Veterans Affairs Revises Medical Regulations, Veterans Choice Program
Excerpts of the rule state:
The
DATES:
Effective date: This rule is effective on
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
The Choice Act, Public Law 113-146, was enacted on
Comments regarding changes in Public Law 114-19 related to the "unusual or excessive burden" standard.
Section 3(a)(2) of Public Law 114-19 amended section 101(b)(2)(D)(ii)(II) of the Choice Act by defining additional criteria that could be the basis for finding that a veteran faced an "unusual or excessive burden" in traveling to receive care in a
Comments regarding changes in Public Law 114-41 related to veteran eligibility, periods of follow up care, wait times, distance requirements, and provider eligibility.
Section 4005(b) of Public Law 114-41 amended section 101 of the Choice Act to remove the
Section 4005(a) of Public Law 114-41 amended section 101(h) of the Choice Act by removing the 60-day limitation on an "episode of care." Sec. 4005(a), Public Law 114-41, 129 Stat. 443. The definition of "episode of care" in *17.1505 was therefore revised in the interim final rule by removing the phrase "which lasts no longer than 60 days from the date of the first appointment with a non-
Section 4005(d) of Public Law 114-41 amended section 101(b)(2)(A) of the Choice Act to create eligibility for veterans that are unable to be scheduled for an appointment within "the period determined necessary for [clinically necessary] care or services if such period is shorter than" VHA's wait time goals. Section 4005(d), Public Law 114-41, 129 Stat. 443. This new wait-times based criterion was added as paragraph (b)(1)(ii) of *17.1510, and created eligibility when a veteran is unable to schedule an appointment within a period of time that
Section 4005(e) of Public Law 114-41 amended section 101(b)(2)(B) of the Choice Act to modify the 40-mile distance eligibility criterion to provide that veterans may be eligible if they reside more than 40 miles from "(i) with respect to a veteran who is seeking primary care, a medical facility of the Department, including a community-based outpatient clinic, that is able to provide such primary care by a full-time primary care physician; or (ii) with respect to a veteran not covered under clause (i), the medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran."
Section 4005(c) of Public Law 114-41 amended sections 101(a)(1)(B) and 101(d) of the Choice Act to permit
Miscellaneous Comments
The remaining five comments do not specifically pertain to the regulatory changes in the interim final rule, and are addressed here in turn.
One commenter requested that the end date of
Another commenter expressed a generalized concern that the Choice Program created additional barriers to access healthcare as well as expressed specific concerns about the Choice Program. To address the commenter's generalized concern related to barriers to access, we acknowledge the difficulties that some veterans have experienced and expressed since the inception of the Choice Program in
As to the commenter's specific concerns, the commenter stated that there are no clear channels for resolution of complaints or problems when authorization for care has been delayed. The commenter further elaborated that it is difficult to access the Choice Program call centers and, once contact is made with the call center, it is difficult to receive answers from the employees working in the call centers. The commenter suggested that a process be put in place to address complaint resolution. We interpret these concerns to be limited to issues that arise administratively when the veteran is already enrolled in the Choice Program, such as delays in authorization, and not concerns regarding eligibility to participate in the Choice Program or concerns with clinical decisions throughout the course of treatment. Therefore, we further interpret these concerns to relate to the internal processes relating to administration of the program and do not make any regulatory changes. However, we describe below processes and improvements that both
The commenter next expressed the specific concern that rural veterans are disproportionately negatively impacted by barriers created by the Choice Act and
The commenter also stated that the Choice Program has created coordination of care issues for non-
Finally, the commenter explained that it was easier to seek care prior to the Choice Program and that, even though the Program is voluntary, veterans are being told that they must use the Choice Program over
The final three comments are beyond the scope of the interim final rule and we will not make any regulatory changes based on the comments. One commenter expressed concern about the recertification process to become a vendor and contract with
Another commenter supported the interim final rule because it would enable the commenter to access community care near the commenter's residence in
Another commenter expressed a concern over the potentially burdensome nature of the administrative requirements to participate in the Choice Program. Specifically, the commenter requested that
Effect of Rulemaking
Title 38 of the Code of Federal Regulations, as confirmed by this final rule, represents
Paperwork Reduction Act
Although this action contains provisions constituting collections of information, at 38 CFR 17.1530(d), under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521), no new or proposed revised collections of information are associated with this final rule. The information collection requirements for *17.1530(d) are currently approved by the
Executive Orders 12866, 13563, and 13771
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. Executive Order 12866 (Regulatory Planning and Review) defines a "significant regulatory action," which requires review by the
The economic, interagency, budgetary, legal, and policy implications of this regulatory action have been examined and it has been determined that this is an economically significant regulatory action under Executive Order 12866.
Congressional Review Act
This regulatory action is a major rule under the Congressional Review Act, 5 U.S.C. 801-08, because it may result in an annual effect on the economy of
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
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 final rule will not have a significant economic impact on participating eligible entities and providers who enter into agreements with
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic Assistance numbers and titles for the programs affected by this document are as follows: 64.008--Veterans Domiciliary 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
List of Subjects in 38 CFR Part 17
Administrative practice and procedure
Alcohol abuse
Alcoholism
Claims
Day care
Dental health
Drug abuse
Government contracts
Grant programs-health
Grant programs-veterans
Health care
Health facilities
Health professions
Health records
Homeless
Mental health programs
Nursing homes
Reporting and recordkeeping requirements
Travel and transportation expenses
Veterans
Signing Authority
The Secretary of
Dated:
Regulations Development Coordinator,
PART 17--MEDICAL
Accordingly, the interim rules amending 38 CFR part 17 which were published at 80 FR 74991 on
[FR Doc. 2018-10054 Filed 5-10-18;
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