Health Care for Certain Children of Vietnam Veterans and Certain Korea Veterans-Covered Birth Defects and Spina Bifida, 27878-27883 [2015-11718]
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(1) Propose or adopt regulations only
upon a reasoned determination that
their benefits justify their costs
(recognizing that some benefits and
costs are difficult to quantify);
(2) Tailor its regulations to impose the
least burden on society, consistent with
obtaining regulatory objectives and
taking into account—among other things
and to the extent practicable—the costs
of cumulative regulations;
(3) In choosing among alternative
regulatory approaches, select those
approaches that maximize net benefits
(including potential economic,
environmental, public health and safety,
and other advantages; distributive
impacts; and equity);
(4) To the extent feasible, specify
performance objectives, rather than the
behavior or manner of compliance a
regulated entity must adopt; and
(5) Identify and assess available
alternatives to direct regulation,
including economic incentives—such as
user fees or marketable permits—to
encourage the desired behavior, or
provide information that enables the
public to make choices.
Executive Order 13563 also requires
an agency ‘‘to use the best available
techniques to quantify anticipated
present and future benefits and costs as
accurately as possible.’’ The Office of
Information and Regulatory Affairs of
OMB has emphasized that these
techniques may include ‘‘identifying
changing future compliance costs that
might result from technological
innovation or anticipated behavioral
changes.’’
We are issuing this proposed priority
and these proposed definitions only on
a reasoned determination that their
benefits would justify their costs. In
choosing among alternative regulatory
approaches, we selected those
approaches that would maximize net
benefits. Based on the analysis that
follows, the Department believes that
this regulatory action is consistent with
the principles in Executive Order 13563.
We also have determined that this
regulatory action would not unduly
interfere with State, local, and tribal
governments in the exercise of their
governmental functions.
In accordance with both Executive
orders, the Department has assessed the
potential costs and benefits, both
quantitative and qualitative, of this
regulatory action. The potential costs
are those resulting from statutory
requirements and those we have
determined as necessary for
administering the Department’s
programs and activities.
The benefits of the Demonstration and
Training program have been well
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established over the years through the
successful completion of similar
projects. For example, the projects first
funded in FY 2007 to demonstrate
collaborative practices that lead to
postsecondary education and
employment of youth with disabilities
have served as a rich source of practices
for the VR field. This proposed priority
and these proposed definitions would
promote projects that would serve as
models in developing and implementing
career pathways for individuals with
disabilities that could be replicated by
other State VR agencies so that such
agencies could improve employment
outcomes for individuals with
disabilities.
Intergovernmental Review: This
program is subject to Executive Order
12372 and the regulations in 34 CFR
part 79. One of the objectives of the
Executive order is to foster an
intergovernmental partnership and a
strengthened federalism. The Executive
order relies on processes developed by
State and local governments for
coordination and review of proposed
Federal financial assistance.
This document provides early
notification of our specific plans and
actions for this program.
Accessible Format: Individuals with
disabilities can obtain this document in
an accessible format (e.g., braille, large
print, audiotape, or compact disc) on
request to the program contact person
listed under FOR FURTHER INFORMATION
CONTACT.
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DEPARTMENT OF VETERANS
AFFAIRS
Dated: May 12, 2015.
Sue Swenson,
Acting Assistant Secretary for Special
Education and Rehabilitative Services.
FOR FURTHER INFORMATION CONTACT:
[FR Doc. 2015–11829 Filed 5–14–15; 8:45 am]
BILLING CODE 4000–01–P
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38 CFR Part 17
RIN 2900–AP09
Health Care for Certain Children of
Vietnam Veterans and Certain Korea
Veterans—Covered Birth Defects and
Spina Bifida
Department of Veterans Affairs.
Proposed rule.
AGENCY:
ACTION:
The Department of Veterans
Affairs (VA) proposes to amend its
regulations concerning the provisions of
health care to birth children of Vietnam
veterans and veterans of covered service
in Korea diagnosed with spina bifida,
except for spina bifida occulta, and
certain other birth defects. The
proposed changes would more clearly
define the types of health care VA
provides, including day health care and
health-related services, which VA
would define as homemaker or home
health aide services that provide
assistance with Activities of Daily
Living or Instrumental Activities of
Daily Living that have therapeutic
value. We would also make changes to
the list of health care services that
require preauthorization by VA.
DATES: Comments must be received by
VA on or before July 14, 2015.
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. Comments should
indicate that they are submitted in
response to ‘‘RIN 2900–AP09—Health
Care for Certain Children of Vietnam
Veterans and Certain Korea Veterans—
Covered Birth Defects and Spina
Bifida.’’ 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 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 https://
www.regulations.gov.
SUMMARY:
Karyn Barrett, Director, Program
Administration Directorate, Chief
Business Office Purchased Care
(10NB3), Veterans Health
Administration, Department of Veterans
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Affairs, 810 Vermont Ave. NW.,
Washington, DC 20420, (303) 331–7500.
(This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: Chapter
18 of title 38, United States Code,
provides for benefits for certain birth
children of Vietnam veterans and
veterans of covered service in Korea
who have been diagnosed with spina
bifida, except spina bifida occulta, and
certain other birth defects. These
benefits include: (1) Monthly monetary
allowances for various disability levels;
(2) health care; and (3) vocational
training and rehabilitation. VA has
published regulations at 38 CFR 17.900
through 17.905 concerning health care
for children authorized by 38 U.S.C.
1803 as well as 1813. Section 1803(a)
authorizes VA to provide a child of a
Vietnam veteran who is suffering from
spina bifida, except spina bifida occulta,
with health care. Section 1813(a)
authorizes VA to provide a child of a
woman Vietnam veteran who has been
diagnosed with certain other birth
defects needed health care for that
child’s covered birth defects or any
disability that is associated with those
birth defects. The definitions in section
1803(c) apply to both programs, with
two narrow exceptions that are not
relevant to this rulemaking.
The term ‘‘health care’’ under 38
U.S.C. 1803(c)(1) is defined as home
care, hospital care, nursing home care,
outpatient care, preventive care,
habilitative and rehabilitative care, case
management, and respite care. In
addition, health care includes the
training of appropriate members of a
child’s family or household in the care
of the child; the provision of
pharmaceuticals; supplies (including
continence-related supplies such as
catheters, pads, and diapers); equipment
(including durable medical equipment);
devices; appliances; assistive
technology; and direct transportation
costs to and from approved health care
providers (including any necessary costs
for meals and lodging en route and
accompaniment by an attendant or
attendants). Certain of these benefits
and services require preauthorization by
VA under § 17.902.
Health care that is not provided
directly by VA must be provided by
contract with an approved health care
provider or by other arrangement with
an approved health care provider.
Under current § 17.900, ‘‘approved
health care provider’’ means a health
care provider currently approved by the
Center for Medicare and Medicaid
Services (CMS), Department of Defense
TRICARE Program, Civilian Health and
Medical Program of the Department of
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Veterans Affairs (CHAMPVA), Joint
Commission on Accreditation of Health
Care Organizations (JCAHO), or
currently approved for providing health
care under a license or certificate issued
by a governmental entity with
jurisdiction. An entity or individual will
be deemed to be an approved health
care provider only when acting within
the scope of the approval, license, or
certificate. We do not propose any
substantive changes to the definition of
approved health care provider, but the
definition is relevant here because we
use the term in this rulemaking.
VA has identified a need for certain
types of care for these individuals and
intends to clarify in regulation which
services are authorized by 38 U.S.C.
1803 and 1813 and will be provided
under this authority. We propose to
amend our regulations to clarify what
services constitute health care under
§ 17.900 and to revise the list of health
care services that would require
preauthorization by VA under § 17.902.
These proposed changes are based on an
advisory opinion from VA’s Office of
the General Counsel (OGC).
VAOPGCADV 5–2013 (June 13, 2013).
OGC issued this advisory opinion in
response to a VA request for
clarification as to whether VA is
authorized by 38 U.S.C. 1803 to provide
various types of health care services.
One of those services is day health
care. Day health care services are a noninstitutional alternative to nursing home
care, and we believe that VA may
reimburse these services under its
authority in 38 U.S.C. 1803 to provide
outpatient care and respite care.
Outpatient care is defined at 38 U.S.C.
1803(c)(6) to mean care and treatment of
a disability, and preventive health
services, furnished to an individual
other than hospital care or nursing
home care. The phrase ‘‘care and
treatment’’ is also found in the
definitions of hospital care, nursing
home care, and preventive care at 38
U.S.C. 1803(c)(4) through (7). The
inclusion of the phrase ‘‘care and
treatment’’ in the definitions of the
categories of authorized health care
services indicates legislative intent that
a therapeutic component must be part of
the service provided. Accordingly, we
would define day health care to also
include a therapeutic component. So
defined, we believe that day health care
services constitute care and treatment
furnished outside of hospital care or
nursing home care, and, therefore, that
VA may provide day health care
services as part of outpatient care
authorized by 38 U.S.C. 1803. We would
also amend the definition of outpatient
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care to include day health care as an
authorized health care service.
We would define ‘‘day health care’’ to
mean a therapeutic program prescribed
by an approved health care provider
that provides necessary medical
services, rehabilitation, therapeutic
activities, socialization, nutrition, and
transportation services in a congregate
setting. Day health care services
contemplated under this proposal are
equivalent to adult day health care
provided to disabled veterans under 38
CFR 17.111(c)(1), except that such
services would be provided to
individuals who are not veterans. The
essential features are the therapeutic
focus of the day health care services and
provision of these services in a
congregate setting.
Current § 17.900 defines outpatient
care as care and treatment, including
preventive health services, furnished to
a child other than hospital care or
nursing home care. We would amend
this definition to include day health
care to clarify that day health care is a
component of outpatient care.
Day health care services are also a
component of respite care. Respite care
is currently defined at § 17.900 as care
furnished by an approved health care
provider on an intermittent basis for a
limited period to an individual who
resides primarily in a private residence
when such care will help the individual
continue residing in such private
residence. Respite care is a service that
pays for a person to come to an
individual beneficiary’s home or for the
beneficiary to go to a program, including
a day health care program, so the family
caregiver can have a period during
which the caregiver is not responsible to
provide care to the beneficiary. Respite
care allows the family caregiver to run
errands without worrying about leaving
the beneficiary alone at home. Respite
care can help reduce the stress a family
caregiver may feel when managing a
beneficiary’s long-term care needs at
home, and therefore can improve the
quality of care and assistance provided
to the beneficiary. VA currently
provides day health care to eligible
beneficiaries as an element of respite
care, and we would amend the
definition of respite care to clarify that
it is an included service.
Home care is defined at § 17.900 as
medical care, habilitative and
rehabilitative care, preventive health
services, and health-related services
furnished to a child in the child’s home
or other place of residence. The
regulation also defines habilitative and
rehabilitative care and preventive health
care but does not define ‘‘health-related
services.’’ We propose to define ‘‘health-
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related services’’ for purposes of
§§ 17.900 through 17.905 as homemaker
or home health aide services furnished
in the individual’s home or other place
of residence to the extent that those
services involve assistance with
Activities of Daily Living (ADLs) and
Instrumental Activities of Daily Living
(IADLs) that have therapeutic value.
This is consistent with VA’s
interpretation of the term ‘‘healthrelated services’’ as it is used relative to
care provided to veterans.
We would define homemaker services
to mean certain activities that help to
maintain a safe, healthy environment for
an individual in the home or other place
of residence. Such services contribute to
the prevention, delay, or reduction of
risk of harm or hospital, nursing home,
or other institutional care. Homemaker
services would include assistance with
personal care; home management;
completion of simple household tasks;
nutrition, including menu planning and
meal preparation; consumer education;
and hygiene education. Homemaker
services may include assistance with
IADLs, such as: Light housekeeping;
laundering; meal preparation; necessary
services to maintain a safe and sanitary
environment in the areas of the home
used by the individual; and services
essential to the comfort and cleanliness
of the individual and ensuring
individual safety. We would require that
homemaker services must be provided
according to the individual’s written
plan of care and must be prescribed by
an approved health care provider.
Home health aide services would
mean personal care and related support
services to an individual in the home or
other place of residence. Home health
aide services may include assistance
with ADLs such as: Bathing; toileting;
eating; dressing; aid in ambulating or
transfers; active and passive exercises;
assistance with medical equipment; and
routine health monitoring. We would
also provide that home health aide
services must be provided according to
the individual’s written plan of care and
must be prescribed by an approved
health care provider.
Homemaker and home health aide
services that are provided outside the
beneficiary’s residence, such as services
related to grocery shopping, would not
be covered, because the definition of
home care is limited to those services
provided in the child’s home or other
place of residence. Activities that have
no therapeutic value or are not medical
in nature also would not be covered.
These activities include assisting an
individual with personal
correspondence or paying bills. For this
reason, we define ‘‘health-related
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services’’ to include only those ADLs
and IADLs with therapeutic value.
As with all services under section
1803, however, only those healthrelated services that are medical in
nature and provided by an approved
health care provider are covered by VA.
Health-related services generally are
delivered by different types of providers
including personal attendants, custodial
care providers, or companion services
providers, and there may be instances in
which these service providers are not
‘‘approved health care providers’’ as
that term is defined by statute and
regulation. As discussed in further
detail below, we propose to require
preauthorization for homemaker
services, which is a subset of healthrelated services, and would be a newly
defined service provided under existing
statutory authority. VA already has an
established review and payment process
in place for home health aide services.
Preauthorization for certain health care
services is covered in § 17.902 and is
discussed below. We believe that these
requirements appropriately balance the
needs of the beneficiaries served
through this program and the statutory
and regulatory requirements that any
services provided through the program
must be medical in nature and provided
by an approved health care provider.
As noted above, home care is
furnished to a child in the child’s home
or other place of residence. The term
‘‘other place of residence’’ is not further
defined. In general, we believe this term
applies to those instances in which the
child may need a level of assistance that
is not available in the home, but a
higher level of care such as admission
to a nursing home is not needed. We
propose to define ‘‘other place of
residence’’ to include assisted living
facilities or residential group homes,
both of which provide an intermediate
level of assistance. We note that, while
VA would provide home care services
in an assisted living facility or
residential group home, VA is not
authorized to pay for a child to stay in
either an assisted living facility or
residential group home. The types of
alternatives to home care that VA may
provide under section 1803 are nursing
home care, hospital care, and respite
care.
We would also add a definition of
‘‘long-term care’’ to clarify the types of
long-term care VA is authorized to
provide under these programs. The term
‘‘long-term care’’ is not currently
defined, and VA is frequently asked
what types of long-term care VA is
authorized to provide. Generally, ‘‘longterm care’’ encompasses a variety of
services that include medical and non-
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medical care to people who have a
chronic illness or disability. However,
VA is authorized to provide only those
types of long-term care that constitute
‘‘health care’’ as defined in 38 U.S.C.
1803(c)(1)(A). The three categories of
health care VA has determined would
be considered long-term care are home
care, nursing home care, and respite
care. We propose to define the term
‘‘long-term care’’ consistent with that
determination. We would also amend
the definition of ‘‘health care’’ to
include long-term care.
In addition to the definitional
clarifications proposed above, we
propose to amend § 17.902, which sets
forth the list of services and benefits for
which preauthorization by VA is
required. Preauthorization allows VA to
ensure that health care services are
provided by approved health care
providers, prescribed and medically
necessary, and provided at a reasonable
cost. Requiring prior approval also
limits the likelihood that beneficiaries
will incur liability for non-reimbursable
expenses. In selecting those services
that require preauthorization, we
focused on those services where there is
likely to be a high cost and some
question regarding whether a particular
health care service meets the
requirements of §§ 17.900 and 17.901.
Preauthorization is currently required
for all mental health services. We would
amend § 17.902(a) to provide that
preauthorization is required only for
outpatient mental health services in
excess of 23 visits in a calendar year.
We believe this change would assist
beneficiaries by providing them with
greater flexibility in obtaining needed
mental health services. The proposed
change would also align the
preauthorization requirements for these
programs with CHAMPVA, which does
not require preauthorization for
inpatient mental health services and
requires preauthorization for outpatient
mental health services only after the
23rd visit in a calendar year. CHAMPVA
likewise covers non-veteran
beneficiaries, and following the
CHAMPVA standard here would ensure
consistency. In addition, this proposed
change would decrease the
administrative burden for beneficiaries
and would ensure that there is no delay
in initiating necessary outpatient mental
health services.
We also propose to add homemaker
services to the list of services that
require preauthorization. Both
homemaker services and home health
aide services are defined as healthrelated services. We would not require
preauthorization for home health aide
services, because VA has an existing
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payment schedule and an established
review process for these services.
However, we would require
preauthorization for homemaker
services, because VA’s authority to
provide homemaker services is limited
by type and scope. VA believes that
requiring preauthorization for
homemaker services would mitigate the
possibility of beneficiaries receiving
certain homemaker services that would
not be covered by VA because the
service was provided outside the
individual’s home or other place of
residence, or the service had no
therapeutic value.
As we noted above, day health care is
an element of both outpatient care and
respite care. VA already provides day
health care to eligible beneficiaries as
part of respite care, but it would now
also be included as an element of
outpatient care. Respite care, as a
distinct class of services, does not
require preauthorization. However, we
would require preauthorization for day
health care as part of outpatient care
only to ensure that the day health care
being claimed is a therapeutic program
prescribed by an approved health care
provider that provides necessary
medical services, rehabilitation,
therapeutic activities, socialization, and
nutrition, and that the service is
obtained at a reasonable cost.
Preauthorization would still be required
for dental services; substance abuse
treatment; training; transplantation
services; and travel (other than mileage
at the General Services Administration
rate for privately owned automobiles).
Current § 17.902(a) states that
authorization will only be given in
spina bifida cases where there is a
demonstrated medical need. ‘‘Medically
necessary’’ is a more easily understood
and more commonly used term than is
‘‘demonstrated medical need’’ and we
propose to amend this paragraph to
reflect the more commonly used term.
Payment for health care services is
addressed in § 17.903(a)(1). The current
rule states that payment for health care
services will be determined using the
same payment methodologies as
provided for under CHAMPVA
regulations. VA recognizes that services
covered by CHAMPVA change
periodically, and there may be instances
in which CHAMPVA does not have a
payment methodology for all health care
services available under §§ 17.900
through 17.905. For instance,
homemaker services are excluded from
CHAMPVA coverage at 38 CFR
17.272(a)(55) but may be covered as
health-related services under § 17.900.
To address this, we propose to amend
this paragraph to state that payment for
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services or benefits covered by §§ 17.900
through 17.905 but not covered by
CHAMPVA regulations will be
determined using the same or similar
payment methodologies applied by VA
for the equivalent services or benefits
provided to veterans. This may include
negotiating a rate with the provider or
using a national average or the Medicare
rate.
We would make a technical edit to the
definition of ‘‘approved health care
provider’’ found in § 17.900. The
current definition of ‘‘approved health
care provider’’ includes health care
providers currently approved by the
Joint Commission on Accreditation of
Health Care Organizations (JCAHO). In
2007, JCAHO changed its name to The
Joint Commission and we would amend
this definition to reflect that change.
Finally, we address the Office of
Management and Budget (OMB) control
number referenced in §§ 17.902 through
17.904. OMB had approved information
collection for purposes of the Paperwork
Reduction Act under OMB control
number 2900–0578 for provision of
health care, preauthorization, payment,
review, and appeals. In 2010, OMB
determined that information collection
for the Spina Bifida Health Care Benefits
program should be combined with a
parallel information collection approved
for CHAMPVA. This combined
information collection was approved
under OMB control number 2900–0219.
We would make a technical edit to
reflect the correct OMB control number.
Effect of Rulemaking
The Code of Federal Regulations, as
proposed to be revised by this proposed
rulemaking, would represent the
exclusive legal authority on this subject.
No contrary rules or procedures would
be authorized. All VA guidance would
be read to conform with this proposed
rulemaking if possible or, if not
possible, such guidance would be
superseded by this rulemaking.
Paperwork Reduction Act
This proposed rule includes
provisions constituting a modification
to a collection of information under the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501–3521) that requires
approval by OMB. Accordingly, under
44 U.S.C. 3507(d), VA has submitted a
copy of this rulemaking to OMB for
review.
OMB assigns control numbers to
collections of information it approves.
VA may not conduct or sponsor, and a
person is not required to respond to, a
collection of information unless it
displays a currently valid OMB control
number. Proposed § 17.902 contains a
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collection of information under the
Paperwork Reduction Act of 1995. If
OMB does not approve the modification
as requested, VA will immediately
remove the provisions containing a
collection of information or take such
other action as is directed by OMB.
Comments on the modification to the
collection[s] of information contained in
this proposed rule should be submitted
to the Office of Management and
Budget, Attention: Desk Officer for the
Department of Veterans Affairs, Office
of Information and Regulatory Affairs,
Washington, DC 20503, with copies sent
by mail or hand delivery to the Director,
Regulation Policy and Management
(02REG), Department of Veterans
Affairs, 810 Vermont Avenue NW.,
Room 1068, Washington, DC 20420; fax
to (202) 273–9026; or through
www.Regulations.gov. Comments
should indicate that they are submitted
in response to ‘‘RIN 2900–AP09—Health
Care for Certain Children of Vietnam
Veterans and Certain Korea Veterans—
Covered Birth Defects and Spina
Bifida.’’
OMB is required to make a decision
concerning the modification to the
collection of information contained in
this proposed rule between 30 and 60
days after publication of this document
in the Federal Register. Therefore, a
comment to OMB is best assured of
having its full effect if OMB receives it
within 30 days of publication. This does
not affect the deadline for the public to
comment on the proposed rule.
VA considers comments by the public
on proposed collections of information
in—
• Evaluating whether the proposed
collections of information are necessary
for the proper performance of the
functions of VA, including whether the
information will have practical utility;
• Evaluating the accuracy of VA’s
estimate of the burden of the proposed
collections of information, including the
validity of the methodology and
assumptions used;
• Enhancing the quality, usefulness,
and clarity of the information to be
collected; and
• Minimizing the burden of the
collections of information on those who
are to respond, including through the
use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology,
e.g., permitting electronic submission of
responses.
The modifications to the collection of
information contained in 38 CFR 17.902
are described immediately following
this paragraph, under their respective
titles.
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Federal Register / Vol. 80, No. 94 / Friday, May 15, 2015 / Proposed Rules
Title: Health Care for Certain Children
of Vietnam Veterans and Certain Korea
Veterans—Covered Birth Defects and
Spina Bifida.
Summary of collection of information:
Section 17.902(a) states that
preauthorization from VA is required for
certain services or benefits under
§§ 17.900 through 17.905. VA is
modifying the preauthorization
requirement for mental health services
to only require preauthorization for
outpatient mental health services in
excess of 23 visits in a calendar year.
VA also adds day health care provided
as outpatient care and homemaker
services to the list of services or benefits
that must receive preauthorization.
Description of the need for
information and proposed use of
information: The information collected
is needed to carry out the health care
programs for certain children of Korea
and/or Vietnam veterans authorized
under 38 U.S.C. chapter 18, as amended
by section 401, Public Law 106–419 and
section 102, Public Law 108–183. VA’s
medical regulations 38 CFR part 17
(17.900 through 17.905) establish
regulations regarding provisions of
health care for certain children of Korea
and Vietnam veterans and women
Vietnam veterans’ children born with
spina bifida and certain other covered
birth defects. These regulations specify
this information to be included in
requests for preauthorization and claims
from approved health care providers
and eligible Veterans.
Description of likely respondents:
Veterans and eligible family members
seeking reimbursement for claims
associated with spina bifida and certain
other covered birth defects.
Estimated number of respondents per
year: 12.
Estimated frequency of responses: 1
time per year.
Estimated average burden per
response: 10 minutes.
Estimated total annual reporting and
recordkeeping burden: 2 hours.
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Regulatory Flexibility Act
The Secretary hereby certifies that
this proposed rule would not have a
significant economic impact on a
substantial number of small entities as
they are defined in the Regulatory
Flexibility Act, 5 U.S.C. 601–612. This
proposed rule would directly affect only
individuals and would not directly
affect small entities. Therefore, pursuant
to 5 U.S.C. 605(b), this rulemaking is
exempt from the initial and final
regulatory flexibility analysis
requirements of 5 U.S.C. 603 and 604.
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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), unless OMB waives such
review, 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
https://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 https://www.va.gov/orpm/, by
following the link for VA Regulations
Published From FY 2004 to FYTD.
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
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(adjusted annually for inflation) in any
1 year. This proposed rule would have
no such effect on State, local, and tribal
governments, or on the private sector.
Catalog of Federal Domestic Assistance
There are no Catalog of Federal
Domestic Assistance numbers and titles
for the programs affected by this
document.
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 April 2, 2015, 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, Grant programs—
veterans, Health care, Health facilities,
Health professions, Health records,
Homeless, Medical and dental schools,
Medical devices, Medical research,
Mental health programs, Nursing
homes, Reporting and recordkeeping
requirements, Travel and transportation
expenses, Veterans.
Dated: May 11, 2015.
William F. Russo,
Acting Director, Office of Regulation Policy
& Management, Office of the General Counsel,
Department of Veterans Affairs.
For the reasons stated in the
preamble, Department of Veterans
Affairs proposes to amend 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 § 17.900 by:
a. In the definition of ‘‘Approved
health care provider’’ removing ‘‘Joint
Commission on Accreditation of Health
Care Organizations (JCAHO)’’ from the
first sentence and adding, in its place,
‘‘The Joint Commission’’;
■ b. Adding in alphabetical order a
definition of ‘‘Day health care’’;
■ c. In the definition of ‘‘Health care’’
adding ‘‘long-term care,’’ to the first
sentence immediately after ‘‘hospital
care,’’;
■ d. Adding in alphabetical order
definitions of ‘‘Health-related services’’,
■
■
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Federal Register / Vol. 80, No. 94 / Friday, May 15, 2015 / Proposed Rules
‘‘Home health aide
services’’,‘‘Homemaker services’’,
‘‘Long-term care’’, and ‘‘Other place of
residence’’;
■ e. In the definition of ‘‘Outpatient
care’’ adding ‘‘day health care and’’
immediately after the word ‘‘including’’;
and
■ f. Revising the definition of ‘‘Respite
care’’.
The additions and revision read as
follows:
§ 17.900
Definitions.
wreier-aviles on DSK5TPTVN1PROD with PROPOSALS
*
*
*
*
*
Day health care means a therapeutic
program prescribed by an approved
health care provider that provides
necessary medical services,
rehabilitation, therapeutic activities,
socialization, nutrition, and
transportation services in a congregate
setting. Day health care may be
provided as a component of outpatient
care or respite care.
*
*
*
*
*
Health-related services means
homemaker or home health aide
services furnished in the individual’s
home or other place of residence to the
extent that those services provide
assistance with Activities of Daily
Living and Instrumental Activities of
Daily Living that have therapeutic
value.
*
*
*
*
*
Home health aide services is a
component of health-related services
providing personal care and related
support services to an individual in the
home or other place of residence. Home
health aide services may include
assistance with Activities of Daily
Living such as: Bathing; toileting;
eating; dressing; aid in ambulating or
transfers; active and passive exercises;
assistance with medical equipment; and
routine health monitoring. Home health
aide services must be provided
according to the individual’s written
plan of care and must be prescribed by
an approved health care provider.
Homemaker services is a component
of health-related services encompassing
certain activities that help to maintain a
safe, healthy environment for an
individual in the home or other place of
residence. Such services contribute to
the prevention, delay, or reduction of
risk of harm or hospital, nursing home,
or other institutional care. Homemaker
services include assistance with
personal care; home management;
completion of simple household tasks;
nutrition, including menu planning and
meal preparation; consumer education;
and hygiene education. Homemaker
services may include assistance with
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Instrumental Activities of Daily Living,
such as: Light housekeeping;
laundering; meal preparation; necessary
services to maintain a safe and sanitary
environment in the areas of the home
used by the individual; and services
essential to the comfort and cleanliness
of the individual and ensuring
individual safety. Homemaker services
must be provided according to the
individual’s written plan of care and
must be prescribed by an approved
health care provider.
*
*
*
*
*
Long-term care means home care,
nursing home care, and respite care.
*
*
*
*
*
Other place of residence includes an
assisted living facility or residential
group home.
*
*
*
*
*
Respite care means care, including
day health care, furnished by an
approved health care provider on an
intermittent basis for a limited period to
an individual who resides primarily in
a private residence when such care will
help the individual continue residing in
such private residence.
*
*
*
*
*
■ 3. Amend § 17.902 by:
■ a. Revising the first three sentences of
paragraph (a); and
■ b. At the end of the section, removing
‘‘2900–0578’’ from the notice of the
Office of Management and Budget
control number and adding, in its place,
‘‘2900–0219’’.
The revisions read as follows:
■
§ 17.902
27883
AGENCY:
Preauthorization.
(a) Preauthorization from VA is
required for the following services or
benefits under §§ 17.900 through
17.905: Rental or purchase of durable
medical equipment with a total rental or
purchase price in excess of $300,
respectively, day health care provided
as outpatient care; dental services;
homemaker services; outpatient mental
health services in excess of 23 visits in
a calendar year; substance abuse
treatment; training; transplantation
services; and travel (other than mileage
at the General Services Administration
rate for privately owned automobiles).
Authorization will only be given in
spina bifida cases where it is
demonstrated that the care is medically
necessary. In cases of other covered
birth defects, authorization will only be
given where it is demonstrated that the
care is medically necessary and related
to the covered birth defects. * * *
*
*
*
*
*
■ 4. Amend § 17.903 by:
■ a. In paragraph (a)(1), adding a second
sentence; and
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Fmt 4702
Sfmt 4702
b. At the end of the section, removing
‘‘2900–0578’’ from the notice of the
Office of Management and Budget
control number and adding, in its place,
‘‘2900–0219’’.
The addition reads as follows:
§ 17.903
Payment.
(a)(1) * * * For those services or
benefits covered by §§ 17.900 through
17.905 but not covered by CHAMPVA
we will use payment methodologies the
same or similar to those used for
equivalent services or benefits provided
to veterans.
*
*
*
*
*
§ 17.904
[Amended]
5. Amending § 17.904 by, at the end
of the section, removing ‘‘2900–0578’’
from the notice of the Office of
Management and Budget control
number and adding, in its place, ‘‘2900–
0219’’.
■
[FR Doc. 2015–11718 Filed 5–14–15; 8:45 am]
BILLING CODE 8320–01–P
ENVIRONMENTAL PROTECTION
AGENCY
40 CFR Part 300
[EPA–HQ–SFUND–1986–0005; FRL–9927–
73–Region 5]
National Oil and Hazardous
Substances Pollution Contingency
Plan; National Priorities List Deletion
of the Burrows Sanitation Superfund
Site
Environmental Protection
Agency.
ACTION: Proposed rule; notice of intent.
The U.S. Environmental
Protection Agency (EPA) Region 5 is
issuing a Notice of Intent to Delete the
Burrows Sanitation Superfund Site
located in Hartford Township, Van
Buren County, Michigan from the
National Priorities List (NPL) and
requests public comments on this
proposed action. The NPL, promulgated
pursuant to section 105 of the
Comprehensive Environmental
Response, Compensation, and Liability
Act (CERCLA) of 1980, as amended, is
an appendix of the National Oil and
Hazardous Substances Pollution
Contingency Plan (NCP). EPA and the
State of Michigan, through the Michigan
Department of Environment Quality
(MDEQ), have determined that all
appropriate response actions under
CERCLA have been completed.
However, this deletion does not
preclude future actions under
Superfund.
SUMMARY:
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]]>Agencies
[Federal Register Volume 80, Number 94 (Friday, May 15, 2015)]
[Proposed Rules]
[Pages 27878-27883]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-11718]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AP09
Health Care for Certain Children of Vietnam Veterans and Certain
Korea Veterans--Covered Birth Defects and Spina Bifida
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its
regulations concerning the provisions of health care to birth children
of Vietnam veterans and veterans of covered service in Korea diagnosed
with spina bifida, except for spina bifida occulta, and certain other
birth defects. The proposed changes would more clearly define the types
of health care VA provides, including day health care and health-
related services, which VA would define as homemaker or home health
aide services that provide assistance with Activities of Daily Living
or Instrumental Activities of Daily Living that have therapeutic value.
We would also make changes to the list of health care services that
require preauthorization by VA.
DATES: Comments must be received by VA on or before July 14, 2015.
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. Comments should indicate that they are submitted
in response to ``RIN 2900-AP09--Health Care for Certain Children of
Vietnam Veterans and Certain Korea Veterans--Covered Birth Defects and
Spina Bifida.'' 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 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 https://www.regulations.gov.
FOR FURTHER INFORMATION CONTACT: Karyn Barrett, Director, Program
Administration Directorate, Chief Business Office Purchased Care
(10NB3), Veterans Health Administration, Department of Veterans
[[Page 27879]]
Affairs, 810 Vermont Ave. NW., Washington, DC 20420, (303) 331-7500.
(This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: Chapter 18 of title 38, United States Code,
provides for benefits for certain birth children of Vietnam veterans
and veterans of covered service in Korea who have been diagnosed with
spina bifida, except spina bifida occulta, and certain other birth
defects. These benefits include: (1) Monthly monetary allowances for
various disability levels; (2) health care; and (3) vocational training
and rehabilitation. VA has published regulations at 38 CFR 17.900
through 17.905 concerning health care for children authorized by 38
U.S.C. 1803 as well as 1813. Section 1803(a) authorizes VA to provide a
child of a Vietnam veteran who is suffering from spina bifida, except
spina bifida occulta, with health care. Section 1813(a) authorizes VA
to provide a child of a woman Vietnam veteran who has been diagnosed
with certain other birth defects needed health care for that child's
covered birth defects or any disability that is associated with those
birth defects. The definitions in section 1803(c) apply to both
programs, with two narrow exceptions that are not relevant to this
rulemaking.
The term ``health care'' under 38 U.S.C. 1803(c)(1) is defined as
home care, hospital care, nursing home care, outpatient care,
preventive care, habilitative and rehabilitative care, case management,
and respite care. In addition, health care includes the training of
appropriate members of a child's family or household in the care of the
child; the provision of pharmaceuticals; supplies (including
continence-related supplies such as catheters, pads, and diapers);
equipment (including durable medical equipment); devices; appliances;
assistive technology; and direct transportation costs to and from
approved health care providers (including any necessary costs for meals
and lodging en route and accompaniment by an attendant or attendants).
Certain of these benefits and services require preauthorization by VA
under Sec. 17.902.
Health care that is not provided directly by VA must be provided by
contract with an approved health care provider or by other arrangement
with an approved health care provider. Under current Sec. 17.900,
``approved health care provider'' means a health care provider
currently approved by the Center for Medicare and Medicaid Services
(CMS), Department of Defense TRICARE Program, Civilian Health and
Medical Program of the Department of Veterans Affairs (CHAMPVA), Joint
Commission on Accreditation of Health Care Organizations (JCAHO), or
currently approved for providing health care under a license or
certificate issued by a governmental entity with jurisdiction. An
entity or individual will be deemed to be an approved health care
provider only when acting within the scope of the approval, license, or
certificate. We do not propose any substantive changes to the
definition of approved health care provider, but the definition is
relevant here because we use the term in this rulemaking.
VA has identified a need for certain types of care for these
individuals and intends to clarify in regulation which services are
authorized by 38 U.S.C. 1803 and 1813 and will be provided under this
authority. We propose to amend our regulations to clarify what services
constitute health care under Sec. 17.900 and to revise the list of
health care services that would require preauthorization by VA under
Sec. 17.902. These proposed changes are based on an advisory opinion
from VA's Office of the General Counsel (OGC). VAOPGCADV 5-2013 (June
13, 2013). OGC issued this advisory opinion in response to a VA request
for clarification as to whether VA is authorized by 38 U.S.C. 1803 to
provide various types of health care services.
One of those services is day health care. Day health care services
are a non-institutional alternative to nursing home care, and we
believe that VA may reimburse these services under its authority in 38
U.S.C. 1803 to provide outpatient care and respite care.
Outpatient care is defined at 38 U.S.C. 1803(c)(6) to mean care and
treatment of a disability, and preventive health services, furnished to
an individual other than hospital care or nursing home care. The phrase
``care and treatment'' is also found in the definitions of hospital
care, nursing home care, and preventive care at 38 U.S.C. 1803(c)(4)
through (7). The inclusion of the phrase ``care and treatment'' in the
definitions of the categories of authorized health care services
indicates legislative intent that a therapeutic component must be part
of the service provided. Accordingly, we would define day health care
to also include a therapeutic component. So defined, we believe that
day health care services constitute care and treatment furnished
outside of hospital care or nursing home care, and, therefore, that VA
may provide day health care services as part of outpatient care
authorized by 38 U.S.C. 1803. We would also amend the definition of
outpatient care to include day health care as an authorized health care
service.
We would define ``day health care'' to mean a therapeutic program
prescribed by an approved health care provider that provides necessary
medical services, rehabilitation, therapeutic activities,
socialization, nutrition, and transportation services in a congregate
setting. Day health care services contemplated under this proposal are
equivalent to adult day health care provided to disabled veterans under
38 CFR 17.111(c)(1), except that such services would be provided to
individuals who are not veterans. The essential features are the
therapeutic focus of the day health care services and provision of
these services in a congregate setting.
Current Sec. 17.900 defines outpatient care as care and treatment,
including preventive health services, furnished to a child other than
hospital care or nursing home care. We would amend this definition to
include day health care to clarify that day health care is a component
of outpatient care.
Day health care services are also a component of respite care.
Respite care is currently defined at Sec. 17.900 as care furnished by
an approved health care provider on an intermittent basis for a limited
period to an individual who resides primarily in a private residence
when such care will help the individual continue residing in such
private residence. Respite care is a service that pays for a person to
come to an individual beneficiary's home or for the beneficiary to go
to a program, including a day health care program, so the family
caregiver can have a period during which the caregiver is not
responsible to provide care to the beneficiary. Respite care allows the
family caregiver to run errands without worrying about leaving the
beneficiary alone at home. Respite care can help reduce the stress a
family caregiver may feel when managing a beneficiary's long-term care
needs at home, and therefore can improve the quality of care and
assistance provided to the beneficiary. VA currently provides day
health care to eligible beneficiaries as an element of respite care,
and we would amend the definition of respite care to clarify that it is
an included service.
Home care is defined at Sec. 17.900 as medical care, habilitative
and rehabilitative care, preventive health services, and health-related
services furnished to a child in the child's home or other place of
residence. The regulation also defines habilitative and rehabilitative
care and preventive health care but does not define ``health-related
services.'' We propose to define ``health-
[[Page 27880]]
related services'' for purposes of Sec. Sec. 17.900 through 17.905 as
homemaker or home health aide services furnished in the individual's
home or other place of residence to the extent that those services
involve assistance with Activities of Daily Living (ADLs) and
Instrumental Activities of Daily Living (IADLs) that have therapeutic
value. This is consistent with VA's interpretation of the term
``health-related services'' as it is used relative to care provided to
veterans.
We would define homemaker services to mean certain activities that
help to maintain a safe, healthy environment for an individual in the
home or other place of residence. Such services contribute to the
prevention, delay, or reduction of risk of harm or hospital, nursing
home, or other institutional care. Homemaker services would include
assistance with personal care; home management; completion of simple
household tasks; nutrition, including menu planning and meal
preparation; consumer education; and hygiene education. Homemaker
services may include assistance with IADLs, such as: Light
housekeeping; laundering; meal preparation; necessary services to
maintain a safe and sanitary environment in the areas of the home used
by the individual; and services essential to the comfort and
cleanliness of the individual and ensuring individual safety. We would
require that homemaker services must be provided according to the
individual's written plan of care and must be prescribed by an approved
health care provider.
Home health aide services would mean personal care and related
support services to an individual in the home or other place of
residence. Home health aide services may include assistance with ADLs
such as: Bathing; toileting; eating; dressing; aid in ambulating or
transfers; active and passive exercises; assistance with medical
equipment; and routine health monitoring. We would also provide that
home health aide services must be provided according to the
individual's written plan of care and must be prescribed by an approved
health care provider.
Homemaker and home health aide services that are provided outside
the beneficiary's residence, such as services related to grocery
shopping, would not be covered, because the definition of home care is
limited to those services provided in the child's home or other place
of residence. Activities that have no therapeutic value or are not
medical in nature also would not be covered. These activities include
assisting an individual with personal correspondence or paying bills.
For this reason, we define ``health-related services'' to include only
those ADLs and IADLs with therapeutic value.
As with all services under section 1803, however, only those
health-related services that are medical in nature and provided by an
approved health care provider are covered by VA. Health-related
services generally are delivered by different types of providers
including personal attendants, custodial care providers, or companion
services providers, and there may be instances in which these service
providers are not ``approved health care providers'' as that term is
defined by statute and regulation. As discussed in further detail
below, we propose to require preauthorization for homemaker services,
which is a subset of health-related services, and would be a newly
defined service provided under existing statutory authority. VA already
has an established review and payment process in place for home health
aide services. Preauthorization for certain health care services is
covered in Sec. 17.902 and is discussed below. We believe that these
requirements appropriately balance the needs of the beneficiaries
served through this program and the statutory and regulatory
requirements that any services provided through the program must be
medical in nature and provided by an approved health care provider.
As noted above, home care is furnished to a child in the child's
home or other place of residence. The term ``other place of residence''
is not further defined. In general, we believe this term applies to
those instances in which the child may need a level of assistance that
is not available in the home, but a higher level of care such as
admission to a nursing home is not needed. We propose to define ``other
place of residence'' to include assisted living facilities or
residential group homes, both of which provide an intermediate level of
assistance. We note that, while VA would provide home care services in
an assisted living facility or residential group home, VA is not
authorized to pay for a child to stay in either an assisted living
facility or residential group home. The types of alternatives to home
care that VA may provide under section 1803 are nursing home care,
hospital care, and respite care.
We would also add a definition of ``long-term care'' to clarify the
types of long-term care VA is authorized to provide under these
programs. The term ``long-term care'' is not currently defined, and VA
is frequently asked what types of long-term care VA is authorized to
provide. Generally, ``long-term care'' encompasses a variety of
services that include medical and non-medical care to people who have a
chronic illness or disability. However, VA is authorized to provide
only those types of long-term care that constitute ``health care'' as
defined in 38 U.S.C. 1803(c)(1)(A). The three categories of health care
VA has determined would be considered long-term care are home care,
nursing home care, and respite care. We propose to define the term
``long-term care'' consistent with that determination. We would also
amend the definition of ``health care'' to include long-term care.
In addition to the definitional clarifications proposed above, we
propose to amend Sec. 17.902, which sets forth the list of services
and benefits for which preauthorization by VA is required.
Preauthorization allows VA to ensure that health care services are
provided by approved health care providers, prescribed and medically
necessary, and provided at a reasonable cost. Requiring prior approval
also limits the likelihood that beneficiaries will incur liability for
non-reimbursable expenses. In selecting those services that require
preauthorization, we focused on those services where there is likely to
be a high cost and some question regarding whether a particular health
care service meets the requirements of Sec. Sec. 17.900 and 17.901.
Preauthorization is currently required for all mental health
services. We would amend Sec. 17.902(a) to provide that
preauthorization is required only for outpatient mental health services
in excess of 23 visits in a calendar year. We believe this change would
assist beneficiaries by providing them with greater flexibility in
obtaining needed mental health services. The proposed change would also
align the preauthorization requirements for these programs with
CHAMPVA, which does not require preauthorization for inpatient mental
health services and requires preauthorization for outpatient mental
health services only after the 23rd visit in a calendar year. CHAMPVA
likewise covers non-veteran beneficiaries, and following the CHAMPVA
standard here would ensure consistency. In addition, this proposed
change would decrease the administrative burden for beneficiaries and
would ensure that there is no delay in initiating necessary outpatient
mental health services.
We also propose to add homemaker services to the list of services
that require preauthorization. Both homemaker services and home health
aide services are defined as health-related services. We would not
require preauthorization for home health aide services, because VA has
an existing
[[Page 27881]]
payment schedule and an established review process for these services.
However, we would require preauthorization for homemaker services,
because VA's authority to provide homemaker services is limited by type
and scope. VA believes that requiring preauthorization for homemaker
services would mitigate the possibility of beneficiaries receiving
certain homemaker services that would not be covered by VA because the
service was provided outside the individual's home or other place of
residence, or the service had no therapeutic value.
As we noted above, day health care is an element of both outpatient
care and respite care. VA already provides day health care to eligible
beneficiaries as part of respite care, but it would now also be
included as an element of outpatient care. Respite care, as a distinct
class of services, does not require preauthorization. However, we would
require preauthorization for day health care as part of outpatient care
only to ensure that the day health care being claimed is a therapeutic
program prescribed by an approved health care provider that provides
necessary medical services, rehabilitation, therapeutic activities,
socialization, and nutrition, and that the service is obtained at a
reasonable cost. Preauthorization would still be required for dental
services; substance abuse treatment; training; transplantation
services; and travel (other than mileage at the General Services
Administration rate for privately owned automobiles).
Current Sec. 17.902(a) states that authorization will only be
given in spina bifida cases where there is a demonstrated medical need.
``Medically necessary'' is a more easily understood and more commonly
used term than is ``demonstrated medical need'' and we propose to amend
this paragraph to reflect the more commonly used term.
Payment for health care services is addressed in Sec.
17.903(a)(1). The current rule states that payment for health care
services will be determined using the same payment methodologies as
provided for under CHAMPVA regulations. VA recognizes that services
covered by CHAMPVA change periodically, and there may be instances in
which CHAMPVA does not have a payment methodology for all health care
services available under Sec. Sec. 17.900 through 17.905. For
instance, homemaker services are excluded from CHAMPVA coverage at 38
CFR 17.272(a)(55) but may be covered as health-related services under
Sec. 17.900. To address this, we propose to amend this paragraph to
state that payment for services or benefits covered by Sec. Sec.
17.900 through 17.905 but not covered by CHAMPVA regulations will be
determined using the same or similar payment methodologies applied by
VA for the equivalent services or benefits provided to veterans. This
may include negotiating a rate with the provider or using a national
average or the Medicare rate.
We would make a technical edit to the definition of ``approved
health care provider'' found in Sec. 17.900. The current definition of
``approved health care provider'' includes health care providers
currently approved by the Joint Commission on Accreditation of Health
Care Organizations (JCAHO). In 2007, JCAHO changed its name to The
Joint Commission and we would amend this definition to reflect that
change.
Finally, we address the Office of Management and Budget (OMB)
control number referenced in Sec. Sec. 17.902 through 17.904. OMB had
approved information collection for purposes of the Paperwork Reduction
Act under OMB control number 2900-0578 for provision of health care,
preauthorization, payment, review, and appeals. In 2010, OMB determined
that information collection for the Spina Bifida Health Care Benefits
program should be combined with a parallel information collection
approved for CHAMPVA. This combined information collection was approved
under OMB control number 2900-0219. We would make a technical edit to
reflect the correct OMB control number.
Effect of Rulemaking
The Code of Federal Regulations, as proposed to be revised by this
proposed rulemaking, would represent the exclusive legal authority on
this subject. No contrary rules or procedures would be authorized. All
VA guidance would be read to conform with this proposed rulemaking if
possible or, if not possible, such guidance would be superseded by this
rulemaking.
Paperwork Reduction Act
This proposed rule includes provisions constituting a modification
to a collection of information under the Paperwork Reduction Act of
1995 (44 U.S.C. 3501-3521) that requires approval by OMB. Accordingly,
under 44 U.S.C. 3507(d), VA has submitted a copy of this rulemaking to
OMB for review.
OMB assigns control numbers to collections of information it
approves. VA may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a
currently valid OMB control number. Proposed Sec. 17.902 contains a
collection of information under the Paperwork Reduction Act of 1995. If
OMB does not approve the modification as requested, VA will immediately
remove the provisions containing a collection of information or take
such other action as is directed by OMB.
Comments on the modification to the collection[s] of information
contained in this proposed rule should be submitted to the Office of
Management and Budget, Attention: Desk Officer for the Department of
Veterans Affairs, Office of Information and Regulatory Affairs,
Washington, DC 20503, with copies sent by mail or hand delivery to the
Director, Regulation Policy and Management (02REG), Department of
Veterans Affairs, 810 Vermont Avenue NW., Room 1068, Washington, DC
20420; fax to (202) 273-9026; or through www.Regulations.gov. Comments
should indicate that they are submitted in response to ``RIN 2900-
AP09--Health Care for Certain Children of Vietnam Veterans and Certain
Korea Veterans--Covered Birth Defects and Spina Bifida.''
OMB is required to make a decision concerning the modification to
the collection of information contained in this proposed rule between
30 and 60 days after publication of this document in the Federal
Register. Therefore, a comment to OMB is best assured of having its
full effect if OMB receives it within 30 days of publication. This does
not affect the deadline for the public to comment on the proposed rule.
VA considers comments by the public on proposed collections of
information in--
Evaluating whether the proposed collections of information
are necessary for the proper performance of the functions of VA,
including whether the information will have practical utility;
Evaluating the accuracy of VA's estimate of the burden of
the proposed collections of information, including the validity of the
methodology and assumptions used;
Enhancing the quality, usefulness, and clarity of the
information to be collected; and
Minimizing the burden of the collections of information on
those who are to respond, including through the use of appropriate
automated, electronic, mechanical, or other technological collection
techniques or other forms of information technology, e.g., permitting
electronic submission of responses.
The modifications to the collection of information contained in 38
CFR 17.902 are described immediately following this paragraph, under
their respective titles.
[[Page 27882]]
Title: Health Care for Certain Children of Vietnam Veterans and
Certain Korea Veterans--Covered Birth Defects and Spina Bifida.
Summary of collection of information: Section 17.902(a) states that
preauthorization from VA is required for certain services or benefits
under Sec. Sec. 17.900 through 17.905. VA is modifying the
preauthorization requirement for mental health services to only require
preauthorization for outpatient mental health services in excess of 23
visits in a calendar year. VA also adds day health care provided as
outpatient care and homemaker services to the list of services or
benefits that must receive preauthorization.
Description of the need for information and proposed use of
information: The information collected is needed to carry out the
health care programs for certain children of Korea and/or Vietnam
veterans authorized under 38 U.S.C. chapter 18, as amended by section
401, Public Law 106-419 and section 102, Public Law 108-183. VA's
medical regulations 38 CFR part 17 (17.900 through 17.905) establish
regulations regarding provisions of health care for certain children of
Korea and Vietnam veterans and women Vietnam veterans' children born
with spina bifida and certain other covered birth defects. These
regulations specify this information to be included in requests for
preauthorization and claims from approved health care providers and
eligible Veterans.
Description of likely respondents: Veterans and eligible family
members seeking reimbursement for claims associated with spina bifida
and certain other covered birth defects.
Estimated number of respondents per year: 12.
Estimated frequency of responses: 1 time per year.
Estimated average burden per response: 10 minutes.
Estimated total annual reporting and recordkeeping burden: 2 hours.
Regulatory Flexibility Act
The Secretary hereby certifies that this proposed rule would not
have a significant economic impact on a substantial number of small
entities as they are defined in the Regulatory Flexibility Act, 5
U.S.C. 601-612. This proposed rule would directly affect only
individuals and would not directly affect small entities. Therefore,
pursuant to 5 U.S.C. 605(b), this rulemaking 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), unless OMB waives such review, 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 https://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 https://www.va.gov/orpm/, by following the link for VA
Regulations Published From FY 2004 to FYTD.
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 1 year. This proposed rule would have no such effect
on State, local, and tribal governments, or on the private sector.
Catalog of Federal Domestic Assistance
There are no Catalog of Federal Domestic Assistance numbers and
titles for the programs affected by this document.
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 April 2, 2015, 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, Grant programs--veterans, Health care, Health
facilities, Health professions, Health records, Homeless, Medical and
dental schools, Medical devices, Medical research, Mental health
programs, Nursing homes, Reporting and recordkeeping requirements,
Travel and transportation expenses, Veterans.
Dated: May 11, 2015.
William F. Russo,
Acting Director, Office of Regulation Policy & Management, Office of
the General Counsel, Department of Veterans Affairs.
For the reasons stated in the preamble, Department of Veterans
Affairs proposes to amend 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. 17.900 by:
0
a. In the definition of ``Approved health care provider'' removing
``Joint Commission on Accreditation of Health Care Organizations
(JCAHO)'' from the first sentence and adding, in its place, ``The Joint
Commission'';
0
b. Adding in alphabetical order a definition of ``Day health care'';
0
c. In the definition of ``Health care'' adding ``long-term care,'' to
the first sentence immediately after ``hospital care,'';
0
d. Adding in alphabetical order definitions of ``Health-related
services'',
[[Page 27883]]
``Home health aide services'',``Homemaker services'', ``Long-term
care'', and ``Other place of residence'';
0
e. In the definition of ``Outpatient care'' adding ``day health care
and'' immediately after the word ``including''; and
0
f. Revising the definition of ``Respite care''.
The additions and revision read as follows:
Sec. 17.900 Definitions.
* * * * *
Day health care means a therapeutic program prescribed by an
approved health care provider that provides necessary medical services,
rehabilitation, therapeutic activities, socialization, nutrition, and
transportation services in a congregate setting. Day health care may be
provided as a component of outpatient care or respite care.
* * * * *
Health-related services means homemaker or home health aide
services furnished in the individual's home or other place of residence
to the extent that those services provide assistance with Activities of
Daily Living and Instrumental Activities of Daily Living that have
therapeutic value.
* * * * *
Home health aide services is a component of health-related services
providing personal care and related support services to an individual
in the home or other place of residence. Home health aide services may
include assistance with Activities of Daily Living such as: Bathing;
toileting; eating; dressing; aid in ambulating or transfers; active and
passive exercises; assistance with medical equipment; and routine
health monitoring. Home health aide services must be provided according
to the individual's written plan of care and must be prescribed by an
approved health care provider.
Homemaker services is a component of health-related services
encompassing certain activities that help to maintain a safe, healthy
environment for an individual in the home or other place of residence.
Such services contribute to the prevention, delay, or reduction of risk
of harm or hospital, nursing home, or other institutional care.
Homemaker services include assistance with personal care; home
management; completion of simple household tasks; nutrition, including
menu planning and meal preparation; consumer education; and hygiene
education. Homemaker services may include assistance with Instrumental
Activities of Daily Living, such as: Light housekeeping; laundering;
meal preparation; necessary services to maintain a safe and sanitary
environment in the areas of the home used by the individual; and
services essential to the comfort and cleanliness of the individual and
ensuring individual safety. Homemaker services must be provided
according to the individual's written plan of care and must be
prescribed by an approved health care provider.
* * * * *
Long-term care means home care, nursing home care, and respite
care.
* * * * *
Other place of residence includes an assisted living facility or
residential group home.
* * * * *
Respite care means care, including day health care, furnished by an
approved health care provider on an intermittent basis for a limited
period to an individual who resides primarily in a private residence
when such care will help the individual continue residing in such
private residence.
* * * * *
0
3. Amend Sec. 17.902 by:
0
a. Revising the first three sentences of paragraph (a); and
0
b. At the end of the section, removing ``2900-0578'' from the notice of
the Office of Management and Budget control number and adding, in its
place, ``2900-0219''.
The revisions read as follows:
Sec. 17.902 Preauthorization.
(a) Preauthorization from VA is required for the following services
or benefits under Sec. Sec. 17.900 through 17.905: Rental or purchase
of durable medical equipment with a total rental or purchase price in
excess of $300, respectively, day health care provided as outpatient
care; dental services; homemaker services; outpatient mental health
services in excess of 23 visits in a calendar year; substance abuse
treatment; training; transplantation services; and travel (other than
mileage at the General Services Administration rate for privately owned
automobiles). Authorization will only be given in spina bifida cases
where it is demonstrated that the care is medically necessary. In cases
of other covered birth defects, authorization will only be given where
it is demonstrated that the care is medically necessary and related to
the covered birth defects. * * *
* * * * *
0
4. Amend Sec. 17.903 by:
0
a. In paragraph (a)(1), adding a second sentence; and
0
b. At the end of the section, removing ``2900-0578'' from the notice of
the Office of Management and Budget control number and adding, in its
place, ``2900-0219''.
The addition reads as follows:
Sec. 17.903 Payment.
(a)(1) * * * For those services or benefits covered by Sec. Sec.
17.900 through 17.905 but not covered by CHAMPVA we will use payment
methodologies the same or similar to those used for equivalent services
or benefits provided to veterans.
* * * * *
Sec. 17.904 [Amended]
0
5. Amending Sec. 17.904 by, at the end of the section, removing
``2900-0578'' from the notice of the Office of Management and Budget
control number and adding, in its place, ``2900-0219''.
[FR Doc. 2015-11718 Filed 5-14-15; 8:45 am]
BILLING CODE 8320-01-P
