Payment of Emergency Medication by VA, 44318-44320 [2015-18331]

Download as PDF 44318 Federal Register / Vol. 80, No. 143 / Monday, July 27, 2015 / Proposed Rules report) in effect as of December 31, 2007. (3) In the case of a plan year for which a plan is subject to the Cooperative and Small Employer Charity Pension Flexibility Act, Public Law 113–97, dealing with certain defined benefit pension plans maintained by more than one employer, the plan must meet the requirements in connection with the actuarial valuation report in accordance with instructions on PBGC’s Web site, https://www.pbgc.gov. ■ 5. Section 4010.11 is revised to read as follows: mstockstill on DSK4VPTVN1PROD with PROPOSALS § 4010.11 Waivers and extensions. (a) Plan funding/participant count waiver. Unless reporting is required by § 4010.4(a)(2) or (3), reporting is waived for a person (that would be a filer if not for the waiver) for an information year if, for the plan year ending within the information year— (1) The aggregate 4010 funding shortfall for all plans (including any exempt plans) maintained by the person’s controlled group (disregarding those plans with no 4010 funding shortfall) does not exceed $15 million; and (2) The aggregate number of participants in all plans (including any exempt plans) maintained by the person’s controlled group is fewer than 500. For this purpose, the number of participants in any plan may be determined either as of the end of the plan year ending within the information year or as of the valuation date for that plan year. (b) 4010 funding shortfall for waivers and exemptions—(1) General. A plan’s 4010 funding shortfall for a plan year equals the funding shortfall as provided under ERISA section 303(c)(4) and Code section 430(c)(4) determined as of the valuation date for the plan year, except that the value of plan assets is determined without regard to the reduction under ERISA section 303(f)(4)(B) and Code section 430(f)(4)(B) (dealing with reduction of assets by the amount of prefunding and funding standard carryover balances). (2) Multiple employer plans. For purposes of § 4010.8(c) and paragraph (a) of this section, the entire 4010 funding shortfall of any multiple employer plan of which the filer or any member of the filer’s controlled group is a contributing sponsor is included. (c) Alternative 4010 FTAP. Unless reporting is required by § 4010.4(a)(2) or (3), reporting is waived for a person for an information year if the 4010 funding target attainment percentage of each plan maintained by the person’s controlled group would be at least 80 VerDate Sep<11>2014 16:26 Jul 24, 2015 Jkt 235001 percent if the value of plan assets used for minimum funding purposes were substituted for the asset value determined without regard to the segment rate stabilized interest provisions of ERISA section 303(h)(2)(iv) for purposes of determining such percentage. (d) Missed contributions resulting in a lien or outstanding minimum funding waivers. Reporting is waived for a person (that would be a filer if not for the waiver) for an information year if, for the plan year ending within the information year, reporting would have been required solely under § 4010.4(a)(2) or (3), provided that the missed contributions or minimum funding waivers (as applicable) were reported to PBGC under part 4043 of this chapter by the due date for the 4010 filing. (e) Other waiver authority. PBGC may waive the requirement to submit information with respect to one or more filers or plans or may extend the applicable due date or dates specified in § 4010.10. PBGC will exercise this discretion in appropriate cases where it finds convincing evidence supporting a waiver or extension; any waiver or extension may be subject to conditions. A request for a waiver or extension must be filed in writing with PBGC at the address provided in § 4010.10(c) no later than 15 days before the applicable due date specified in § 4010.10, and must state the facts and circumstances on which the request is based. Issued in Washington, DC, this 17th day of July, 2015. Alice C. Maroni, Acting Director, Pension Benefit Guaranty Corporation. [FR Doc. 2015–18177 Filed 7–24–15; 8:45 am] BILLING CODE 7709–02–P DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900–AP34 Payment of Emergency Medication by VA Department of Veterans Affairs. Proposed rule. AGENCY: ACTION: The Department of Veterans Affairs (VA) proposes to amend its medical regulations that govern reimbursement of emergency treatment provided by non-VA medical care providers. VA proposes to clarify its regulations insofar as it involves the reimbursement of medications SUMMARY: PO 00000 Frm 00018 Fmt 4702 Sfmt 4702 prescribed or provided to the veteran during the episode of non-VA emergency treatment. DATES: Comments must be received by VA on or before September 25, 2015. ADDRESSES: Written comments may be submitted through https:// www.Regulations.gov; by mail or handdelivery to: Director, Regulation Policy and Management (02REG), Department of Veterans Affairs, 810 Vermont Ave. NW., Room 1068, Washington, DC 20420; or by fax to (202) 273–9026. (This is not a toll-free telephone number.) Comments should indicate that they are submitted in response to ‘‘RIN 2900–AP34–Payment of Emergency Medication by VA.’’ Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1068, between the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except holidays). Please call (202) 461–4902 for an appointment. (This is not a toll-free telephone 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: Kristin J. Cunningham, Director, Business Policy, Chief Business Office (10NB6), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Ave. NW., Washington, DC 20420; (202) 382–2508. (This is not a toll-free number.) SUPPLEMENTARY INFORMATION: VA is authorized under 38 U.S.C. 1725 to reimburse an eligible veteran (or the provider of the emergency treatment or another person or entity who paid such expenses on the veteran’s behalf) for the reasonable value of emergency treatment furnished to the Veteran at a non-VA medical facility. Under 38 U.S.C. 1728, VA is authorized to reimburse eligible veterans (or the provider of the emergency treatment or another person or entity who paid such expenses on the veteran’s behalf) for the customary and usual charges of non-VA emergency treatment furnished to the veteran. Section 1725 provides that in order for VA to reimburse a veteran for the reasonable value of non-VA emergency treatment under that section, such veteran must, among other things, be personally liable for the emergency treatment received in a non-VA medical facility, be enrolled in the VA health care system, and must have received medical care under chapter 17 of title 38 U.S.C. within the 24-month period prior to the receipt of such emergency E:\FR\FM\27JYP1.SGM 27JYP1 mstockstill on DSK4VPTVN1PROD with PROPOSALS Federal Register / Vol. 80, No. 143 / Monday, July 27, 2015 / Proposed Rules treatment. Reimbursement is authorized under section 1728 when non-VA emergency treatment was rendered to such veteran for: The treatment of an adjudicated service-connected disability; a non-service-connected disability associated with and held to be aggravating a service-connected disability; any disability of a veteran if the veteran has a total disability permanent in nature from a serviceconnected disability; and for any illness, injury or dental condition if the veteran is participating in a vocational rehabilitation program and is determined to be in medical need of care or treatment to make possible the veteran’s entrance into a course of training, or prevent interruption of a course of training, or hasten the return to a course of training which was interrupted because of such illness, injury, or dental condition. Current VA regulations implementing 38 U.S.C. 1725 and 1728 each state that covered emergency treatment includes ‘‘medication, including a short course of medication related to and necessary for the treatment of the emergency condition that is provided directly to the patient for use after the emergency condition is stabilized and the patient is discharged.’’ See 38 CFR 17.120(b) and 17.1002. It is undisputed that medications directly provided to the veteran or administered to the veteran as part of the emergency treatment are covered. However, the language ‘‘provided directly to the patient’’ has been found to be vague inasmuch as it does not clearly indicate that it also extends to a short course of necessary medication provided to the veteran by way of a prescription that is written or called in to an outpatient or commercial pharmacy by the emergency non-VA provider with instructions to the veteran-patient to obtain and use the medication post-discharge, as directed. We note this issue was not addressed in the original rulemakings associated with the implementation of section 1725; it was raised however in subsequent amendatory rulemaking in 2011. In 2011, final rulemaking for §§ 17.120(b) and 17.1002 included changes to further define ‘‘emergency treatment.’’ Among other things, new language was added to §§ 17.120(b) and 17.1002 to indicate that emergency treatment includes ‘‘medication, including a short course of medication related to and necessary for the treatment of the emergency condition that is provided directly to the patient for use after the emergency condition is stabilized and the patient is discharged.’’ It was explained that such change merely reflected VA’s original VerDate Sep<11>2014 16:26 Jul 24, 2015 Jkt 235001 intention and was done for clarification purposes only, in response to a commenter’s concerns. See 76 FR 79067, 79069–79070 (Dec. 21, 2011). VA has interpreted, and still interprets, emergency treatment, for purposes of both §§ 17.120 and 17.1002, to extend to situations where the veteran receives, during the emergency treatment episode, a prescription from the non-VA emergency provider for a short course of necessary medication (related to and necessary for treatment of the emergency condition poststabilization) which the veteran-patient is directed to obtain post-discharge and use at home as directed. Nor should it matter whether the non-VA emergency provider, in the course of providing such emergency treatment, provides the prescription in writing or, at the request of a patient, calls it into an outpatient or commercial pharmacy on the patient’s behalf. Again it was never intended or contemplated that the language ‘‘directly provided to the patient’’ would be interpreted to mean only medications actually administered to the patient during the emergency treatment episode and exclude such related prescriptions. The proposed amendments would be consistent with VA policy and would help ensure our regulations are not interpreted more narrowly than VA intends (as discussed herein). Specifically, we propose to amend § 17.120(b) to clarify that VA would reimburse the cost of a short course of medication prescribed for the veteran at the time that the veteran was receiving emergency treatment, by stating that emergency treatment would include ‘‘a short course of medication related to and necessary for the treatment of the emergency condition that is provided directly to or prescribed for the patient for use after the emergency condition is stabilized and the patient is discharged.’’ We propose to make similar amendment to the introductory paragraph of § 17.1002. Effect of Rulemaking Title 38 of the Code of Federal Regulations, as proposed to be revised by this 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 contains no provisions constituting a collection of information under the Paperwork PO 00000 Frm 00019 Fmt 4702 Sfmt 4702 44319 Reduction Act of 1995 (44 U.S.C. 3501– 3521). 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 E:\FR\FM\27JYP1.SGM 27JYP1 44320 Federal Register / Vol. 80, No. 143 / Monday, July 27, 2015 / Proposed Rules 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 Through Fiscal Year to Date.’’ Dated: July 22, 2015. William F. Russo, Acting Director, Office of Regulation Policy & Management, Office of the General Counsel, Department of Veterans Affairs. Unfunded Mandates PART 17—MEDICAL 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 proposed rule would 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; 64.014, 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 mstockstill on DSK4VPTVN1PROD with PROPOSALS List of Subjects in 38 CFR Part 17 Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Health care, Health facilities, Health professions, Health records, Homeless, Mental health programs, Nursing homes, Veterans. 16:26 Jul 24, 2015 1. The authority citation for part 17 continues to read as follows: Authority: 38 U.S.C. 501, and as noted in specific sections. § 17.120 [Amended] 2. Amend the first sentence of § 17.120(b) by adding ‘‘or prescribed for’’ immediately after ‘‘provided directly to’’. ■ § 17.1002 [Amended] 3. Amend the introductory text of § 17.1002 by adding ‘‘or prescribed for’’ immediately after ‘‘provided directly to’’. ■ [FR Doc. 2015–18331 Filed 7–24–15; 8:45 am] BILLING CODE 8320–01–P ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [EPA–R04–OAR–2015–0313; FRL–9931–25– Region 4] Approval and Promulgation of Implementation Plans for the State of Alabama: Cross-State Air Pollution Rule Environmental Protection Agency (EPA). ACTION: Proposed rule. AGENCY: The Environmental Protection Agency (EPA) is proposing to approve the State of Alabama’s March 27, 2015, State Implementation Plan (SIP) revision, submitted by the Alabama Department of Environmental Management. This SIP revision provides Alabama’s state-determined allowance allocations for existing electric generating units (EGUs) in the State for the 2016 control periods and replaces the allowance allocations for the 2016 control periods established by EPA under the Cross-State Air Pollution Rule (CSAPR). The CSAPR addresses the ‘‘good neighbor’’ provision of the Clean Air Act (CAA or Act) that requires states to reduce the transport of pollution that significantly affects downwind nonattainment and maintenance areas. EPA is proposing to approve Alabama’s SIP revision, incorporate the state- SUMMARY: 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. Robert L. Nabors II, Chief of Staff, Department of Veterans Affairs, approved this document on July 20, 2015, for publication. VerDate Sep<11>2014 For the reasons set out in the preamble, VA proposes to amend 38 CFR part 17 as follows: Jkt 235001 PO 00000 Frm 00020 Fmt 4702 Sfmt 4702 determined allocations for the 2016 control periods into the SIP, and amend the regulatory text of the CSAPR Federal Implementation Plan (FIP) to reflect approval and inclusion of the statedetermined allocations. EPA is proposing to approve Alabama’s SIP revision because it meets the requirements of the CAA and the CSAPR requirements to replace EPA’s allowance allocations for the 2016 control periods. This action is being taken pursuant to the CAA and its implementing regulations. In the Final Rules Section of this Federal Register, EPA is approving the State’s implementation plan revision as a direct final rule without prior proposal because the Agency views this as a noncontroversial submittal and anticipates no adverse comments. A detailed rationale for the approval is set forth in the direct final rule. DATES: Written comments must be received on or before August 26, 2015. ADDRESSES: Submit your comments, identified by Docket ID No. EPA–R04– OAR–2015–0313, by one of the following methods: 1. www.regulations.gov: Follow the on-line instructions for submitting comments. 2. Email: R4-ARMS@epa.gov. 3. Fax: (404) 562–9019. 4. Mail: ‘‘EPA–R04–OAR–2015– 0313,’’ Air Regulatory Management Section (formerly Regulatory Development Section), Air Planning and Implementation Branch (formerly Air Planning Branch), Air, Pesticides and Toxics Management Division, U.S. Environmental Protection Agency, Region 4, 61 Forsyth Street SW., Atlanta, Georgia 30303–8960. 5. Hand Delivery or Courier: Ms. Lynorae Benjamin, Chief, Air Regulatory Management Section, Air Planning and Implementation Branch, Air, Pesticides and Toxics Management Division, U.S. Environmental Protection Agency, Region 4, 61 Forsyth Street SW., Atlanta, Georgia 30303–8960. Such deliveries are only accepted during the Regional Office’s normal hours of operation. The Regional Office’s official hours of business are Monday through Friday, 8:30 a.m. to 4:30 p.m., excluding Federal holidays. Please see the direct final rule which is located in the Rules section of this Federal Register for detailed instructions on how to submit comments. FOR FURTHER INFORMATION CONTACT: Twunjala Bradley, Air Regulatory Management Section, Air Planning and Implementation Branch, Air, Pesticides and Toxics Management Division, U.S. E:\FR\FM\27JYP1.SGM 27JYP1

Agencies

[Federal Register Volume 80, Number 143 (Monday, July 27, 2015)]
[Proposed Rules]
[Pages 44318-44320]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-18331]


=======================================================================
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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP34


Payment of Emergency Medication by VA

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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

SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its 
medical regulations that govern reimbursement of emergency treatment 
provided by non-VA medical care providers. VA proposes to clarify its 
regulations insofar as it involves the reimbursement of medications 
prescribed or provided to the veteran during the episode of non-VA 
emergency treatment.

DATES: Comments must be received by VA on or before September 25, 2015.

ADDRESSES: Written comments may be submitted through https://www.Regulations.gov; by mail or hand-delivery to: Director, Regulation 
Policy and Management (02REG), Department of Veterans Affairs, 810 
Vermont Ave. NW., Room 1068, Washington, DC 20420; or by fax to (202) 
273-9026. (This is not a toll-free telephone number.) Comments should 
indicate that they are submitted in response to ``RIN 2900-AP34-Payment 
of Emergency Medication by VA.'' Copies of comments received will be 
available for public inspection in the Office of Regulation Policy and 
Management, Room 1068, between the hours of 8:00 a.m. and 4:30 p.m., 
Monday through Friday (except holidays). Please call (202) 461-4902 for 
an appointment. (This is not a toll-free telephone 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: Kristin J. Cunningham, Director, 
Business Policy, Chief Business Office (10NB6), Veterans Health 
Administration, Department of Veterans Affairs, 810 Vermont Ave. NW., 
Washington, DC 20420; (202) 382-2508. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: VA is authorized under 38 U.S.C. 1725 to 
reimburse an eligible veteran (or the provider of the emergency 
treatment or another person or entity who paid such expenses on the 
veteran's behalf) for the reasonable value of emergency treatment 
furnished to the Veteran at a non-VA medical facility. Under 38 U.S.C. 
1728, VA is authorized to reimburse eligible veterans (or the provider 
of the emergency treatment or another person or entity who paid such 
expenses on the veteran's behalf) for the customary and usual charges 
of non-VA emergency treatment furnished to the veteran.
    Section 1725 provides that in order for VA to reimburse a veteran 
for the reasonable value of non-VA emergency treatment under that 
section, such veteran must, among other things, be personally liable 
for the emergency treatment received in a non-VA medical facility, be 
enrolled in the VA health care system, and must have received medical 
care under chapter 17 of title 38 U.S.C. within the 24-month period 
prior to the receipt of such emergency

[[Page 44319]]

treatment. Reimbursement is authorized under section 1728 when non-VA 
emergency treatment was rendered to such veteran for: The treatment of 
an adjudicated service-connected disability; a non-service-connected 
disability associated with and held to be aggravating a service-
connected disability; any disability of a veteran if the veteran has a 
total disability permanent in nature from a service-connected 
disability; and for any illness, injury or dental condition if the 
veteran is participating in a vocational rehabilitation program and is 
determined to be in medical need of care or treatment to make possible 
the veteran's entrance into a course of training, or prevent 
interruption of a course of training, or hasten the return to a course 
of training which was interrupted because of such illness, injury, or 
dental condition.
    Current VA regulations implementing 38 U.S.C. 1725 and 1728 each 
state that covered emergency treatment includes ``medication, including 
a short course of medication related to and necessary for the treatment 
of the emergency condition that is provided directly to the patient for 
use after the emergency condition is stabilized and the patient is 
discharged.'' See 38 CFR 17.120(b) and 17.1002. It is undisputed that 
medications directly provided to the veteran or administered to the 
veteran as part of the emergency treatment are covered. However, the 
language ``provided directly to the patient'' has been found to be 
vague inasmuch as it does not clearly indicate that it also extends to 
a short course of necessary medication provided to the veteran by way 
of a prescription that is written or called in to an outpatient or 
commercial pharmacy by the emergency non-VA provider with instructions 
to the veteran-patient to obtain and use the medication post-discharge, 
as directed. We note this issue was not addressed in the original 
rulemakings associated with the implementation of section 1725; it was 
raised however in subsequent amendatory rulemaking in 2011. In 2011, 
final rulemaking for Sec. Sec.  17.120(b) and 17.1002 included changes 
to further define ``emergency treatment.'' Among other things, new 
language was added to Sec. Sec.  17.120(b) and 17.1002 to indicate that 
emergency treatment includes ``medication, including a short course of 
medication related to and necessary for the treatment of the emergency 
condition that is provided directly to the patient for use after the 
emergency condition is stabilized and the patient is discharged.'' It 
was explained that such change merely reflected VA's original intention 
and was done for clarification purposes only, in response to a 
commenter's concerns. See 76 FR 79067, 79069-79070 (Dec. 21, 2011).
    VA has interpreted, and still interprets, emergency treatment, for 
purposes of both Sec. Sec.  17.120 and 17.1002, to extend to situations 
where the veteran receives, during the emergency treatment episode, a 
prescription from the non-VA emergency provider for a short course of 
necessary medication (related to and necessary for treatment of the 
emergency condition post-stabilization) which the veteran-patient is 
directed to obtain post-discharge and use at home as directed. Nor 
should it matter whether the non-VA emergency provider, in the course 
of providing such emergency treatment, provides the prescription in 
writing or, at the request of a patient, calls it into an outpatient or 
commercial pharmacy on the patient's behalf. Again it was never 
intended or contemplated that the language ``directly provided to the 
patient'' would be interpreted to mean only medications actually 
administered to the patient during the emergency treatment episode and 
exclude such related prescriptions. The proposed amendments would be 
consistent with VA policy and would help ensure our regulations are not 
interpreted more narrowly than VA intends (as discussed herein).
    Specifically, we propose to amend Sec.  17.120(b) to clarify that 
VA would reimburse the cost of a short course of medication prescribed 
for the veteran at the time that the veteran was receiving emergency 
treatment, by stating that emergency treatment would include ``a short 
course of medication related to and necessary for the treatment of the 
emergency condition that is provided directly to or prescribed for the 
patient for use after the emergency condition is stabilized and the 
patient is discharged.'' We propose to make similar amendment to the 
introductory paragraph of Sec.  17.1002.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as proposed to be 
revised by this 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 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 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

[[Page 44320]]

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 Through Fiscal Year to 
Date.''

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 proposed rule would 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; 64.014, 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. Robert L. 
Nabors II, Chief of Staff, Department of Veterans Affairs, approved 
this document on July 20, 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, Health care, Health 
facilities, Health professions, Health records, Homeless, Mental health 
programs, Nursing homes, Veterans.

    Dated: July 22, 2015.
William F. Russo,
Acting Director, Office of Regulation Policy & Management, Office of 
the General Counsel, Department of Veterans Affairs.

    For the reasons set out in the preamble, VA 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.


Sec.  17.120  [Amended]

0
2. Amend the first sentence of Sec.  17.120(b) by adding ``or 
prescribed for'' immediately after ``provided directly to''.

Sec.  17.1002  [Amended]

0
3. Amend the introductory text of Sec.  17.1002 by adding ``or 
prescribed for'' immediately after ``provided directly to''.
[FR Doc. 2015-18331 Filed 7-24-15; 8:45 am]
 BILLING CODE 8320-01-P
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