Copayments for Medications, 69283-69285 [E9-31124]

Download as PDF 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. * * * * * (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: * * * * * 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 VerDate Nov<24>2008 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 http:// 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 http:// 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: PO 00000 Frm 00041 Fmt 4700 Sfmt 4700 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 E:\FR\FM\31DER1.SGM 31DER1 erowe on DSK5CLS3C1PROD with RULES 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 VerDate Nov<24>2008 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 PO 00000 Frm 00042 Fmt 4700 Sfmt 4700 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, E:\FR\FM\31DER1.SGM 31DER1 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, http://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] 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 * * * * * (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 VerDate Nov<24>2008 13:48 Dec 30, 2009 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 (http://www.fcc.gov/ cgb/ecfs/). (Documents will be available SUPPLEMENTARY INFORMATION: PO 00000 Frm 00043 Fmt 4700 Sfmt 4700 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 E:\FR\FM\31DER1.SGM 31DER1

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]


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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 http://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 http://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, 
http://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]
BILLING CODE P