Authorization for Non-VA Medical Services, 70893-70895 [2012-28778]
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Federal Register / Vol. 77, No. 229 / Wednesday, November 28, 2012 / Rules and Regulations
Instruction. An environmental analysis
checklist supporting this determination
and a Categorical Exclusion
Determination are available in the
docket where indicated under
ADDRESSES. We seek any comments or
information that may lead to the
discovery of a significant environmental
impact from this rule.
List of Subjects in 33 CFR Part 165
Harbors, Marine safety, Navigation
(water), Reporting and recordkeeping
requirements, Security measures, and
Waterways.
For the reasons discussed in the
preamble, the Coast Guard amends 33
CFR part 165 as follows:
PART 165—REGULATED NAVIGATION
AREAS AND LIMITED ACCESS AREAS
1. The authority citation for part 165
continues to read as follows:
■
Authority: 33 U.S.C. 1226, 1231; 46 U.S.C.
Chapter 701, 3306, 3703; 50 U.S.C. 191, 195;
33 CFR 1.05–1, 6.04–1, 6.04–6, and 160.5;
Pub. L. 107–295, 116 Stat. 2064; Department
of Homeland Security Delegation No. 0170.1.
2. Add § 165.T11–534 to read as
follows:
■
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[FR Doc. 2012–28792 Filed 11–27–12; 8:45 am]
BILLING CODE 9110–04–P
38 CFR Part 17
(a) Location. This temporary safety
zone is established in the navigable
waters of the San Francisco Bay near
Yerba Buena Island, California as
depicted in National Oceanic and
Atmospheric Administration (NOAA)
Chart 18650. The safety zone will
encompass the navigable waters of the
San Francisco Bay within a box
connected by the following points:
37°49′06″ N, 122°21′17″ W; 37°49′01″ N,
122°21′12″ W; 37°48′48″ N, 122°21′35″
W; 37°48′53″ N, 122°21′40″ W (NAD 83).
(b) Enforcement Period. The zone
described in paragraph (a) of this
section will be in effect from 12:01 a.m.
on November 1, 2012 until 11:59 p.m.
on July 31, 2013. The Captain of the Port
San Francisco (COTP) will notify the
maritime community of periods during
which this zone will be enforced via
Broadcast Notice to Mariners in
accordance with 33 CFR 165.7.
(c) Definitions. As used in this
section, ‘‘designated representative’’
means a Coast Guard Patrol
Commander, including a Coast Guard
coxswain, petty officer, or other officer
on a Coast Guard vessel or a Federal,
State, or local officer designated by or
assisting the COTP in the enforcement
of the safety zone.
(d) Regulations. (1) Under the general
regulations in 33 CFR part 165, Subpart
11:33 Nov 27, 2012
Dated: November 2, 2012.
Cynthia L. Stowe,
Captain, U.S. Coast Guard, Acting, Captain
of the Port San Francisco.
DEPARTMENT OF VETERANS
AFFAIRS
§ 165.T11–534 Safety zone; Bay Bridge
Construction, San Francisco Bay, San
Francisco, CA.
VerDate Mar<15>2010
C, entry into, transiting or anchoring
within this safety zone is prohibited
unless authorized by the COTP or a
designated representative.
(2) The safety zone is closed to all
vessel traffic, except as may be
permitted by the COTP or a designated
representative.
(3) Vessel operators desiring to enter
or operate within the safety zone must
contact the COTP or a designated
representative to obtain permission to
do so. Vessel operators given permission
to enter or operate in the safety zone
must comply with all directions given to
them by the COTP or a designated
representative. Persons and vessels may
request permission to enter the safety
zone on VHF–23A or through the 24hour Command Center at telephone
(415) 399–3547.
RIN 2900–AO47
Authorization for Non-VA Medical
Services
Department of Veterans Affairs.
Direct final rule.
AGENCY:
ACTION:
The Department of Veterans
Affairs (VA) is taking direct final action
to amend its regulation governing
payment by VA for non-VA outpatient
care under VA’s statutory authority to
provide non-VA care. Under this
authority, VA may contract for certain
hospital care (inpatient care) and
medical services (outpatient care) for
eligible veterans when VA facilities are
not capable of providing such services
due to geographical inaccessibility or
are not capable of providing the services
needed. This amendment revises VA’s
existing regulation in accordance with
statutory authority to remove a
limitation on which veterans are eligible
for medical services under this
authority.
DATES: This final rule is effective on
January 28, 2013, without further notice,
unless VA receives a significant adverse
comment by December 28, 2012.
ADDRESSES: Written comments may be
submitted through
www.Regulations.gov; by mail or handdelivery to the Director, Regulation
SUMMARY:
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70893
Policy and Management (02REG),
Department of Veterans Affairs, 810
Vermont Ave. NW., Room 1068,
Washington, DC 20420; or by fax to
(202) 273–9026. This is not a toll-free
number. Comments should indicate that
they are submitted in response to ‘‘RIN
2900–AO47—Authorization for Non-VA
Medical Services.’’ Copies of comments
received will be available for public
inspection in the Office of Regulation
Policy and Management, Room 1068,
between the hours of 8:00 a.m. and 4:30
p.m., Monday through Friday (except
holidays). Please call (202) 461–4902 for
an appointment. This is not a toll-free
number. In addition, during the
comment period, comments may be
viewed online through the Federal
Docket Management System (FDMS) at
www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT: Lisa
Brown, Chief, Policy Management
Department, Department of Veterans
Affairs, Chief Business Office,
Purchased Care, 3773 Cherry Creek
North Drive, Suite 450, Denver, CO
80209 at (303) 331–7829. This is not a
toll-free number.
SUPPLEMENTARY INFORMATION:
Over the past two decades, the
healthcare industry has increasingly
emphasized providing care in the least
restrictive environment. Care that was
provided in hospitals is now provided
with a full range of outpatient and
ambulatory care options previously
unavailable. VA has adopted this trend
toward outpatient and ambulatory care
and, whenever possible, provides
treatment options to veterans in these
less restrictive modes of healthcare
delivery. Although VA has made great
strides to expand the delivery of
healthcare to veterans, VA is, like the
rest of the healthcare industry,
economically unable to provide all
possible services at all VA-operated
venues of care. VA addresses this in part
by authorizing non-VA care when
necessary to meet the veteran’s plan of
care.
VA uses the authority in 38 U.S.C.
1703 to provide certain hospital care
and medical services to eligible veterans
when VA facilities are not capable of
providing such services due to
geographical inaccessibility or are not
capable of providing the services
needed, ensuring the continuity of care
for the patient and the maximization of
healthcare resources. VA may use this
authority to provide needed non-VA
care using community resources, such
as private physicians or community
hospitals. Care provided under VA’s
authority in 38 U.S.C. 1703 is usually
referred to as the Non-VA Care program.
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70894
Federal Register / Vol. 77, No. 229 / Wednesday, November 28, 2012 / Rules and Regulations
Non-VA care enables VA to maximize
resources and available options for
patient care at the local level, providing
care in the least restrictive mode
possible and closer to the patient’s
home.
Public Law 104–262, 104(b)(2)(B)
amended 38 U.S.C. 1703(a)(2)(B) to
expand VA’s authority to provide nonVA medical services under the non-VA
care authority. As amended, the law
authorizes VA to provide such medical
services for a veteran who has been
furnished hospital care, nursing home
care, domiciliary care, or medical
services and who requires medical
services to complete treatment incident
to such care or services.
At present, 38 CFR 17.52(a)(2)(ii)
provides that ‘‘[a] veteran who has
received VA inpatient care for treatment
of nonservice-connected conditions for
which treatment was begun during the
period of inpatient care’’ is eligible for
non-VA medical services under the nonVA care authority. The existing VA
regulation does not reflect the
amendment made by Public Law 104–
262 to 38 U.S.C. 1703(a)(2)(B). This VA
regulation thus does not permit VA to
complete a veteran’s treatment through
non-VA providers under the non-VA
care authority unless the VA treatment
was begun during a period of
hospitalization.
VA is amending its regulation at 38
CFR 17.52(a)(2)(ii) to reflect the current
statutory authority found at 38 U.S.C.
1703(a)(2)(B). In doing so, VA will
increase the availability of care in areas
where VA cannot directly provide the
care. Paragraph (a)(2)(ii) of this revised
regulation provides that veterans who
have been furnished hospital care,
nursing home care, domiciliary care, or
medical services, and who require
medical services to complete treatment
incident to such care or services, are
eligible for non-VA medical services
under the non-VA care authority. By
expanding veterans’ eligibility for nonVA care, VA will be able to better utilize
resources and enhance patient care at
the local level. This regulation will give
VA greater flexibility to refer patients
for care in the least restrictive and most
convenient setting.
This revision to § 17.52(a)(2)(ii)
clarifies the time period during which
veterans are eligible to receive non-VA
care to complete their treatments.
Currently, § 17.52(a)(2)(ii) states that the
non-VA care treatment period, which
includes ‘‘care furnished in both
facilities of VA and non-VA facilities or
any combination of such modes of
care,’’ is limited to no more than 12
months after the veteran is discharged
from the hospital, unless VA determines
VerDate Mar<15>2010
11:33 Nov 27, 2012
Jkt 229001
that the veteran requires continued nonVA care ‘‘by virtue of the disabilities
being treated.’’ This revision clarifies
that each authorization for non-VA care
needed to complete treatment may
continue for up to 12 months, and that
VA may issue new authorizations as
needed. The requirement to issue a new
authorization gives VA an opportunity
to determine whether non-VA care
continues to be the appropriate means
of providing the veteran’s treatment.
We note that this amendment only
affects the eligibility of certain veterans
for medical services provided by a nonVA provider under the non-VA care
authority in 38 U.S.C. 1703; this
amendment does not require providers
outside of VA to accept VA patients. We
also note that this amendment does not
affect other provisions in this regulation
that specify veterans’ eligibility for nonVA care.
Administrative Procedure Act
VA believes this rule is noncontroversial, anticipates that this rule
will not result in any significant adverse
comment and, therefore, is issuing this
regulatory amendment 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 the Federal Register, VA is
publishing a separate, substantially
identical proposed rule that will serve
as a proposal for the provisions in this
direct final rule in the event that any
significant adverse comment is received
by VA. (See RIN 2900–AO46.)
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 VA receives a significant
adverse comment, VA will publish a
notice of receipt of a significant adverse
comment in the Federal Register and
withdraw the direct final rule. In
determining whether an adverse
comment is significant and warrants
withdrawing a direct final rule, we will
consider whether the comment raises an
issue serious enough to warrant a
substantive response in a notice-andcomment process in accordance with
section 553 of the Administrative
Procedure Act (5 U.S.C. 553). Comments
that are frivolous, insubstantial, or
outside the scope of the rule will not be
considered adverse under this
procedure. For example, a comment
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recommending an additional change to
the rule will not be considered a
significant comment unless the
comment states why the rule would be
ineffective or unacceptable without the
additional change.
Under direct final rule procedures, if
no significant adverse comment is
received within the comment period,
this rule 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 VA received no
significant adverse comment and
restating the date on which the final
rule will become effective. VA will also
publish a notice in the Federal Register
withdrawing the proposed rule, RIN
2900–AO46.
In the event that VA withdraws the
direct final rule because of receipt of
any significant adverse comment, VA
will 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. VA will treat any comments
received in response to the direct final
rule as comments regarding the
proposed rule. VA will consider such
comments in developing a subsequent
final rule. Likewise, VA will consider
any significant adverse comment
received in response to the proposed
rule as a comment regarding the direct
final rule. VA has determined that it is
not necessary to provide a 60-day
comment period for this rulemaking that
would merely align a current regulation
with existing statutory authority and
make a minor modification concerning
determination of the time period during
which veterans are eligible to receive
non-VA care to complete their
treatments. VA has instead specified
that comments must be received within
30 days of publication in the Federal
Register.
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 final rule contains no provisions
constituting a collection of information
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Federal Register / Vol. 77, No. 229 / Wednesday, November 28, 2012 / Rules and Regulations
under the Paperwork Reduction Act of
1995 (44 U.S.C. 3501–3521).
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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
defined in the Regulatory Flexibility
Act, 5 U.S.C. 601–612. This rule affects
only VA beneficiaries and does not
affect a substantial number of small
entities. Because this rule updates an
existing regulation to make it consistent
with existing statutory authority and
reflect current and long-standing VA
practices, VA anticipates no additional
expenditures or actions as a result of
this rule. Therefore, under 5 U.S.C.
605(b), this rulemaking 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’’ requiring 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
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11:33 Nov 27, 2012
Jkt 229001
determined not to be a significant
regulatory action under Executive Order
12866.
Unfunded Mandates Reform Act
70895
Dated: November 21, 2012.
Robert C. McFetridge,
Director, Regulation Policy and Management,
Office of the General Counsel, Department
of Veterans Affairs.
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
expenditures by State, local, and tribal
governments, in the aggregate, or by the
private sector, of $100 million or more,
adjusted annually for inflation, in any
one year. This final rule will have no
such effect on State, local, and tribal
governments, or on the private sector.
For the reasons stated in the
preamble, the Department of Veterans
Affairs amends 38 CFR part 17 as
follows:
Catalog of Federal Domestic Assistance
§ 17.52 Hospital care and medical services
in non-VA facilities.
The Catalog of Federal Domestic
Assistance numbers and titles for the
programs affected by this document are
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;
64.018, 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.
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 November 19, 2012, for
publication.
List of Subjects in 38 CFR Part 17
Administrative practice and
procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug
abuse, Government contracts, Grant
programs—health, Government
programs—veterans, Health care, Health
facilities, Health professions, Health
records, Homeless, Mental health
programs, Nursing homes, Reporting
and recordkeeping requirements,
Veterans.
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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. Revise § 17.52(a)(2)(ii) to read as
follows:
■
(a) * * *
(2) * * *
(ii) A veteran who has been furnished
hospital care, nursing home care,
domiciliary care, or medical services,
and requires medical services to
complete treatment incident to such
care or services (each authorization for
non-VA treatment needed to complete
treatment may continue for up to 12
months, and new authorizations may be
issued by VA as needed), and
*
*
*
*
*
[FR Doc. 2012–28778 Filed 11–27–12; 8:45 am]
BILLING CODE 8320–01–P
POSTAL SERVICE
39 CFR Part 111
New Marking Standards for Parcels
Containing Hazardous Materials
Postal ServiceTM.
Final rule.
AGENCY:
ACTION:
The Postal Service is revising
Mailing Standards of the United States
Postal Service, Domestic Mail Manual
(DMM®) 601.10 to adopt new
mandatory marking standards for
parcels containing mailable hazardous
material that will align with the revised
requirements provided by the
Department of Transportation (DOT).
This revision also provides terminology
and categorization changes needed to
respond to the pending elimination of
the ‘‘Other Regulated Material’’ (ORM–
D) category and the partial elimination
of the ‘‘consumer commodity’’ category
by the DOT.
DATES: Effective January 1, 2013.
FOR FURTHER INFORMATION CONTACT:
Kevin Gunther at 202–268–7208.
SUPPLEMENTARY INFORMATION: The Postal
Service will revise DMM 601.10, and
SUMMARY:
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]]>Agencies
[Federal Register Volume 77, Number 229 (Wednesday, November 28, 2012)]
[Rules and Regulations]
[Pages 70893-70895]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-28778]
=======================================================================
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AO47
Authorization for Non-VA Medical Services
AGENCY: Department of Veterans Affairs.
ACTION: Direct final rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) is taking direct final
action to amend its regulation governing payment by VA for non-VA
outpatient care under VA's statutory authority to provide non-VA care.
Under this authority, VA may contract for certain hospital care
(inpatient care) and medical services (outpatient care) for eligible
veterans when VA facilities are not capable of providing such services
due to geographical inaccessibility or are not capable of providing the
services needed. This amendment revises VA's existing regulation in
accordance with statutory authority to remove a limitation on which
veterans are eligible for medical services under this authority.
DATES: This final rule is effective on January 28, 2013, without
further notice, unless VA receives a significant adverse comment by
December 28, 2012.
ADDRESSES: Written comments may be submitted through
www.Regulations.gov; by mail or hand-delivery to the Director,
Regulation Policy and Management (02REG), Department of Veterans
Affairs, 810 Vermont Ave. NW., Room 1068, Washington, DC 20420; or by
fax to (202) 273-9026. This is not a toll-free number. Comments should
indicate that they are submitted in response to ``RIN 2900-AO47--
Authorization for Non-VA Medical Services.'' Copies of comments
received will be available for public inspection in the Office of
Regulation Policy and Management, Room 1068, between the hours of 8:00
a.m. and 4:30 p.m., Monday through Friday (except holidays). Please
call (202) 461-4902 for an appointment. This is not a toll-free number.
In addition, during the comment period, comments may be viewed online
through the Federal Docket Management System (FDMS) at
www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT: Lisa Brown, Chief, Policy Management
Department, Department of Veterans Affairs, Chief Business Office,
Purchased Care, 3773 Cherry Creek North Drive, Suite 450, Denver, CO
80209 at (303) 331-7829. This is not a toll-free number.
SUPPLEMENTARY INFORMATION:
Over the past two decades, the healthcare industry has increasingly
emphasized providing care in the least restrictive environment. Care
that was provided in hospitals is now provided with a full range of
outpatient and ambulatory care options previously unavailable. VA has
adopted this trend toward outpatient and ambulatory care and, whenever
possible, provides treatment options to veterans in these less
restrictive modes of healthcare delivery. Although VA has made great
strides to expand the delivery of healthcare to veterans, VA is, like
the rest of the healthcare industry, economically unable to provide all
possible services at all VA-operated venues of care. VA addresses this
in part by authorizing non-VA care when necessary to meet the veteran's
plan of care.
VA uses the authority in 38 U.S.C. 1703 to provide certain hospital
care and medical services to eligible veterans when VA facilities are
not capable of providing such services due to geographical
inaccessibility or are not capable of providing the services needed,
ensuring the continuity of care for the patient and the maximization of
healthcare resources. VA may use this authority to provide needed non-
VA care using community resources, such as private physicians or
community hospitals. Care provided under VA's authority in 38 U.S.C.
1703 is usually referred to as the Non-VA Care program.
[[Page 70894]]
Non-VA care enables VA to maximize resources and available options for
patient care at the local level, providing care in the least
restrictive mode possible and closer to the patient's home.
Public Law 104-262, 104(b)(2)(B) amended 38 U.S.C. 1703(a)(2)(B) to
expand VA's authority to provide non-VA medical services under the non-
VA care authority. As amended, the law authorizes VA to provide such
medical services for a veteran who has been furnished hospital care,
nursing home care, domiciliary care, or medical services and who
requires medical services to complete treatment incident to such care
or services.
At present, 38 CFR 17.52(a)(2)(ii) provides that ``[a] veteran who
has received VA inpatient care for treatment of nonservice-connected
conditions for which treatment was begun during the period of inpatient
care'' is eligible for non-VA medical services under the non-VA care
authority. The existing VA regulation does not reflect the amendment
made by Public Law 104-262 to 38 U.S.C. 1703(a)(2)(B). This VA
regulation thus does not permit VA to complete a veteran's treatment
through non-VA providers under the non-VA care authority unless the VA
treatment was begun during a period of hospitalization.
VA is amending its regulation at 38 CFR 17.52(a)(2)(ii) to reflect
the current statutory authority found at 38 U.S.C. 1703(a)(2)(B). In
doing so, VA will increase the availability of care in areas where VA
cannot directly provide the care. Paragraph (a)(2)(ii) of this revised
regulation provides that veterans who have been furnished hospital
care, nursing home care, domiciliary care, or medical services, and who
require medical services to complete treatment incident to such care or
services, are eligible for non-VA medical services under the non-VA
care authority. By expanding veterans' eligibility for non-VA care, VA
will be able to better utilize resources and enhance patient care at
the local level. This regulation will give VA greater flexibility to
refer patients for care in the least restrictive and most convenient
setting.
This revision to Sec. 17.52(a)(2)(ii) clarifies the time period
during which veterans are eligible to receive non-VA care to complete
their treatments. Currently, Sec. 17.52(a)(2)(ii) states that the non-
VA care treatment period, which includes ``care furnished in both
facilities of VA and non-VA facilities or any combination of such modes
of care,'' is limited to no more than 12 months after the veteran is
discharged from the hospital, unless VA determines that the veteran
requires continued non-VA care ``by virtue of the disabilities being
treated.'' This revision clarifies that each authorization for non-VA
care needed to complete treatment may continue for up to 12 months, and
that VA may issue new authorizations as needed. The requirement to
issue a new authorization gives VA an opportunity to determine whether
non-VA care continues to be the appropriate means of providing the
veteran's treatment.
We note that this amendment only affects the eligibility of certain
veterans for medical services provided by a non-VA provider under the
non-VA care authority in 38 U.S.C. 1703; this amendment does not
require providers outside of VA to accept VA patients. We also note
that this amendment does not affect other provisions in this regulation
that specify veterans' eligibility for non-VA care.
Administrative Procedure Act
VA believes this rule is non-controversial, anticipates that this
rule will not result in any significant adverse comment and, therefore,
is issuing this regulatory amendment 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 the Federal Register, VA
is publishing a separate, substantially identical proposed rule that
will serve as a proposal for the provisions in this direct final rule
in the event that any significant adverse comment is received by VA.
(See RIN 2900-AO46.)
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 VA
receives a significant adverse comment, VA will publish a notice of
receipt of a significant adverse comment in the Federal Register and
withdraw the direct final rule. In determining whether an adverse
comment is significant and warrants withdrawing a direct final rule, we
will consider whether the comment raises an issue serious enough to
warrant a substantive response in a notice-and-comment process in
accordance with section 553 of the Administrative Procedure Act (5
U.S.C. 553). Comments that are frivolous, insubstantial, or outside the
scope of the rule will not be considered adverse under this procedure.
For example, a comment recommending an additional change to the rule
will not be considered a significant comment unless the comment states
why the rule would be ineffective or unacceptable without the
additional change.
Under direct final rule procedures, if no significant adverse
comment is received within the comment period, this rule 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 VA received no significant adverse comment and restating the date
on which the final rule will become effective. VA will also publish a
notice in the Federal Register withdrawing the proposed rule, RIN 2900-
AO46.
In the event that VA withdraws the direct final rule because of
receipt of any significant adverse comment, VA will 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. VA will treat any comments received in
response to the direct final rule as comments regarding the proposed
rule. VA will consider such comments in developing a subsequent final
rule. Likewise, VA will consider any significant adverse comment
received in response to the proposed rule as a comment regarding the
direct final rule. VA has determined that it is not necessary to
provide a 60-day comment period for this rulemaking that would merely
align a current regulation with existing statutory authority and make a
minor modification concerning determination of the time period during
which veterans are eligible to receive non-VA care to complete their
treatments. VA has instead specified that comments must be received
within 30 days of publication in the Federal Register.
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 final rule contains no provisions constituting a collection of
information
[[Page 70895]]
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 defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. This rule affects only VA beneficiaries and does not affect a
substantial number of small entities. Because this rule updates an
existing regulation to make it consistent with existing statutory
authority and reflect current and long-standing VA practices, VA
anticipates no additional expenditures or actions as a result of this
rule. Therefore, under 5 U.S.C. 605(b), this rulemaking 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'' requiring 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 Reform Act
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 expenditures by
State, local, and tribal governments, in the aggregate, or by the
private sector, of $100 million or more, adjusted annually for
inflation, in any one year. This final rule will have no such effect on
State, local, and tribal governments, or on the private sector.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic Assistance numbers and titles for
the programs affected by this document are 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; 64.018, 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.
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 November 19, 2012, for publication.
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug abuse, Government contracts,
Grant programs--health, Government programs--veterans, Health care,
Health facilities, Health professions, Health records, Homeless, Mental
health programs, Nursing homes, Reporting and recordkeeping
requirements, Veterans.
Dated: November 21, 2012.
Robert C. McFetridge,
Director, Regulation Policy and Management, Office of the General
Counsel, Department of Veterans Affairs.
For the reasons stated in the preamble, the Department of Veterans
Affairs 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, and as noted in specific sections.
0
2. Revise Sec. 17.52(a)(2)(ii) to read as follows:
Sec. 17.52 Hospital care and medical services in non-VA facilities.
(a) * * *
(2) * * *
(ii) A veteran who has been furnished hospital care, nursing home
care, domiciliary care, or medical services, and requires medical
services to complete treatment incident to such care or services (each
authorization for non-VA treatment needed to complete treatment may
continue for up to 12 months, and new authorizations may be issued by
VA as needed), and
* * * * *
[FR Doc. 2012-28778 Filed 11-27-12; 8:45 am]
BILLING CODE 8320-01-P
