Exempting In-Home Video Telehealth From Copayments, 13195-13198 [2012-5354]
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Federal Register / Vol. 77, No. 44 / Tuesday, March 6, 2012 / Rules and Regulations
DEPARTMENT OF TRANSPORTATION
Federal Aviation Administration
14 CFR Part 71
[Docket No. FAA–2011–0591; Airspace
Docket No. 11–ASO–26]
Amendment of Class E Airspace;
Springfield, TN
Federal Aviation
Administration (FAA), DOT.
AGENCY:
ACTION:
Final rule.
This action amends Class E
Airspace in the Springfield, TN area.
Aydelotte Airport has been abandoned
and controlled airspace is no longer
needed. Airspace reconfiguration is
necessary for the continued safety and
airspace management of Instrument
Flight Rules (IFR) operations within the
Springfield, TN airspace area. This
action also makes a minor adjustment to
the geographic coordinates of the
Springfield Robertson County Airport.
SUMMARY:
Effective 0901 UTC, April 5,
2012. The Director of the Federal
Register approves this incorporation by
reference action under title 1, Code of
Federal Regulations, part 51, subject to
the annual revision of FAA Order
7400.9 and publication of conforming
amendments.
DATES:
John
Fornito, Operations Support Group,
Eastern Service Center, Federal Aviation
Administration, P.O. Box 20636,
Atlanta, Georgia 30320; telephone (404)
305–6364.
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
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History
On September 22, 2011, the FAA
published in the Federal Register a
notice of proposed rulemaking to amend
Class E airspace at Springfield, TN (76
FR 58726). Interested parties were
invited to participate in this rulemaking
effort by submitting written comments
on the proposal to the FAA. No
comments were received. Subsequent to
publication, the FAA found that the
geographic coordinates for Springfield
Robertson County Airport needed to be
adjusted. This action makes that
adjustment. Class E airspace
designations are published in paragraph
6005 of FAA Order 7400.9V dated
August 9, 2011, and effective September
15, 2011, which is incorporated by
reference in 14 CFR Part 71.1. The Class
E airspace designations listed in this
document will be published
subsequently in the Order.
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The Rule
This amendment to Title 14, Code of
Federal Regulations (14 CFR) part 71
amends Class E airspace extending
upward from 700 feet above the surface
at Springfield, TN, as the Aydelotte
Airport has been abandoned and is
being removed from the airspace
description. This action is necessary for
the safety and management of IFR
operations in the Springfield, TN area.
This action also adjusts the geographic
coordinates of the Springfield Robertson
County Airport to be in concert with the
FAAs aeronautical database.
The FAA has determined that this
regulation only involves an established
body of technical regulations for which
frequent and routine amendments are
necessary to keep them operationally
current, is non-controversial and
unlikely to result in adverse or negative
comments. It, therefore, (1) is not a
‘‘significant regulatory action’’ under
Executive Order 12866; (2) is not a
‘‘significant rule’’ under DOT
Regulatory Policies and Procedures (44
FR 11034; February 26, 1979); and (3)
does not warrant preparation of a
Regulatory Evaluation as the anticipated
impact is so minimal. Since this is a
routine matter that will only affect air
traffic procedures and air navigation, it
is certified that this rule, when
promulgated, will not have a significant
economic impact on a substantial
number of small entities under the
criteria of the Regulatory Flexibility Act.
The FAA’s authority to issue rules
regarding aviation safety is found in
Title 49 of the United States Code.
Subtitle I, Section 106 describes the
authority of the FAA Administrator.
Subtitle VII, Aviation Programs,
describes in more detail the scope of the
agency’s authority.
This rulemaking is promulgated
under the authority described in
Subtitle VII, Part A, Subpart I, Section
40103. Under that section, the FAA is
charged with prescribing regulations to
assign the use of airspace necessary to
ensure the safety of aircraft and the
efficient use of airspace. This regulation
is within the scope of that authority as
it amends controlled airspace in the
Springfield, TN area.
Environmental Review
The FAA has determined that this
action qualifies for categorical exclusion
under the National Environmental
Policy Act in accordance with FAA
Order 1050.1E, ‘‘Environmental
Impacts: Policies and Procedures,’’
paragraph 311a. This airspace action is
not expected to cause any potentially
significant environmental impacts, and
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13195
no extraordinary circumstances exist
that warrant preparation of an
environmental assessment.
Lists of Subjects in 14 CFR Part 71
Airspace, Incorporation by reference,
Navigation (air).
Adoption of the Amendment
In consideration of the foregoing, the
Federal Aviation Administration
amends 14 CFR Part 71 as follows:
PART 71—DESIGNATION OF CLASS A,
B, C, D AND E AIRSPACE AREAS; AIR
TRAFFIC SERVICE ROUTES; AND
REPORTING POINTS
1. The authority citation for Part 71
continues to read as follows:
■
Authority: 49 U.S.C. 106(g); 40103, 40113,
40120; E.O. 10854, 24 FR 9565, 3 CFR, 1959–
1963 Comp., p. 389.
§ 71.1
[Amended]
2. The incorporation by reference in
14 CFR 71.1 of Federal Aviation
Administration Order 7400.9V, Airspace
Designations and Reporting Points,
dated August 9, 2011, effective
September 15, 2011, is amended as
follows:
■
Paragraph 6005 Class E airspace areas
extending upward from 700 feet or more
above the surface of the earth.
*
*
*
*
*
ASO TN E5 Springfield, TN [Amended]
Springfield Robertson County Airport, TN
(Lat. 36°32′14″ N., long. 86°55′15″ W.)
That airspace extending upward from 700
feet above the surface within a 7-mile radius
of Springfield Robertson County Airport.
Barry A. Knight,
Manager, Operations Support Group, Eastern
Service Center, Air Traffic Organization.
[FR Doc. 2012–5123 Filed 3–5–12; 8:45 am]
BILLING CODE 4910–13–P
DEPARTMENT OF VETERANS
AFFAIRS
38 CFR Part 17
RIN 2900–AO26
Exempting In-Home Video Telehealth
From Copayments
Department of Veterans Affairs.
Direct final rule.
AGENCY:
ACTION:
The Department of Veterans
Affairs (VA) is taking final action to
amend its regulation that governs VA
services that are not subject to
copayment requirements for inpatient
hospital care or outpatient medical care.
SUMMARY:
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13196
Federal Register / Vol. 77, No. 44 / Tuesday, March 6, 2012 / Rules and Regulations
Specifically, the regulation is amended
to exempt in-home video telehealth care
from having any required copayment.
This removes a barrier that may have
previously discouraged veterans from
choosing to use in-home video
telehealth as a viable medical care
option. In turn, VA hopes to make the
home a preferred place of care,
whenever medically appropriate and
possible.
DATES: This final rule is effective May 7,
2012, without further notice, unless VA
receives relevant adverse comments by
April 5, 2012.
ADDRESSES: Written comments may be
submitted through
www.Regulations.gov; by mail or handdelivery to the 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–
AO26—Exempting In-home Video
Telehealth from Copayments.’’ 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 (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 www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT:
Kristin J. Cunningham, Director
Business Policy, Chief Business Office,
Department of Veterans Affairs, 810
Vermont Ave. NW., Washington, DC
20420; (202) 461–1599. (This is not a
toll-free number.)
SUPPLEMENTARY INFORMATION: Many of
our nation’s veterans must travel great
distances in order to obtain health care
at a VA hospital or medical center. To
improve veterans’ access to VA health
care, VA established community-based
outpatient clinics (CBOCs) located in
local communities. VA has continued
its efforts to improve veterans’ access to
VA medical care by establishing
‘‘telehealth’’ services. Telehealth allows
VA to provide certain medical care
without requiring the veteran to be
physically present with the examining
or treating medical professional.
Telehealth helps ensure that veterans
are able to get their care in a timely and
convenient manner by reducing burdens
on the patient as well as appropriately
reducing the utilization of VA resources
without sacrificing the quality of care
provided. The benefits of using this
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technology include increased access to
specialist consultations, improved
access to primary and ambulatory care,
reduced waiting times, and decreased
veteran travel.
VA provides various telehealth
services, including clinical video
telehealth and in-home video telehealth
care. Clinical video telehealth, as the
name implies, occurs between two
clinical settings, such as two VA
Medical Centers (VAMCs), a VAMC and
a CBOC, or two CBOCs. Clinical video
telehealth may also connect patient and
provider between VAMCs and VA
Centers of Specialized Care, such as
those established for Spinal Cord Injury
(SCI), Traumatic Brain Injury (TBI) and
Multiple Sclerosis (MS). Clinical video
telehealth uses real-time interactive
video conferencing, sometimes with
supportive peripheral devices, such as a
camera to closely examine skin. This
allows a specialist located in another
facility to assess and treat a veteran by
providing care remotely.
Like clinical video telehealth, inhome video telehealth care is used to
connect a veteran to a VA health care
professional using real-time
videoconferencing, and other equipment
as necessary, as a means to replicate
aspects of face-to-face assessment and
care delivery that do not require the
health care professional to make an
examination requiring physical contact.
However, in-home video telehealth care
is provided in a veteran’s home,
eliminating the need for the veteran to
travel to a clinical setting. Using
telehealth capabilities, a VA clinician
can assess elements of a patient’s care,
such as wound management, psychiatric
or psychotherapeutic care, exercise
plans, and medication management. The
clinician may also monitor patient selfcare by reviewing vital signs and
evaluating the patient’s appearance on
video.
Prior to this rulemaking, veterans
have been required to pay a copayment
for in-home video telehealth care. We
believe that VA has authority by statute
to discontinue charging copayments for
these services.
Section 1710(g)(1) of 38 U.S.C. states:
The Secretary may not furnish medical
services (except if such care constitutes
hospice care) under subsection (a) of this
section (including home health services
under section 1717 of this title) to a veteran
who is eligible for hospital care under this
chapter by reason of subsection (a)(3) of this
section unless the veteran agrees to pay to the
United States in the case of each outpatient
visit the applicable amount or amounts
established by the Secretary by regulation.
VA has interpreted section 1710(g)(1) to
mean that VA has the discretion to
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establish the applicable copayment
amount in regulation, even if such
amount is zero. One such implementing
regulation is 38 CFR 17.108.
Generally, VA calculates the amount
of a copayment based on the complexity
of care provided and the resources
needed to provide that care. In addition,
VA may exempt certain care from the
copayment requirement in an effort to
make health care more accessible to
veterans, or to encourage veterans to
become more actively involved in their
medical care, and thereby improve
health care outcomes (which, in turn,
lowers overall health care costs). VA has
determined that in-home video
telehealth care should be exempt from
copayments because it is not used to
provide complex care and its use
significantly reduces impact on VA
resources compared to an in-person,
outpatient visit. It also reduces any
potential negative impact on the
veteran’s health that might be incurred
if the veteran were required to travel to
a VA hospital or medical center to
obtain the care provided via in-home
video telehealth. VA also wants to
encourage veterans to use the in-home
video telehealth care option when their
provider finds it appropriate because we
believe that it will help ensure that
veterans comply with outpatient
treatment plans by regularly following
up with physicians and medical
professionals, taking medication in
appropriate doses on a regular basis,
and generally being more engaged with
their VA health care providers.
As previously stated in this
rulemaking, in-home video telehealth
allows a VA clinician to assess the
elements of a veteran’s care, while the
veteran remains at home. Conversely,
clinical video telehealth assess the
veteran’s medical condition in a clinical
setting using resources and technology
that allows a medical specialist, who
may be hundreds of miles away, to
interact with the veteran and provide
the level of care needed to treat the
medical condition. VA will not exempt
clinical video telehealth services from
the copayment requirement because the
type of care a veteran receives in
clinical video telehealth requires not
just the use of CBOC’s technological
resources, but also patient interaction
between the attending physician that
may be hundreds of miles away, and the
medical staff in the CBOC. The
attending medical staff in the CBOC
follows the attending physician’s
instructions in the placement of the
adapted equipment that is used in
clinical video telehealth in order to
assess the veteran’s medical condition,
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Federal Register / Vol. 77, No. 44 / Tuesday, March 6, 2012 / Rules and Regulations
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to include the set up of the conference,
use of the teleconference room, etc. All
of these additional services provide a
veteran a higher level of care than the
level of care that the veteran receives
through in-home video telehealth.
Paragraph (e) of § 17.108 contains a
list of services that are not subject to
copayment requirements for inpatient
hospital care or outpatient medical care.
Based on the rationale set forth in this
preamble, VA amends § 17.108(e) by
adding a new paragraph (e)(16) to
include in-home video telehealth care as
exempt from copayment requirements.
Administrative Procedure Act
VA anticipates that this noncontroversial rule will not result in
adverse or negative comment and,
therefore, is issuing it as a direct final
rule. Previous actions of this nature,
which remove restrictions on VA
medical benefits to improve health
outcomes, have not been controversial
and have not resulted in significant
adverse comments or objections.
However, in the ‘‘Proposed Rules’’
section of this Federal Register
publication we are publishing a
separate, substantially identical
proposed rule document that will serve
as a proposal for the provisions in this
direct final rule if significant adverse
comments are filed. (See RIN 2900–
AO27).
For purposes of the direct final
rulemaking, a significant adverse
comment is one that explains why the
rule would be inappropriate, including
challenges to the rule’s underlying
premise or approach, or why it would
be ineffective or unacceptable without
change. If significant adverse comments
are received, VA will publish a notice
of receipt of significant adverse
comments in the Federal Register
withdrawing the direct final rule.
Under direct final rule procedures,
unless significant adverse comments are
received within the comment period,
the regulation will become effective on
the date specified above. After the close
of the comment period, VA will publish
a document in the Federal Register
indicating that no adverse comments
were received and confirming the date
on which the final rule will become
effective. VA will also publish a notice
withdrawing the proposed rule, RIN
2900–AO27.
In the event the direct final rule is
withdrawn because of receipt of
significant adverse comments, VA can
proceed with the rulemaking by
addressing the comments received and
publishing a final rule. The comment
period for the proposed rule runs
concurrently with that of the direct final
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rule. Any comments received under the
direct final rule will be treated as
comments regarding the proposed rule.
Likewise, significant adverse comments
submitted to the proposed rule will be
considered as comments to the direct
final rule. VA will consider such
comments in developing a subsequent
final rule.
Effect of Rulemaking
Title 38 of the Code of Federal
Regulations, as revised by this
rulemaking, represents 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 are authorized. All
existing or subsequent VA guidance
must be read to conform with this
rulemaking if possible or, if not
possible, such guidance is superseded
by this rulemaking.
Paperwork Reduction Act
This document contains no provisions
constituting a collection of information
under the Paperwork Reduction Act of
1995 (44 U.S.C. 3501–3521).
Regulatory Flexibility Act
The Secretary hereby certifies that
this regulatory amendment will not
have a significant economic impact on
a substantial number of small entities as
they are defined in the Regulatory
Flexibility Act, 5 U.S.C. 601–612. This
rulemaking will not directly affect any
small entities. Only VA beneficiaries
will be directly affected. Therefore,
pursuant to 5 U.S.C. 605(b), this
amendment is exempt from the initial
and final regulatory flexibility analysis
requirements of sections 603 and 604.
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,’’ which requires
review by the Office of Management and
Budget (OMB), as ‘‘any regulatory action
that is likely to result in a rule that may:
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13197
(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 under Executive Order
12866.
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
expenditure by State, local, or tribal
governments, in the aggregate, or by the
private sector, of $100 million or more
(adjusted annually for inflation) in any
given year. This final rule would have
no such effect on State, local, or tribal
governments, or on the private sector.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic
Assistance program number and title for
this rule are as follows: 64.007 Blind
Rehabilitation Centers; 64.008, Veterans
Domiciliary Care; 64.009, Veterans
Medical Care Benefits; 64.010, Veterans
Nursing Home Care; 64.014, Veterans
State Domiciliary Care; 64.015, Veterans
State Nursing Home Care; 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. John
R. Gingrich, Chief of Staff, Department
of Veterans Affairs, approved this
document on February 28, 2012, for
publication.
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Federal Register / Vol. 77, No. 44 / Tuesday, March 6, 2012 / Rules and Regulations
List of Subjects in 38 CFR Part 17
Administrative practice and
procedure, Health care, Health facilities,
Mental health programs, Nursing
homes, Veterans.
Dated: March 1, 2012.
Robert C. McFetridge,
Director, Office of Regulation Policy and
Management, Office of the General Counsel,
Department of Veterans Affairs.
For the reasons set forth in the
preamble, we are amending 38 CFR part
17 as follows:
PART 17—MEDICAL
1. The authority citation for part 17
continues to read as follows:
■
Authority: 38 U.S.C. 501, and as noted in
specific sections.
2. Amend § 17.108 by adding
paragraph (e)(16) to read as follows:
■
§ 17.108 Copayments for inpatient hospital
care and outpatient medical care.
*
*
*
*
*
(e) * * *
(16) In-home video telehealth care.
*
*
*
*
*
• Global Expedited Package Services 4
(CP2011–54) (Order No. 657), added January
24, 2011.
[FR Doc. 2012–5354 Filed 3–5–12; 8:45 am]
BILLING CODE 8320–01–P
POSTAL REGULATORY COMMISSION
39 CFR Part 3020
[Docket Nos. CP2012–6; CP2012–7;
CP2012–8; CP2012–15; MC2011–29;
MC2012–2; MC2012–3; MC2012–4; MC2012–
5, CP2012–10 and CP2012–11; MC2012–6,
CP2012–12 and CP2012–13; MC2012–7; and
R2011–6]
Product List Update
Postal Regulatory Commission.
Final rule.
AGENCY:
ACTION:
The Commission is updating
the market dominant and competitive
product lists. This action reflects a
publication policy adopted in a recent
Commission order. The referenced
policy assumes periodic updates. The
updates are identified in the body of
this document. The product lists, which
are re-published in their entirety,
include these updates.
DATES: Effective Date: March 6, 2012.
Applicability Dates: February 23, 2012
Priority Mail Contract 36 (MC2012–2
and CP2012–6); Priority Mail Contract
37 (MC2012–3 and CP2012–7); Priority
Mail Contract 38 (MC2012–7 and
CP2012–15); First-Class Package
Service; Global Expedited Package
Services Non-published Rates 3
(MC2012–4 and CP2012–8); Global Plus
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SUMMARY:
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1C (MC2012–6, CP2012–12 and
CP2012–13); Global Plus 2C (MC2012–
5, CP2012–10 and CP2012–11); and
`
Inbound Market Dominant Expres
Service Agreement 1 (R2011–6).
FOR FURTHER INFORMATION CONTACT:
Stephen L. Sharfman, General Counsel
at 202–789–6820.
SUPPLEMENTARY INFORMATION: This
document identifies an update to the
market dominant and competitive
product lists, which appear as 39 CFR
Appendix A to Subpart A of Part 3020—
Mail Classification Schedule.
Publication of updated product lists in
the Federal Register is addressed in the
Postal Accountability and Enhancement
Act (PAEA) of 2006.
Authorization. The Commission
process for periodic publication of
updates was established in Order No.
445, April 22, 2010.
Changes. Since publication of the
product lists in the Federal Register on
April 22, 2011 (76 FR 22618), an
addition to the competitive product list
that was previously overlooked has been
made:
In addition, a correction to the market
dominant product list, replacing The
Strategic Bilateral Agreement Between
United States Postal Service and
Koninklijke TNT Post BV and TNT Post
Pakketservice Benelux BV, collectively
‘‘TNT Post’’ and China Post Group—
United States Postal Service Letter Post
Bilateral Agreement (MC2010–35,
R2010–5 and R2010–6) with Inbound
Market Dominant Multi-Service
Agreements with Foreign Postal
Operators 1, has been made.
Updated product lists. The referenced
change to the market dominant and
competitive product lists are identified
following the Secretary’s signature.
List of Subjects in 39 CFR Part 3020
Administrative practice and
procedure, Postal services.
By the Commission.
Shoshana M. Grove,
Secretary.
For the reasons discussed in the
preamble, the Postal Regulatory
Commission amends chapter III of title
39 of the Code of Federal Regulations as
follows:
PART 3020—PRODUCT LISTS
1. The authority citation for part 3020
continues to read as follows:
■
Authority: 39 U.S.C. 503; 3622; 3631;
3642; 3682.
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2. Revise Appendix A to Subpart A of
Part 3020—Mail Classification Schedule
to read as follows:
■
Appendix A to Subpart A of Part
3020—Mail Classification Schedule
Part A—Market Dominant Products
1000 Market Dominant Product List
First-Class Mail
Single-Piece Letters/Postcards
Bulk Letters/Postcards
Flats
Parcels
Outbound Single-Piece First-Class Mail
International
Inbound Single-Piece First-Class Mail
International
Standard Mail (Regular and Nonprofit)
High Density and Saturation Letters
High Density and Saturation Flats/Parcels
Carrier Route
Letters
Flats
Not Flat-Machinables (NFMs)/Parcels
Periodicals
Within County Periodicals
Outside County Periodicals
Package Services
Single-Piece Parcel Post
Inbound Surface Parcel Post (at UPU rates)
Bound Printed Matter Flats
Bound Printed Matter Parcels
Media Mail/Library Mail
Special Services
Ancillary Services
International Ancillary Services
Address Management Services
Caller Service
Change-of-Address Credit Card
Authentication
Confirm
Customized Postage
International Reply Coupon Service
International Business Reply Mail Service
Money Orders
Post Office Box Service
Stamp Fulfillment Services
Negotiated Service Agreements
Bookspan Negotiated Service Agreement
Bank of America Corporation Negotiated
Service Agreement
Discover Financial Services 1
HSBC North America Holdings Inc.
Negotiated Service Agreement
`
Inbound Market Dominant Expres Service
Agreement 1 (R2011–6)
The Bradford Group Negotiated Service
Agreement
Inbound International
Canada Post—United States Postal Service
Contractual Bilateral Agreement for
Inbound Market Dominant Services
(MC2010–12 and R2010–2)
Inbound Market Dominant Multi-Service
Agreements with Foreign Postal
Operators 1
Market Dominant Product Descriptions
First-Class Mail
Single-Piece Letters/Postcards
Bulk Letters/Postcards
Flats
Parcels
Outbound Single-Piece First-Class Mail
International
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]]>Agencies
[Federal Register Volume 77, Number 44 (Tuesday, March 6, 2012)]
[Rules and Regulations]
[Pages 13195-13198]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-5354]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AO26
Exempting In-Home Video Telehealth From Copayments
AGENCY: Department of Veterans Affairs.
ACTION: Direct final rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) is taking final action
to amend its regulation that governs VA services that are not subject
to copayment requirements for inpatient hospital care or outpatient
medical care.
[[Page 13196]]
Specifically, the regulation is amended to exempt in-home video
telehealth care from having any required copayment. This removes a
barrier that may have previously discouraged veterans from choosing to
use in-home video telehealth as a viable medical care option. In turn,
VA hopes to make the home a preferred place of care, whenever medically
appropriate and possible.
DATES: This final rule is effective May 7, 2012, without further
notice, unless VA receives relevant adverse comments by April 5, 2012.
ADDRESSES: Written comments may be submitted through
www.Regulations.gov; by mail or hand-delivery to the 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-AO26--Exempting In-home Video Telehealth from
Copayments.'' 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 (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 www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT: Kristin J. Cunningham, Director
Business Policy, Chief Business Office, Department of Veterans Affairs,
810 Vermont Ave. NW., Washington, DC 20420; (202) 461-1599. (This is
not a toll-free number.)
SUPPLEMENTARY INFORMATION: Many of our nation's veterans must travel
great distances in order to obtain health care at a VA hospital or
medical center. To improve veterans' access to VA health care, VA
established community-based outpatient clinics (CBOCs) located in local
communities. VA has continued its efforts to improve veterans' access
to VA medical care by establishing ``telehealth'' services. Telehealth
allows VA to provide certain medical care without requiring the veteran
to be physically present with the examining or treating medical
professional. Telehealth helps ensure that veterans are able to get
their care in a timely and convenient manner by reducing burdens on the
patient as well as appropriately reducing the utilization of VA
resources without sacrificing the quality of care provided. The
benefits of using this technology include increased access to
specialist consultations, improved access to primary and ambulatory
care, reduced waiting times, and decreased veteran travel.
VA provides various telehealth services, including clinical video
telehealth and in-home video telehealth care. Clinical video
telehealth, as the name implies, occurs between two clinical settings,
such as two VA Medical Centers (VAMCs), a VAMC and a CBOC, or two
CBOCs. Clinical video telehealth may also connect patient and provider
between VAMCs and VA Centers of Specialized Care, such as those
established for Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI)
and Multiple Sclerosis (MS). Clinical video telehealth uses real-time
interactive video conferencing, sometimes with supportive peripheral
devices, such as a camera to closely examine skin. This allows a
specialist located in another facility to assess and treat a veteran by
providing care remotely.
Like clinical video telehealth, in-home video telehealth care is
used to connect a veteran to a VA health care professional using real-
time videoconferencing, and other equipment as necessary, as a means to
replicate aspects of face-to-face assessment and care delivery that do
not require the health care professional to make an examination
requiring physical contact. However, in-home video telehealth care is
provided in a veteran's home, eliminating the need for the veteran to
travel to a clinical setting. Using telehealth capabilities, a VA
clinician can assess elements of a patient's care, such as wound
management, psychiatric or psychotherapeutic care, exercise plans, and
medication management. The clinician may also monitor patient self-care
by reviewing vital signs and evaluating the patient's appearance on
video.
Prior to this rulemaking, veterans have been required to pay a
copayment for in-home video telehealth care. We believe that VA has
authority by statute to discontinue charging copayments for these
services.
Section 1710(g)(1) of 38 U.S.C. states:
The Secretary may not furnish medical services (except if such
care constitutes hospice care) under subsection (a) of this section
(including home health services under section 1717 of this title) to
a veteran who is eligible for hospital care under this chapter by
reason of subsection (a)(3) of this section unless the veteran
agrees to pay to the United States in the case of each outpatient
visit the applicable amount or amounts established by the Secretary
by regulation.
VA has interpreted section 1710(g)(1) to mean that VA has the
discretion to establish the applicable copayment amount in regulation,
even if such amount is zero. One such implementing regulation is 38 CFR
17.108.
Generally, VA calculates the amount of a copayment based on the
complexity of care provided and the resources needed to provide that
care. In addition, VA may exempt certain care from the copayment
requirement in an effort to make health care more accessible to
veterans, or to encourage veterans to become more actively involved in
their medical care, and thereby improve health care outcomes (which, in
turn, lowers overall health care costs). VA has determined that in-home
video telehealth care should be exempt from copayments because it is
not used to provide complex care and its use significantly reduces
impact on VA resources compared to an in-person, outpatient visit. It
also reduces any potential negative impact on the veteran's health that
might be incurred if the veteran were required to travel to a VA
hospital or medical center to obtain the care provided via in-home
video telehealth. VA also wants to encourage veterans to use the in-
home video telehealth care option when their provider finds it
appropriate because we believe that it will help ensure that veterans
comply with outpatient treatment plans by regularly following up with
physicians and medical professionals, taking medication in appropriate
doses on a regular basis, and generally being more engaged with their
VA health care providers.
As previously stated in this rulemaking, in-home video telehealth
allows a VA clinician to assess the elements of a veteran's care, while
the veteran remains at home. Conversely, clinical video telehealth
assess the veteran's medical condition in a clinical setting using
resources and technology that allows a medical specialist, who may be
hundreds of miles away, to interact with the veteran and provide the
level of care needed to treat the medical condition. VA will not exempt
clinical video telehealth services from the copayment requirement
because the type of care a veteran receives in clinical video
telehealth requires not just the use of CBOC's technological resources,
but also patient interaction between the attending physician that may
be hundreds of miles away, and the medical staff in the CBOC. The
attending medical staff in the CBOC follows the attending physician's
instructions in the placement of the adapted equipment that is used in
clinical video telehealth in order to assess the veteran's medical
condition,
[[Page 13197]]
to include the set up of the conference, use of the teleconference
room, etc. All of these additional services provide a veteran a higher
level of care than the level of care that the veteran receives through
in-home video telehealth.
Paragraph (e) of Sec. 17.108 contains a list of services that are
not subject to copayment requirements for inpatient hospital care or
outpatient medical care.
Based on the rationale set forth in this preamble, VA amends Sec.
17.108(e) by adding a new paragraph (e)(16) to include in-home video
telehealth care as exempt from copayment requirements.
Administrative Procedure Act
VA anticipates that this non-controversial rule will not result in
adverse or negative comment and, therefore, is issuing it as a direct
final rule. Previous actions of this nature, which remove restrictions
on VA medical benefits to improve health outcomes, have not been
controversial and have not resulted in significant adverse comments or
objections. However, in the ``Proposed Rules'' section of this Federal
Register publication we are publishing a separate, substantially
identical proposed rule document that will serve as a proposal for the
provisions in this direct final rule if significant adverse comments
are filed. (See RIN 2900-AO27).
For purposes of the direct final rulemaking, a significant adverse
comment is one that explains why the rule would be inappropriate,
including challenges to the rule's underlying premise or approach, or
why it would be ineffective or unacceptable without change. If
significant adverse comments are received, VA will publish a notice of
receipt of significant adverse comments in the Federal Register
withdrawing the direct final rule.
Under direct final rule procedures, unless significant adverse
comments are received within the comment period, the regulation will
become effective on the date specified above. After the close of the
comment period, VA will publish a document in the Federal Register
indicating that no adverse comments were received and confirming the
date on which the final rule will become effective. VA will also
publish a notice withdrawing the proposed rule, RIN 2900-AO27.
In the event the direct final rule is withdrawn because of receipt
of significant adverse comments, VA can proceed with the rulemaking by
addressing the comments received and publishing a final rule. The
comment period for the proposed rule runs concurrently with that of the
direct final rule. Any comments received under the direct final rule
will be treated as comments regarding the proposed rule. Likewise,
significant adverse comments submitted to the proposed rule will be
considered as comments to the direct final rule. VA will consider such
comments in developing a subsequent final rule.
Effect of Rulemaking
Title 38 of the Code of Federal Regulations, as revised by this
rulemaking, represents 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 are authorized.
All existing or subsequent VA guidance must be read to conform with
this rulemaking if possible or, if not possible, such guidance is
superseded by this rulemaking.
Paperwork Reduction Act
This document contains no provisions constituting a collection of
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).
Regulatory Flexibility Act
The Secretary hereby certifies that this regulatory amendment will
not have a significant economic impact on a substantial number of small
entities as they are defined in the Regulatory Flexibility Act, 5
U.S.C. 601-612. This rulemaking will not directly affect any small
entities. Only VA beneficiaries will be directly affected. Therefore,
pursuant to 5 U.S.C. 605(b), this amendment is exempt from the initial
and final regulatory flexibility analysis requirements of sections 603
and 604.
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,'' which requires review by the Office
of Management and Budget (OMB), 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 under
Executive Order 12866.
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 expenditure by
State, local, or tribal governments, in the aggregate, or by the
private sector, of $100 million or more (adjusted annually for
inflation) in any given year. This final rule would have no such effect
on State, local, or tribal governments, or on the private sector.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic Assistance program number and title
for this rule are as follows: 64.007 Blind Rehabilitation Centers;
64.008, Veterans Domiciliary Care; 64.009, Veterans Medical Care
Benefits; 64.010, Veterans Nursing Home Care; 64.014, Veterans State
Domiciliary Care; 64.015, Veterans State Nursing Home Care; 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. John R.
Gingrich, Chief of Staff, Department of Veterans Affairs, approved this
document on February 28, 2012, for publication.
[[Page 13198]]
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Health care, Health
facilities, Mental health programs, Nursing homes, Veterans.
Dated: March 1, 2012.
Robert C. McFetridge,
Director, Office of Regulation Policy and Management, Office of the
General Counsel, Department of Veterans Affairs.
For the reasons set forth in the preamble, we are amending 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, and as noted in specific sections.
0
2. Amend Sec. 17.108 by adding paragraph (e)(16) to read as follows:
Sec. 17.108 Copayments for inpatient hospital care and outpatient
medical care.
* * * * *
(e) * * *
(16) In-home video telehealth care.
* * * * *
[FR Doc. 2012-5354 Filed 3-5-12; 8:45 am]
BILLING CODE 8320-01-P
