[Federal Register Volume 89, Number 145 (Monday, July 29, 2024)]
[Rules and Regulations]
[Pages 60825-60827]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-16601]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AR18


Center for Innovation for Care and Payment Update

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) amends its medical 
regulations governing the Center for Innovation for Care and Payment. 
This final rule is making several technical revisions to revise the 
organizational alignment of the Center for Innovation for Care and 
Payment and to revise where evaluation results are posted for public 
review for the pilot programs.

DATES: This rule is effective July 29, 2024.

FOR FURTHER INFORMATION CONTACT: David Au, Executive Director, VHA

[[Page 60826]]

Center for Care and Payment Innovation (14HIL3), 810 Vermont Ave. NW, 
Washington, DC 20420. (202-461-7002). (This is not a toll-free 
telephone number.)

SUPPLEMENTARY INFORMATION: On June 6, 2018, section 152 of Public Law 
115-182, the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson 
VA Maintaining Internal Systems and Strengthening Integrated Outside 
Networks Act of 2018 (the MISSION Act), amended title 38 of the United 
States Code (U.S.C.) by adding a new section 1703E. This new section 
established the Center for Innovation for Care and Payment (the Center) 
and authorized the conduct of pilot programs designed to develop 
innovative approaches to testing payment and care models to reduce 
expenditures while preserving or enhancing the quality of care 
furnished by VA.
    On October 25, 2019, VA published a final rule implementing section 
1703E in title 38, Code of Federal Regulations (CFR) 17.450. See 84 
Federal Register (FR) 57327. This new regulation, which became 
effective on November 25, 2019, established the parameters for the 
Center in its conduct of pilot programs. These parameters included, but 
were not limited to, geographic location decisions, limitations on the 
number of pilot programs to be operated at the same time, VA's 
evaluation and reporting on the pilot programs, and when VA may expand, 
modify, and terminate pilot programs.
    As explained in more detail below, we now amend Sec.  17.450 by 
making several technical revisions. VA is not making any substantive 
edits to the content of Sec.  17.450.

38 CFR 17.450(a)(2)

    Current paragraph (a) of Sec.  17.450 sets forth the purpose and 
organization of the Center. Paragraph (a)(2) provides that the Center 
will not operate within any specific administration within VA but 
rather will operate in VA's corporate portfolio, to ensure the limited 
number of concurrent pilot programs under Sec.  17.450 are not 
redundant of or conflicted by ongoing innovation efforts within any 
specific administration. We explained in the proposed rule for Sec.  
17.450 that the Center will be operationally independent from any of 
VA's three administrations and will be responsible for collaborating 
across VA to develop and implement pilot programs under this section. 
84 FR 36508 (July 29, 2019). As further explained in proposed 
paragraphs (a)(2) and (3), being operationally independent referred to 
the decision-making authority of the Center regarding the strategic, 
procedural, and tactical aspects of managing the pilot programs under 
this section. Id. However, we received public comments indicating that 
the proposed language was unclear. See 84 FR 57328-57329 (October 25, 
2019). We thus eliminated the reference to and definition of 
operational independence in proposed paragraph (a)(2) and redesignated 
paragraph (a)(3) to paragraph (a)(2), which is the language in current 
38 CFR 17.450(a)(2). We further clarified in the final rule that the 
Center is part of VA and acts at the direction of the Secretary, so it 
is not ``independent'' from VA. 84 FR 57329.
    Consistent with paragraph (a)(2), the Center had operated under 
VA's Office of Enterprise Integration (OEI), which is a VA corporate 
level office, since November 25, 2019.
    However, since April 5, 2021, the Center has operated under the 
Office of Discovery, Education, and Affiliate Networks (DEAN) under the 
Veterans Health Administration (VHA). The Center moved from OEI to DEAN 
to align these pilot programs with other established, complementary 
innovation programs that are health-care focused initiatives within VHA 
and to enable more efficient and effective oversight and execution of 
all pilot programming which enhances care and service delivery for 
veterans. As a result, this move has facilitated more efficient daily 
operations, while continuing to maintain Department-wide connections 
across VA. More specifically, this move has allowed the Center to 
leverage the well-established practices of advancing innovation through 
the VA innovation lifecycle developed and maintained by DEAN and the 
Office of Healthcare Innovation and Learning (HIL) while still 
permitting VA to ensure that the pilots managed by the Center are not 
redundant of or conflict with ongoing innovation efforts within VA; 
DEAN and HIL have several existing partnerships with programs across VA 
and have established connections to ensure feedback is considered and 
integrated into pilot-programming decision-making. This has been 
achieved through formal governance and through structured 
collaborations with programs across VA's three administrations (that 
is, health, benefits, and memorial affairs). This facilitates cross-
agency communication, prevents redundant or conflicting efforts, and 
ensures pilots drive transformational change across VA.
    Because the organizational alignment of the Center has moved from 
VA's corporate portfolio to VHA, we now amend Sec.  17.450(a)(2) to 
reflect that change. However, in order to avoid amending Sec.  
17.450(a)(2) in the future in the event that the name of the office 
under which the Center will operate changes, we will not add the name 
of DEAN and will instead state in Sec.  17.450(a)(2) that the Center 
for Innovation for Care and Payment will operate within the Veterans 
Health Administration. We are also making a technical edit to the last 
part of Sec.  17.450(a)(2), which currently states in part that 
concurrent pilot programs under Sec.  17.450 are not redundant of or 
conflicted by ongoing innovation efforts within any specific 
administration. We are removing the phrase ``conflicted by'' and 
replacing it with ``conflicting with'' for clarity. This edit will not 
change the meaning of the text.

38 CFR 17.450(g)

    Current Sec.  17.450(g) establishes evaluation and reporting 
provisions related to the Center. This paragraph states that VA will 
evaluate each pilot program operated under this section and report its 
findings. Such evaluations may be based on quantitative data, 
qualitative data, or both; and whenever appropriate, evaluations will 
include a survey of participants or beneficiaries to determine their 
satisfaction with the pilot program. This paragraph further states that 
VA will make the evaluation results available to the public on the VA 
Innovation Center website on the schedule identified in VA's proposal 
for the pilot program. As part of this rulemaking, we are revising the 
last sentence of paragraph (g) to state that VA will make the 
evaluation results available to the public on a VA website on the 
schedule identified in VA's proposal for the pilot program. We 
reference a VA website instead of the VA Innovation Center website 
because the specific name of the website and sub-pages for pilot 
programs vary, and referencing a VA website provides consistency and 
avoids the potential need for additional regulatory updates; we believe 
that the broader identification of a VA website in the regulation will 
allow VA to more accurately and consistently identify the location of 
the website where the evaluation results for the relevant pilot program 
will be published. The website will still be identified on the schedule 
in the proposal for such pilot program.

Administrative Procedure Act

    This final rule will neither amend the substantive content of the 
regulations cited nor have a substantive impact on the public. We are 
merely providing technical revisions to revise the

[[Page 60827]]

organizational alignment of the Center for Innovation for Care and 
Payment and to revise the location of the website where evaluation 
results are posted for public review for the pilot programs. 
Consequently, this rule is exempt from the notice-and-comment and 
delayed-effective-date requirements as a rule of agency organization, 
procedure, or practice pursuant to section 553(b)(A) in Title 5 of 
United States Code.

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 Regulatory Flexibility Act, 5 U.S.C. 601-612, is not applicable 
to this rulemaking because notice of proposed rulemaking is not 
required. 5 U.S.C. 601(2), 603(a), 604(a).

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

    This final rule contains no provisions constituting a collection of 
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).

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).

Assistance Listing

    The Assistance Listing numbers and titles for the programs affected 
by this document are as follows: 64.007, Blind Rehabilitation Centers; 
64.008, Veterans Domiciliary Care; 64.009, Veterans Medical Care 
Benefits; 64.010, Veterans Nursing Home Care; 64.011, Veterans Dental 
Care; 64.012, Veterans Prescription Service; 64.013, Veterans 
Prosthetic Appliances; 64.014, Veterans State Domiciliary Care; 64.015, 
Veterans State Nursing Home Care; 64.016, Veterans State Hospital Care; 
64.018, Sharing Specialized Medical Resources; 64.019, Veterans 
Rehabilitation Alcohol and Drug Dependence; and 64.022, Veterans Home 
Based Primary Care.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
Government contracts, Grant programs-health, Grant programs-veterans, 
Health care, Health facilities, Health professions, Health records, 
Homeless, Medical and dental schools, Medical devices, Medical 
research, Mental health programs, Nursing homes, Philippines, Reporting 
and recordkeeping requirements, Scholarships and fellowships, Travel 
and transportation expenses, Veterans.

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved this 
document on July 23, 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 general authority citation for part 17 continues to read as 
follows:

    Authority: 38 U.S.C. 501, and as noted in specific sections.


0
2. Amend Sec.  17.450 by revising paragraphs (a)(2) and (g) to read as 
follows:


Sec.  17.450  Center for Innovation for Care and Payment.

    (a) * * *
    (2) The Center for Innovation for Care and Payment will operate 
within the Veterans Health Administration, which will ensure that the 
limited number of concurrent pilots under this section are not 
redundant of or conflicting with ongoing innovation efforts within any 
specific administration.
* * * * *
    (g) Evaluation and reporting. VA will evaluate each pilot program 
operated under this section and report its findings. Evaluations may be 
based on quantitative data, qualitative data, or both. Whenever 
appropriate, evaluations will include a survey of participants or 
beneficiaries to determine their satisfaction with the pilot program. 
VA will make the evaluation results available to the public on a VA 
website on the schedule identified in VA's proposal for the pilot 
program.
* * * * *
[FR Doc. 2024-16601 Filed 7-26-24; 8:45 am]
BILLING CODE 8320-01-P