[Federal Register Volume 89, Number 118 (Tuesday, June 18, 2024)]
[Rules and Regulations]
[Pages 51444-51446]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-13367]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AR98


VA Health Professional Scholarship Program

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) adopts as final, 
without changes, a proposed rule to amend its regulations that govern 
the VA Health Professional Scholarship Program (HPSP) by implementing 
the mandates of the Consolidated Appropriations Act, which would expand 
the number of scholarships available to those who are pursuing degrees 
or training in occupations providing care within mental health 
programs. This rule also adopts as final technical corrections under 
the Paperwork Reduction Act section to correct an approved Office of 
Management and Budget (OMB) control number.

DATES: This rule is effective July 18, 2024.

FOR FURTHER INFORMATION CONTACT: Nicole Nedd, Director, Scholarships 
and Clinical Education, Workforce Management and Consulting Office, 810 
Vermont Ave. NW, Washington, DC 20420. ((504) 881-4036). (This is not a 
toll-free telephone number.)

SUPPLEMENTARY INFORMATION: In a document published in the Federal 
Register (FR) on August 14, 2023, VA proposed to revise its VA Health 
Professional Scholarship Program (HPSP) regulations. The purpose of the 
HPSP is to award scholarships to students pursuing a course of study 
leading to a degree in certain health care occupations, listed in 38 
U.S.C. 7401(1) and (3). See Sec.  17.600. The HPSP allows VA to provide 
scholarship awards to facilitate recruitment and retention of employees 
in several hard-to-fill health care occupations. Id. In the proposed 
rule we stated that we would amend the HPSP to reflect statutory 
changes made by section 104(a) of Division V of the Consolidated 
Appropriations Act (the Act), Public Law 117-328, which expanded HPSP 
by requiring VA to specifically award scholarships to applicants 
pursuing degrees or training in mental health disciplines, including 
advanced practice nursing (with a focus on mental health or substance 
use disorder), psychology, and social work. Section 104(a) of the Act 
also required that VA provide no fewer than an additional 50 awards (as 
compared to academic year 2021, which provided 33 awards) to such 
applicants per academic year starting in academic year 2022. 88 FR 
54972. The rule also proposed to make a technical edit to the HPSP 
regulations to correct an approved Office of Management and Budget 
(OMB) control number. Id.
    VA provided a 60-day comment period, which ended on October 13, 
2023. VA received 13 comments on the proposed rule. One comment 
supported the proposed rule and will not be further addressed in this 
final rule. The remaining comments are summarized and addressed in the 
discussion below.

Public Comments

Physician Assistants

    VA received 11 comments regarding physician assistants (PAs). The 
comments suggested or supported the inclusion of PAs as mental health 
care professionals eligible to receive scholarships under proposed 
Sec.  17.603(b)(2). For instance, a commenter suggested that generally 
PAs should receive scholarships under proposed Sec.  17.603(b)(2) and 
another stated that PAs are a core mental health profession. VA does 
not make any changes based on these comments.
    PAs are eligible to apply for and receive HPSP scholarships for 
mental health disciplines under proposed Sec.  17.603(b)(2). Consistent 
with section 104(a) of Division V of the Act, VA proposed to revise 
Sec.  17.603(b)(2) to expand HPSP to applicants who are pursuing 
degrees or training in mental health disciplines, including advanced 
practice nursing (with a focus on mental health or substance use 
disorder), psychology, and social work. As noted in the proposed rule, 
this is not an exhaustive list and merely mirrors section 104(a) of 
Division V of the Act. 88 FR 54974. VA acknowledges that PAs' training 
includes core mental health training and mandatory psychiatry clinical 
rotations, and they may provide mental health care. Thus, PAs are 
eligible to apply for and may receive HPSP scholarships for mental 
health disciplines under proposed Sec.  17.603(b)(2) once this rule is 
final and effective.
    Other commenters suggested that PAs be listed in proposed Sec.  
17.603(b)(2) as a mental health profession eligible for a HPSP 
scholarship pursuant to the Act. Relatedly, one commenter stated that 
VA should provide an exhaustive list of health care professions that 
may be awarded the HPSP scholarship under proposed Sec.  17.603(b)(2). 
We do not make changes to the rule based on these comments.
    As VA explained in the proposed rule, the list of mental health 
disciplines in proposed Sec.  17.603(b)(2) is not an exhaustive list, 
as there are other mental health disciplines not included in the Act. 
(See 88 FR 54974). Other mental health disciplines may include licensed 
professional mental health counselor, marriage and family therapist, 
and rehabilitation counseling. The list in proposed Sec.  17.603(b)(2) 
was merely meant to mirror the statutory language and is not 
exclusionary of other mental health care professions. VA determined 
that it should maintain a non-exhaustive list in the regulation to 
permit flexibility so that new mental health professions can be 
included without the need to amend the regulations. Therefore, other 
occupations not listed in proposed Sec.  17.603(b)(2) that may provide 
clinical care in mental health programs may,

[[Page 51445]]

and are encouraged to, apply for and receive HPSP scholarships.
    One commenter recommended that VA expand HPSP scholarships to 
mandate inclusion for PAs. We are not making any changes based on this 
comment.
    To the extent that the commenter is suggesting that VA mandate that 
PAs be prioritized over other potential applicants, VA cannot mandate 
that PAs be selected over other health care professions. Under 38 
U.S.C. 7612(D), VA may provide scholarships with a preference for 
applicants who are veterans. VA does not have any other preferential 
statutory authority. The awarding of HPSP scholarships is based on VA 
recruitment needs. As previously stated in this rulemaking, an HPSP 
scholarship will be awarded only when necessary to assist VA in 
alleviating shortages or anticipated shortages of personnel in the 
health professions.
    One commenter raised concerns that the HPSP website indicates that 
existing HPSP scholarships are limited to only those PAs with veteran 
status. VA is not making any changes to the rule based on this comment.
    VA acknowledges that its HPSP website previously indicated that the 
PA scholarship is only open to those that have veteran status. VA has 
since updated its HPSP website to ensure it clearly explains that all 
PA students are allowed to apply for an HPSP scholarship, but that a 
preference may be given to veterans, consistent with Sec.  17.605. 
While the eligibility criteria for HPSP does not require that 
applicants have any military experience (see Sec.  17.602), if there 
are a larger number of equally qualified applicants than there are 
awards to be made, VA will first select veterans, then use a random 
method as the basis for further selection. See Sec.  17.605(a). This 
provision applies to all health care professions eligible for HPSP 
scholarships, not just PAs.

Awarding HPSP Scholarships in Academic Year 2023

    One commenter encouraged VA to issue the 50 additional awards in 
the 2023 academic year, as increasing access to mental health care is 
critical.
    Consistent with section 104(a) of Division V of the Act, VA 
proposed to provide no fewer than an additional 50 awards (as compared 
to academic year 2021) to applicants who are pursuing degrees or 
training in mental health disciplines per academic year starting in 
academic year 2022. See proposed Sec.  17.603(b)(2) and 88 FR 54973. 
However, VA will not be able to implement this regulation until this 
final rule is published and effective, which will be after the start of 
the 2023 academic year. VA notes that under the current regulations, VA 
is authorized to provide HPSP scholarships to disciplines that provide 
clinical care within mental health programs and in academic year 2023, 
VA offered 87 scholarships for professions providing clinical care 
within mental health programs, which is more than the required 83 
scholarships for mental health professions as required under the Act. 
VA is not making any changes based on this comment.

Chaplains

    While not entirely clear, one commenter appeared to request 
chaplains be eligible for HPSP scholarships since they should be 
considered mental health professionals who are eligible under the 
changes VA proposed to make to Sec.  17.603(b)(2) in the proposed rule. 
VA is not making changes based on this comment.
    VA considers chaplains to be an integral part of the veteran's 
mental health and individuals who are pursuing a degree that leads to 
placement as a chaplain may be eligible to receive HPSP scholarships 
under Sec. Sec.  17.603(b)(2) and (3) as revised and made final in this 
rule. However, in order to be eligible under Sec.  17.603(b)(2) the 
criteria in Sec.  17.603(b)(1) still needs to be met, which provides 
that an HPSP scholarship will be awarded only when necessary to assist 
VA in alleviating shortages or anticipated shortages of personnel in 
the health professions stated in paragraph (b) of this section. These 
occupations are identified in OIG's Determination of Veterans Health 
Administration's Severe Occupational Staffing Shortages Fiscal Year 
2023. However, the OIG's report did not list the chaplain occupation as 
one of the severe shortage occupations within VA. Therefore, VA cannot 
award HPSP scholarships to individuals who are pursuing a degree 
leading to a position as a VA chaplain at this time. VA may offer HPSP 
scholarships to these individuals in the future should there be a 
shortage of VA chaplains.

Employment in a Mental Health Care Profession

    A commenter questioned whether HPSP participants would be 
guaranteed placement in positions in VA that are mental health related 
if they are earning a degree that could be used to provide either 
mental health care or a different type of health care. VA is not making 
any changes based on this comment.
    Pursuant to Sec.  17.607(a), each participant is obligated to 
provide service as a Department of Veterans Affairs employee in full-
time clinical practice in the participant's discipline in an assignment 
or location determined by the Secretary. Consistent with Sec.  17.607, 
individuals who are awarded an HPSP scholarship under Sec.  
17.603(b)(2), as revised and made final in this rule, will be placed in 
positions that are mental health related.

Comments That Are Beyond the Scope of the Proposed Rule

    Several comments were beyond the scope of the proposed rule. For 
instance, one commenter indicated that health care professionals need 
more mental health training. Another commenter requested changes be 
made to other VA directives and policies to better incorporate PAs as 
mental health providers. As these comments are beyond the scope of the 
rulemaking, we will not address them further.
    Based on the rationale set forth in the proposed rule and in this 
final rule, VA is adopting the proposed rule as final with no changes.

Executive Orders 12866, 13563, and 14094

    Executive Order 12866 (Regulatory Planning and Review) directs 
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. Executive Order 14094 (Executive order on 
Modernizing Regulatory Review) supplements and reaffirms the 
principles, structures, and definitions governing contemporary 
regulatory review established in Executive Order 12866 of September 30, 
1993 (Regulatory Planning and Review), and Executive Order 13563 of 
January 18, 2011 (Improving Regulation and Regulatory Review). The 
Office of Information and Regulatory Affairs has determined that this 
rulemaking is not a significant regulatory action under Executive Order 
12866, as amended by Executive Order 14094. The Regulatory Impact 
Analysis associated with this rulemaking can be found as a supporting 
document at www.regulations.gov.

Regulatory Flexibility Act

    The Secretary hereby certifies that this final rule will not have a 
significant

[[Page 51446]]

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 
final rule will solely be operated and administered within VA and will 
only affect individuals who apply and are awarded an HPSP scholarship. 
On this basis, the Secretary certifies that the adoption of 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. Therefore, under 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.

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.

Paperwork Reduction Act

    Although this final rule contains an increase in the provisions 
constituting a collection of information under the provisions of the 
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521), this increase is 
already captured in an existing collection of information. The 
collection of information for 38 CFR 17.602 is currently approved by 
the Office of Management and Budget (OMB) and has been assigned OMB 
control number 2900-0793. However, Sec.  17.602 incorrectly reflects 
OMB control number 2900-0352. VA is correcting this technical error in 
this rulemaking by updating the reference in Sec.  17.602 to OMB 
control number 2900-0793.

Congressional Review Act

    Pursuant to Subtitle E of the Small Business Regulatory Enforcement 
Fairness Act of 1996 (known as the Congressional Review Act) (5 U.S.C. 
801 et seq.), the Office of Information and Regulatory Affairs 
designated this rule as not satisfying the criteria under 5 U.S.C. 
804(2).

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 June 12, 2024, 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 stated in the preamble, the Department of Veterans 
Affairs amends 38 CFR part 17 as set forth below:

PART 17--MEDICAL

0
1. The authority citation for part 17 is amended by adding an entry for 
Sec. Sec.  17.600 through 17.612, in numerical order, to read as 
follows:

    Authority:  38 U.S.C. 501, and as noted in specific sections.
* * * * *
    Sections 17.600 through 17.612 are also issued under 38 U.S.C. 
7601-7619, 7633, 7634, 7636, and sec. 104(a), div. V, Public Law 
117-328.
* * * * *


Sec.  17.602  [Amended]

0
2. Amend Sec.  17.602 by revising the parenthetical at the end of the 
section to read as follows:


Sec.  17.602  Eligibility.

* * * * *
(Approved by the Office of Management and Budget under control 
number 2900-0793)


Sec.  17.603   [Amended]

0
3. Amend Sec.  17.603 by:
0
a. Redesignating paragraph (b)(2) as new paragraph (b)(3); and
0
b. Adding new paragraph (b)(2) to read as follows:


Sec.  17.603   Availability of HPSP scholarships.

* * * * *
    (b) * * *
    (2) Mental health disciplines. Notwithstanding paragraphs (b)(1) 
and (3) of this section, VA will award not less than 83 HPSP 
scholarships each year to individuals who are accepted for or are 
enrolled in a program of education or training leading to employment in 
a mental health discipline, including, but limited to, advanced 
practice nursing (with a focus on mental health or substance use 
disorder), psychology, or social work.
* * * * *
[FR Doc. 2024-13367 Filed 6-17-24; 8:45 am]
BILLING CODE 8320-01-P