Authorization for Non-VA Medical Services, 76061-76063 [2013-29311]

Download as PDF Federal Register / Vol. 78, No. 241 / Monday, December 16, 2013 / Rules and Regulations that the amendment of this danger zone has practically no economic impact on the public, no anticipated navigational hazard, or interference with existing waterway traffic. This final rule will have no significant economic impact on small entities. c. Review Under the National Environmental Policy Act Due to the administrative nature of this action and because there is no intended change in the use of the area, the Corps determined this amendment to the regulation will not have a significant impact to the quality of the human environment and, therefore, preparation of an environmental impact statement is not required. An environmental assessment (EA) was prepared after the public notice period closed and all comments received from the public were considered. The environmental assessment may be viewed at the District office listed at the end of the FOR FURTHER INFORMATION CONTACT section, above. d. Unfunded Mandates Act This final rule does not impose an enforceable duty among the private sector and, therefore, it is not a Federal private sector mandate and it is not subject to the requirements of either Section 202 or Section 205 of the Unfunded Mandates Act. The Corps has also found under Section 203 of the Act, that small governments will not be significantly and uniquely affected by this rulemaking. List of Subjects in 33 CFR Part 334 Danger zones, Marine safety, Navigation (water), Restricted areas, Waterways. For the reasons set out in the preamble, the Corps amends 33 CFR part 334 as follows: PART 334—DANGER ZONE AND RESTRICTED AREA REGULATIONS 1. The authority citation for 33 CFR part 334 continues to read as follows: ■ Authority: 40 Stat. 266 (33 U.S.C. 1) and 40 Stat. 892 (33 U.S.C. 3). 2. Revise § 334.1390 to read as follows: pmangrum on DSK3VPTVN1PROD with RULES ■ § 334.1390 Pacific Ocean off the Pacific Missile Range Facility at Barking Sands, Island of Kauai, Hawaii; danger zone. (a) The danger zone. All navigable waters within an area beginning at a point on the shore at latitude 22°04′13.65″ N, longitude 159°46′30.76″ W; and continue south along the shoreline to latitude 21°58′42.77″ N, and longitude 159°45′26.35″ W. Thence VerDate Mar<15>2010 13:31 Dec 13, 2013 Jkt 232001 extending southwest to latitude 21°56′6.00″ N, and longitude 159°46′55.91″ W extending northwest to latitude 21°58′59.81″ N and longitude 159°50′51.42″ W, continuing north to latitude 22°02′28.09″ N, and longitude 159°51′28.15″ W, and continuing northeast to latitude 22°06′ 30.71″ N, longitude 159°49′20.43″ W; and thence to point of beginning. All coordinates reference 1983 North American Datum (NAD 83). (b) The regulations. (1) Dredging, dragging, seining, and other similar operations within the danger zone are prohibited. (2) All persons, boats, vessels, or other craft are prohibited from entering, transiting, or remaining within the danger zone during range operations, test and training activities, or increases in force protection that pose a hazard to the general public, as determined by the enforcing agency. The enforcing agency’s determination of the necessity of closing the danger zone due to increases in force protection will be based on the Department of Defense Force Protection Condition (FPCON) System. From the lowest security level to the highest, FPCON levels are titled Normal, Alpha, Bravo, Charlie and Delta. (3) Closure of the danger zone will be indicated by Notice to Mariners, the presence of Pacific Missile Range Facility range boats, beach markings including beach signs along the north and south beach borders alerting shoreline foot traffic, security patrols, and radio transmissions on common ocean frequencies to include Marine band channel 6 (156.300 Mhz), Marine band channel 16 (156.800 Mhz), and CB channel 22. The enforcing agency will post the danger zone closure schedule on its official Navy Web site, http:// www.cnic.navy.mil/PMRF/, and Facebook page, http:// www.facebook.com/ PacificMissileRangeFacility. The danger zone closure schedule may also be obtained by calling the following phone numbers: 808–335–4301, 808–335– 4388, and 808–335–4523. (4) Consistent with paragraph (b)(2) of this section, the enforcing agency is authorized to prohibit access into the danger zone by anyone, and all willful violations of the enforcing agency’s prohibitions are punishable under 33 U.S.C. 3. (c) The enforcing agency. The regulations in this section shall be enforced by the Commanding Officer, Pacific Missile Range Facility, Hawaii and such agencies or persons as he or she may designate. PO 00000 Frm 00031 Fmt 4700 Sfmt 4700 76061 Dated: December 11, 2013. James R. Hannon, Chief, Operations and Regulatory Directorate of Civil Works. [FR Doc. 2013–29878 Filed 12–13–13; 8:45 am] BILLING CODE 3720–58–P DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900–AO46 Authorization for Non-VA Medical Services Department of Veterans Affairs. Final rule. AGENCY: ACTION: This Department of Veterans Affairs (VA) rulemaking amends VA’s regulations regarding payment by VA for medical services under VA’s statutory authority for non-VA medical care. In the Federal Register on November 28, 2012, VA proposed to remove an outdated regulatory limitation on veterans’ eligibility to be referred for non-VA medical care. On the same date, VA also published a companion direct final rule that would have made the same amendments effective on January 28, 2013, if no significant adverse comments were received. Because VA received adverse comments on the direct final rule, VA is withdrawing it in a companion document in this issue of the Federal Register. This rulemaking includes VA’s responses to comments on the proposed and direct final rules. DATES: Effective Date: This rule is effective January 15, 2014. 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: On November 28, 2012, VA proposed a rule in the Federal Register, at 77 FR 70967, to amend its regulations authorizing non-VA medical care. Under our nonVA medical care authority in 38 U.S.C. 1703, VA may provide certain hospital care (inpatient care) and medical services (outpatient care) for eligible veterans when VA facilities are not capable of providing economical services due to geographical inaccessibility or are not capable of providing the services needed. VA proposed to revise its existing regulation, at 38 CFR 17.52(a)(2)(ii), to SUMMARY: E:\FR\FM\16DER1.SGM 16DER1 pmangrum on DSK3VPTVN1PROD with RULES 76062 Federal Register / Vol. 78, No. 241 / Monday, December 16, 2013 / Rules and Regulations remove a limitation that barred VA from authorizing non-VA medical services for certain veterans who had not previously been furnished VA hospital care. Without this revision, these veterans were eligible for non-VA medical services under § 17.52(a)(2)(ii) to complete treatment of a nonserviceconnected disability only if they had received VA hospital care for that disability. On the same date, VA published a companion direct final rule at 77 FR 70893 that would have made the same amendments as those in the proposed rule effective on January 28, 2013, if no adverse public comments were received. The direct final rule and proposed rule each provided a 30-day comment period that ended on December 28, 2012. VA received comments on the proposed rule and direct final rule, including some adverse comments. VA is, therefore, withdrawing the direct final rule in a companion document in this issue of the Federal Register. VA addresses comments received on both the direct final and proposed rules in this action. This final rule adopts the proposed rule without changes. We received several comments urging VA to expand eligibility for non-VA medical care to allow all veterans the option of using the program for any needed treatment. VA lacks statutory authority to make this change. VA may provide non-VA medical care under 38 U.S.C. 1703 only in limited circumstances: When VA cannot provide economical hospital care or medical services because of geographic inaccessibility, or when VA facilities are not capable of providing the hospital care or medical services that a veteran needs. See 38 U.S.C. 1703(a). Further, if those conditions are met, VA has authority to provide non-VA medical care to a veteran only if the veteran meets the eligibility requirements set forth in section 1703. Thus, VA cannot make the changes these commenters request because to do so would be contrary to VA’s statutory authority under 38 U.S.C. 1703. One commenter who recommended that VA allow veterans to choose to receive care from private providers also stated that ‘‘VA hospitals should be for emergency care and for those who are having operations and need weeks or months to recover, such as multi-trauma cases,’’ suggesting that all other care should be referred to non-VA providers. We emphasize that the VA health care system does provide emergency medical services and hospital care to eligible veterans, including surgical services and acute inpatient polytrauma VerDate Mar<15>2010 13:31 Dec 13, 2013 Jkt 232001 rehabilitation, as recommended by the commenter. By statute, the VA health care system must also provide ‘‘a complete medical and hospital service for the medical care and treatment of veterans’’ (38 U.S.C. 7301(b)) and therefore cannot reduce the availability of VA care in the manner suggested by the commenter. VA makes no changes based on this comment. One commenter expressed support for this regulation and stated that veterans receiving non-VA emergency treatment would not need to be transferred from a non-VA hospital to a VA hospital to complete treatment. This comment does not accurately characterize the effect of this rulemaking. To clarify, this action only applies to the provision of non-VA medical services after the veteran has received VA care and the non-VA medical services are needed to complete the VA care. One commenter stated that VA should not ‘‘duplicat[e] medical services readily available by well qualified providers’’ and that ‘‘[m]any veterans are forced by current VA practices to utilize local medical services, even though the services are in theory available from the VA at other than a ‘local’ VA facility.’’ This comment can be interpreted in two ways. One interpretation is that some veterans are forced to pay for their own care from community providers in order to avoid traveling when their local VA facilities refer them to VA facilities located in other geographic areas. Another interpretation is that VA refers veterans to community providers when care would be better provided at a VA facility. Neither interpretation is within the scope of this rulemaking. VA therefore does not make any changes to this rulemaking based on these comments. The same commenter recommended that veterans’ ‘‘expenses in utilizing [Medicare] should be offset by VA reimbursement.’’ We note that the VA health care system and Medicare are separate programs run under distinct statutory authorities. VA has no authority to reimburse Medicare beneficiaries for expenses they incur to obtain medical care under Medicare in the manner suggested by the commenter (see 42 U.S.C. 1395y(a)(3)). VA does not make any changes based on this comment. One commenter asked whether this rulemaking would result in additional administrative burdens for veterans to obtain referrals or for providers to obtain payments for non-VA medical care. This rulemaking only removes a limitation; it does not create any new burdens or procedures. VA’s regulations PO 00000 Frm 00032 Fmt 4700 Sfmt 4700 and policies pertaining to how veterans obtain referrals and how VA processes payments for non-VA medical care will remain the same. There will be no additional administrative burden on veterans or non-VA providers as a result of this rulemaking. The majority of the comments that VA received on this rulemaking requested that VA allow hearing-aid specialists to perform diagnostic hearing evaluations for veterans. We received over one hundred comments on this issue. Some of the commenters requested to become recognized VA providers. VA allows only audiologists to perform such evaluations. We are not aware of any State that licenses hearing-aid specialists to perform such evaluations. VA will consider these comments internally as appropriate, but the request is outside the scope of this rulemaking, so we make no changes based on these comments. VA received a comment expressing support for the proposed rule, but expressing concern about a draft request for proposals issued by VA for the procurement of non-VA medical care surgical services. This rulemaking affects only eligibility for non-VA medical services, and not VA’s means of procuring such services. This comment, therefore, is outside of the scope of the regulation, and we make no changes based on it. VA will consider this comment in its evaluation of the draft request for proposals as appropriate. VA received a comment expressing support for the proposed rule, but asking VA to remove ‘‘a burdensome regulatory requirement that prescriptions for veterans must be written by a VA-affiliated provider for the veteran to obtain the prescription at the VA’s discounted price. Instead, the VA should recognize the validity of a community-based physician’s prescription.’’ We do not make changes based on this comment because the issue is outside the scope of this regulation. VA will consider the recommendation internally as appropriate. VA received one comment expressing support for the proposed rule and requesting that physicians certified by osteopathic boards of medicine be included in all VA activities concerning veterans’ healthcare. This comment is outside the scope of this regulation, but no change is required for VA to fulfill the request because VA considers doctors of osteopathic medicine as physicians, and does not distinguish between physicians based on their types of degrees. VA received one comment stating ‘‘[v]ote no.’’ Since the commenter did E:\FR\FM\16DER1.SGM 16DER1 Federal Register / Vol. 78, No. 241 / Monday, December 16, 2013 / Rules and Regulations not state a reason for disagreeing with this rulemaking, VA does not make any changes based on this comment. In addition to the comments described above, VA received several comments expressing general support for the proposed rulemaking. Based on the rationale set forth in the proposed rule and in this document, VA is adopting the provisions of the proposed rule as a final rule with no changes. Effect of Rulemaking Title 38 of the Code of Federal Regulations, as revised by this final 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 under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501–3521). pmangrum on DSK3VPTVN1PROD with RULES Regulatory Flexibility Act The Secretary hereby certifies that this final rule 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 final rule directly affects only individuals and will not directly affect small entities. Therefore, pursuant to 5 U.S.C. 605(b), this amendment is exempt from the initial and final regulatory flexibility analysis requirements of 5 U.S.C. 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 VerDate Mar<15>2010 13:31 Dec 13, 2013 Jkt 232001 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. VA’s impact analysis can be found as a supporting document at http://www.regulations.gov, usually within 48 hours after the rulemaking document is published. Additionally, a copy of the rulemaking and its impact analysis are available on VA’s Web site at http://www1.va.gov/orpm/, by following the link for ‘‘VA Regulations Published.’’ Unfunded Mandates The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 1532, that agencies prepare an assessment of anticipated costs and benefits before issuing any rule that may result in the expenditure by State, local, and tribal governments, in the aggregate, or by the private sector, of $100 million or more (adjusted annually for inflation) in any one year. This 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 PO 00000 Frm 00033 Fmt 4700 Sfmt 9990 76063 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. Jose D. Riojas, Chief of Staff, Department of Veterans Affairs, approved this document on November 6, 2013 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: December 4, 2013. 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 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: ■ § 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. 2013–29311 Filed 12–13–13; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\16DER1.SGM 16DER1

Agencies

[Federal Register Volume 78, Number 241 (Monday, December 16, 2013)]
[Rules and Regulations]
[Pages 76061-76063]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-29311]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AO46


Authorization for Non-VA Medical Services

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

-----------------------------------------------------------------------

SUMMARY: This Department of Veterans Affairs (VA) rulemaking amends 
VA's regulations regarding payment by VA for medical services under 
VA's statutory authority for non-VA medical care. In the Federal 
Register on November 28, 2012, VA proposed to remove an outdated 
regulatory limitation on veterans' eligibility to be referred for non-
VA medical care. On the same date, VA also published a companion direct 
final rule that would have made the same amendments effective on 
January 28, 2013, if no significant adverse comments were received. 
Because VA received adverse comments on the direct final rule, VA is 
withdrawing it in a companion document in this issue of the Federal 
Register. This rulemaking includes VA's responses to comments on the 
proposed and direct final rules.

DATES: Effective Date: This rule is effective January 15, 2014.

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: On November 28, 2012, VA proposed a rule in 
the Federal Register, at 77 FR 70967, to amend its regulations 
authorizing non-VA medical care. Under our non-VA medical care 
authority in 38 U.S.C. 1703, VA may provide certain hospital care 
(inpatient care) and medical services (outpatient care) for eligible 
veterans when VA facilities are not capable of providing economical 
services due to geographical inaccessibility or are not capable of 
providing the services needed. VA proposed to revise its existing 
regulation, at 38 CFR 17.52(a)(2)(ii), to

[[Page 76062]]

remove a limitation that barred VA from authorizing non-VA medical 
services for certain veterans who had not previously been furnished VA 
hospital care. Without this revision, these veterans were eligible for 
non-VA medical services under Sec.  17.52(a)(2)(ii) to complete 
treatment of a nonservice-connected disability only if they had 
received VA hospital care for that disability.
    On the same date, VA published a companion direct final rule at 77 
FR 70893 that would have made the same amendments as those in the 
proposed rule effective on January 28, 2013, if no adverse public 
comments were received. The direct final rule and proposed rule each 
provided a 30-day comment period that ended on December 28, 2012. VA 
received comments on the proposed rule and direct final rule, including 
some adverse comments. VA is, therefore, withdrawing the direct final 
rule in a companion document in this issue of the Federal Register. VA 
addresses comments received on both the direct final and proposed rules 
in this action.
    This final rule adopts the proposed rule without changes.
    We received several comments urging VA to expand eligibility for 
non-VA medical care to allow all veterans the option of using the 
program for any needed treatment. VA lacks statutory authority to make 
this change. VA may provide non-VA medical care under 38 U.S.C. 1703 
only in limited circumstances: When VA cannot provide economical 
hospital care or medical services because of geographic 
inaccessibility, or when VA facilities are not capable of providing the 
hospital care or medical services that a veteran needs. See 38 U.S.C. 
1703(a). Further, if those conditions are met, VA has authority to 
provide non-VA medical care to a veteran only if the veteran meets the 
eligibility requirements set forth in section 1703. Thus, VA cannot 
make the changes these commenters request because to do so would be 
contrary to VA's statutory authority under 38 U.S.C. 1703.
    One commenter who recommended that VA allow veterans to choose to 
receive care from private providers also stated that ``VA hospitals 
should be for emergency care and for those who are having operations 
and need weeks or months to recover, such as multi-trauma cases,'' 
suggesting that all other care should be referred to non-VA providers. 
We emphasize that the VA health care system does provide emergency 
medical services and hospital care to eligible veterans, including 
surgical services and acute inpatient polytrauma rehabilitation, as 
recommended by the commenter. By statute, the VA health care system 
must also provide ``a complete medical and hospital service for the 
medical care and treatment of veterans'' (38 U.S.C. 7301(b)) and 
therefore cannot reduce the availability of VA care in the manner 
suggested by the commenter. VA makes no changes based on this comment.
    One commenter expressed support for this regulation and stated that 
veterans receiving non-VA emergency treatment would not need to be 
transferred from a non-VA hospital to a VA hospital to complete 
treatment. This comment does not accurately characterize the effect of 
this rulemaking. To clarify, this action only applies to the provision 
of non-VA medical services after the veteran has received VA care and 
the non-VA medical services are needed to complete the VA care.
    One commenter stated that VA should not ``duplicat[e] medical 
services readily available by well qualified providers'' and that 
``[m]any veterans are forced by current VA practices to utilize local 
medical services, even though the services are in theory available from 
the VA at other than a `local' VA facility.'' This comment can be 
interpreted in two ways. One interpretation is that some veterans are 
forced to pay for their own care from community providers in order to 
avoid traveling when their local VA facilities refer them to VA 
facilities located in other geographic areas. Another interpretation is 
that VA refers veterans to community providers when care would be 
better provided at a VA facility. Neither interpretation is within the 
scope of this rulemaking. VA therefore does not make any changes to 
this rulemaking based on these comments.
    The same commenter recommended that veterans' ``expenses in 
utilizing [Medicare] should be offset by VA reimbursement.'' We note 
that the VA health care system and Medicare are separate programs run 
under distinct statutory authorities. VA has no authority to reimburse 
Medicare beneficiaries for expenses they incur to obtain medical care 
under Medicare in the manner suggested by the commenter (see 42 U.S.C. 
1395y(a)(3)). VA does not make any changes based on this comment.
    One commenter asked whether this rulemaking would result in 
additional administrative burdens for veterans to obtain referrals or 
for providers to obtain payments for non-VA medical care. This 
rulemaking only removes a limitation; it does not create any new 
burdens or procedures. VA's regulations and policies pertaining to how 
veterans obtain referrals and how VA processes payments for non-VA 
medical care will remain the same. There will be no additional 
administrative burden on veterans or non-VA providers as a result of 
this rulemaking.
    The majority of the comments that VA received on this rulemaking 
requested that VA allow hearing-aid specialists to perform diagnostic 
hearing evaluations for veterans. We received over one hundred comments 
on this issue. Some of the commenters requested to become recognized VA 
providers. VA allows only audiologists to perform such evaluations. We 
are not aware of any State that licenses hearing-aid specialists to 
perform such evaluations. VA will consider these comments internally as 
appropriate, but the request is outside the scope of this rulemaking, 
so we make no changes based on these comments.
    VA received a comment expressing support for the proposed rule, but 
expressing concern about a draft request for proposals issued by VA for 
the procurement of non-VA medical care surgical services. This 
rulemaking affects only eligibility for non-VA medical services, and 
not VA's means of procuring such services. This comment, therefore, is 
outside of the scope of the regulation, and we make no changes based on 
it. VA will consider this comment in its evaluation of the draft 
request for proposals as appropriate.
    VA received a comment expressing support for the proposed rule, but 
asking VA to remove ``a burdensome regulatory requirement that 
prescriptions for veterans must be written by a VA-affiliated provider 
for the veteran to obtain the prescription at the VA's discounted 
price. Instead, the VA should recognize the validity of a community-
based physician's prescription.'' We do not make changes based on this 
comment because the issue is outside the scope of this regulation. VA 
will consider the recommendation internally as appropriate.
    VA received one comment expressing support for the proposed rule 
and requesting that physicians certified by osteopathic boards of 
medicine be included in all VA activities concerning veterans' 
healthcare. This comment is outside the scope of this regulation, but 
no change is required for VA to fulfill the request because VA 
considers doctors of osteopathic medicine as physicians, and does not 
distinguish between physicians based on their types of degrees.
    VA received one comment stating ``[v]ote no.'' Since the commenter 
did

[[Page 76063]]

not state a reason for disagreeing with this rulemaking, VA does not 
make any changes based on this comment.
    In addition to the comments described above, VA received several 
comments expressing general support for the proposed rulemaking.
    Based on the rationale set forth in the proposed rule and in this 
document, VA is adopting the provisions of the proposed rule as a final 
rule with no changes.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as revised by this 
final 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 under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).

Regulatory Flexibility Act

    The Secretary hereby certifies that this final rule 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 final rule directly affects only individuals and will not 
directly affect small entities. Therefore, pursuant to 5 U.S.C. 605(b), 
this amendment is exempt from the initial and final regulatory 
flexibility analysis requirements of 5 U.S.C. 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. VA's impact analysis can be found as a 
supporting document at http://www.regulations.gov, usually within 48 
hours after the rulemaking document is published. Additionally, a copy 
of the rulemaking and its impact analysis are available on VA's Web 
site at http://www1.va.gov/orpm/, by following the link for ``VA 
Regulations Published.''

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before issuing any rule that may result in the expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any one year. This 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. Jose D. 
Riojas, Chief of Staff, Department of Veterans Affairs, approved this 
document on November 6, 2013 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: December 4, 2013.
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. 2013-29311 Filed 12-13-13; 8:45 am]
BILLING CODE 8320-01-P