Notice of Request for Information Regarding Health Care Access Standards, 30818-30819 [2018-13952]

Download as PDF 30818 Federal Register / Vol. 83, No. 126 / Friday, June 29, 2018 / Notices DEPARTMENT OF TRANSPORTATION Maritime Administration [Docket No. MARAD–2018–0105] Requested Administrative Waiver of the Coastwise Trade Laws: Vessel MELISSA; Invitation for Public Comments Maritime Administration, DOT. Notice. AGENCY: ACTION: The Secretary of Transportation, as represented by the Maritime Administration (MARAD), is authorized to grant waivers of the U.S.build requirement of the coastwise laws under certain circumstances. A request for such a waiver has been received by MARAD. The vessel, and a brief description of the proposed service, is listed below. DATES: Submit comments on or before July 30, 2018. ADDRESSES: Comments should refer to docket number MARAD–2018–0105. Written comments may be submitted by hand or by mail to the Docket Clerk, U.S. Department of Transportation, Docket Operations, M–30, West Building Ground Floor, Room W12–140, 1200 New Jersey Avenue SE, Washington, DC 20590. You may also send comments electronically via the internet at https://www.regulations.gov. All comments will become part of this docket and will be available for inspection and copying at the above address between 10:00 a.m. and 5:00 p.m., Monday through Friday, except federal holidays. An electronic version of this document and all documents entered into this docket is available at https://www.regulations.gov. FOR FURTHER INFORMATION CONTACT: Bianca Carr, U.S. Department of Transportation, Maritime Administration, 1200 New Jersey Avenue SE, Room W23–453, Washington, DC 20590. Telephone 202– 366–9309, email Bianca.carr@dot.gov. SUPPLEMENTARY INFORMATION: As described by the applicant the intended service of the vessel MELISSA is: —INTENDED COMMERCIAL USE OF VESSEL: ‘‘coast wise sightseeing, whale watching, sailing lessons’’ —GEOGRAPHIC REGION: ‘‘Hawaii, California’’ sradovich on DSK3GMQ082PROD with NOTICES SUMMARY: The complete application is given in DOT docket MARAD–2018–0105 at https://www.regulations.gov. Interested parties may comment on the effect this action may have on U.S. vessel builders or businesses in the U.S. that use U.S.flag vessels. If MARAD determines, in VerDate Sep<11>2014 17:58 Jun 28, 2018 Jkt 244001 accordance with 46 U.S.C. 12121 and MARAD’s regulations at 46 CFR part 388, that the issuance of the waiver will have an unduly adverse effect on a U.S.vessel builder or a business that uses U.S.-flag vessels in that business, a waiver will not be granted. Comments should refer to the docket number of this notice and the vessel name in order for MARAD to properly consider the comments. Comments should also state the commenter’s interest in the waiver application, and address the waiver criteria given in section 388.4 of MARAD’s regulations at 46 CFR part 388. Privacy Act In accordance with 5 U.S.C. 553(c), DOT/MARAD solicits comments from the public to better inform its rulemaking process. DOT/MARAD posts these comments, without edit, to www.regulations.gov, as described in the system of records notice, DOT/ALL– 14 FDMS, accessible through www.dot.gov/privacy. In order to facilitate comment tracking and response, we encourage commenters to provide their name, or the name of their organization; however, submission of names is completely optional. Whether or not commenters identify themselves, all timely comments will be fully considered. If you wish to provide comments containing proprietary or confidential information, please contact the agency for alternate submission instructions. Authority: 49 CFR 1.93(a), 46 U.S.C. 55103, 46 U.S.C. 12121. * * * * * Dated: June 26, 2018. By order of the Maritime Administrator. T. Mitchell Hudson, Jr., Secretary, Maritime Administration. [FR Doc. 2018–14065 Filed 6–28–18; 8:45 am] BILLING CODE 4910–81–P DEPARTMENT OF VETERANS AFFAIRS Notice of Request for Information Regarding Health Care Access Standards Department of Veterans Affairs. Request for information. AGENCY: ACTION: The Department of Veterans Affairs (VA) is requesting information to assist in implementing section 1703B of title 38, United States Code (U.S.C.), as added by section 104(a) of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening SUMMARY: PO 00000 Frm 00136 Fmt 4703 Sfmt 4703 Integrated Outside Networks (MISSION) Act of 2018 (the VA MISSION Act) which directs VA to establish access standards for furnishing hospital care, medical services, and extended care services to covered veterans for purposes of the Veterans Community Care Program. In establishing these access standards, VA is required to consult with all pertinent Federal, private sector, and non-governmental entities. VA requests information from the public regarding the development of these access standards, including but not limited to information with regard to health plans on the use of access standards for the design of health plan provider networks, referrals from network providers to out-of-network providers, the appeals process for exemptions from benefit limits to out-ofnetwork providers, and the measurement of performance against federal or state regulatory standards. With regard to health systems, VA requests information from the public including but not limited to the existence of standards for appointment wait times, the use of travel distance for establishing service areas, the development or use of guidelines to refer patients to out of system providers, and the measurement of performance against federal or state regulatory standards. Responses to this notice will support industry research and VA’s evaluation of access standards. DATES: July 30, 2018. ADDRESSES: Written comments may be submitted through https:// www.regulations.gov; by mail or hand delivery to the Director, Office of 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 ‘‘Notice of Request for Information Regarding Health Care Access Standards’’. Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management (00REG), Department of Veterans Affairs, 810 Vermont Ave. NW, Room 1063B, Washington, DC 20420, between the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except Federal holidays). Please call (202) 461–4902 (this is not a toll-free number) for an appointment. During the comment period, comments may also be viewed online through the Federal Docket Management System at www.regulations.gov. FOR FURTHER INFORMATION CONTACT: Christina Hosenfeld, Management E:\FR\FM\29JNN1.SGM 29JNN1 sradovich on DSK3GMQ082PROD with NOTICES Federal Register / Vol. 83, No. 126 / Friday, June 29, 2018 / Notices Analyst, Office of the Deputy Under Secretary for Health for Community Care, Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202) 461–4112. This is not a toll free number. SUPPLEMENTARY INFORMATION: The John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, Public Law 115–182, (the VA MISSION Act) creates a new 38 U.S.C. 1703B that contains requirements for VA to facilitate the establishment and use of access standards. Section 1703B(c) specifically requires VA to consult with all pertinent Federal entities, entities in the private sector, and other nongovernmental entities in establishing access standards. This notice and request for information serves as one of the means for VA to consult with these groups and entities. We note that VA will also hold a public hearing on Friday, July 13, 2018, to provide these groups and entities an opportunity to provide additional information. VA will use the comments it receives to help determine the access standards in compliance with the VA MISSION Act. VA will then submit a report, no later than March 3, 2019, as required by section 1703B(d)(1), detailing the access standards to the appropriate committees of Congress. The access standards will ultimately be published in the Federal Register and will be made available on a VA internet website. In order to submit a report to Congress detailing the access standards by March 3, 2019, VA must expedite this consultation, which will be foundational to the process of determining the access standards. Hence, this notice and request for information has a comment period of 30 days. VA believes that 30 days is sufficient to provide comments, as the groups and entities with expertise in access standards will likely have the information readily available or can quickly compile and submit such information. This notice is a request for information only. Commenters are encouraged to provide complete but concise responses to the questions outlined below. VA may choose to contact individual commenters, and such communications would serve to further clarify their written comments. Request for Information: VA requests information that will assist in developing the access standards required by the VA MISSION Act. This VerDate Sep<11>2014 17:58 Jun 28, 2018 Jkt 244001 includes information regarding the development of these access standards, including but not limited to information, with regard to health plans, on the use of access standards for the design of health plan provider networks, referrals from network providers to outof-network providers, the appeals process for exemptions from benefit limits to out-of-network providers, and with respect to health systems, the existence of standards for appointment wait times, the use of travel distance for establishing service areas, the development or use of guidelines to refer patients to out of system providers, and the measurement of performance against regulatory standards. Specifically, VA requests information from health plans and systems related to the below: 1. Do health plans use internal access standards for the design of provider networks and the application of in network/out of network benefits that are more stringent than regulatory standards (time or distance of travel, appointment wait times, provider/member ratios)? If so, what are these internal standards? How does the health plan measure performance against regulatory and internal access standards? How does the health plan respond to findings when access standards are not being met? Are current regulatory access standards costeffective while maintaining quality standards? Do health plans have a process to handle routine requests from members or referring providers for exemptions to benefit limits when members seek out of network care or a lower tier provider? 2. Do health plans allow for appeals by providers or members to request exemptions from benefit limits related to out of network care or care by a lower tier provider? Is external review allowed for such appeals? 3. What are health plan practices regarding internal, regulatory, and/or accreditation standards for appointment wait times, including variance by specialty or type of service? How does the health plan use travel distance or time and/or provider-to-population ratios in deciding which geographic areas to consider as primary or secondary service areas? 4. Are clinicians within the health system given guidelines or rules on when to refer patients to out of system providers? For example, are clinicians encouraged to refer out of system if insystem wait times are longer than standard, travel time or distance to an in-system provider is too long, the patient’s ability to travel is compromised or the frequency of PO 00000 Frm 00137 Fmt 4703 Sfmt 4703 30819 treatment makes travel to an in-network provider difficult? 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 25, 2018, for publication. Dated: June 25, 2018. Jeffrey M. Martin, Impact Analyst, Office of Regulation Policy & Management, Office of the Secretary, Department of Veterans Affairs. [FR Doc. 2018–13952 Filed 6–28–18; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS Announcement for Public Meeting Regarding Health Care Access Standards Department of Veterans Affairs. Announcement of public meeting. AGENCY: ACTION: The Department of Veterans Affairs (VA) is holding a public meeting to seek information from pertinent entities relating to implementation of 1703B of title 38, United States Code, as added by section 104(a) of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 (the VA MISSION Act) which directs VA to establish access standards for furnishing hospital care, medical services, and extended care services to covered veterans for purposes of the Veterans Community Care Program. In establishing these access standards, VA is required to consult with all pertinent Federal, private sector, and non-governmental entities. VA requests information from the public regarding the development of these access standards, including but not limited to information on the use of access standards for the design of health plan provider networks, referrals from network providers to out-of-network providers, the appeals process for exemptions from benefit limits to out-ofnetwork providers, the existence of standards for appointment wait times, the use of travel distance for establishing service areas, the development or use of guidelines to SUMMARY: E:\FR\FM\29JNN1.SGM 29JNN1

Agencies

[Federal Register Volume 83, Number 126 (Friday, June 29, 2018)]
[Notices]
[Pages 30818-30819]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-13952]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information Regarding Health Care Access 
Standards

AGENCY: Department of Veterans Affairs.

ACTION: Request for information.

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

SUMMARY: The Department of Veterans Affairs (VA) is requesting 
information to assist in implementing section 1703B of title 38, United 
States Code (U.S.C.), as added by section 104(a) of the John S. McCain 
III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal 
Systems and Strengthening Integrated Outside Networks (MISSION) Act of 
2018 (the VA MISSION Act) which directs VA to establish access 
standards for furnishing hospital care, medical services, and extended 
care services to covered veterans for purposes of the Veterans 
Community Care Program. In establishing these access standards, VA is 
required to consult with all pertinent Federal, private sector, and 
non-governmental entities. VA requests information from the public 
regarding the development of these access standards, including but not 
limited to information with regard to health plans on the use of access 
standards for the design of health plan provider networks, referrals 
from network providers to out-of-network providers, the appeals process 
for exemptions from benefit limits to out-of-network providers, and the 
measurement of performance against federal or state regulatory 
standards. With regard to health systems, VA requests information from 
the public including but not limited to the existence of standards for 
appointment wait times, the use of travel distance for establishing 
service areas, the development or use of guidelines to refer patients 
to out of system providers, and the measurement of performance against 
federal or state regulatory standards. Responses to this notice will 
support industry research and VA's evaluation of access standards.

DATES: July 30, 2018.

ADDRESSES: Written comments may be submitted through https://www.regulations.gov; by mail or hand delivery to the Director, Office 
of 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 ``Notice of Request for Information Regarding Health 
Care Access Standards''. Copies of comments received will be available 
for public inspection in the Office of Regulation Policy and Management 
(00REG), Department of Veterans Affairs, 810 Vermont Ave. NW, Room 
1063B, Washington, DC 20420, between the hours of 8:00 a.m. and 4:30 
p.m., Monday through Friday (except Federal holidays). Please call 
(202) 461-4902 (this is not a toll-free number) for an appointment. 
During the comment period, comments may also be viewed online through 
the Federal Docket Management System at www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Christina Hosenfeld, Management

[[Page 30819]]

Analyst, Office of the Deputy Under Secretary for Health for Community 
Care, Veterans Health Administration, Department of Veterans Affairs, 
810 Vermont Avenue NW, Washington, DC 20420, (202) 461-4112. This is 
not a toll free number.

SUPPLEMENTARY INFORMATION: The John S. McCain III, Daniel K. Akaka, and 
Samuel R. Johnson VA Maintaining Internal Systems and Strengthening 
Integrated Outside Networks Act of 2018, Public Law 115-182, (the VA 
MISSION Act) creates a new 38 U.S.C. 1703B that contains requirements 
for VA to facilitate the establishment and use of access standards. 
Section 1703B(c) specifically requires VA to consult with all pertinent 
Federal entities, entities in the private sector, and other 
nongovernmental entities in establishing access standards. This notice 
and request for information serves as one of the means for VA to 
consult with these groups and entities. We note that VA will also hold 
a public hearing on Friday, July 13, 2018, to provide these groups and 
entities an opportunity to provide additional information. VA will use 
the comments it receives to help determine the access standards in 
compliance with the VA MISSION Act. VA will then submit a report, no 
later than March 3, 2019, as required by section 1703B(d)(1), detailing 
the access standards to the appropriate committees of Congress. The 
access standards will ultimately be published in the Federal Register 
and will be made available on a VA internet website.
    In order to submit a report to Congress detailing the access 
standards by March 3, 2019, VA must expedite this consultation, which 
will be foundational to the process of determining the access 
standards. Hence, this notice and request for information has a comment 
period of 30 days. VA believes that 30 days is sufficient to provide 
comments, as the groups and entities with expertise in access standards 
will likely have the information readily available or can quickly 
compile and submit such information.
    This notice is a request for information only. Commenters are 
encouraged to provide complete but concise responses to the questions 
outlined below. VA may choose to contact individual commenters, and 
such communications would serve to further clarify their written 
comments.
    Request for Information: VA requests information that will assist 
in developing the access standards required by the VA MISSION Act. This 
includes information regarding the development of these access 
standards, including but not limited to information, with regard to 
health plans, on the use of access standards for the design of health 
plan provider networks, referrals from network providers to out-of-
network providers, the appeals process for exemptions from benefit 
limits to out-of-network providers, and with respect to health systems, 
the existence of standards for appointment wait times, the use of 
travel distance for establishing service areas, the development or use 
of guidelines to refer patients to out of system providers, and the 
measurement of performance against regulatory standards.
    Specifically, VA requests information from health plans and systems 
related to the below:
    1. Do health plans use internal access standards for the design of 
provider networks and the application of in network/out of network 
benefits that are more stringent than regulatory standards (time or 
distance of travel, appointment wait times, provider/member ratios)? If 
so, what are these internal standards? How does the health plan measure 
performance against regulatory and internal access standards? How does 
the health plan respond to findings when access standards are not being 
met? Are current regulatory access standards cost-effective while 
maintaining quality standards? Do health plans have a process to handle 
routine requests from members or referring providers for exemptions to 
benefit limits when members seek out of network care or a lower tier 
provider?
    2. Do health plans allow for appeals by providers or members to 
request exemptions from benefit limits related to out of network care 
or care by a lower tier provider? Is external review allowed for such 
appeals?
    3. What are health plan practices regarding internal, regulatory, 
and/or accreditation standards for appointment wait times, including 
variance by specialty or type of service? How does the health plan use 
travel distance or time and/or provider-to-population ratios in 
deciding which geographic areas to consider as primary or secondary 
service areas?
    4. Are clinicians within the health system given guidelines or 
rules on when to refer patients to out of system providers? For 
example, are clinicians encouraged to refer out of system if in-system 
wait times are longer than standard, travel time or distance to an in-
system provider is too long, the patient's ability to travel is 
compromised or the frequency of treatment makes travel to an in-network 
provider difficult?

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 25, 2018, for publication.

    Dated: June 25, 2018.
Jeffrey M. Martin,
Impact Analyst, Office of Regulation Policy & Management, Office of the 
Secretary, Department of Veterans Affairs.
[FR Doc. 2018-13952 Filed 6-28-18; 8:45 am]
 BILLING CODE 8320-01-P
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