Definition of Domiciliary Care, 14804-14807 [2018-07082]
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Federal Register / Vol. 83, No. 67 / Friday, April 6, 2018 / Proposed Rules
• RIN 2900–AL72, Burial Benefits
(April 8, 2008)
• RIN 2900–AL74, Apportionments to
Dependents and Payments to
Fiduciaries and Incarcerated
Beneficiaries (January 14, 2011)
• RIN 2900–AL76, Benefits for Certain
Filipino Veterans and Survivors (June
30, 2006)
• RIN 2900–AL82, Rights and
Responsibilities of Claimants and
Beneficiaries (May 10, 2005)
• RIN 2900–AL83, Elections of
Improved Pension; Old-Law and
Section 306 Pension (December 27,
2004)
• RIN 2900–AL84, Special and
Ancillary Benefits for Veterans,
Dependents, and Survivors (March 9,
2007)
• RIN 2900–AL87, General Provisions
(March 31, 2006)
• RIN 2900–AL88, Special Ratings
(October 17, 2008)
• RIN 2900–AL89, Dependency and
Indemnity Compensation Benefits
(October 21, 2005)
• RIN 2900–AL94, Dependents and
Survivors (September 20, 2006)
• RIN 2900–AL95, Payments to
Beneficiaries Who Are Eligible for
More than One Benefit (October 2,
2007)
• RIN 2900–AM01, General Evidence
Requirements, Effective Dates,
Revision of Decisions, and Protection
of Existing Ratings (May 22, 2007)
• RIN 2900–AM04, Improved Pension
(September 26, 2007)
• RIN 2900–AM05, Matters Affecting
the Receipt of Benefits (May 31, 2006)
• RIN 2900–AM06, Payments and
Adjustments to Payments (October 31,
2008)
• RIN 2900–AM07, Service-Connected
Disability Compensation (September
1, 2010)
• RIN 2900–AM16, VA Benefit Claims
(April 14, 2008)
VA received numerous comments to
the 20 NPRMs and on November 27,
2013, proposed amendments to the 20
NPRMs in one document, RIN 2900–
AO13. 78 FR at 71,042. VA received
additional comments on AO13, from
private individuals and several Veterans
Service Organizations, and VA thanks
the commenters for the time they
invested and their input.
As noted in RIN 2900–AO13, in 2012,
the Veterans Benefits Administration
(VBA) formulated a Transformation Plan
to improve the delivery of benefits to
veterans and their dependents and
survivors. 78 FR at 71,043. VA
acknowledged that, to ensure successful
implementation of the plan, a final rule
with regard to the Rewrite Project would
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not be published in the near future and
would ultimately require an evaluation
of the feasibility of a one-time
implementation of proposed Part 5. Id.
In the interim, VA assured, Part 3
regulations would be updated and
improved as needed, to include the type
of readability changes proposed for Part
5. Id.
Over the past five years, such updates
have occurred, see, e.g., 79 FR 32,653
(June 6, 2014) (implementing
improvements sourced in RIN 2900–
AL72), and VA proposes to continue
this current rulemaking approach—
updating Part 3 and Part 4 as needed—
but at an accelerated pace designed to
also incorporate needed changes from
proposed Part 5 for clarity and
simplicity. Thus, it will not be adopting
a one-time implementation of proposed
Part 5. This will avoid the inevitable
confusion caused by two co-existing sets
of regulations and manuals that may or
may not be applicable depending on the
date of the claim. It will avoid the
delays and decreases in productivity
inherent in any transition where
adjudicators have to familiarize
themselves with all new sections and
provisions. It will also ease
programming complexity and allow
VBA to manage the risk associated with
the transition to revised regulations. VA
has already undertaken a review to
identify and prioritize the needs and
expectations for incorporating proposed
Part 5 improvements, where possible,
into the current Part 3 and Part 4.
Phased implementation allows for
incremental assessment and
development of the required system
modifications. Controlling the rate of
rewrite implementation allows VBA to
retain, plan for, and mitigate adverse
system impacts and development needs
by reordering phases as necessary. The
plan also affords VBA flexibility in
scaling personnel and other resource
allocations to each new phase, if
necessary. One-time implementation
would require extensive training for
personnel, as well as costs associated
with IT equipment, installation,
maintenance, support, and system
updates. Even though the proposed
rules were not intended to alter
substantive law, they would alter the
terminology, section numbers, and
organization of the current regulations
upon which current VA systems,
applications, forms, and tools are based.
Thus, one-time implementation would
involve a rework of numerous
computer-based processing
applications, claims-related training
tools and materials, quality assurance
tools, claims-related forms, and the
Adjudication Procedures Manual. It
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would syphon resources from existing
modernization priorities, such as
improvements to the Veterans Benefits
Management System and National Work
Queue. This phased rollout minimizes
disruption of these major IT
modernization projects, as well as other
VA initiatives requiring substantial
personnel or training.
Changes in Part 3 and Part 4
regulations, to include incorporation of
proposed Part 5 improvements, where
appropriate, can be achieved over a
number of years. Some of these changes
are already underway, with VA’s
modernized Part 4, VA Schedule for
Rating Disabilities, slated for
publication in the near future. This
multi-year approach minimizes
disruption on field operations (and
ultimately claim production and
accuracy), as well as VBA Central Office
staffing required to implement the
revised regulations.
For the above reasons, VA is
withdrawing RIN 2900–AO13.
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.
Jacquelyn Hayes-Byrd, Deputy Chief of
Staff, Department of Veterans Affairs,
approved this document on April 3,
2018, for publication.
Dated: April 3, 2018.
Jeffrey M. Martin,
Impact Analyst, Office of Regulation Policy
& Management, Office of the Secretary,
Department of Veterans Affairs.
[FR Doc. 2018–07078 Filed 4–5–18; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
38 CFR Part 17
RIN 2900–AP00
Definition of Domiciliary Care
Department of Veterans Affairs.
Proposed rule.
AGENCY:
ACTION:
The Department of Veterans
Affairs (VA) proposes to amend its rule
defining domiciliary care, to accurately
reflect the scope of services currently
provided under the Domiciliary Care
Program. VA’s Domiciliary Care
Program provides a temporary home to
certain veterans, which includes the
furnishing of shelter, goods, clothing
and other comforts of home, as well as
SUMMARY:
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medical services. In 2005 VA designated
its Mental Health Residential
Rehabilitation Treatment Program (MH
RRTP) as a type of domiciliary care. MH
RRTP provides clinically intensive
residential rehabilitative services to
certain mental health patient
populations. We propose to amend the
definition of domiciliary care to reflect
that domiciliary care includes MH
RRTP. In addition, VA domiciliary care,
as a matter of long-standing practice,
includes non-permanent housing, but
this is not clear in the regulation. The
proposed rule would clarify that
domiciliary care provides temporary,
not permanent, residence to affected
veterans.
DATES: Comment Date: Comments on
the proposed rule must be received by
VA on or before June 5, 2018.
ADDRESSES: Written comments may be
submitted through https://
www.Regulations.gov; by mail or hand
delivery to the Director, Regulation
Policy and Management (00REG),
Department of Veterans Affairs, 810
Vermont Avenue NW, Room 1063B,
Washington, DC 20420; or by fax to
(202) 273–9026. Comments should
indicate that they are submitted in
response to ‘‘RIN 2900–AP00—
Definition of Domiciliary Care.’’ Copies
of comments received will be available
for public inspection in the Office of
Regulation Policy and Management,
Room 1063B between the hours of 8:00
a.m. and 4:30 p.m., Monday through
Friday (except holidays). Please call
(202) 461–4902 for an appointment.
(This is not a toll-free number.) In
addition, during the comment period,
comments may be viewed online
through the Federal Docket Management
System at www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT:
Jamie R. Ploppert, National Director,
Mental Health Residential Treatment
Programs (10P4M), Veterans Health
Administration, Department of Veterans
Affairs, 810 Vermont Avenue NW,
Washington, DC 20420 or (757) 722–
9991 extension 1123. (This is not a tollfree number.)
SUPPLEMENTARY INFORMATION: Title 38,
United States Code (U.S.C.), section
1710(b)(2) authorizes VA to provide
needed domiciliary care to veterans
whose annual income does not exceed
the applicable maximum annual rate of
VA pension and to veterans who have
no adequate means of support. The term
‘‘domiciliary care’’ is currently defined
at 38 Code of Federal Regulations (CFR)
17.30(b) as the furnishing of a home to
a veteran, embracing the furnishing of
shelter, food, clothing and other
comforts of home, including necessary
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medical services, as well as travel and
incidental expenses pursuant to 38 CFR
70.10. Veterans must meet eligibility
criteria found in § 17.46(b) as well as
§ 17.47(b)(2) and (c) to receive
domiciliary care.
The domiciliary program was
authorized to provide eligible veterans
with a home and coordinated
ambulatory medical care as needed.
Typically, domiciliaries are co-located
with VA medical centers or exist as
designated bed-settings within the
centers. By law, eligible veterans
include only: Those whose annual
income does not exceed the maximum
annual rate of pension payable to a
Veteran in need of regular aid and
attendance; or (2) those who have no
adequate means of support, as this
phrase is defined in 38 CFR 17.47(b)(2),
who can perform the activities specified
in 38 CFR 17.46(b) but who suffer from
a chronic disability, disease, or defect
that results in the veteran being unable
to earn a living for a prospective period.
See 38 CFR 17.47 (b)(2) and (c).
VA domiciliaries served initially as
‘‘Soldiers’ Homes’’ for economicallydisadvantaged Veterans with chronic
medical needs that can be addressed on
an outpatient basis. Domiciliary care
provides services to economicallydisadvantaged veterans, and VA
remains committed to serving that
group. Historically, domiciliary care in
VA has primarily been focused on
delivering care to older residents who
cannot live independently but who do
not require admission to a nursing
home. However, ‘‘domiciliary care’’ has
expanded to also provide services to
veterans who require residential
rehabilitation treatment for mental
health or substance use issues. While
the above-referenced statutory
definitions and eligibility criteria still
apply as do the regulatory criteria of
§§ 17.46(b) and 17.47(b)(2), the scope of
services furnished under the program
has evolved significantly, requiring
revision of § 17.30(b) and § 17.47(c). We
propose to amend the definition of
domiciliary care to reflect that change.
The scope of clinical services
available to VA domiciliary residents
has necessarily become specialized over
time due to the characteristics of the
patient populations served by the
residential rehabilitation treatment
model. In 2005, VA administratively
designated all MH RRTP facilities as
domiciliary care facilities to fully
integrate mental health; residential
rehabilitation; and treatment and
domiciliary care. VA established the
first MH RRTP in 1995. MH RRTPs
provide comprehensive supervised
treatment and rehabilitative services to
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veterans with mental health or
substance use disorders, and coexisting
medical or psychosocial needs such as
homelessness and unemployment. MH
RRTPs identify and address goals of
rehabilitation, recovery, health
maintenance, improved quality of life,
and community integration in addition
to specific treatment of medical
conditions, mental illnesses, addictive
disorders, and homelessness. The
residential component emphasizes
incorporation of clinical treatment gains
into a lifestyle of self-care and personal
responsibility. MH RRTPs provide a 24
hours-per-day, 7 days-per-week
structured and supportive residential
environment similar to that in
traditional domiciliary care. However,
there are differences in the type of care
delivered. The goals of care for
residential rehabilitation treatment
reflect a stronger emphasis on
rehabilitative services, including
professional, counseling, and guidance
services as well as treatment programs.
Rehabilitative services are designed to
facilitate the process of recovery from
injury, illness, or disease. These services
are intended to restore, to the maximum
extent possible, the physical, mental,
and psychological functioning of
veterans receiving residential
rehabilitation treatment.
Since 2010, domiciliary care has been
included as part of VA’s MH RRTP,
which began in 1995. VA domiciliaries
are used currently for VA’s Domiciliary
Residential Rehabilitation Treatment
Programs; Domiciliary Care for
Homeless Veterans Program; Health
Maintenance Domiciliary Beds Program;
General Domiciliary or Psychosocial
Residential Rehabilitation Treatment
Program; Domiciliary Substance Abuse
Programs; and Domiciliary PostTraumatic Stress Disorder Programs.
These are the patient populations
currently residing in our domiciliaries.
VA therefore proposes to update the
definition of domiciliary care in
§ 17.30(b) to reflect the scope of
clinically intensive rehabilitation
services included in the program.
Current § 17.30(b) defines domiciliary
care as the furnishing of a home to a
veteran, embracing the furnishing of
shelter, food, clothing and other
comforts of home, including necessary
medical services. We would amend this
definition by stating that domiciliary
care means a ‘‘temporary home’’ rather
than ‘‘home.’’ This is consistent with
VA’s long-standing practice of providing
domiciliary care as a non-permanent
living arrangement for eligible veterans.
This proposed change would not alter
VA’s commitment to ensure extended or
geriatric care is available to older
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veterans eligible for VA domiciliary
care, that is, those who cannot live
independently but who do not require
admission to a nursing home. These
veterans receive their domiciliary care
through State Veterans Homes
Domiciliary Programs and VA pays half
of the cost of that care through per diem
payments. We would define domiciliary
care to also mean a day hospital
program consisting of intensive
supervised rehabilitation and treatment
provided in a therapeutic residential
setting for residents with mental health
or substance use disorders, and cooccurring medical or psychosocial
needs such as homelessness and
unemployment.
Current § 17.47 addresses
considerations applicable in
determining eligibility for hospital care,
medical services, nursing home care, or
domiciliary care. Current paragraph (c)
clarifies that ‘‘domiciliary care, as the
term implies, is the provision of a home,
with such ambulant medical care as is
needed.’’ For the reasons stated above,
we would amend this paragraph to
reflect that domiciliary care provides a
temporary home.
Effect of Rulemaking
The CFR, as proposed to be revised by
this proposed rule, would represent the
exclusive legal authority on this subject.
No contrary rules or procedures are
authorized. All VA guidance will be
read to conform with this proposed
rulemaking if possible or, if not
possible, such guidance will be
superseded by this rulemaking.
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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 treated within VA and
would not affect any 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 sections 603
and 604.
Executive Orders 12866, 13563 and
13771
Executive Orders (E.O.) 12866 and
13563 direct agencies to assess the costs
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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). E.O.
13563 (Improving Regulation and
Regulatory Review) emphasizes the
importance of quantifying both costs
and benefits, reducing costs,
harmonizing rules, and promoting
flexibility. E.O. 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 E.O. 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 website at https://
www.va.gov/orpm/, by following the
link for ‘‘VA Regulations Published
From FY 2004 Through Fiscal Year to
Date.’’
This proposed rule is not expected to
be an E.O. 13771 regulatory action
because this proposed rule is not
significant under E.O. 12866.
Unfunded Mandates
The Unfunded Mandates Reform Act
of 1995 requires, at 2 U.S.C. 1532, that
agencies prepare an assessment of
anticipated costs and benefits before
issuing any rule that may result in 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
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; 64.013,
Veterans Prosthetic Appliances; 64.014,
Veterans State Domiciliary Care; 64.015,
Veterans State Nursing Home Care;
64.018, Sharing Specialized Medical
Resources; 64.019, Veterans
Rehabilitation Alcohol and Drug
Dependence; 64.022, Veterans Home
Based Primary Care; and 64.024, VA
Homeless Providers Grant and Per Diem
Program.
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.
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. Gina
S. Farrisee, Deputy Chief of Staff,
Department of Veterans Affairs,
approved this document on February
27, 2018, for publication.
Dated: April 3, 2018.
Consuela Benjamin,
Regulations Development Coordinator, Office
of Regulation Policy & Management, Office
of the Secretary, 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:
■
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Authority: 38 U.S.C. 501, and as noted in
specific sections.
Section 17.38 also issued under 38 U.S.C.
101, 501, 1701, 1705, 1710, 1710A, 1721,
1722, 1782, and 1786.
Section 17.63 also issued under 38 U.S.C.
1730.
Section 17.169 also issued under 38 U.S.C.
1712C.
Sections 17.380 and 17.412 are also issued
under sec. 260, Public Law 114–223, 130
Stat. 857.
Section 17.410 is also issued under 38
U.S.C. 1787.
Section 17.415 is also issued under 38
U.S.C. 7301, 7304, 7402, and 7403.
Sections 17.640 and 17.647 are also issued
under sec. 4, Public Law 114–2, 129 Stat. 30.
Sections 17.641 through 17.646 are also
issued under 38 U.S.C. 501(a) and sec. 4,
Public Law 114–2, 129 Stat. 30.
2. Amend § 17.30 by revising
paragraph (b) to read as follows:
■
§ 17.30
Definitions.
*
*
*
*
*
(b) Domiciliary care. The term
domiciliary care—
(1) Means the furnishing of:
(i) A temporary home to a veteran,
embracing the furnishing of shelter,
food, clothing and other comforts of
home, including necessary medical
services; or
(ii) A day hospital program consisting
of intensive supervised rehabilitation
and treatment provided in a therapeutic
residential setting for residents with
mental health or substance use
disorders, and co-occurring medical or
psychosocial needs such as
homelessness and unemployment.
(2) Includes travel and incidental
expenses pursuant to § 70.10 of this
chapter.
*
*
*
*
*
■ 3. Amend § 17.47 by removing the
word ‘‘home’’ in the second sentence of
paragraph (c) and adding, in its place,
‘‘temporary home’’.
[FR Doc. 2018–07082 Filed 4–5–18; 8:45 am]
BILLING CODE 8320–01–P
ENVIRONMENTAL PROTECTION
AGENCY
40 CFR Part 52
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[EPA–R08–OAR–2017–0567, FRL–9975–
09—Region 8]
Promulgation of State Implementation
Plan Revisions; Colorado; Attainment
Demonstration for the 2008 8-Hour
Ozone Standard for the Denver Metro/
North Front Range Nonattainment
Area, and Approval of Related
Revisions
Environmental Protection
Agency (EPA).
AGENCY:
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ACTION:
Proposed rule.
On May 31, 2017, the State of
Colorado submitted State
Implementation Plan (SIP) revisions
related to attainment of the 2008 8-hour
ozone National Ambient Air Quality
Standards (NAAQS) for the Denver
Metro/North Front Range (DMNFR)
Moderate nonattainment area by the
applicable attainment date of July 20,
2018. The Environmental Protection
Agency (EPA) proposes to approve the
majority of the submittal, which
includes an attainment demonstration,
base and future year emission
inventories, a reasonable further
progress (RFP) demonstration, a
reasonably available control measures
(RACM) analysis, a motor vehicle
inspection and maintenance (I/M)
program in Colorado Regulation
Number 11 (Reg. No. 11), a
nonattainment new source review
(NNSR) program, a contingency
measures plan, 2017 motor vehicle
emissions budgets (MVEBs) for
transportation conformity, and revisions
to Colorado Regulation Number 7 (Reg.
No. 7). The EPA is also proposing to
approve portions of the reasonably
available control technology (RACT)
analysis. Finally, the EPA proposes to
approve revisions made to Colorado’s
Reg. No. 7 in a May 5, 2013 SIP
submission. This action is being taken
in accordance with the Clean Air Act
(CAA).
SUMMARY:
Comments must be received on
or before May 7, 2018.
ADDRESSES: Submit your comments,
identified by Docket ID No. EPA–R08–
OAR–2017–0567, at https://
www.regulations.gov. Follow the online
instructions for submitting comments.
Once submitted, comments cannot be
edited or removed from Regulations.gov.
The EPA may publish any comment
received to its public docket. Do not
submit electronically any information
you consider to be Confidential
Business Information (CBI) or other
information whose disclosure is
restricted by statute. Multimedia
submissions (audio, video, etc.) must be
accompanied by a written comment.
The written comment is considered the
official comment and should include
discussion of all points you wish to
make. The EPA will generally not
consider comments or comment
contents located outside of the primary
submission (i.e., on the web, cloud, or
other file sharing system). For
additional submission methods, the full
EPA public comment policy,
information about CBI or multimedia
submissions, and general guidance on
DATES:
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14807
making effective comments, please visit
https://www2.epa.gov/dockets/
commenting-epa-dockets.
FOR FURTHER INFORMATION CONTACT:
Abby Fulton, Air Program, U.S.
Environmental Protection Agency
(EPA), Region 8, Mail Code 8P–AR,
1595 Wynkoop Street, Denver, Colorado
80202–1129, (303) 312–6563,
fulton.abby@epa.gov.
SUPPLEMENTARY INFORMATION:
I. What action is the Agency taking?
As explained below, the EPA is
proposing various actions on Colorado’s
proposed revisions to its SIP that it
submitted to the EPA on May 5, 2013,
and May 31, 2017. Specifically, we are
proposing to approve Colorado’s 2017
attainment demonstration for the 2008
8-hour ozone NAAQS. In addition, we
propose to approve the MVEBs
contained in the State’s submittal. We
also propose to approve all other aspects
of the submittal, except for certain area
source categories and major source
RACT, which we will be acting on at a
later date. We propose to approve the
revisions to Colorado’s Reg. 11 and 7,
except for Section X.E of Reg. 7, which
we will be acting on at a later date. We
propose to approve the revisions to
Colorado Reg. 7 Sections I, II, VI, VII,
VIII, and IX from the State’s May 5, 2013
submittal.
The specific bases for our proposed
actions and our analyses and findings
are discussed in this proposed
rulemaking. Technical information that
we rely upon in this proposal is
contained in the docket, available at
https://www.regulations.gov, Docket No.
EPA–R08–OAR–2017–0567.
II. Background
On March 12, 2008, the EPA revised
both the primary and secondary NAAQS
for ozone to a level of 0.075 parts per
million (ppm) (based on the annual
fourth-highest daily maximum 8-hour
average concentration, averaged over 3
years) to provide increased protection of
public health and the environment (73
FR 16436, March 27, 2008). The 2008
ozone NAAQS retains the same general
form and averaging time as the 0.08
ppm NAAQS set in 1997, but is set at
a more protective level. Specifically, the
2008 8-hour ozone NAAQS is attained
when the 3-year average of the annual
fourth-highest daily maximum 8-hour
average ambient air quality ozone
concentrations is less than or equal to
0.075 ppm. See 40 CFR 50.15.
Effective July 20, 2012, the EPA
designated as nonattainment any area
that was violating the 2008 8-hour
ozone NAAQS based on the three most
E:\FR\FM\06APP1.SGM
06APP1
]]>Agencies
[Federal Register Volume 83, Number 67 (Friday, April 6, 2018)]
[Proposed Rules]
[Pages 14804-14807]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-07082]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AP00
Definition of Domiciliary Care
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
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SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its
rule defining domiciliary care, to accurately reflect the scope of
services currently provided under the Domiciliary Care Program. VA's
Domiciliary Care Program provides a temporary home to certain veterans,
which includes the furnishing of shelter, goods, clothing and other
comforts of home, as well as
[[Page 14805]]
medical services. In 2005 VA designated its Mental Health Residential
Rehabilitation Treatment Program (MH RRTP) as a type of domiciliary
care. MH RRTP provides clinically intensive residential rehabilitative
services to certain mental health patient populations. We propose to
amend the definition of domiciliary care to reflect that domiciliary
care includes MH RRTP. In addition, VA domiciliary care, as a matter of
long-standing practice, includes non-permanent housing, but this is not
clear in the regulation. The proposed rule would clarify that
domiciliary care provides temporary, not permanent, residence to
affected veterans.
DATES: Comment Date: Comments on the proposed rule must be received by
VA on or before June 5, 2018.
ADDRESSES: Written comments may be submitted through https://www.Regulations.gov; by mail or hand delivery to the Director,
Regulation Policy and Management (00REG), Department of Veterans
Affairs, 810 Vermont Avenue NW, Room 1063B, Washington, DC 20420; or by
fax to (202) 273-9026. Comments should indicate that they are submitted
in response to ``RIN 2900-AP00--Definition of Domiciliary Care.''
Copies of comments received will be available for public inspection in
the Office of Regulation Policy and Management, Room 1063B between the
hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except
holidays). Please call (202) 461-4902 for an appointment. (This is not
a toll-free number.) In addition, during the comment period, comments
may be viewed online through the Federal Docket Management System at
www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT: Jamie R. Ploppert, National Director,
Mental Health Residential Treatment Programs (10P4M), Veterans Health
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW,
Washington, DC 20420 or (757) 722-9991 extension 1123. (This is not a
toll-free number.)
SUPPLEMENTARY INFORMATION: Title 38, United States Code (U.S.C.),
section 1710(b)(2) authorizes VA to provide needed domiciliary care to
veterans whose annual income does not exceed the applicable maximum
annual rate of VA pension and to veterans who have no adequate means of
support. The term ``domiciliary care'' is currently defined at 38 Code
of Federal Regulations (CFR) 17.30(b) as the furnishing of a home to a
veteran, embracing the furnishing of shelter, food, clothing and other
comforts of home, including necessary medical services, as well as
travel and incidental expenses pursuant to 38 CFR 70.10. Veterans must
meet eligibility criteria found in Sec. 17.46(b) as well as Sec.
17.47(b)(2) and (c) to receive domiciliary care.
The domiciliary program was authorized to provide eligible veterans
with a home and coordinated ambulatory medical care as needed.
Typically, domiciliaries are co-located with VA medical centers or
exist as designated bed-settings within the centers. By law, eligible
veterans include only: Those whose annual income does not exceed the
maximum annual rate of pension payable to a Veteran in need of regular
aid and attendance; or (2) those who have no adequate means of support,
as this phrase is defined in 38 CFR 17.47(b)(2), who can perform the
activities specified in 38 CFR 17.46(b) but who suffer from a chronic
disability, disease, or defect that results in the veteran being unable
to earn a living for a prospective period. See 38 CFR 17.47 (b)(2) and
(c).
VA domiciliaries served initially as ``Soldiers' Homes'' for
economically-disadvantaged Veterans with chronic medical needs that can
be addressed on an outpatient basis. Domiciliary care provides services
to economically-disadvantaged veterans, and VA remains committed to
serving that group. Historically, domiciliary care in VA has primarily
been focused on delivering care to older residents who cannot live
independently but who do not require admission to a nursing home.
However, ``domiciliary care'' has expanded to also provide services to
veterans who require residential rehabilitation treatment for mental
health or substance use issues. While the above-referenced statutory
definitions and eligibility criteria still apply as do the regulatory
criteria of Sec. Sec. 17.46(b) and 17.47(b)(2), the scope of services
furnished under the program has evolved significantly, requiring
revision of Sec. 17.30(b) and Sec. 17.47(c). We propose to amend the
definition of domiciliary care to reflect that change.
The scope of clinical services available to VA domiciliary
residents has necessarily become specialized over time due to the
characteristics of the patient populations served by the residential
rehabilitation treatment model. In 2005, VA administratively designated
all MH RRTP facilities as domiciliary care facilities to fully
integrate mental health; residential rehabilitation; and treatment and
domiciliary care. VA established the first MH RRTP in 1995. MH RRTPs
provide comprehensive supervised treatment and rehabilitative services
to veterans with mental health or substance use disorders, and
coexisting medical or psychosocial needs such as homelessness and
unemployment. MH RRTPs identify and address goals of rehabilitation,
recovery, health maintenance, improved quality of life, and community
integration in addition to specific treatment of medical conditions,
mental illnesses, addictive disorders, and homelessness. The
residential component emphasizes incorporation of clinical treatment
gains into a lifestyle of self-care and personal responsibility. MH
RRTPs provide a 24 hours-per-day, 7 days-per-week structured and
supportive residential environment similar to that in traditional
domiciliary care. However, there are differences in the type of care
delivered. The goals of care for residential rehabilitation treatment
reflect a stronger emphasis on rehabilitative services, including
professional, counseling, and guidance services as well as treatment
programs. Rehabilitative services are designed to facilitate the
process of recovery from injury, illness, or disease. These services
are intended to restore, to the maximum extent possible, the physical,
mental, and psychological functioning of veterans receiving residential
rehabilitation treatment.
Since 2010, domiciliary care has been included as part of VA's MH
RRTP, which began in 1995. VA domiciliaries are used currently for VA's
Domiciliary Residential Rehabilitation Treatment Programs; Domiciliary
Care for Homeless Veterans Program; Health Maintenance Domiciliary Beds
Program; General Domiciliary or Psychosocial Residential Rehabilitation
Treatment Program; Domiciliary Substance Abuse Programs; and
Domiciliary Post-Traumatic Stress Disorder Programs. These are the
patient populations currently residing in our domiciliaries. VA
therefore proposes to update the definition of domiciliary care in
Sec. 17.30(b) to reflect the scope of clinically intensive
rehabilitation services included in the program.
Current Sec. 17.30(b) defines domiciliary care as the furnishing
of a home to a veteran, embracing the furnishing of shelter, food,
clothing and other comforts of home, including necessary medical
services. We would amend this definition by stating that domiciliary
care means a ``temporary home'' rather than ``home.'' This is
consistent with VA's long-standing practice of providing domiciliary
care as a non-permanent living arrangement for eligible veterans. This
proposed change would not alter VA's commitment to ensure extended or
geriatric care is available to older
[[Page 14806]]
veterans eligible for VA domiciliary care, that is, those who cannot
live independently but who do not require admission to a nursing home.
These veterans receive their domiciliary care through State Veterans
Homes Domiciliary Programs and VA pays half of the cost of that care
through per diem payments. We would define domiciliary care to also
mean a day hospital program consisting of intensive supervised
rehabilitation and treatment provided in a therapeutic residential
setting for residents with mental health or substance use disorders,
and co-occurring medical or psychosocial needs such as homelessness and
unemployment.
Current Sec. 17.47 addresses considerations applicable in
determining eligibility for hospital care, medical services, nursing
home care, or domiciliary care. Current paragraph (c) clarifies that
``domiciliary care, as the term implies, is the provision of a home,
with such ambulant medical care as is needed.'' For the reasons stated
above, we would amend this paragraph to reflect that domiciliary care
provides a temporary home.
Effect of Rulemaking
The CFR, as proposed to be revised by this proposed rule, would
represent the exclusive legal authority on this subject. No contrary
rules or procedures are authorized. All VA guidance will be read to
conform with this proposed rulemaking if possible or, if not possible,
such guidance will 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 treated within VA and would not affect any 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
sections 603 and 604.
Executive Orders 12866, 13563 and 13771
Executive Orders (E.O.) 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). E.O. 13563 (Improving Regulation and Regulatory Review)
emphasizes the importance of quantifying both costs and benefits,
reducing costs, harmonizing rules, and promoting flexibility. E.O.
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 E.O.
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 website at
https://www.va.gov/orpm/, by following the link for ``VA Regulations
Published From FY 2004 Through Fiscal Year to Date.''
This proposed rule is not expected to be an E.O. 13771 regulatory
action because this proposed rule is not significant under E.O. 12866.
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.
1532, that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in 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; 64.013, Veterans
Prosthetic Appliances; 64.014, Veterans State Domiciliary Care; 64.015,
Veterans State Nursing Home Care; 64.018, Sharing Specialized Medical
Resources; 64.019, Veterans Rehabilitation Alcohol and Drug Dependence;
64.022, Veterans Home Based Primary Care; and 64.024, VA Homeless
Providers Grant and Per Diem Program.
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.
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. Gina S.
Farrisee, Deputy Chief of Staff, Department of Veterans Affairs,
approved this document on February 27, 2018, for publication.
Dated: April 3, 2018.
Consuela Benjamin,
Regulations Development Coordinator, Office of Regulation Policy &
Management, Office of the Secretary, 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:
[[Page 14807]]
Authority: 38 U.S.C. 501, and as noted in specific sections.
Section 17.38 also issued under 38 U.S.C. 101, 501, 1701, 1705,
1710, 1710A, 1721, 1722, 1782, and 1786.
Section 17.63 also issued under 38 U.S.C. 1730.
Section 17.169 also issued under 38 U.S.C. 1712C.
Sections 17.380 and 17.412 are also issued under sec. 260,
Public Law 114-223, 130 Stat. 857.
Section 17.410 is also issued under 38 U.S.C. 1787.
Section 17.415 is also issued under 38 U.S.C. 7301, 7304, 7402,
and 7403.
Sections 17.640 and 17.647 are also issued under sec. 4, Public
Law 114-2, 129 Stat. 30.
Sections 17.641 through 17.646 are also issued under 38 U.S.C.
501(a) and sec. 4, Public Law 114-2, 129 Stat. 30.
0
2. Amend Sec. 17.30 by revising paragraph (b) to read as follows:
Sec. 17.30 Definitions.
* * * * *
(b) Domiciliary care. The term domiciliary care--
(1) Means the furnishing of:
(i) A temporary home to a veteran, embracing the furnishing of
shelter, food, clothing and other comforts of home, including necessary
medical services; or
(ii) A day hospital program consisting of intensive supervised
rehabilitation and treatment provided in a therapeutic residential
setting for residents with mental health or substance use disorders,
and co-occurring medical or psychosocial needs such as homelessness and
unemployment.
(2) Includes travel and incidental expenses pursuant to Sec. 70.10
of this chapter.
* * * * *
0
3. Amend Sec. 17.47 by removing the word ``home'' in the second
sentence of paragraph (c) and adding, in its place, ``temporary home''.
[FR Doc. 2018-07082 Filed 4-5-18; 8:45 am]
BILLING CODE 8320-01-P
