Copayments for Medications, 69283-69285 [E9-31124]
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Federal Register / Vol. 74, No. 250 / Thursday, December 31, 2009 / Rules and Regulations
customer and noncustomer positions in
accounts carried by the FCM, subject to
the following.
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(9) Cleared over the counter derivative
positions means ‘‘over the counter
derivative instrument’’ (as defined in 12
U.S.C. 4421) positions of any person in
accounts carried on the books of the
futures commission merchant and
cleared by any organization permitted to
clear such instruments under the laws
of the relevant jurisdiction.
(10) Cleared over the counter
customer means any person that is not
a proprietary person as defined in
§ 1.3(y) and for whom the futures
commission merchant carries on its
books one or more accounts for the over
the counter-cleared derivative positions
of such person.
(c) * * *
(5) * * *
(x) In the case of open futures
contracts or cleared OTC derivative
positions and granted (sold) commodity
options held in proprietary accounts
carried by the applicant or registrant
which are not covered by a position
held by the applicant or registrant or
which are not the result of a ‘‘changer
trade’’ made in accordance with the
rules of a contract market:
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Issued in Washington, DC, on December
24, 2009, by the Commission.
David A. Stawick,
Secretary of the Commission.
[FR Doc. E9–31058 Filed 12–30–09; 8:45 am]
BILLING CODE P
DEPARTMENT OF VETERANS
AFFAIRS
38 CFR Part 17
RIN 2900–AN50
Copayments for Medications
Department of Veterans Affairs.
Interim final rule.
AGENCY:
erowe on DSK5CLS3C1PROD with RULES
ACTION:
SUMMARY: The Department of Veterans
Affairs (VA) is taking action to amend
its medical regulations concerning the
copayment required for certain
medications. Under current regulations,
the copayment amount must be
increased based on the prescription
drug component of the Medical
Consumer Price Index, and the
maximum annual copayment amount
must be increased when the copayment
is increased. Under the amendments in
this document, we will freeze
copayments at the current rate for the
next 6 months, and thereafter resume
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13:48 Dec 30, 2009
Jkt 220001
increasing copayments in accordance
with any change in the prescription
drug component of the Medical
Consumer Price Index.
DATES: This rule is effective on
December 31, 2009. Comments must be
received on or before February 1, 2010.
ADDRESSES: Written comments may be
submitted by e-mail through https://
www.regulations.gov; by mail or handdelivery to Director, Regulations
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–
AN50 Copayments for Medications.’’
Copies of comments received will be
available for public inspection in the
Office of Regulation Policy and
Management, Room 1063B, between the
hours of 8 a.m. and 4:30 p.m. Monday
through Friday (except holidays). Please
call (202) 461–4902 for an appointment.
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:
Roscoe Butler, Acting Director, Business
Policy, Chief Business Office, 810
Vermont Ave., Washington, DC 20420,
202–461–1586. (This is not a toll-free
number.)
Under 38
U.S.C. 1722A(a), VA must require
veterans to pay a $2 copayment for each
30-day supply of medication furnished
on an outpatient basis for the treatment
of a nonservice-connected disability or
condition. Under 38 U.S.C. 1722A(b),
VA ‘‘may’’ by regulation increase that
copayment and establish a maximum
annual copayment (a ‘‘cap’’). We
interpret section 1722A(b) to mean that
VA has discretion to determine the
appropriate copayment amount and
annual cap amount for medication
furnished on an outpatient basis for
covered treatment, provided that any
decision by VA to increase the
copayment amount or annual cap
amount is the subject of a rulemaking
proceeding. We have implemented this
statute in 38 CFR 17.110.
Under current 38 CFR 17.110(b)(1),
veterans are ‘‘obligated to pay VA a
copayment for each 30-day or less
supply of medication provided by VA
on an outpatient basis (other than
medication administered during
treatment).’’ The regulation ties any
increase in that copayment amount to
the prescription drug component of the
Medical Consumer Price Index (CPI–P).
SUPPLEMENTARY INFORMATION:
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69283
The current regulation includes an
escalator provision for the copayment
amount. The regulation states that the
copayment amount for each calendar
year after 2002 is established using the
CPI–P as follows: For each calendar year
beginning after December 31, 2002, the
Index as of the previous September 30
will be divided by the Index as of
September 30, 2001. The ratio so
obtained will be multiplied by the
original copayment amount of $7. The
copayment amount for the new year will
be this result, rounded down to the
whole dollar amount.
Current § 17.110(b)(2), also includes a
cap on the total amount of copayments
in a calendar year for a veteran enrolled
in one of the priority categories 2
through 6. The amount of the cap was
$840 for the year 2002. The current
regulation also requires that ‘‘[i]f the
copayment amount increases * * * the
cap of $840 shall be increased by $120
for each $1 increase in the copayment
amount.’’ 38 CFR 17.110(b)(2).
In January 2006, based on this
regulation, the copayment amount
increased to $8 and the cap on priority
categories 2 through 6 increased to
$960. This change was announced in 70
FR 72329 (December 2, 2005). These are
the current copayment requirements.
Based on our analysis of the average rate
of growth of the CPI–P, the current
regulatory methodology, calculated
according to the CPI–P as of September
30, 2009, would automatically escalate
the copayment amount from $8 to $9 in
January 2010. Current § 17.110(b) does
not afford the Secretary any discretion
on increasing the copayment amount as
calculated by the CPI–P.
Although we continue to believe that
the CPI–P is a relevant indicator of the
costs of prescriptions nationwide, we
need time to determine whether an
increase might pose a significant
financial hardship for certain veterans
and if so, what alternative approach
would provide appropriate relief for
these veterans. In light of this
anticipated review, we are delaying
implementation of the $1 increase in the
copayment amount (and the
corresponding $120 increase in the cap)
until the completion of our review.
Maintaining the current copayment and
cap amounts will give us time to
determine whether the current
methodology for establishing copayment
amounts, consistent with our
responsibility under 38 U.S.C. 1722A to
require a copayment in order to control
health-care costs, is appropriate for all
veterans.
Therefore, we are, for the next 6
months (i.e., through June 30, 2010),
freezing the copayment amount at the
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31DER1
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69284
Federal Register / Vol. 74, No. 250 / Thursday, December 31, 2009 / Rules and Regulations
current rate ($8) in order to complete
the analysis regarding veterans for
whom the copayment increase might
pose a significant financial hardship.
We are also freezing the cap at the
current level ($960).
This rule maintains the current
escalator clause. Depending on the
results of the analysis described above,
the Secretary may initiate new
rulemaking on this subject rather than
continue to rely on the CPI–P escalator
provision to determine the copayment
amount. Any change in the copayment
amount and cap, along with the
associated calculations explaining the
basis for the increase, would be
published in a Federal Register notice.
At the end of June 30, 2010, unless
additional rulemaking is initiated, VA
would once again utilize the CPI–P
methodology in § 17.110(b)(1) to
determine whether to increase
copayments and calculate any mandated
increase in the copayment amount. At
that time the CPI–P as of June 30, 2010,
would be divided by the index as of
September 30, 2001. The ratio would
then be multiplied by the original
copayment amount of $7. The
copayment amount of the new calendar
year would be rounded down to the
whole dollar amount. As mandated by
the § 17.110(b)(2), the annual cap would
be calculated by increasing the cap by
$120 for each $1 increase in the
copayment amount. Any change in the
copayment amount and cap, along with
the associated calculations explaining
the basis for the increase, would be
published in a Federal Register notice.
Thus, the intended effect of this rule is
to temporarily freeze copayments and
the copayment cap, following which
copayments and the copayment cap
would increase as prescribed in
§ 17.110(b).
The current regulation includes a note
to paragraph (b)(1) that provides an
example of how the CPI–P calculation is
made. We are updating this note to
provide a recent example of how these
amounts are calculated. This example
reflects the calculation that was made
on December 2, 2005, when VA
published notice of the increase in
copayments from $7 to $8. This note
reflects the last calculation made under
this regulation.
We are also adding a new paragraph
(b)(3), which informs the public where
it can find information on the current
copayment and cap amounts.
Administrative Procedure Act
In accordance with 5 U.S.C.
553(b)(3)(B) and (d)(3), the Secretary of
Veterans Affairs finds that there is good
cause to dispense with the opportunity
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13:48 Dec 30, 2009
Jkt 220001
for advance notice and opportunity for
public comment and good cause to
publish this rule with an immediate
effective date. As stated above, this rule
freezes at current rates the prescription
drug copayment that VA charges
veterans. The Secretary finds that it is
impracticable and contrary to the public
interest to delay this regulation for the
purpose of soliciting advance public
comment, or to have a delayed effective
date, because increasing the copayment
on January 1, 2010, might cause
significant financial hardship on certain
veterans.
For these reasons, the Secretary of
Veterans Affairs is issuing this rule as
an interim final rule. The Secretary of
Veterans Affairs will consider and
address comments that are received
within 30 days of the date this interim
final rule is published in the Federal
Register.
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 an
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
given year. This rule would have no
such effect on State, local, and tribal
governments, or on the private sector.
Paperwork Reduction Act
This document contains no provisions
constituting a collection of information
under the Paperwork Reduction Act (44
U.S.C. 3501–3521).
Executive Order 12866
Executive Order 12866 directs
agencies to assess all 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, and other advantages;
distributive impacts; and equity). The
Executive Order classifies a regulatory
action as a ‘‘significant regulatory
action,’’ requiring review by the Office
of Management and Budget (OMB)
unless OMB waives such review, if it is
a 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
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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 the Executive
Order.
The economic, interagency,
budgetary, legal, and policy
implications of this rule have been
examined and it has been determined
not to be a significant regulatory action
under Executive Order 12866.
Regulatory Flexibility Act
The Secretary hereby certifies that
this regulatory amendment 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
rule will freeze the copayments that
certain veterans are required to pay for
prescription drugs furnished by VA. The
rule affects individuals and has no
impact on any small entities. Therefore,
pursuant to 5 U.S.C. 605(b), this interim
final rule 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 program numbers and titles
for this rule are as follows: 64.005,
Grants to States for Construction of State
Home Facilities; 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; 64.022, Veterans
Home Based Primary Care; and 64.024,
VA Homeless Providers Grant and Per
Diem Program.
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,
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Federal Register / Vol. 74, No. 250 / Thursday, December 31, 2009 / Rules and Regulations
Reporting and recordkeeping
requirements, Scholarships and
fellowships, Travel and transportation
expenses, Veterans.
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. John
R. Gingrich approved this document for
publication on December 28, 2009.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
For the reasons set forth in the
preamble, VA amends 38 CFR part 17 as
follows:
■
one of the priority categories 2 through
6 of VA’s health care system (see
§ 17.36) shall not exceed the cap
established for the calendar year. During
the period from January 1, 2010 through
June 30, 2010, the cap will be $960. If
the copayment amount increases after
June 30, 2010, the cap of $960 shall be
increased by $120 for each $1 increase
in the copayment amount.
(3) Information on copayment/cap
amounts. Current copayment and cap
amounts are available at any VA
Medical Center and on our Web site,
https://www.va.gov. Notice of any
increases to the copayment and
corresponding increases to annual cap
amount will be published in the Federal
Register.
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[FR Doc. E9–31124 Filed 12–30–09; 8:45 am]
PART 17—MEDICAL
BILLING CODE P
1. The authority citation for part 17
continues to read as follows:
■
Authority: 38 U.S.C. 501, 1721, and as
noted in specific sections.
FEDERAL COMMUNICATIONS
COMMISSION
2. In § 17.110, paragraph (b) is revised
to read as follows:
47 CFR Part 76
■
§ 17.110
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(b) Copayments—(1) Copayment
amount. Unless exempted under
paragraph (c) of this section, a veteran
is obligated to pay VA a copayment for
each 30-day or less supply of
medication provided by VA on an
outpatient basis (other than medication
administered during treatment). For the
period from January 1, 2010 through
June 30, 2010, the copayment amount is
$8. Thereafter, the copayment amount
for each calendar year or other period as
determined by the Secretary will be
established by using the prescription
drug component of the Medical
Consumer Price Index as follows: The
Index as of the previous September 30
will be divided by the Index as of
September 30, 2001. The ratio so
obtained will be multiplied by the
original copayment amount of $7. The
new copayment amount will be this
result, rounded down to the whole
dollar amount.
erowe on DSK5CLS3C1PROD with RULES
[FCC 09–113]
Copayments for medication.
Note to paragraph (b)(1): Example for
determining copayment amount.
The ratio of the prescription drug
component of the Medical Consumer Price
Index for September 30, 2005, to the
corresponding Index for September 30, 2001,
was 1.1542. This ratio, when multiplied by
the original copayment amount of $7 equals
$8.08, and the copayment amount beginning
in calendar year 2006, rounded down to the
whole dollar amount, was set at $8.
(2) The total amount of copayments in
a calendar year for a veteran enrolled in
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Jkt 220001
Implementation of Section 1003(b) of
the Department of Defense
Appropriations Act, 2010
AGENCY: Federal Communications
Commission.
ACTION: Final rule.
SUMMARY: This document establishes a
new sunset date for certain
Commission’s rules applicable to
retransmission consent in accordance
with Section 1003(b) of the Department
of Defense Appropriations Act, 2010,
Public Law No. 111–118.
DATES: Effective December 31, 2009.
ADDRESSES: Federal Communications
Commission, 445 12th Street, SW.,
Washington, DC 20554.
FOR FURTHER INFORMATION CONTACT: For
additional information on this
proceeding, contact David Konczal,
David.Konczal@fcc.gov, of the Media
Bureau, Policy Division, (202) 418–
2120.
This is a
summary of the Order, FCC 09–113,
adopted and released on December 28,
2009. The full text of this document is
available for public inspection and
copying during regular business hours
in the FCC Reference Center, Federal
Communications Commission, 445 12th
Street, SW., CY–A257, Washington, DC
20554. This document will also be
available via ECFS (https://www.fcc.gov/
cgb/ecfs/). (Documents will be available
SUPPLEMENTARY INFORMATION:
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69285
electronically in ASCII, Word 97, and/
or Adobe Acrobat.) The complete text
may be purchased from the
Commission’s copy contractor, 445 12th
Street, SW., Room CY–B402,
Washington, DC 20554. To request this
document in accessible formats
(computer diskettes, large print, audio
recording, and Braille), send an e-mail
to fcc504@fcc.gov or call the
Commission’s Consumer and
Governmental Affairs Bureau at (202)
418–0530 (voice), (202) 418–0432
(TTY).
Summary of the Order
I. Introduction
1. In this Order, we amend §§ 76.64(l)
and 76.65(f) of the Commission’s rules
in accordance with Section 1003(b) of
the Department of Defense
Appropriations Act, 2010, Public Law
No. 111–118, Sec. 1003(b) (2009), which
was enacted on December 19, 2009.
Section 325(b)(3)(C)(ii) of the
Communications Act of 1934, as
amended (the ‘‘Act’’), required the
Commission to adopt regulations that,
until January 1, 2010, prohibit a
television broadcast station that
provides retransmission consent from
engaging in exclusive contracts for
carriage or failing to negotiate in good
faith. 47 U.S.C. 325(b)(3)(C)(ii). Section
325(b)(3)(C)(iii) required the
Commission to adopt regulations that,
until January 1, 2010, prohibit a
multichannel video programming
distributor from failing to negotiate in
good faith for retransmission consent.
47 U.S.C. 325(b)(3)(C)(iii). The
Commission has previously adopted
rules to implement these provisions,
including §§ 76.64(l) and 76.65(f) to
reflect the sunset date of January 1,
2010. See 47 CFR 76.64(l) (‘‘Exclusive
retransmission consent agreements are
prohibited. No television broadcast
station shall make or negotiate any
agreement with one multichannel video
programming distributor for carriage to
the exclusion of other multichannel
video programming distributors. This
paragraph shall terminate at midnight
on December 31, 2009.’’); 47 CFR
76.65(f) (‘‘Termination of rules. This
section shall terminate at midnight on
December 31, 2009.’’).
2. In Section 1003(b) of the
Department of Defense Appropriations
Act, 2010, Congress amended Sections
325(b)(3)(C)(ii) and (iii) to replace the
previous sunset date of January 1, 2010
with a new sunset date of March 1,
2010. See Department of Defense
Appropriations Act, 2010, Public Law
No. 111–118, Sec. 1003(b). Accordingly,
we are amending our rules to reflect the
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Agencies
[Federal Register Volume 74, Number 250 (Thursday, December 31, 2009)]
[Rules and Regulations]
[Pages 69283-69285]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-31124]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AN50
Copayments for Medications
AGENCY: Department of Veterans Affairs.
ACTION: Interim final rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) is taking action to
amend its medical regulations concerning the copayment required for
certain medications. Under current regulations, the copayment amount
must be increased based on the prescription drug component of the
Medical Consumer Price Index, and the maximum annual copayment amount
must be increased when the copayment is increased. Under the amendments
in this document, we will freeze copayments at the current rate for the
next 6 months, and thereafter resume increasing copayments in
accordance with any change in the prescription drug component of the
Medical Consumer Price Index.
DATES: This rule is effective on December 31, 2009. Comments must be
received on or before February 1, 2010.
ADDRESSES: Written comments may be submitted by e-mail through https://www.regulations.gov; by mail or hand-delivery to Director, Regulations
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-AN50 Copayments for Medications.'' Copies of comments received
will be available for public inspection in the Office of Regulation
Policy and Management, Room 1063B, between the hours of 8 a.m. and 4:30
p.m. Monday through Friday (except holidays). Please call (202) 461-
4902 for an appointment. 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: Roscoe Butler, Acting Director,
Business Policy, Chief Business Office, 810 Vermont Ave., Washington,
DC 20420, 202-461-1586. (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: Under 38 U.S.C. 1722A(a), VA must require
veterans to pay a $2 copayment for each 30-day supply of medication
furnished on an outpatient basis for the treatment of a nonservice-
connected disability or condition. Under 38 U.S.C. 1722A(b), VA ``may''
by regulation increase that copayment and establish a maximum annual
copayment (a ``cap''). We interpret section 1722A(b) to mean that VA
has discretion to determine the appropriate copayment amount and annual
cap amount for medication furnished on an outpatient basis for covered
treatment, provided that any decision by VA to increase the copayment
amount or annual cap amount is the subject of a rulemaking proceeding.
We have implemented this statute in 38 CFR 17.110.
Under current 38 CFR 17.110(b)(1), veterans are ``obligated to pay
VA a copayment for each 30-day or less supply of medication provided by
VA on an outpatient basis (other than medication administered during
treatment).'' The regulation ties any increase in that copayment amount
to the prescription drug component of the Medical Consumer Price Index
(CPI-P). The current regulation includes an escalator provision for the
copayment amount. The regulation states that the copayment amount for
each calendar year after 2002 is established using the CPI-P as
follows: For each calendar year beginning after December 31, 2002, the
Index as of the previous September 30 will be divided by the Index as
of September 30, 2001. The ratio so obtained will be multiplied by the
original copayment amount of $7. The copayment amount for the new year
will be this result, rounded down to the whole dollar amount.
Current Sec. 17.110(b)(2), also includes a cap on the total amount
of copayments in a calendar year for a veteran enrolled in one of the
priority categories 2 through 6. The amount of the cap was $840 for the
year 2002. The current regulation also requires that ``[i]f the
copayment amount increases * * * the cap of $840 shall be increased by
$120 for each $1 increase in the copayment amount.'' 38 CFR
17.110(b)(2).
In January 2006, based on this regulation, the copayment amount
increased to $8 and the cap on priority categories 2 through 6
increased to $960. This change was announced in 70 FR 72329 (December
2, 2005). These are the current copayment requirements. Based on our
analysis of the average rate of growth of the CPI-P, the current
regulatory methodology, calculated according to the CPI-P as of
September 30, 2009, would automatically escalate the copayment amount
from $8 to $9 in January 2010. Current Sec. 17.110(b) does not afford
the Secretary any discretion on increasing the copayment amount as
calculated by the CPI-P.
Although we continue to believe that the CPI-P is a relevant
indicator of the costs of prescriptions nationwide, we need time to
determine whether an increase might pose a significant financial
hardship for certain veterans and if so, what alternative approach
would provide appropriate relief for these veterans. In light of this
anticipated review, we are delaying implementation of the $1 increase
in the copayment amount (and the corresponding $120 increase in the
cap) until the completion of our review. Maintaining the current
copayment and cap amounts will give us time to determine whether the
current methodology for establishing copayment amounts, consistent with
our responsibility under 38 U.S.C. 1722A to require a copayment in
order to control health-care costs, is appropriate for all veterans.
Therefore, we are, for the next 6 months (i.e., through June 30,
2010), freezing the copayment amount at the
[[Page 69284]]
current rate ($8) in order to complete the analysis regarding veterans
for whom the copayment increase might pose a significant financial
hardship. We are also freezing the cap at the current level ($960).
This rule maintains the current escalator clause. Depending on the
results of the analysis described above, the Secretary may initiate new
rulemaking on this subject rather than continue to rely on the CPI-P
escalator provision to determine the copayment amount. Any change in
the copayment amount and cap, along with the associated calculations
explaining the basis for the increase, would be published in a Federal
Register notice.
At the end of June 30, 2010, unless additional rulemaking is
initiated, VA would once again utilize the CPI-P methodology in Sec.
17.110(b)(1) to determine whether to increase copayments and calculate
any mandated increase in the copayment amount. At that time the CPI-P
as of June 30, 2010, would be divided by the index as of September 30,
2001. The ratio would then be multiplied by the original copayment
amount of $7. The copayment amount of the new calendar year would be
rounded down to the whole dollar amount. As mandated by the Sec.
17.110(b)(2), the annual cap would be calculated by increasing the cap
by $120 for each $1 increase in the copayment amount. Any change in the
copayment amount and cap, along with the associated calculations
explaining the basis for the increase, would be published in a Federal
Register notice. Thus, the intended effect of this rule is to
temporarily freeze copayments and the copayment cap, following which
copayments and the copayment cap would increase as prescribed in Sec.
17.110(b).
The current regulation includes a note to paragraph (b)(1) that
provides an example of how the CPI-P calculation is made. We are
updating this note to provide a recent example of how these amounts are
calculated. This example reflects the calculation that was made on
December 2, 2005, when VA published notice of the increase in
copayments from $7 to $8. This note reflects the last calculation made
under this regulation.
We are also adding a new paragraph (b)(3), which informs the public
where it can find information on the current copayment and cap amounts.
Administrative Procedure Act
In accordance with 5 U.S.C. 553(b)(3)(B) and (d)(3), the Secretary
of Veterans Affairs finds that there is good cause to dispense with the
opportunity for advance notice and opportunity for public comment and
good cause to publish this rule with an immediate effective date. As
stated above, this rule freezes at current rates the prescription drug
copayment that VA charges veterans. The Secretary finds that it is
impracticable and contrary to the public interest to delay this
regulation for the purpose of soliciting advance public comment, or to
have a delayed effective date, because increasing the copayment on
January 1, 2010, might cause significant financial hardship on certain
veterans.
For these reasons, the Secretary of Veterans Affairs is issuing
this rule as an interim final rule. The Secretary of Veterans Affairs
will consider and address comments that are received within 30 days of
the date this interim final rule is published in the Federal Register.
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 an 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 given year. This rule would have no such effect on
State, local, and tribal governments, or on the private sector.
Paperwork Reduction Act
This document contains no provisions constituting a collection of
information under the Paperwork Reduction Act (44 U.S.C. 3501-3521).
Executive Order 12866
Executive Order 12866 directs agencies to assess all 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,
and other advantages; distributive impacts; and equity). The Executive
Order classifies a regulatory action as a ``significant regulatory
action,'' requiring review by the Office of Management and Budget (OMB)
unless OMB waives such review, if it is a 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
the Executive Order.
The economic, interagency, budgetary, legal, and policy
implications of this rule have been examined and it has been determined
not to be a significant regulatory action under Executive Order 12866.
Regulatory Flexibility Act
The Secretary hereby certifies that this regulatory amendment 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 rule will freeze the copayments that certain
veterans are required to pay for prescription drugs furnished by VA.
The rule affects individuals and has no impact on any small entities.
Therefore, pursuant to 5 U.S.C. 605(b), this interim final rule 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 program numbers and
titles for this rule are as follows: 64.005, Grants to States for
Construction of State Home Facilities; 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; 64.022, Veterans Home Based
Primary Care; and 64.024, VA Homeless Providers Grant and Per Diem
Program.
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,
[[Page 69285]]
Reporting and recordkeeping requirements, Scholarships and fellowships,
Travel and transportation expenses, Veterans.
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. John R.
Gingrich approved this document for publication on December 28, 2009.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
0
For the reasons set forth in the preamble, VA amends 38 CFR part 17 as
follows:
PART 17--MEDICAL
0
1. The authority citation for part 17 continues to read as follows:
Authority: 38 U.S.C. 501, 1721, and as noted in specific
sections.
0
2. In Sec. 17.110, paragraph (b) is revised to read as follows:
Sec. 17.110 Copayments for medication.
* * * * *
(b) Copayments--(1) Copayment amount. Unless exempted under
paragraph (c) of this section, a veteran is obligated to pay VA a
copayment for each 30-day or less supply of medication provided by VA
on an outpatient basis (other than medication administered during
treatment). For the period from January 1, 2010 through June 30, 2010,
the copayment amount is $8. Thereafter, the copayment amount for each
calendar year or other period as determined by the Secretary will be
established by using the prescription drug component of the Medical
Consumer Price Index as follows: The Index as of the previous September
30 will be divided by the Index as of September 30, 2001. The ratio so
obtained will be multiplied by the original copayment amount of $7. The
new copayment amount will be this result, rounded down to the whole
dollar amount.
Note to paragraph (b)(1): Example for determining copayment
amount.
The ratio of the prescription drug component of the Medical
Consumer Price Index for September 30, 2005, to the corresponding
Index for September 30, 2001, was 1.1542. This ratio, when
multiplied by the original copayment amount of $7 equals $8.08, and
the copayment amount beginning in calendar year 2006, rounded down
to the whole dollar amount, was set at $8.
(2) The total amount of copayments in a calendar year for a veteran
enrolled in one of the priority categories 2 through 6 of VA's health
care system (see Sec. 17.36) shall not exceed the cap established for
the calendar year. During the period from January 1, 2010 through June
30, 2010, the cap will be $960. If the copayment amount increases after
June 30, 2010, the cap of $960 shall be increased by $120 for each $1
increase in the copayment amount.
(3) Information on copayment/cap amounts. Current copayment and cap
amounts are available at any VA Medical Center and on our Web site,
https://www.va.gov. Notice of any increases to the copayment and
corresponding increases to annual cap amount will be published in the
Federal Register.
* * * * *
[FR Doc. E9-31124 Filed 12-30-09; 8:45 am]
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