Medical Care in Foreign Countries and Filing for Reimbursement for Community Care Not Previously Authorized by VA, 29447-29449 [2018-13487]

Download as PDF Federal Register / Vol. 83, No. 122 / Monday, June 25, 2018 / Rules and Regulations Federal Register, the Coast Guard will provide the maritime community with extensive advanced notification of enforcement of these safety zones via the Local Notice to Mariners. Dated: June 19, 2018. M.M. Balding, Captain, U.S. Coast Guard, Captain of the Port Puget Sound. [FR Doc. 2018–13518 Filed 6–22–18; 8:45 am] BILLING CODE 9110–04–P DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900–AP55 Medical Care in Foreign Countries and Filing for Reimbursement for Community Care Not Previously Authorized by VA Department of Veterans Affairs. Final rule. AGENCY: ACTION: The Department of Veterans Affairs (VA) adopts as final, with no changes, a proposed rule amending its medical regulations related to hospital care and medical services in foreign countries. We simplified and clarified the scope of these regulations, address medical services provided to eligible veterans in the Republic of the Philippines, and removed provisions related to grants to the Republic of the Philippines that are no longer supported by statutory authority. VA also amends its medical regulations related to filing claims for reimbursement of medical expenses incurred for VA care not previously authorized. We provided a 60-day period to receive comments from the public on the proposed changes, and received no comments. VA adopts the proposed rule as final, with no changes. DATES: This final rule is effective July 25, 2018. FOR FURTHER INFORMATION CONTACT: Joseph Duran, Director, Policy and Planning, Office of Community Care (10D1A1), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (303) 372–4629. (This is not a toll-free number) or Joseph.Duran2@va.gov. SUPPLEMENTARY INFORMATION: Section 1724 of title 38 United States Code (U.S.C.) prohibits VA from furnishing hospital care or medical services outside any State except under specific circumstances. VA is authorized under 38 U.S.C. 1724(b)(1) to furnish care and services to an eligible veteran outside any State if VA ‘‘determines that such amozie on DSK3GDR082PROD with RULES SUMMARY: VerDate Sep<11>2014 16:14 Jun 22, 2018 Jkt 244001 care and services are needed for the treatment of a service-connected disability of the veteran or as part of a rehabilitation program under chapter 31 of this title.’’ VA furnishes health care to eligible veterans in the Republic of the Philippines under this authority. In addition, 38 U.S.C. 1724(c) provides that ‘‘within the limits’’ of the Veterans Memorial Medical Center at Manila, Republic of the Philippines, VA may enter into contracts to furnish necessary hospital care to a veteran for any nonservice-connected disability if such veteran is unable to defray the expenses of necessary hospital care. VA may also operate an outpatient clinic in the Republic of the Philippines to furnish necessary medical services to a veteran who has a service-connected disability. 38 U.S.C. 1724(e). Several sections of title 38 Code of Federal Regulations (CFR) part 17 address VA’s authority to provide for hospital care and medical services for eligible veterans outside the United States, as well as submission of claims for reimbursement for services obtained from community care providers outside the United States. On January 31, 2018, VA proposed to revise or amend these regulations to consolidate similar content, clarify provisions, and ensure that these regulations reflect current VA practice and statutory authority. (83 FR 4454). We proposed simplifying language in § 17.35 to make it easier to understand, adding a new paragraph (b) to address hospital care and outpatient services provided to eligible veterans in the Republic of the Philippines as authorized in 38 U.S.C. 1724, and paragraph (c) to provide guidance on which sections of part 17 apply to claims for payment or reimbursement of services not previously authorized by the Foreign Medical Program. We proposed amending § 17.125 which focuses on filing claims. We proposed stating that in those cases where VA payment for such services has not been authorized in advance, claims for payment for such health care services provided in a State should be submitted to the VA medical facility nearest to where those services were provided. We also proposed amending that section to provide specific guidance on where and how to file claims. We proposed removing §§ 17.140 and 17.141 as the subject matter of delegation of authority would be covered by proposed revisions to § 17.125. Finally, we proposed removing §§ 17.350 through 17.370 which addressed grants to the Republic of the Philippines, as our authority to provide these grants under 38 U.S.C. 1732(b) has expired. VA still retains authority under PO 00000 Frm 00011 Fmt 4700 Sfmt 4700 29447 38 U.S.C. 1731 to assist the Republic of the Philippines in fulfilling its responsibility in providing medical care and treatment for Commonwealth Army veterans and new Philippine Scouts in need of such care and treatment for service-connected disabilities and nonservice-connected disabilities under certain conditions. We provided a 60-day period to the public to comment on the proposed rule. The comment period closed April 2, 2018, and we received no comments. Based on the rationale set forth in the proposed rule and in this document, VA is adopting the provisions of the proposed rule as a final rule with no changes. Effect of Rulemaking Title 38 of the Code of Federal Regulations, as revised by this final rulemaking, represents VA’s implementation of its legal authority on this subject. Other than future amendments to this regulation or governing statutes, no contrary guidance or procedures are authorized. All existing or subsequent VA guidance must be read to conform with this rulemaking if possible or, if not possible, such guidance is superseded by this rulemaking. Paperwork Reduction Act This final rule contains no provisions constituting a collection of information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501–3521). Regulatory Flexibility Act The Secretary hereby certifies that this final regulatory amendment does 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 rulemaking does not directly affect any small entities. Only VA beneficiaries and certain community care providers would be directly affected. Therefore, pursuant to 5 U.S.C. 605(b), this amendment is be exempt from the initial and final regulatory flexibility analysis requirements of sections 603 and 604. Executive Orders 12866, 13563, and 13771 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). E:\FR\FM\25JNR1.SGM 25JNR1 amozie on DSK3GDR082PROD with RULES 29448 Federal Register / Vol. 83, No. 122 / Monday, June 25, 2018 / Rules and Regulations 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.’’ VA has examined the economic, interagency, budgetary, legal, and policy implications of this regulatory action and determined that the action is not 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 website at https:// www.va.gov/orpm by following the link for VA Regulations Published from FY 2004 through FYTD. [For information about economically significant regulations, see Impact Analysis Procedures guide on the 00REG intranet site.] Executive Order 13771 (Reducing Regulation and Controlling Regulatory Costs) requires an agency, unless prohibited by law, to identify at least two existing regulations to be repealed when the agency publicly proposes for notice and comment, or otherwise promulgates, a new regulation. In furtherance of this requirement, section 2(c) of E.O. 13771 requires that the new incremental costs associated with new regulations shall, to the extent permitted by law, be offset by the elimination of existing costs associated with at least two prior regulations. This final rule is not subject to the requirements of E.O. 13771 because there is no incremental cost associated with this rule. VerDate Sep<11>2014 16:14 Jun 22, 2018 Jkt 244001 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 expenditure by State, local, or tribal governments, in the aggregate, or by the private sector, of $100 million or more (adjusted annually for inflation) in any given year. This final rule has no such effect on State, local, or tribal governments, or on the private sector. Catalog of Federal Domestic Assistance The Catalog of Federal Domestic Assistance program number and title for this rule are as follows: 64.008— Veterans Domiciliary Care; 64.011— Veterans Dental Care; 64.012—Veterans Prescription Service; 64.013—Veterans Prosthetic Appliances; 64.029— Purchase Care Program; 64.040—VHA Inpatient Medicine; 64.041—VHA Outpatient Specialty Care; 64.042— VHA Inpatient Surgery; 64.043—VHA Mental Health Residential; 64.044— VHA Home Care; 64.045—VHA Outpatient Ancillary Services; 64.046— VHA Inpatient Psychiatry; 64.047— VHA Primary Care; 64.048—VHA Mental Health clinics; and 64.050— VHA Diagnostic Care. List of Subjects in 38 CFR Part 17 Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Foreign relations, 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, Philippines, Reporting and recordkeeping requirements, Scholarships and fellowships, 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. Jacquelyn Hayes-Byrd, Acting Chief of Staff, Department of Veterans Affairs, approved this document on June 19, 2018, for publication. PO 00000 Frm 00012 Fmt 4700 Sfmt 4700 Dated: June 19, 2018 Consuela Benjamin, Regulation Development Coordinator, Office of Regulation Policy & Management, Office of the Secretary, Department of Veterans Affairs. For the reasons stated in the preamble, the Department of Veterans Affairs amends 38 CFR part 17 as follows: PART 17—MEDICAL 1. The authority citation for part 17 is amended by adding statutory authority citations for §§ 17.35 and 17.125 in numerical order to read as follows: ■ Authority: 38 U.S.C. 501, and as noted in specific sections. Section 17.35 is also issued under 38 U.S.C. 1724. * * * * * Section 17.125 is also issued under 38 U.S.C. 7304. * ■ * * * * 2. Revise § 17.35 to read as follows: § 17.35 Hospital care and outpatient services in foreign countries. (a) Under the VA Foreign Medical Program, VA may furnish hospital care and outpatient services to any veteran outside of the United States, without regard to the veteran’s citizenship: (1) If necessary for treatment of a service-connected disability, or any disability associated with and held to be aggravating a service-connected disability; (2) If the care and services are furnished to a veteran participating in a rehabilitation program under 38 U.S.C. chapter 31 who requires care and services for the reasons enumerated in § 17.47(i)(2). (b) Under the Foreign Medical Program, the care and services authorized under paragraph (a) of this section are available in the Republic of the Philippines to a veteran who meets the requirements of paragraph (a) of this section. VA may also provide outpatient services to a veteran referenced in paragraph (a)(1) in the VA outpatient clinic in Manila for the treatment of such veteran’s service-connected conditions within the limits of the clinic. Non-service connected conditions of a veteran who has a service-connected disability may be treated within the limits of the VA outpatient clinic in Manila. (c) Claims for payment or reimbursement for services not previously authorized by VA under this section are governed by §§ 17.123– 17.127 and 17.129–17.132. ■ 3. Revise § 17.125 to read as follows: E:\FR\FM\25JNR1.SGM 25JNR1 Federal Register / Vol. 83, No. 122 / Monday, June 25, 2018 / Rules and Regulations § 17.125 Where to file claims. ACTION: Generally, VA must preauthorize VA payment for health care services provided in the community when such care is provided in a State as that term is defined in 38 U.S.C. 101(20). (a) Where VA payment for such services has not been authorized in advance, claims for payment for such health care services provided in a State should be submitted to the VA medical facility nearest to where those services were provided. (b) Claims for payment for hospital care and outpatient services authorized under § 17.35(a) and provided in Canada must be submitted to Veterans Affairs Canada, Foreign Countries Operations Unit, 2323 Riverside Dr., 2nd Floor, Ottawa, Ontario, Canada K1A OP5. (c) All other claims for payment for hospital care and outpatient services authorized under § 17.35(a) and provided outside a State must be submitted to the Foreign Medical Program, P.O. Box 469061, Denver, CO 80246–9061. § 17.140 [Removed] 4. Remove § 17.140 and the undesignated center heading ‘‘Delegations of Authority’’, immediately preceding it. ■ § 17.141 [Removed] 5. Remove § 17.141. 6. Add an undesignated center heading, ‘‘Delegation of Authority’’ immediately preceding § 17.142. ■ 7. Remove the undesignated center heading, ‘‘Grants to the Republic of the Philippines’’, immediately preceding § 17.350. ■ ■ §§ 17.350–17.352, 17.355, 17.362–17.367, 17.369, and 17.370 [Removed] 8. Remove §§ 17.350 through 17.352, 17.355, 17.362 through 17.367, 17.369, and 17.370. ■ [FR Doc. 2018–13487 Filed 6–22–18; 8:45 am] I. Background 40 CFR Part 52 amozie on DSK3GDR082PROD with RULES [EPA–R10–OAR–2016–0590; FRL–9979– 87—Region 10] Air Plan Approval; AK; Interstate Transport Requirements for the 2010 Nitrogen Dioxide and Sulfur Dioxide National Ambient Air Quality Standards VerDate Sep<11>2014 16:14 Jun 22, 2018 Jkt 244001 SUPPLEMENTARY INFORMATION: Throughout this document whenever ‘‘we,’’ ‘‘us,’’ or ‘‘our’’ is used, it is intended to refer to the EPA. Information is organized as follows: I. Background II. Final Action III. Statutory and Executive Order Reviews ENVIRONMENTAL PROTECTION AGENCY Environmental Protection Agency (EPA). The Environmental Protection Agency (EPA) is approving the State Implementation Plan (SIP) submittal from the Alaska Department of Environmental Conservation (Alaska DEC) demonstrating that the SIP meets certain interstate transport requirements of the Clean Air Act (CAA) for the National Ambient Air Quality Standards (NAAQS) promulgated in 2010 for nitrogen dioxide (NO2) and sulfur dioxide (SO2). The EPA has determined that Alaska’s SIP contains adequate provisions to ensure that air emissions in Alaska do not significantly contribute to nonattainment or interfere with the maintenance of the 2010 NO2 and SO2 NAAQS in any other state. DATES: This final rule is effective July 25, 2018. ADDRESSES: The EPA has established a docket for this action under Docket ID No. EPA–R10–OAR–2016–0590. All documents in the docket are listed on the https://www.regulations.gov website. Although listed in the index, some information is not publicly available, e.g., CBI or other information whose disclosure is restricted by statute. Certain other material, such as copyrighted material, is not placed on the internet and will be publicly available only in hard copy form. Publicly available docket materials are available through https:// www.regulations.gov, or please contact the person identified in the FOR FURTHER INFORMATION CONTACT section for additional availability information. FOR FURTHER INFORMATION CONTACT: John Chi at (206) 553–1185, or chi.john@ epa.gov. SUMMARY: Table of Contents BILLING CODE 8320–01–P AGENCY: Final rule. On April 23, 2018, the EPA proposed to approve Alaska’s March 10, 2016, SIP submission as meeting CAA section 110(a)(2)(D)(i)(I) interstate transport provisions for the 2010 NO2 and 2010 SO2 NAAQS (83 FR 17627). Please see our proposed rulemaking for further explanation and the basis for our finding (April 23, 2018, 83 FR 17627). The public comment period for the EPA’s proposed action ended on May 23, 2018. We received no adverse PO 00000 Frm 00013 Fmt 4700 Sfmt 4700 29449 comments. There were four electronic comments submitted through https:// www.regulations.gov. We reviewed the comments and we have determined that none are germane to this action. Therefore, we are finalizing our action as proposed. II. Final Action The EPA is approving Alaska’s March 10, 2016, SIP submission as demonstrating sources in Alaska do not significantly contribute to nonattainment, or interfere with maintenance, of the 2010 NO2 and SO2 NAAQS in any other state. Based on our review, we find the Alaska SIP meets the CAA section 110(a)(2)(D)(i)(I) interstate transport requirements for the 2010 NO2 and SO2 NAAQS. III. Statutory and Executive Order Reviews Under the CAA, the Administrator is required to approve a SIP submission that complies with the provisions of the Act and applicable federal regulations. 42 U.S.C. 7410(k); 40 CFR 52.02(a). Thus, in reviewing SIP submissions, the EPA’s role is to approve state choices, provided that they meet the criteria of the CAA. Accordingly, this action merely approves state law as meeting federal requirements and does not impose additional requirements beyond those imposed by state law. For that reason, this action: • Is not a ‘‘significant regulatory action’’ subject to review by the Office of Management and Budget under Executive Orders 12866 (58 FR 51735, October 4, 1993) and 13563 (76 FR 3821, January 21, 2011); • is not an Executive Order 13771 (82 FR 9339, February 2, 2017) regulatory action because SIP approvals are exempted under Executive Order 12866; • does not impose an information collection burden under the provisions of the Paperwork Reduction Act (44 U.S.C. 3501 et seq.); • is certified as not having a significant economic impact on a substantial number of small entities under the Regulatory Flexibility Act (5 U.S.C. 601 et seq.); • does not contain any unfunded mandate or significantly or uniquely affect small governments, as described in the Unfunded Mandates Reform Act of 1995 (Pub. L. 104–4); • does not have Federalism implications as specified in Executive Order 13132 (64 FR 43255, August 10, 1999); • is not an economically significant regulatory action based on health or safety risks subject to Executive Order 13045 (62 FR 19885, April 23, 1997); E:\FR\FM\25JNR1.SGM 25JNR1

Agencies

[Federal Register Volume 83, Number 122 (Monday, June 25, 2018)]
[Rules and Regulations]
[Pages 29447-29449]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-13487]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP55


Medical Care in Foreign Countries and Filing for Reimbursement 
for Community Care Not Previously Authorized by VA

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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

SUMMARY: The Department of Veterans Affairs (VA) adopts as final, with 
no changes, a proposed rule amending its medical regulations related to 
hospital care and medical services in foreign countries. We simplified 
and clarified the scope of these regulations, address medical services 
provided to eligible veterans in the Republic of the Philippines, and 
removed provisions related to grants to the Republic of the Philippines 
that are no longer supported by statutory authority. VA also amends its 
medical regulations related to filing claims for reimbursement of 
medical expenses incurred for VA care not previously authorized. We 
provided a 60-day period to receive comments from the public on the 
proposed changes, and received no comments. VA adopts the proposed rule 
as final, with no changes.

DATES: This final rule is effective July 25, 2018.

FOR FURTHER INFORMATION CONTACT: Joseph Duran, Director, Policy and 
Planning, Office of Community Care (10D1A1), Veterans Health 
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, 
Washington, DC 20420, (303) 372-4629. (This is not a toll-free number) 
or [email protected].

SUPPLEMENTARY INFORMATION: Section 1724 of title 38 United States Code 
(U.S.C.) prohibits VA from furnishing hospital care or medical services 
outside any State except under specific circumstances. VA is authorized 
under 38 U.S.C. 1724(b)(1) to furnish care and services to an eligible 
veteran outside any State if VA ``determines that such care and 
services are needed for the treatment of a service-connected disability 
of the veteran or as part of a rehabilitation program under chapter 31 
of this title.'' VA furnishes health care to eligible veterans in the 
Republic of the Philippines under this authority. In addition, 38 
U.S.C. 1724(c) provides that ``within the limits'' of the Veterans 
Memorial Medical Center at Manila, Republic of the Philippines, VA may 
enter into contracts to furnish necessary hospital care to a veteran 
for any non-service-connected disability if such veteran is unable to 
defray the expenses of necessary hospital care. VA may also operate an 
outpatient clinic in the Republic of the Philippines to furnish 
necessary medical services to a veteran who has a service-connected 
disability. 38 U.S.C. 1724(e). Several sections of title 38 Code of 
Federal Regulations (CFR) part 17 address VA's authority to provide for 
hospital care and medical services for eligible veterans outside the 
United States, as well as submission of claims for reimbursement for 
services obtained from community care providers outside the United 
States.
    On January 31, 2018, VA proposed to revise or amend these 
regulations to consolidate similar content, clarify provisions, and 
ensure that these regulations reflect current VA practice and statutory 
authority. (83 FR 4454). We proposed simplifying language in Sec.  
17.35 to make it easier to understand, adding a new paragraph (b) to 
address hospital care and outpatient services provided to eligible 
veterans in the Republic of the Philippines as authorized in 38 U.S.C. 
1724, and paragraph (c) to provide guidance on which sections of part 
17 apply to claims for payment or reimbursement of services not 
previously authorized by the Foreign Medical Program. We proposed 
amending Sec.  17.125 which focuses on filing claims. We proposed 
stating that in those cases where VA payment for such services has not 
been authorized in advance, claims for payment for such health care 
services provided in a State should be submitted to the VA medical 
facility nearest to where those services were provided. We also 
proposed amending that section to provide specific guidance on where 
and how to file claims.
    We proposed removing Sec. Sec.  17.140 and 17.141 as the subject 
matter of delegation of authority would be covered by proposed 
revisions to Sec.  17.125. Finally, we proposed removing Sec. Sec.  
17.350 through 17.370 which addressed grants to the Republic of the 
Philippines, as our authority to provide these grants under 38 U.S.C. 
1732(b) has expired. VA still retains authority under 38 U.S.C. 1731 to 
assist the Republic of the Philippines in fulfilling its responsibility 
in providing medical care and treatment for Commonwealth Army veterans 
and new Philippine Scouts in need of such care and treatment for 
service-connected disabilities and non-service-connected disabilities 
under certain conditions.
    We provided a 60-day period to the public to comment on the 
proposed rule. The comment period closed April 2, 2018, and we received 
no comments. Based on the rationale set forth in the proposed rule and 
in this document, VA is adopting the provisions of the proposed rule as 
a final rule with no changes.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as revised by this 
final rulemaking, represents VA's implementation of its legal authority 
on this subject. Other than future amendments to this regulation or 
governing statutes, no contrary guidance or procedures are authorized. 
All existing or subsequent VA guidance must be read to conform with 
this rulemaking if possible or, if not possible, such guidance is 
superseded by this rulemaking.

Paperwork Reduction Act

    This final rule contains no provisions constituting a collection of 
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).

Regulatory Flexibility Act

    The Secretary hereby certifies that this final regulatory amendment 
does 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 rulemaking does not directly affect any small 
entities. Only VA beneficiaries and certain community care providers 
would be directly affected. Therefore, pursuant to 5 U.S.C. 605(b), 
this amendment is be exempt from the initial and final regulatory 
flexibility analysis requirements of sections 603 and 604.

Executive Orders 12866, 13563, and 13771

    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).

[[Page 29448]]

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.''
    VA has examined the economic, interagency, budgetary, legal, and 
policy implications of this regulatory action and determined that the 
action is not 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 website at 
https://www.va.gov/orpm by following the link for VA Regulations 
Published from FY 2004 through FYTD. [For information about 
economically significant regulations, see Impact Analysis Procedures 
guide on the 00REG intranet site.]
    Executive Order 13771 (Reducing Regulation and Controlling 
Regulatory Costs) requires an agency, unless prohibited by law, to 
identify at least two existing regulations to be repealed when the 
agency publicly proposes for notice and comment, or otherwise 
promulgates, a new regulation. In furtherance of this requirement, 
section 2(c) of E.O. 13771 requires that the new incremental costs 
associated with new regulations shall, to the extent permitted by law, 
be offset by the elimination of existing costs associated with at least 
two prior regulations. This final rule is not subject to the 
requirements of E.O. 13771 because there is no incremental cost 
associated with this rule.

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 expenditure by 
State, local, or tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any given year. This final rule has no such effect on 
State, local, or tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance program number and title 
for this rule are as follows: 64.008--Veterans Domiciliary Care; 
64.011--Veterans Dental Care; 64.012--Veterans Prescription Service; 
64.013--Veterans Prosthetic Appliances; 64.029--Purchase Care Program; 
64.040--VHA Inpatient Medicine; 64.041--VHA Outpatient Specialty Care; 
64.042--VHA Inpatient Surgery; 64.043--VHA Mental Health Residential; 
64.044--VHA Home Care; 64.045--VHA Outpatient Ancillary Services; 
64.046--VHA Inpatient Psychiatry; 64.047--VHA Primary Care; 64.048--VHA 
Mental Health clinics; and 64.050--VHA Diagnostic Care.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
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, Philippines, Reporting 
and recordkeeping requirements, Scholarships and fellowships, 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. Jacquelyn 
Hayes-Byrd, Acting Chief of Staff, Department of Veterans Affairs, 
approved this document on June 19, 2018, for publication.

    Dated: June 19, 2018
Consuela Benjamin,
Regulation Development Coordinator, Office of Regulation Policy & 
Management, Office of the Secretary, Department of Veterans Affairs.

    For the reasons stated in the preamble, the Department of Veterans 
Affairs amends 38 CFR part 17 as follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 is amended by adding statutory 
authority citations for Sec. Sec.  17.35 and 17.125 in numerical order 
to read as follows:

    Authority:  38 U.S.C. 501, and as noted in specific sections.
    Section 17.35 is also issued under 38 U.S.C. 1724.
* * * * *
    Section 17.125 is also issued under 38 U.S.C. 7304.

* * * * *


0
2. Revise Sec.  17.35 to read as follows:


Sec.  17.35   Hospital care and outpatient services in foreign 
countries.

    (a) Under the VA Foreign Medical Program, VA may furnish hospital 
care and outpatient services to any veteran outside of the United 
States, without regard to the veteran's citizenship:
    (1) If necessary for treatment of a service-connected disability, 
or any disability associated with and held to be aggravating a service-
connected disability;
    (2) If the care and services are furnished to a veteran 
participating in a rehabilitation program under 38 U.S.C. chapter 31 
who requires care and services for the reasons enumerated in Sec.  
17.47(i)(2).
    (b) Under the Foreign Medical Program, the care and services 
authorized under paragraph (a) of this section are available in the 
Republic of the Philippines to a veteran who meets the requirements of 
paragraph (a) of this section. VA may also provide outpatient services 
to a veteran referenced in paragraph (a)(1) in the VA outpatient clinic 
in Manila for the treatment of such veteran's service-connected 
conditions within the limits of the clinic. Non-service connected 
conditions of a veteran who has a service-connected disability may be 
treated within the limits of the VA outpatient clinic in Manila.
    (c) Claims for payment or reimbursement for services not previously 
authorized by VA under this section are governed by Sec. Sec.  17.123-
17.127 and 17.129-17.132.

0
3. Revise Sec.  17.125 to read as follows:

[[Page 29449]]

Sec.  17.125   Where to file claims.

    Generally, VA must preauthorize VA payment for health care services 
provided in the community when such care is provided in a State as that 
term is defined in 38 U.S.C. 101(20).
    (a) Where VA payment for such services has not been authorized in 
advance, claims for payment for such health care services provided in a 
State should be submitted to the VA medical facility nearest to where 
those services were provided.
    (b) Claims for payment for hospital care and outpatient services 
authorized under Sec.  17.35(a) and provided in Canada must be 
submitted to Veterans Affairs Canada, Foreign Countries Operations 
Unit, 2323 Riverside Dr., 2nd Floor, Ottawa, Ontario, Canada K1A OP5.
    (c) All other claims for payment for hospital care and outpatient 
services authorized under Sec.  17.35(a) and provided outside a State 
must be submitted to the Foreign Medical Program, P.O. Box 469061, 
Denver, CO 80246-9061.


Sec.  17.140   [Removed]

0
4. Remove Sec.  17.140 and the undesignated center heading 
``Delegations of Authority'', immediately preceding it.


Sec.  17.141   [Removed]

0
5. Remove Sec.  17.141.

0
6. Add an undesignated center heading, ``Delegation of Authority'' 
immediately preceding Sec.  17.142.

0
7. Remove the undesignated center heading, ``Grants to the Republic of 
the Philippines'', immediately preceding Sec.  17.350.


Sec. Sec.  17.350-17.352, 17.355, 17.362-17.367, 17.369, and 17.370   
[Removed]

0
8. Remove Sec. Sec.  17.350 through 17.352, 17.355, 17.362 through 
17.367, 17.369, and 17.370.

[FR Doc. 2018-13487 Filed 6-22-18; 8:45 am]
 BILLING CODE 8320-01-P
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