maximum capacity of 30 individuals has been 
reached.
    Individual Registration: VA encourages individual registrations for 
those not affiliated with or representing a group, association, or 
organization.
    Group Registration: Identification of the name of the group, 
association, or organization should be indicated in your registration 
request. Due to the meeting's maximum capacity for those providing oral 
comments, testimonies, and/or technical remarks at 30 individuals, VA 
may limit the number of registrants from a single group to two 
individuals representing the same group to allow receipt of comments, 
testimonies, and/or technical remarks from a broader, more diverse 
group of stakeholders. Efforts will be made to accommodate all 
registrants who wish to attend. However, VA will give priority to 
pertinent Federal, private sector, and non-governmental entities who 
request registration before November 22, 2021, 4:00 p.m. ET. Please 
provide the names of people your organization would like to attend, and 
VA will accommodate as capacity allows; organizations should list names 
in the order of importance of their attendance to ensure that VA allows 
admission for the preferred representatives. The length of time 
allotted for attendees to provide oral comments, testimonies, and/or 
technical remarks during the meeting may be subject to the number of 
attendees and to ensure ample time is allotted to those registered 
attendees. There will be no opportunity for audio-visual presentations 
during the meeting. Written comments will be accepted by those 
registered (see above instructions for submitting written comments).
    Audio (for listening purposes only): Attending the live audio of 
the meeting is limited to the first 750 participants on a first-come, 
first-served basis. Advance registration is not required. Audio 
attendees will not be allowed to offer oral comments, testimonies, and/
or technical remarks, as the audio line will be muted. Written comments 
will be accepted from those participating via audio (see above 
instructions for submitting written comments). Please note this meeting 
will be recorded.

    Note: VA will conduct the public meeting informally, and 
technical rules of evidence will not apply. VA will arrange for 
written minutes of the meeting to be posted in the docket of the 
RFI. Should it be necessary to cancel the meeting due to an 
emergency, VA will take available measures to notify registered 
participants.

Agenda

08:30-12:00 Morning Public Meeting Session
12:00-13:00 Lunch Break
13:00-16:30 Afternoon Public Meeting Session
16:30 Adjourn

Public Meeting Topics

    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 the following: 
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 following: 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 (e.g., time 
or distance of travel, appointment wait times, provider/member ratios)? 
If so, what are these internal standards? Has the Coronavirus Disease 
2019 (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

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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 29, 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.
[FR Doc. 2021-24571 Filed 11-12-21; 8:45 am]
BILLING CODE 8320-01-P