Veterans Transportation Service, 30190-30200 [2015-12724]

Agencies

• DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 80, Number 101 (Wednesday, May 27, 2015)]
[Proposed Rules]
[Pages 30190-30200]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-12724]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 70

RIN 2900-AO92


Veterans Transportation Service

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its 
medical regulations concerning the transportation of persons for the 
purposes of examination, treatment, and care. Public Law 112-260, as 
amended, authorized VA to carry out a program to transport any person 
to or from a VA facility or other place, among other things, for the 
purpose of examination, treatment, or care. This authority expires on 
December 31, 2015. These regulations would provide guidelines for 
veterans and the public regarding VA's Veterans Transportation Service 
(VTS).

DATES: Comment Date: Comments must be received on or before July 27, 
2015.

ADDRESSES: Written comments may be submitted through https://www.regulations.gov; by mail or hand-delivery to Director, Regulation 
Policy and Management (02REG), Department of Veterans Affairs, 810 
Vermont Ave. NW., Room 1068, Washington, DC 20420; or by fax to (202) 
273-9026. Comments should indicate that they are submitted in response 
to ``RIN 2900-AO92-Veterans Transportation Service.'' Copies of 
comments received will be available for public inspection in the Office 
of Regulation Policy and Management, Room 1068, between the hours of 
8:00 a.m. and 4:30 p.m. Monday through Friday (except holidays). Please 
call (202) 461-4902 for an appointment. (This is not a toll-free 
number.) In addition, during the comment period, comments may be viewed 
online through the Federal Docket Management System (FDMS) at https://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: David Riley, Director, Veterans 
Transportation Program, Chief Business Office (10NB2G), 2957 Clairmont 
Rd., Atlanta, GA 30329-1647, (404) 828-5601. (This is not a toll-free 
number.)

SUPPLEMENTARY INFORMATION: 
    Executive Summary: Purpose of This Regulatory Action: We would 
create new regulations concerning the Veterans Transportation Service 
(VTS), a program where the Department of Veterans Affairs (VA) directly 
transports veterans and other persons to or from VA or VA-authorized 
facilities for the purposes of examination, treatment, or care. 
Specifically, these regulations would define which persons are 
eligible, how they may apply for transportation benefits, and how VA 
would provide transportation, including such limitations as are 
necessary for the safe and effective operation of the program.
    Summary of the Major Provisions of this Regulatory Action: This 
proposed rule would--
     Modify VA's existing transportation regulations by 
including new content specific to VA's direct transportation of 
veterans and other persons for the purposes of examination, treatment, 
or care.
     Define key terms used throughout the regulation. These 
terms would include attendant, which would be similar to the term used 
in VA's beneficiary travel program and refer to a person who is 
required to aid or assist another person; guest, which would be a 
person whose presence is not medically required; scheduled visit,

[[Page 30191]]

which would be an appointment arranged prior to a person's appearance 
at a VA or VA-authorized facility; and unscheduled visit, which would 
be a visit that was not recorded in VA's scheduling system prior to the 
visit.
     Define eligible persons, which would include enrolled and 
non-enrolled veterans; servicemembers; prospective and approved family 
caregivers; attendants; persons receiving counseling, training, or 
mental health services; beneficiaries of the Civilian Health and 
Medical Program of the Department of Veterans Affairs (CHAMPVA); and 
guests. The regulation would also define limitations on eligibility, 
such as if the person's behavior has jeopardized or could jeopardize 
the health or safety of others, or could interfere with the safe 
transportation of persons. The regulations also would limit access so 
that only one person may accompany a veteran or servicemember unless a 
VA clinician determines that more than one person should attend the 
visit. The regulation also would provide some restrictions for persons 
under the age of 18.
     Identify and describe the types of transportation 
authorized under VTS, including door-to-door service, travel to and 
from designated locations, service between VA facilities, and travel to 
and from other locations.
     Explain the process for arranging transportation services 
and how VA would determine which persons can travel if demand for VTS 
services exceeds supply.
    Costs and Benefits: As further detailed in the Regulatory Impact 
Analysis, which can be found as a supporting document at https://www.regulations.gov and is available on VA's Web site at https://www.va.gov/orpm/, by following the link for ``VA Regulations Published 
From FY 2004 Through Fiscal Year to Date,'' the proposed rule would 
expand access to transportation options for veterans and other persons. 
Increasing transportation options should allow more veterans and other 
beneficiaries to access VA health care services and reduce demand for 
travel reimbursement under the beneficiary travel program.
    General Discussion: In section 202 of the Dignified Burial and 
Other Veterans' Benefits Improvement Act of 2012 (the Act), Public Law 
112-260, 126 Stat. 2417 (2013), as amended by Public Law 113-59, 127 
Stat. 658 (2013) and Public Law 113-175, 128 Stat. 1901 (2014), 
Congress codified a new statute, 38 U.S.C. 111A, which authorizes the 
Department of Veterans Affairs (VA), until December 31, 2015, to 
transport any person to or from a VA facility or other place in 
connection with vocational rehabilitation, counseling required by 
chapters 34 or 35 of title 38, U.S.C., or for the purpose of 
examination, treatment, or care. Vocational rehabilitation is 
authorized by chapter 31 of title 38, U.S.C., and assists veterans with 
service-connected disabilities in preparing for, finding, and keeping 
suitable employment. Chapters 34 and 35 of title 38, U.S.C., authorize 
education benefits for eligible veterans and their survivors and 
dependents. Vocational rehabilitation and the education benefits 
provided under chapters 34 and 35 are administered by the Veterans 
Benefits Administration (VBA), and are not typically provided at VA 
health care facilities. Moreover, almost all VA health care facilities 
administer transportation programs in the form of beneficiary travel 
payments, and many have already begun addressing transportation service 
issues by developing infrastructure or identifying the travel needs of 
their patients as a result of this authority. Consequently, VA is 
limiting this rulemaking to health care access (meaning any hospital 
care or medical services under the medical benefits package in 38 CFR 
17.38), and we do not include transportation for vocational 
rehabilitation or education benefits under chapters 34 and 35. VA has 
promulgated regulations in part 70 of 38 CFR governing transportation 
benefits for travel to health care facilities, and this rulemaking is 
consistent with those existing rules. We would use the term ``VA 
facility'' rather than the more specific ``VA health care facility'' in 
this regulation because the term ``VA facility'' is already a defined 
term in 38 CFR 70.2 that refers to health care facilities.
    We propose organizing these regulations in 38 CFR part 70, which 
also contains regulations governing the Veterans Health 
Administration's (VHA) beneficiary travel program, so that eligible 
persons and members of the public who are interested in VA 
transportation benefits could find all relevant information in one 
location in VA's regulations. Accordingly, we would amend the title for 
part 70 to read, ``Veterans Transportation Programs,'' to indicate that 
it contains regulations related to more than one transportation 
program. Under this heading, there would be two subheadings. The first 
would identify a new subpart for the current part 70 regulations 
related to beneficiary travel (Sec. Sec.  70.1-70.50). This subheading 
would read, ``Subpart A-Beneficiary Travel and Special Mode 
Transportation under 38 U.S.C. 111.'' The second subheading, ``Subpart 
B-Veterans Transportation Service under 38 U.S.C. 111A,'' would contain 
the regulations promulgated by this proposed rule. We also would modify 
the list of authorities for part 70 to include 38 U.S.C. 111A.
    This rulemaking is intended to cover only those transportation 
services provided to eligible persons by the Veterans Transportation 
Service (VTS) pursuant to 38 U.S.C. 111A. The Veterans Transportation 
Service is a program where VA transports eligible persons to and from 
VA or VA-authorized health care facilities and other locations for the 
purpose of examination, treatment or care. The current regulations 
governing the beneficiary travel program, located at Sec. Sec.  70.1 
through 70.50, contain numerous references to part 70. For example, 
Sec.  70.1(a) states that ``[t]his part [i.e., part 70] provides a 
mechanism under 38 U.S.C. 111 for the Veterans Health Administration 
(VHA) to make payments for travel expenses,'' and Sec.  70.1(b) states 
that part 70 does not cover payment for certain other specified 
transportation. Section 70.2 provides definitions applicable to all of 
part 70. Because we are organizing the VTS regulations under part 70, 
these part 70 references and definitions also apply to the VTS program. 
We have carefully reviewed part 70 and believe that all of the 
references are appropriate and will not create confusion. For example, 
the definitions in Sec.  70.2 generally are consistent with the 
proposed VTS regulations that would be promulgated with this 
rulemaking, with one exception as noted below. Also, the references in 
Sec. Sec.  70.1 and 70.10 clearly refer to beneficiary travel, and VTS 
is not part of the beneficiary travel program. We are not revising the 
beneficiary travel regulations at this time. Commenters who identify 
confusing or contrary sections in part 70 are encouraged to provide 
comments to this rulemaking. We are currently reviewing the other 
regulations in part 70 and will make appropriate revisions in a future 
action. We do not intend to make any changes to the beneficiary travel 
program as a result of this rulemaking, and this rulemaking should not 
be interpreted to modify the current beneficiary travel regulations in 
any way.

70.70 Purpose and Definitions

    Paragraph (a) of Sec.  70.70 states that this subpart would apply 
to VTS, a program that transports eligible persons to or from a VA or 
VA-authorized facility or other place for the purpose of

[[Page 30192]]

examination, treatment, or care. A VA-authorized health care facility 
is defined in Sec.  70.2 as a non-VA health care facility where VA has 
approved care for an eligible beneficiary at VA expense. Travel to such 
facilities would be covered under VTS as it currently is under the 
beneficiary travel program.
    In Sec.  70.70(b), we would set forth definitions applicable to 
VTS. The definition of ``attendant'' for purposes of VTS would include, 
but not be limited to, the definition used in 38 CFR 70.2. Under Sec.  
70.2, an attendant is ``an individual traveling with a beneficiary who 
is eligible for beneficiary travel and requires the aid and/or physical 
assistance of another person.'' Because VTS is intended to support a 
broader population, VA is not limiting attendants for purposes of VTS 
to only those persons who are eligible for beneficiary travel. Thus, 
for purposes of VTS, an attendant also would mean an individual 
traveling with a veteran or servicemember who is eligible for VTS and 
requires the aid and/or assistance of another person. This definition 
would ensure that VA may transport attendants through VTS for all 
veterans and servicemembers who are eligible for VTS on their own.
    We would define an ``eligible person'' as one described in Sec.  
70.71, which would define categories of eligible persons in detail.
    We would define a ``guest'' as any individual the veteran or 
servicemember would like to have accompany him or her to an appointment 
but whose presence is not medically required. Some examples of guests 
who might be asked to attend would be a general caregiver (that is, not 
a Family Caregiver, which is described later and in regulations at 38 
CFR part 71) who provides supervision or other basic support or a 
friend who can provide emotional support during an appointment.
    We also would define ``scheduled visit'' and ``unscheduled visit.'' 
A scheduled visit would mean that a VA beneficiary had an appointment 
that was made before she or he appeared at a VA or VA-authorized 
facility, or that a VA beneficiary was specifically authorized to 
appear at such facility on the date of the visit in order to obtain 
examination, treatment, or care. Examples of scheduled visits include: 
Regular appointments for examination, treatment, or care; visits to 
undergo laboratory work; or doctor-recommended visits to clinics with 
open hours. This definition would be consistent with common usage of 
the term in the health care community. An unscheduled visit would be 
when a veteran travels to a VA or VA-authorized facility for purposes 
of examination, treatment, or care not recorded in VA's scheduling 
system prior to the veteran's visit. An unscheduled visit is commonly 
made for mental health visits, counseling sessions, or other types of 
clinical interventions, such as weight management counseling or smoking 
cessation. These visits need not be for an appointment with a VA 
clinician; for example, a veteran may be traveling to attend a peer-led 
counseling session. These definitions would allow VA to ensure veterans 
are able to travel using VTS for the full array of services we provide.

70.71 Eligibility

    Section 70.71 would define the categories of persons eligible for 
transportation services under this authority. Eligibility for VTS would 
be broader than eligibility for the beneficiary travel program for a 
number of reasons. First, 38 U.S.C. 111A authorizes VA to provide 
transportation to ``any person'' to or from a VA facility or other 
place, among other things, for the purpose of examination, treatment, 
or care. In other provisions of title 38, U.S.C., the term person is 
defined as being broader than the term veteran. For example, in 38 
U.S.C. 1708(b), persons eligible for temporary lodging in a Fisher 
House or other appropriate facility include veterans, family members, 
and others who accompany a veteran and provide the equivalent of 
familial support within that definition. We interpret the broad term 
``any person'' to authorize VA to provide VTS to the widest possible 
range of individuals, including former members of the Armed Forces, 
family members, and other beneficiaries. In addition, veterans may be 
eligible for VTS whether they are enrolled in VA's health care system 
or not.
    VA also would include additional persons as eligible for VTS 
because 38 U.S.C. 111A does not require VA to provide direct 
transportation to specific types of persons, as the law did for 
beneficiary travel payments in 38 U.S.C. 111(b). Moreover, VTS has a 
negligible marginal cost for each new user of the service compared to 
beneficiary travel recipients. VTS is designed to provide 
transportation to several people at once using a single vehicle, and 
provided that vehicles are not full, adding one more passenger results 
in extremely small cost increases for VA.
    Furthermore the purpose of 38 U.S.C. 111A is to expand 
transportation options for persons who receive certain benefits from 
VA. During the House of Representatives' consideration of the bill, the 
Chairman of the Veterans' Affairs Committee described the intent of 
this provision as being to complement, and not replace, existing 
programs that offer transportation assistance to veterans. See 158 
Cong. Rec. H7445 (Dec. 30, 2012). This regulation would achieve that 
goal. Consequently, we would interpret the term ``any person'' in 38 
U.S.C. 111A more broadly than the same term in 38 U.S.C. 111.
    Paragraph (a) of Sec.  70.71 would define all persons eligible for 
beneficiary travel as also being eligible for VTS benefits. This 
definition would be consistent with the statutory authorities for VTS 
and the beneficiary travel program. Specifically, the language in 38 
U.S.C. 111(a) that authorizes VA to make beneficiary travel payments is 
the same as the language in 38 U.S.C. 111A in terms of the purpose for 
the travel. Thus, VA is interpreting 38 U.S.C. 111A as authorizing VTS 
benefits to the categories of persons eligible for beneficiary travel 
payments under Sec.  70.10.
    Because some individuals will be eligible for transportation 
benefits under both VTS and the beneficiary travel program, paragraph 
(a) would prohibit beneficiaries from claiming more than one type of 
transportation benefit for the same travel. Essentially, this provision 
would prohibit a beneficiary from receiving direct transportation 
services through VTS under subpart B of part 70 while also filing a 
claim for mileage reimbursement or special mode transportation under 
VA's beneficiary travel program in subpart A of part 70 for the same 
travel. However, participation in VTS would not prevent a person 
eligible for beneficiary travel from receiving benefits under that 
program for travel expenses actually incurred. For example, if veterans 
eligible for mileage reimbursement under the beneficiary travel program 
drove from their residences to a designated location where they boarded 
a van that took them to a VA facility, these veterans would receive 
mileage reimbursement for their travel from their residences to the 
designated location and back, but would not be eligible for 
reimbursement for the portion of the trip provided by VA. This would be 
consistent with VA's requirements in regulations at Sec.  70.30(a) that 
VA will pay for beneficiary travel by an eligible beneficiary when 
travel expenses are actually incurred.
    Enrolled veterans would be eligible under paragraph (b) if they are 
traveling for a scheduled visit or urgent care; for retrieval, 
adjustment, or training

[[Page 30193]]

concerning medications or prosthetic appliances; to acquire and become 
adjusted to a service dog provided pursuant to 38 CFR 17.148; for an 
unscheduled visit; or to participate and attend other events or 
functions for the purposes of examination, treatment, or care. Some of 
these visits are recorded in the files of the specific clinical 
practice or service line but may not be recorded as a clinical 
encounter in VA's scheduling package. Veterans may travel to other 
events or functions, such as Stand Downs for homeless veterans and 
special events like the Wheelchair Games and the Summer and Winter 
Sports Clinics, when VA has clinically determined that the event or 
function is for the purpose of examination, treatment, or care.
    VA staff would work to ensure appropriate accommodations are made 
for veterans traveling with a service animal.
    Urgent care may also qualify as an unscheduled visit; however, 
veterans with emergent care needs should call 911. VTS is not equipped 
to provide the level of care and services that veterans in a medical 
emergency require.
    Veterans who are not enrolled in VA's health care system also would 
be eligible for transportation by VTS under paragraph (c) if they are 
travelling for an unscheduled or walk-in visit. This type of visit will 
often result from direct interaction with a VA employee or a 
solicitation by VA to apply for enrollment or other health care 
benefits for which the person is eligible, but a veteran could choose 
to come to VA independently. Establishing this category would ensure 
that VA is able to transport veterans seeking enrollment in the VA 
health care system or access to other veterans' benefits (such as for 
compensation and pension) and those who qualify for VA assistance (such 
as homeless veterans) but who are not currently in VA's health care 
system. Veterans, whether they are enrolled or not, also would be 
eligible if they are traveling for a medical examination related to a 
claim for compensation or pension benefits from the Veterans Benefits 
Administration. Veterans who are not enrolled also would be allowed to 
travel to other events or functions VA has clinically determined are 
for the purpose of examination, treatment, or care.
    Paragraph (d) would establish eligibility for active duty 
servicemembers and members of the National Guard or Reserve traveling 
to a VA or VA-authorized facility for the purpose of examination, 
treatment, or care; for a compensation and pension examination; or to 
enroll or otherwise receive benefits for which they are eligible from a 
VA or VA-authorized facility. In many locations across the country, 
active duty personnel receive health care from a VA facility pursuant 
to a sharing agreement or other arrangement. In other cases, 
servicemembers may be in the process of transitioning from the Armed 
Forces to the VA system. Including these individuals would facilitate 
the delivery of health care and improve access for persons 
transitioning from military service.
    Paragraph (e) would authorize VA to transport prospective and 
designated Family Caregivers under 38 CFR 71.25. Family caregivers 
could travel either to receive their own benefits or to accompany the 
veteran or servicemember to whom they are furnishing caregiver 
services. Under paragraph (j)(2) of this section, only one person, 
whether an attendant, Family Caregiver, or guest would be able to 
travel at a time for the care of an eligible veteran or servicemember, 
unless a VA clinician determines that more than one Family Caregiver 
should be present when services are provided to the eligible veteran or 
servicemember. This limitation is intended to ensure that eligible 
veterans and servicemembers have the support of their family caregivers 
and allow for training and education of Family Caregivers, while still 
ensuring other veterans and servicemembers are able to access 
transportation services. The Family Caregiver would not need to travel 
with the eligible veteran or servicemember. For example, an eligible 
veteran or servicemember may be receiving inpatient care, and the 
Family Caregiver may need to travel back and forth to the facility 
several times during the patient's admission.
    Family Caregivers also would be able to travel for receipt of 
benefits made available to them under the Family Caregivers Program in 
part 71. When traveling in connection with the examination, treatment, 
or care of a veteran or servicemember, the Family Caregiver is 
essentially traveling as an attendant, and VA may limit the number of 
attendants who can accompany a veteran or servicemember. VA would limit 
travel to one Family Caregiver per veteran or servicemember at a time 
when the Family Caregiver is accompanying the veteran or servicemember 
in the interest of ensuring that veterans or servicemembers have 
sufficient access to VTS for their own health care needs. This 
limitation also would apply when a Family Caregiver is traveling 
without an eligible veteran or servicemember but in connection with the 
examination, treatment, or care of an eligible veteran or 
servicemember. In both circumstances, if a VA clinician determined that 
more than one Family Caregiver should travel in connection with the 
examination, treatment, or care of a veteran or servicemember, all of 
the Family Caregivers requested by the clinician would be able to 
travel. If the Family Caregiver were traveling for benefits available 
under the Family Caregivers Program, he or she would be able to travel 
independent of the veteran or servicemember, and the limitation of only 
one Family Caregiver per trip would no longer apply. Specifically, 
prospective Family Caregivers would be able to travel for an initial 
mandatory assessment and training under 38 CFR 71.25(c)-(d), and Family 
Caregivers would be able to travel for benefits in 38 CFR 71.40(b), 
which includes general caregiver benefits; continuing instruction, 
preparation, or training related to the care of the veteran or 
servicemember; ongoing technical support in a timely manner; and 
counseling, training, or mental health services as described in 38 CFR 
71.50 and 71.40(b)(5). Family Caregivers also would be able to travel 
if they were designated as Primary Family Caregivers and were seeking 
benefits in 38 CFR 71.40(c)(1) or (2), which includes all of the Family 
Caregiver benefits just described and respite care. VA also would 
provide transportation to a VA facility if the Primary Family Caregiver 
is eligible under 38 CFR 71.40(c)(3) to receive health care under the 
Civilian Health and Medical Program of the Department of Veterans 
Affairs (CHAMPVA) and if such care is being delivered at a VA facility 
under the CHAMPVA Inhouse Treatment Initiative (CITI). CITI is an 
initiative through which VA provides eligible non-veterans with care in 
VA facilities. Although this program is not available at every 
facility, extending transportation to these individuals would result in 
no additional expenditure of resources while providing greater access 
to health care.
    Paragraph (f) would authorize VA to transport an attendant. For 
purposes of VTS, an attendant, as defined in Sec.  70.70(b), would have 
the meaning set forth in Sec.  70.2 and also mean an individual 
traveling with a veteran or servicemember who is eligible for travel 
under VTS and requires the aid and/or assistance of another person. 
Such travel would be permitted when it is in connection with the 
examination, treatment, or care of any enrolled or non-enrolled veteran 
or servicemember.

[[Page 30194]]

    Paragraph (g) would authorize VA to transport persons receiving 
counseling, training, or mental health services under 38 U.S.C. 1782 
and 38 CFR 71.50. Under these authorities, VA provides consultation, 
professional counseling, marriage and family counseling, training, and 
mental health services to family members of veterans when necessary in 
connection with the treatment of a disability (both service-connected 
and non-service connected) for which the veteran is receiving treatment 
through VA. These services are offered as an extension to the care 
provided for veterans, and access to these services by family members 
can be improved by offering direct transportation services to them. For 
purposes of 38 CFR 71.50, the term ``family member'' means ``(1) A 
person related to the veteran by birth or marriage who lives with the 
veteran or has regular personal contact with the veteran; (2) The 
veteran's legal guardian or surrogate; (3) A Primary or Secondary 
Family Caregiver or a General Caregiver; or (4) The individual in whose 
household the veteran has certified an intention to live.'' 38 CFR 
71.50(b). The terms ``primary family caregiver,'' ``secondary family 
caregiver,'' and ``general caregiver'' are defined and described in 
Sec. Sec.  71.25 and 71.30. Under 38 CFR 71.50(c), VA may provide 
referral services for family members who cannot be provided benefits 
under that section because their need is not necessary in connection 
with the treatment of the veteran. VA would not provide VTS services to 
aid these family members in following up on these referrals because by 
definition it lacks authority to provide care to these persons.
    Paragraph (h) would authorize VA to transport certain CHAMPVA 
beneficiaries, specifically those eligible for and receiving care 
through CITI. CHAMPVA beneficiaries are the spouses or dependents of 
certain veterans, or as noted previously, the designated Primary Family 
Caregiver of an eligible veteran. Few CHAMPVA beneficiaries receive 
care at VA facilities through this program, but including them as 
eligible persons for VTS will help ensure access to health care. VA 
would not extend transportation services under this authority to allow 
transportation to non-VA facilities for CHAMPVA beneficiaries because 
these persons could receive care at a number of different locations, 
and providing transportation to these various facilities would be too 
costly and time-consuming, ultimately depriving veterans and 
servicemembers of transportation resources. VA Mobility Managers or 
other designated personnel could assist CHAMPVA beneficiaries receiving 
care at non-VA facilities in accessing other resources to travel for 
their care. Throughout the regulation, we refer to the ``facility 
director or designee'' as the responsible official; in almost all 
cases, this would be the facility's Mobility Manager.
    Paragraph (i) would authorize VA to transport a guest of a veteran 
or servicemember who is traveling for the purpose of examination, 
treatment, or care. Section 70.70(b) includes a definition of the word 
guest. A guest would be a person who accompanies an eligible person but 
who is not providing necessary clinical support. In contrast, an 
attendant would be someone who has been determined to be clinically 
needed to aid and assist another person. Including these individuals is 
important to the care and treatment of veterans because it can provide 
comfort to the veteran during the clinical encounter and can assist 
with the veteran's care after the veteran has returned home by either 
training the guest or supporting the veteran's recollection of the 
provider's instructions. Transporting one additional individual on a 
vehicle represents only a marginal cost to VA and can provide a 
significant benefit to the veteran. However, guests would be 
transported only as resources permit. Consequently, if a veteran 
requested transportation for a guest, VA could decline to transport 
that person if it could not accommodate all veterans, servicemembers, 
Family Caregivers, attendants, and other CHAMPVA beneficiaries who have 
requested transportation services. VA Mobility Managers or other 
designated personnel would provide referrals to other non-VA 
transportation resources for guests in such a scenario. VA believes 
this limitation is important because it would allow VA to transport 
others for the benefit of the veteran, without compromising access for 
veterans, servicemembers, Family Caregivers, attendants, or other 
CHAMPVA beneficiaries.
    Paragraph (j) would define limitations on eligibility. Under 
paragraph (j)(1), VA would have the authority to restrict access to VTS 
when VA has determined that transporting a person has jeopardized or 
could jeopardize the health or safety of other eligible users of VTS or 
VA staff. A person may also be ineligible if the person's behavior has 
interfered or could interfere with the safe transportation of eligible 
persons to or from a VA facility or other place. Decisions to limit 
access under this paragraph would be made after considering, for 
example, the nature of the risk to other VTS users and VA staff, the 
individual's particular circumstances, and any prior decisions to 
restrict access to VTS. This provision is intended to balance an 
otherwise eligible individual's need for VTS services and the safety 
and well-being of veterans, other VTS users, and VA employees.
    Paragraph (j)(2) would limit the number of Family Caregivers, 
attendants, or guests that may travel with an eligible person on a 
given trip. Unless otherwise indicated by a VA clinician, a veteran or 
servicemember would not be able to be accompanied by more than one 
Family Caregiver, one attendant, or one guest per trip. This limitation 
is intended to preserve transportation resources for veterans and 
servicemembers, while allowing flexibility to ensure that patient needs 
are appropriately satisfied. However, more than one Family Caregiver 
may travel for receipt of his or her own benefits under Sec.  
70.71(e)(1) or (e)(2)(ii).
    Finally, paragraph (j)(3) would provide conditions under which a 
person under the age of 18 may accompany another person using VTS. 
Specifically, a parent or legal guardian would have to consent to the 
transportation, and the facility director or designee would have to 
consent to the transportation as well. The facility director or 
designee would consider the special transportation needs of the child, 
if any; the ability to transport the child safely using the available 
resources; the availability of services at the facility to accommodate 
the needs of the child; the appropriateness of transporting the child; 
and any other relevant factors. Applying these criteria, a facility 
director or designee may not consent to the transport of a child for 
several reasons. For example, if the person is an infant or small 
child, he or she may require a special car seat or other restraining 
device to ensure safe transportation. VA transportation of children 
would not be available if State law required the use of a child 
restraint, such as a child safety seat or booster seat. This limitation 
would be specifically noted in this paragraph, due to the potential 
dangers and liabilities that could result from improper use of a 
child's car seat or use of an improper child's car seat.
    Children could be accompanying another person using VTS because 
child care services could not be arranged. VA notes that a limited 
number of VA facilities offer child care services through a pilot 
program authorized by Public Law 111-163, 124 Stat. 1130 (2010), the 
Caregivers and Veterans

[[Page 30195]]

Omnibus Health Services Act of 2010. VA also could consider any other 
relevant factors on a case-by-case basis when making these 
determinations. VA does not provide benefits through CITI to persons 
under the age of 18, and as a result, this section would not address 
their eligibility.

70.72 Types of Transportation

    Under 38 CFR 70.72, VTS would be operated in one or more of the 
following types: Door-to-door service, designated location service, 
service between VA facilities, and other locations.
    Door-to-door service, as defined in paragraph (a), would consist of 
transporting an eligible person between a VA or VA-authorized facility 
and his or her residence or place where the person is staying. The 
eligible person could select a location other than his or her residence 
or place where the person is staying, but the selection of any other 
location would be subject to the approval of the facility director or 
designee assessing whether such a location is financially favorable to 
VA. The focus of this type of transportation is transporting the 
eligible person between a VA or VA-authorized facility and his or her 
home. This arrangement is the most patient-centered option and can 
allow VA to make multiple stops along the way to ensure as many persons 
are transported for care as possible. This type of transportation is 
likely to be particularly effective when persons are geographically 
concentrated in one location, as well as for persons with limited 
mobility or other disabilities, such as visual impairment, that would 
make transportation for health care services more difficult. VA could 
use this type of transportation to transport a patient who is being 
discharged from inpatient care and requests door-to-door service on an 
unscheduled basis. This is designed to ensure that veterans who have 
received inpatient care and may not have another means of returning 
home can do so safely.
    The default location for transportation would be the eligible 
person's residence or place where the person is staying, as it is with 
other VA transportation programs, most notably the beneficiary travel 
program. Under VTS, VA could transport persons from another location 
when such transportation is financially favorable to VA. For example, 
if a veteran lives in a remote area but works in an urban center and 
requests transportation from his or place of employment to a VA medical 
facility, VA could approve the requested transportation even though the 
departure location is the person's place of employment as it would 
require fewer miles driven and fewer resources used by VA. 
Determinations regarding financial favorability to the Department are 
currently made for VA's beneficiary travel program under Sec.  
70.30(b)(8), and.VA would apply these same criteria in the context of 
VTS.
    VA could also identify designated locations in communities from 
which it would transport eligible persons on a scheduled basis to VA or 
VA-authorized health care facilities and to which they would be 
transported under paragraph (b). This type of transportation moves 
eligible persons between VA or VA-authorized facilities and designated 
locations in the community. Veterans or other eligible persons wishing 
to ensure transport should contact the facility's Mobility Manager or 
other designated personnel using the process described in Sec.  70.73 
to reserve a seat on the vehicle. Decisions regarding reservations and 
allocation of seats when demand for transportation services exceeds 
supply would be made in accordance with established guidelines and 
criteria, as discussed in Sec.  70.73, but eligible persons generally 
would be accommodated on a first come, first served basis. VA intends 
that designated locations generally would be identified based upon 
convenience of access for persons and the consent of the property 
owner. In some communities, a private shopping complex might be the 
best location for persons to meet for transportation services, and in 
such a situation, the VA facility would need to agree with the property 
owner on the use of the property. Alternatively, a military base or a 
VA Regional Office may be ideally located, in which case such an 
agreement would not be necessary, provided the eligible VTS users 
otherwise have access to the area.
    Under paragraph (c), VA could transport eligible persons between VA 
or VA-authorized health care facilities either on a scheduled or 
unscheduled basis. An eligible person may need to travel from one VA 
building to another within a single VA campus for scheduled or 
unscheduled visits, for example, or a VA facility may wish to transport 
a veteran to another VA or VA-authorized facility for care that cannot 
be provided at one location but that could be accommodated at another. 
Any persons requiring emergency care that could be accommodated at the 
facility would be transported by ambulance (not a VTS vehicle) to the 
nearest VA or non-VA medical facility capable of delivering the 
required care. Payment of the ambulance costs would be determined in 
accordance with existing regulations in part 70. As indicated above, 
paragraph (c) also would authorize transportation from one building to 
another on a single VA campus. This is intended to ensure eligible 
veterans and other health care beneficiaries can safely access 
treatment and services.
    Finally, under paragraph (d), VA could transport eligible persons 
to and/or from a VA or VA-authorized facility or other locations. This 
type of transportation would allow VA to move eligible persons from one 
location to another when a VA clinician has determined that such 
transport is needed to promote, preserve, or restore the health of the 
individual and is in accord with generally accepted standards of 
medical practice as defined in Sec.  17.38(b). This is consistent with 
38 U.S.C. 111A, which requires that transportation be for the purpose 
of examination, treatment or care, and with VA's standards for the 
delivery of care in the medical benefits package in 38 CFR 17.38(b). 
Eligible persons could be transported from their home to another 
location, or from a VA or VA-authorized facility to another location, 
to promote, preserve, or restore the health of the individual. For 
example, blind or visually impaired veterans often need assistance in 
learning or updating navigation skills, and clinicians in VA's Blind 
Rehabilitation Center provide this support. Other transportation, such 
as day trips for nursing home patients or trips to retreat settings for 
persons undergoing counseling, could also be undertaken using VTS 
because the transportation would be considered treatment or care, 
authorized by chapter 17 of title 38. Travel under paragraph (d) would 
be permissible only for veterans and servicemembers and any attendants 
because the basis for transportation is to promote, preserve, or 
restore the health of an individual seeking or receiving VA care. VA 
could also transport a CHAMPVA beneficiary receiving health care 
benefits under the CITI program.

70.73 Arranging Transportation Services

    Eligible persons should contact the facility director or designee, 
in many cases the Mobility Manager, at the VA facility that is 
providing or authorizing the examination, treatment, or care for which 
the person is traveling to request transportation services. Persons 
could make a reservation by requesting transportation and providing the 
necessary information, including their name, the basis for the 
eligibility for transportation (as defined in Sec.  70.71), the name of 
the veteran or

[[Page 30196]]

servicemember they are accompanying (if applicable), the time of the 
appointment (if known), the location from and to which they will 
require transportation, any special needs that must be accommodated to 
allow for transportation (e.g., wheelchair, oxygen tank, service or 
guide dog), and other relevant information.
    Under paragraph (b), persons could travel without a reservation if 
they were being discharged from an inpatient setting or were traveling 
for an unscheduled visit pursuant to a recommendation by an attending 
VA clinician. Eligible persons could also travel without a reservation 
from one VA or VA-authorized facility to another, such as when a 
patient needs transportation from one building on campus to another. 
Eligible persons, whether requesting scheduled or unscheduled 
transport, would have to provide the necessary information described 
above. This information is needed to ensure a proper accounting of the 
program and to identify unmet transportation needs within the eligible 
population.
    Generally, transportation services under this authority would be 
provided on a first come, first served basis. However, paragraph (c) 
states that, when there are more requests for transportation than 
available resources, VA could prioritize the provision of 
transportation services using several criteria. These criteria are not 
listed in order of importance or consideration, and decisions would be 
made based on the totality of the circumstances so that no one factor 
is determinative. Requests made first in time generally would be 
prioritized over later requests, but VA could consider the clinical 
needs of each patient, the inability of a person to transport him or 
herself, the eligibility of a person for other transportation services 
and benefits, the availability of other transportation services, and 
the Department's ability to maximize the use of available resources.
    Under paragraph (c)(1), VA also could prioritize according to the 
eligibility bases for those seeking transportation services. Within 
this criterion, there would be a hierarchy: Enrolled veterans would 
receive first priority, followed, in order, by non-enrolled veterans; 
servicemembers; Family Caregivers; persons receiving counseling, 
training, or mental health services under 38 U.S.C. 1782 and 38 CFR 
71.50; CHAMPVA beneficiaries participating in the CITI program; and 
guests. VA realizes that some veterans are eligible for examination, 
treatment, care, or other services without enrolling. However, as a 
general practice, VA encourages veterans who seek care to enroll, so we 
believe the population of unenrolled veterans who would be affected by 
this hierarchy would be quite small. Based on past experience, VA 
anticipates the vast majority of eligible veterans would be enrolled 
but VA wishes to ensure that unenrolled veterans who have not 
previously come to VA for care or benefits have access to 
transportation to do so. VA understands that some eligible veterans may 
nonetheless choose to not enroll for various reasons, and we note that 
an unenrolled veteran who would be eligible for care notwithstanding 
his or her enrollment likely would receive priority after consideration 
of other criteria included here, including the clinical needs of the 
patient, the inability of the person to transport him or herself, and 
the availability of other transportation services.
    If a veteran or servicemember requires an attendant and is provided 
transportation through VTS, VA would provide transportation to the 
attendant as well because by definition, the veteran would be unable to 
travel without the aid of the attendant. This hierarchy reflects VA's 
core mission, to provide health care for veterans. Family Caregivers 
travel for purposes related to a veteran's or servicemember's 
conditions, and consequently would be prioritized next. Similarly, 
persons receiving counseling, training, or mental health services under 
38 U.S.C. 1782 and 38 CFR 71.50 are receiving these benefits as an 
extension of care for veterans. CHAMPVA beneficiaries participating in 
the CITI program are traveling for their own health care conditions and 
independent of a veteran's care, and consequently would follow. 
Finally, guests would be accommodated on an ``as available'' basis.
    Persons who are eligible under more than one designation (e.g., a 
veteran serves as a Family Caregiver for another veteran) would be 
considered based on the highest priority category applicable to that 
trip. For example, CHAMPVA beneficiaries participating in the CITI 
program traveling for their own benefits would qualify only under that 
designation, but if they were traveling to assist an eligible veteran 
or servicemember for that person's appointment, they would be traveling 
as an attendant. Similarly, if a Family Caregiver is also a veteran and 
is traveling for his or her own medical care, he or she would be 
traveling as a veteran. VA's Mobility Managers or other designated 
personnel would work with those seeking to arrange transportation 
services to determine the proper basis for eligibility.
    VA could also consider other criteria. These criteria would allow 
VA to ensure those with the greatest need are able to access these 
services. For example, an enrolled veteran in need of urgent care could 
be given priority over an enrolled veteran in need of non-urgent care. 
VA facilities also could make decisions to maximize the use of 
available resources. For example, if a group of veterans located in the 
same area request transportation and one veteran in another area 
several hours away also requests transportation, VA could choose to 
serve the similarly located veterans using VTS to ensure maximum access 
to its facilities and health care, and assist the remote veteran with 
finding transportation alternatives.
    VA would endeavor to maintain a greater supply of transportation 
slots than demand in all locations, but in cases where demand exceeds 
supply, VA Mobility Managers or other designated personnel at each 
facility would be responsible for informing persons whose 
transportation request cannot be accommodated by VTS that VA would not 
be able to transport them as requested. The Mobility Managers or other 
designated personnel would be responsible for assisting eligible 
persons with alternative transportation options.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as proposed to be 
revised by this proposed rulemaking, would represent VA's 
implementation of its legal authority on this subject. Other than 
future amendments to this regulation or governing statutes, no contrary 
guidance or procedures on this subject would be authorized. All VA 
guidance would be read to conform with this rulemaking if possible or, 
if not possible, such guidance would be superseded by this rulemaking.

Paperwork Reduction Act

    This proposed rule includes a collection of information under the 
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521) that requires 
approval by the Office of Management and Budget (OMB). Accordingly, 
under 44 U.S.C. 3507(d), VA has submitted a copy of this rulemaking to 
OMB for review.
    OMB assigns a control number for each collection of information it 
approves. VA may not conduct or sponsor, and a person is not required 
to respond to, a collection of information unless it displays a 
currently valid OMB control number. Section 70.73 contains a collection 
of information under the

[[Page 30197]]

Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521). If OMB does not 
approve the collection of information as requested, VA will immediately 
remove the provisions containing a collection of information or take 
such other action as is directed by OMB.
    Comments on the collection of information contained in this 
proposed rule should be submitted to the Office of Management and 
Budget, Attention: Desk Officer for the Department of Veterans Affairs, 
Office of Information and Regulatory Affairs, Washington, DC 20503, 
with copies sent by mail or hand delivery to the Director, Regulation 
Policy and Management (02REG), Department of Veterans Affairs, 810 
Vermont Avenue NW., Room 1068, Washington, DC 20420; fax to (202) 273-
9026; or through www.Regulations.gov. Comments should indicate that 
they are submitted in response to ``RIN 2900-AO92-Veterans 
Transportation Service.''
    OMB is required to make a decision concerning the collections of 
information contained in this rule between 30 and 60 days after 
publication of this document in the Federal Register. Therefore, a 
comment to OMB is best assured of having its full effect if OMB 
receives it within 30 days of publication. This does not affect the 
deadline for the public to comment on the rule.
    VA considers comments by the public on proposed collections of 
information in--
     Evaluating whether the proposed collections of information 
are necessary for the proper performance of the functions of VA, 
including whether the information will have practical utility;
     Evaluating the accuracy of VA's estimate of the burden of 
the proposed collections of information, including the validity of the 
methodology and assumptions used;
     Enhancing the quality, usefulness, and clarity of the 
information to be collected; and
     Minimizing the burden of the collections of information on 
those who are to respond, including through the use of appropriate 
automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology, e.g., permitting 
electronic submission of responses.
    The amendments to title 38 CFR part 70 contain collections of 
information under the Paperwork Reduction Act of 1995 for which we are 
requesting approval by OMB. These collections of information are 
described immediately following this paragraph, under their respective 
titles.
    Title: Veterans Transportation Service.
    Summary of collection of information: Section 70.73 would require 
eligible persons requesting transportation services from VA to provide 
their name, the basis of their eligibility (veteran, servicemember, 
Family Caregiver, attendant, CITI beneficiary, or guest), the name of 
the veteran or servicemember they are accompanying (if applicable), the 
time of the appointment (if known), the location of the person's 
arrival or departure, any special needs that must be accommodated to 
allow for transportation (e.g., wheelchair, oxygen tank, service or 
guide dog), and other relevant information.
    Description of the need for information and proposed use of 
information: The information is needed to ensure that only eligible 
persons are receiving VTS benefits, and to ensure the integrity of 
related transportation programs such as beneficiary travel. It is also 
necessary to measure and evaluate VTS to determine the effectiveness 
and need for the program, especially as it relates to the possibility 
of eligible persons also being eligible for beneficiary travel 
benefits. This information is also needed to ensure the safety of 
veterans in the event of an accident or other problem in the operation 
of the vehicle, and to ensure VA is prepared to assist the person in 
entering, exiting, and riding in the vehicle safely. VA may use this 
information to identify trends in usage of transportation services and 
make decisions on the allocation of resources to maximize benefits to 
the eligible population.
    Description of likely respondents: Eligible persons seeking 
transportation services from VA.
    Estimated number of respondents per year: 100,872 eligible persons.
    Estimated frequency of responses per month: 3.32 times per month.
    Estimated average burden per response: 5 minutes.
    Estimated total annual reporting and recordkeeping burden: 334,895 
hours.

Executive Orders 12866 and 13563

    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'' requiring review by OMB, unless OMB 
waives such review, as ``any regulatory action that is likely to result 
in a rule that may: (1) Have an annual effect on the economy of $100 
million or more or adversely affect in a material way the economy, a 
sector of the economy, productivity, competition, jobs, the 
environment, public health or safety, or State, local, or tribal 
governments or communities; (2) Create a serious inconsistency or 
otherwise interfere with an action taken or planned by another agency; 
(3) Materially alter the budgetary impact of entitlements, grants, user 
fees, or loan programs or the rights and obligations of recipients 
thereof; or (4) Raise novel legal or policy issues arising out of legal 
mandates, the President's priorities, or the principles set forth in 
this Executive Order.''
    The economic, interagency, budgetary, legal, and policy 
implications of this regulatory action have been examined, and it has 
been determined not to be a significant regulatory action. VA's impact 
analysis can be found as a supporting document at https://www.regulations.gov, usually within 48 hours after the rulemaking 
document is published. Additionally, a copy of the rulemaking and its 
impact analysis are available on VA's Web site at https://www.va.gov/orpm/, by following the link for VA Regulations Published from FY 2004 
through FYTD.

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 proposed rule would have no such 
effect on State, local, and tribal governments, or on the private 
sector.

Regulatory Flexibility Act

    The Secretary hereby certifies that this proposed rule would 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 proposed rule would authorize VA to transport 
eligible persons to and from VA or VA-authorized health care

[[Page 30198]]

facilities for the purposes of examination, treatment, or care. The 
proposed rule would affect individuals and have no impact on any small 
entities. Therefore, pursuant to 5 U.S.C. 605(b), this rulemaking is 
exempt from the initial and final regulatory flexibility analysis 
requirements of sections 603 and 604.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance numbers and titles for 
the programs affected by this document are as follows: 64.007, Blind 
Rehabilitation Centers; 64.009, Veterans Medical Care Benefits; 64.010, 
Veterans Nursing Home Care; 64.011, Veterans Dental Care; 64.013, 
Veterans Prosthetic Appliances; 64.018, Sharing Specialized Medical 
Resources; 64.019, Veterans Rehabilitation Alcohol and Drug Dependence; 
and 64.022, Veterans Home Based Primary Care.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document 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. Jose D. 
Riojas, Chief of Staff, Department of Veterans Affairs, approved this 
document on January 9, 2015, for publication.

List of Subjects in 38 CFR Part 70

    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.

    Dated: May 21, 2015 .
Michael Shores,
Chief Impact Analyst, Office of Regulation Policy & Management, Office 
of the General Counsel, U.S. Department of Veterans Affairs.

    For the reasons set forth in the preamble, VA proposes to amend 38 
CFR part 70 as follows:

PART 70--VETERANS TRANSPORTATION PROGRAMS

0
1. The authority citation for part 70 is revised to read as follows:

    Authority: 38 U.S.C. 101, 111, 111A, 501, 1701, 1714, 1720, 
1728, 1782, 1783, and E.O. 11302.

0
2. Revise the heading of part 70 to read as set forth above.
0
3. Add a heading for subpart A immediately before Sec.  70.1 to read as 
follows:

Subpart A--Beneficiary Travel and Special Mode Transportation under 
38 U.S.C. 111

0
4. Designate Sec. Sec.  70.1 through 70.50 as subpart A.
0
5. Add subpart B to read as follows:

Subpart B--Veterans Transportation Service under 38 U.S.C. 111A
Sec.
70.70 Purpose and definitions.
70.71 Eligibility.
70.72 Types of transportation.
70.73 Arranging transportation services.

Subpart B--Veterans Transportation Service under 38 U.S.C. 111A


Sec.  70.70  Purpose and definitions.

    (a) Purpose. This subpart implements the Veterans Transportation 
Service (VTS), through which VA transports eligible persons to or from 
a VA or VA-authorized facility or other place for the purpose of 
examination, treatment, or care.
    (b) Definitions. For purposes of this subpart:
    Attendant has the meaning set forth in Sec.  70.2, and also means 
an individual traveling with a veteran or servicemember who is eligible 
for travel under VTS and requires the aid and/or assistance of another 
person.
    Eligible person means a person described in Sec.  70.71.
    Guest means any individual the veteran or servicemember would like 
to have accompany him or her to an appointment but whose presence is 
not medically required.
    Scheduled visit means that a VA beneficiary had an appointment that 
was made before she or he appeared at a VA, or VA-authorized, facility, 
or that a VA beneficiary was specifically authorized to appear at such 
facility on the date of the visit in order to obtain examination, 
treatment, or care. Examples of scheduled visits include: regular 
appointments for examination, treatment, or care; visits to undergo 
laboratory work; or doctor-recommended visits to clinics with open 
hours.
    Unscheduled visit means a visit to a VA, or VA-authorized, facility 
for purposes of examination, treatment, or care that was not recorded 
in VA's scheduling system prior to the veteran's visit. For example, an 
unscheduled visit may be for a simple check of a person's blood 
pressure, for counseling, or for clinical intervention.

(Authority: 38 U.S.C. 111A, 501, 1714)

Sec.  70.71  Eligibility.

    Except as provided in paragraph (j) of this section, VA facilities 
may provide VTS benefits to the following:
    (a) Persons eligible for beneficiary travel. All persons eligible 
for beneficiary travel benefits in Sec.  70.10 are eligible for VTS 
benefits (however, persons cannot claim benefits under both programs 
for the same trip or portion of a trip).
    (b) Enrolled veterans. Regardless of a veteran's eligibility for 
beneficiary travel, VA may provide VTS to veterans enrolled in VA's 
health care system who need transportation authorized under Sec.  70.72 
for:
    (1) A scheduled visit or urgent care;
    (2) Retrieval of, adjustment of, or training concerning 
medications, prosthetic appliances, or a service dog (as defined in 38 
CFR 17.148);
    (3) An unscheduled visit; or
    (4) To participate and attend other events or functions, as 
clinically determined by VA, for the purposes of examination, 
treatment, or care.
    (c) Non-enrolled veterans. VA may provide VTS to veterans not 
enrolled in VA's health care system who need transportation authorized 
under Sec.  70.72 for:
    (1) A compensation and pension examination;
    (2) An unscheduled or walk-in visit;
    (3) To apply for enrollment or health care benefits; or
    (4) To participate and attend other events or functions, as 
clinically determined by VA, for the purposes of examination, 
treatment, or care.
    (d) Servicemembers. VA may provide VTS to a member of the Armed 
Forces (including the National Guard or Reserve) traveling to a VA or 
VA-authorized facility for VA hospital care or medical services, 
including examination, treatment or care, a compensation and pension 
examination, or to enroll or otherwise receive benefits for which they 
are eligible.
    (e) Prospective Family Caregivers and Family Caregivers. (1) VA may 
provide VTS to a prospective Family Caregiver who has applied for 
designation as a Family Caregiver under 38 CFR 71.25(a) when the travel 
is for purposes of assessment and training under 38 CFR 71.25(c) and 
(d).
    (2) VA may provide VTS to a Family Caregiver (who is approved and 
designated under 38 CFR 71.25) of veteran or servicemember described in

[[Page 30199]]

paragraphs (b) through (d) of this section to:
    (i) Accompany or travel independently from a veteran or 
servicemember for purposes of examination, treatment, or care of the 
veteran or servicemember; or
    (ii) Receive benefits under 38 CFR 71.40(b) or 71.40(c). For health 
care benefits provided under 38 CFR 71.40(c)(3), Primary Family 
Caregivers may travel using VTS for care only if it is provided at a VA 
facility through the Civilian Health and Medical Program of the 
Department of Veterans Affairs (CHAMPVA) Inhouse Treatment Initiative 
(CITI).
    (f) Attendants. VA may provide VTS to an attendant of a veteran or 
servicemember described in paragraphs (b) through (d) of this section.
    (g) Persons receiving counseling, training, or mental health 
services. VA may provide VTS to persons receiving counseling, training, 
or mental health services under 38 U.S.C. 1782 and 38 CFR 71.50.
    (h) CHAMPVA beneficiaries. VA may provide VTS to persons eligible 
for health care under the Civilian Health and Medical Program of the 
Department of Veterans Affairs (CHAMPVA) under 38 CFR 17.270 through 
17.278, provided that such care is being provided at a VA facility 
through the CHAMPVA Inhouse Treatment Initiative (CITI).
    (i) Guests. For each veteran described in paragraph (b) or (c) of 
this section or member of the Armed Forces described in paragraph (d) 
of this section, a guest may travel with the veteran or servicemember 
provided resources are still available after providing services to 
individuals identified in paragraphs (b) through (h) of this section.
    (j) Limitations on eligibility. Notwithstanding an individual's 
eligibility under this section:
    (1) A person may be ineligible for transportation services if VA 
determines the person's behavior has jeopardized or could jeopardize 
the health or safety of other eligible users of VTS or VA staff, or 
otherwise has interfered or could interfere with the safe 
transportation of eligible persons to or from a VA facility or other 
place.
    (2) Only one person may travel with an eligible veteran or 
servicemember as a Family Caregiver, attendant, or guest, unless a VA 
clinician determines that more than one such person is needed or would 
otherwise be beneficial to the examination, treatment, or care of the 
eligible veteran or servicemember. Family Caregivers traveling for 
benefits under paragraph (e)(1) or (e)(2)(ii) of this section are not 
subject to this limitation.
    (3) Persons under the age of 18 may accompany another person using 
VTS with the consent of their parent or legal guardian and the medical 
facility director or designee. VA transportation of children is not 
available if State law requires the use of a child restraint, such as a 
child safety seat or booster seat. In making determinations under this 
provision, the medical facility director or designee will consider:
    (i) The special transportation needs of the child, if any;
    (ii) The ability to transport the child safely using the available 
resources;
    (iii) The availability of services at the facility to accommodate 
the needs of the child;
    (iv) The appropriateness of transporting the child; and
    (v) Any other relevant factors.

(Authority: 38 U.S.C. 111A, 1714, 1720G, 1781, 1782, 501)

Sec.  70.72  Types of transportation.

    The following types of transportation may be provided by VA 
facilities through VTS:
    (a) Door-to-door service. VA facilities may use VTS to transport, 
on a scheduled or unscheduled basis, eligible persons between a VA or 
VA-authorized facility and their residence or a place where the person 
is staying. VA facilities may use VTS to transport eligible persons to 
and from a VA or VA-authorized facility and another location identified 
by the person when it is financially favorable to the government to do 
so.
    (b) Travel to and from designated locations. VA facilities may use 
VTS to provide transportation between a VA or VA-authorized facility 
and a designated location in the community on a scheduled basis.
    (c) Service between VA facilities. VA facilities may use VTS to 
provide scheduled or unscheduled transportation between VA or VA-
authorized health care facilities. This includes travel from one 
building to another within a single VA campus.
    (d) Other locations. VA facilities may use VTS to provide scheduled 
or unscheduled transportation to and/or from a VA or VA-authorized 
facility or other places when a VA clinician has determined that such 
transportation of the veteran, servicemember, their attendant(s), or 
CHAMPVA beneficiary receiving benefits through the CITI program would 
be needed to promote, preserve, or restore the health of the individual 
and is in accord with generally accepted standards of medical practice, 
as defined in 38 CFR 17.38(b).

(Authority: 38 U.S.C. 111A, 501, 1718, 7301)

Sec.  70.73  Arranging transportation services.

    (a) Requesting VTS. An eligible person may request transportation 
services by contacting the facility director or designee at the VA 
facility providing or authorizing the examination, treatment, or care 
to be delivered. The person must provide the facility director or 
designee with information necessary to arrange these services, 
including the name of the person, the basis for eligibility, the name 
of the veteran or servicemember they are accompanying (if applicable), 
the time of the appointment (if known), the eligible person's departure 
location and destination, any special needs that must be accommodated 
to allow for transportation (e.g., wheelchair, oxygen tank, service or 
guide dog), and other relevant information. Transportation services 
generally will be provided on a first come, first served basis.
    (b) Travel without a reservation. Eligible persons who have 
provided the facility director or designee with the information 
referred to in the previous paragraph may travel without a reservation 
for the purpose of examination, treatment, or care when, for example:
    (1) The person is being discharged from inpatient care;
    (2) The person is traveling for an unscheduled visit, pursuant to a 
recommendation for such a visit by an attending VA clinician; or
    (3) The person is being transported to another VA or VA-authorized 
facility.
    (c) Determining priority for transportation. When the facility 
director or designee determines there are insufficient resources to 
transport all persons requesting transportation services, he or she 
will assist any person denied VTS in identifying and accessing other 
transportation options. VTS resources will be allocated using the 
following criteria, which are to be assessed in the context of the 
totality of the circumstances, so that no one factor is determinative:
    (1) The eligible person's basis for eligibility. Enrolled veterans 
will receive first priority, followed in order by non-enrolled 
veterans; servicemembers; Family Caregivers; persons receiving 
counseling, training, or mental health services under 38 U.S.C. 1782 
and 38 CFR 71.50; CITI beneficiaries; and guests. Persons eligible 
under more than one designation will be considered in the highest 
priority category for which that trip permits. VA will provide 
transportation to any attendant accompanying a veteran or servicemember 
who is approved for transportation.

[[Page 30200]]

    (2) First in time request.
    (3) An eligible person's clinical need.
    (4) An eligible person's inability to transport him or herself 
(e.g., visual impairment, immobility, etc.).
    (5) An eligible person's eligibility for other transportation 
services or benefits.
    (6) The availability of other transportation services (e.g., common 
carriers, veterans' service organizations, etc.).
    (7) The VA facility's ability to maximize the use of available 
resources. (The Office of Management and Budget has approved the 
information collection requirements in this section under control 
number XXXX-XXXX.)

(Authority: 38 U.S.C. 111A, 501)


[FR Doc. 2015-12724 Filed 5-26-15; 8:45 am]
 BILLING CODE 8320-01-P