Service Members Group Life Insurance-Definition of Stillborn Child for Purposes of Coverage, 30060-30062 [2019-13553]
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Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Proposed Rules
List of Subjects in 33 CFR Part 100
Marine safety, Navigation (water),
Reporting and recordkeeping
requirements, Waterways.
For the reasons discussed in the
preamble, the Coast Guard is proposing
to amend 33 CFR part 100 as follows:
transit of event participants or official
patrol vessels in the regulated areas
during the effective date and time.
D.G. Throop,
RADM, U.S. Coast Guard, Commander,
Thirteenth Coast Guard District.
[FR Doc. 2019–13627 Filed 6–25–19; 8:45 am]
BILLING CODE 9110–04–P
PART 100—SAFETY OF LIFE ON
NAVIGABLE WATERS
DEPARTMENT OF VETERANS
AFFAIRS
1. The authority citation for part 100
continues to read as follows:
■
Authority: 46 U.S.C. 70041; 33 CFR 1.05–
1.
38 CFR Part 9
RIN 2900–AQ49
2. Add § 100.T13–0431 to read as
follows:
■
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§ 165.T13–0431 Special Local Regulation;
Roy Webster Cross Channel Swim,
Columbia River, Cascade Locks, OR.
(a) Regulated area. These waters are
in the in the vicinity of Cascade Locks,
OR on the Columbia River between
River Mile 149 and River Mile 151.
(b) Effective period. This regulation
will be in effect from 5:30 a.m. to noon
on September 2, 2019.
(c) Special Local regulations. (1) Nonparticipant personnel and vessels are
prohibited from entering the regulated
area unless authorized by the Coast
Guard Patrol Commander (PATCOM).
(2) The Coast Guard may patrol
regulated area under the direction of a
designated PATCOM. The PATCOM
may be contacted on Channel 16 VHF–
FM (156.8 MHz) by the call sign
‘‘PATCOM.’’ Official patrol vessels may
consist of any Coast Guard, Coast Guard
Auxiliary, state, or local law
enforcement vessels assigned or
approved by the Captain of the Port,
Sector Columbia River.
(3) PATCOM may control the
movement of all vessels in the regulated
area. When hailed or signaled by an
official patrol vessel, a vessel shall come
to an immediate stop and comply with
the lawful directions issued. Failure to
comply with a lawful direction may
result in expulsion from the area,
citation for failure to comply, or both.
(4) PATCOM may delay or terminate
the event at any time it is deemed
necessary to ensure the safety of life or
property. Such action may be justified
as a result of weather, traffic density,
spectator operation or participant
behavior.
(5) Vessels may not transit the
regulated areas without PATCOM
approval. Vessels permitted to transit
must operate at a no wake speed, in a
manner which will not endanger
participants or other crafts in the event.
(6) Spectators or other vessels shall
not anchor, block, loiter, or impede the
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Service Members Group Life
Insurance—Definition of Stillborn Child
for Purposes of Coverage
Department of Veterans Affairs.
Proposed rule.
AGENCY:
ACTION:
The Department of Veterans
Affairs (VA) proposes to amend the
regulation defining ‘‘member’s stillborn
child’’ for purposes of the
Servicemembers’ Group Life Insurance
(SGLI) program. The current definition
of a ‘‘member’s stillborn child’’ is that
a fetus must weigh at least 350 grams or,
if the fetal weight is unknown, duration
in utero is at least 20 completed weeks
of gestation. VA proposes to amend the
definition to allow reliance upon the
fetus’ gestational age even if the fetus’
weight is known. As a result, a fetus
whose duration in utero is 20 completed
weeks of gestation but who weighs less
than 350 grams would qualify as a
‘‘member’s stillborn child.’’
DATES: Comments must be received on
or before August 26, 2019.
ADDRESSES: Written comments may be
submitted through https://
www.Regulations.gov; by mail or handdelivery to: Director, Office of
Regulation Policy and Management
(00REG), Department of Veterans
Affairs, 810 Vermont Ave. NW, Room
1064, Washington, DC 20420; or by fax
to (202) 273–9026. (This is not a toll-free
telephone number.) Comments should
indicate that they are submitted in
response to ‘‘RIN 2900–AQ49—
Servicemembers’ Group Life Insurance,
Definition of Stillborn Child.’’
All comments received will be
available for public inspection in the
Office of Regulation Policy and
Management, Room 1064, between the
hours of 8:00 a.m. and 4:30 p.m.,
Monday through Friday (except
holidays). Please call (202) 461–4902 for
an appointment. (This is not a toll-free
telephone number.) In addition,
comments may be viewed online
through the Federal Docket Management
SUMMARY:
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System (FDMS) at https://
www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT:
Ruth Berkheimer, Insurance Specialist,
Department of Veterans Affairs
Insurance Center (310/290B), 5000
Wissahickon Avenue, Philadelphia, PA
19144, (215) 842–2000, ext. 4275. (This
is not a toll-free number.)
SUPPLEMENTARY INFORMATION: The
Veterans’ Survivor Benefits
Improvements Act of 2001, Public Law
107–14, 4, 115 Stat. 25, 26–28,
authorized automatic insurance
coverage for spouses and dependent
children of servicemembers (hereinafter
‘‘servicemembers’’ or ‘‘members’’)
enrolled in Servicemembers’ Group Life
Insurance (SGLI). This insurance is
referred to as Family Servicemembers’
Group Life Insurance (FSGLI), which
provides a maximum of $100,000 of
coverage for a spouse, not to exceed the
servicemember’s SGLI coverage amount,
and $10,000 for each dependent child.
The servicemember pays the premium
for spousal coverage, while dependent
children are insured at no cost.
Members cannot decline or reduce
coverage for dependent children if the
member is insured under SGLI. See 38
U.S.C. 1967(a)(3)(B). Dependent child
coverage begins on the date of birth or,
‘‘if the child is not the natural child of
the member, the date on which the child
acquires status as an insurable
dependent of the member.’’ 38 U.S.C.
1967(a)(5)(F).
Section 402 of the Veterans’ Benefits
Improvement Act of 2008, Public Law
110–389, 122 Stat. 4145, 4174,
expanded the definition of ‘‘insurable
dependent’’ for SGLI purposes to
include a ‘‘member’s stillborn child.’’
On November 18, 2009, VA added
paragraph (k)(1) to 38 CFR 9.1 to define
the term ‘‘member’s stillborn child’’ for
purposes of SGLI coverage to mean:
A member’s natural child—
(i) Whose death occurs before
expulsion, extraction, or delivery; and
(ii) Whose—
(A) Fetal weight is 350 grams or more;
or
(B) If fetal weight is unknown,
duration in utero is 20 completed weeks
of gestation or more, calculated from the
date the last normal menstrual period
began to the date of expulsion,
extraction, or delivery.
74 FR 59,478, 59,479 (Nov. 18, 2009).
(The word ‘‘natural’’ was changed to
‘‘biological’’ in 2012. 77 FR 70374,
70376 (Nov. 26, 2012)). VA promulgated
this definition pursuant to S. Rep. No.
110–449, at 41 (2008), which stated that
the ‘‘Committee expects VA to . . .
define the term [‘‘stillborn child’’] . . .
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Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Proposed Rules
consistent with the 1992 recommended
reporting requirements’’ of fetal deaths
of the Model State Vital Statistics Act
and Regulations as drafted by the
Centers for Disease Control and
Prevention’s National Center for Health
Statistics. Id. at 59,478. Since the rule
was promulgated in 2009, VA has been
asked to reevaluate the stillbirth
standard by servicemembers whose
claims have been denied because the
fetus did not meet the minimum weight
of 350 grams but was 20 weeks or more
in gestation.
Although the 1992 Model Act
recommended the reporting
requirements for fetal death, states have
the authority enact their own reporting
requirements, and as a result, the
reporting criteria for fetal death enacted
by states vary as to birth weight and
gestational age. MacDorman MF, Fetal
and Perinatal Mortality: United States,
2013. Natl Vital Stat Rep 2015 Jul; 64(8),
Table I. We believe that only three
states, Delaware, Montana, and Texas,
currently use the criteria for reporting
fetal deaths in the 1992 Model Act. Del.
Code Ann. tit. 16, § 3124 (2019); Mont.
Code Ann § 50–15–403(1) (2019); 25
Tex. Admin. Code § 181.7(a) (2019). We
note that, nonetheless, Montana defines
a ‘‘stillbirth’’ as a fetal death occurring
after 20 weeks of gestation. Mont. Code
Ann § 50–15–101(15) (2019). Most states
require either that a death be reported
if a fetus is 20 weeks of gestation or 350
grams, or if it is 20 weeks of gestation.
Fetal and Perinatal Mortality: United
States, 2013, Table I. In addition, the
American Academy of Pediatrics (AAP)
Committee on Fetus and Newborn, uses
the term ‘‘stillborn’’ to describe fetal
deaths at 20 weeks’ gestation or more,
without regard to a fetus’ weight.
Barfield WD, Committee on Fetus and
Newborn. Clinical Reports—Standard
Terminology for Fetal, Infant, and
Perinatal Deaths. Pediatrics 2011 Jul;
128(1): 177–81.
The cutoff of 350 grams is the 50th
percentile for weight at 20 weeks of
gestation. American College of
Obstetricians & Gynecologists (ACOG)
Practice Bulletin No. 102: Management
of Stillbirth. Obstet Gynecol. 2009 Mar;
113(3):748–6. There are many variables
that may account for a fetus’ gestational
weight, e.g., mother’s health, nutrition,
height, weight, parity, race, ethnicity,
tobacco use, and congenital anomalies.
Buck Louis GM, Racial/Ethnic
Standards for Fetal Growth, the NICHD
Fetal Growth Studies. Am J Obstet
Gynecol 2015 Oct.; 213(4): 449.e1–
449.e41; Gardosi J, A customized
standard to assess fetal growth in a US
population. Am J Obstet Gynecol 2009
Jul; 201: 25.e1–7; Diego MA, Prenatal
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depression restricts fetal growth. Early
Hum Dev. 2009 Jan.; 85(1): 65–70;
Alexander GR, 1994–1996 U.S.
Singleton Birth Weight Percentiles for
Gestational Age by Race, Hispanic
Origin, and Gender. Matern Child
Health J 1999; 3(4) 225–31. We believe
that reliance on a fetus’ gestation only
in cases in which the fetus’ weight is
unknown creates inequities because a
fetus may weigh less than 350 grams
due to these factors but nonetheless be
20 weeks of gestation. We therefore
propose to amend the criteria in
§ 9.20(k)(1) to include a larger cohort of
stillborn children.
As part of VA’s research, VA
contacted obstetrics and gynecology
professionals about the FSGLI stillbirth
criteria to obtain their input. The
organizations contacted were the
American Board of Obstetrics and
Gynecology (ACOG), VA Women’s
Health Services, Children’s Hospital of
Philadelphia, VA Palo Alto Health Care
System, and Stanford University School
of Medicine. The responses received
indicated that revising the portion of the
current definition of stillborn child in
38 CFR 9.1(k)(1)(ii) to provide that
either a weight of 350 grams or a
gestation period of 20 weeks or greater
in utero irrespective of the fetus’ weight
would be in keeping with current,
sound medical understanding of preterm infants. A physician from the
ACOG stated that ‘‘VA offers a valuable
benefit to families who experienced a
stillbirth, and I encourage VA to use a
more expansive definition to determine
which fetal loss would be covered.’’
Similarly, medical professionals from
the Children’s Hospital of Philadelphia,
Division of Neonatology, stated that,
‘‘using either the weight criteria or the
gestational age criteria . . . to qualify is
very reasonable as those targets would
capture a lower limit of viability.’’
Given that the vast majority of states
require reporting the death of a fetus at
20 weeks of gestation without regard to
weight; the AAP describes the term
‘‘stillbirth’’ as fetal deaths of 20 weeks
of gestation or more; and the inequities
that result from reliance on a fetus’
gestation only in cases in which the
fetus’ weight is unknown, VA proposes
to eliminate the requirement in 38 CFR
9.1(k)(1)(ii)(B) that VA may rely on a
fetus’ gestational period only in cases in
which the fetus’ weight is unknown.
Section 9.1(k)(1) would instead provide
that a member’s biological child whose
death occurs before expulsion,
extraction, or delivery and who meets
either component of the definition, i.e.,
fetal weight is at least 350 grams or a
gestation period of 20 completed weeks
or greater in utero, calculated from the
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30061
date the last normal menstrual period
began to the date of expulsion,
extraction, or delivery will satisfy the
definition of a member’s stillborn child.
Effect of Rulemaking
Title 38 of the Code of Federal
Regulations, as proposed to be revised
by this proposed rulemaking, would
represent the exclusive legal authority
on this subject. Other than future
amendments to this regulation or
governing statutes, no contrary guidance
or procedures would be authorized. All
existing or subsequent VA guidance
would be read to conform with this
rulemaking if possible or, if not
possible, such guidance would be
superseded by this rulemaking.
Paperwork Reduction Act
This notice of proposed rulemaking
contains no provisions constituting a
collection of information under the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501–3521).
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.
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).
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
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Federal Register / Vol. 84, No. 123 / Wednesday, June 26, 2019 / Proposed Rules
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 proposed regulatory
action have been examined and it has
been determined to be a significant
regulatory action under Executive Order
12866, because it may 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’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 subject to the
requirements of EO13771 because this
proposed rule is expected to result in no
more than de minimis costs.
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.
Therefore, pursuant to 5 U.S.C. 605(b),
this proposed rulemaking is exempt
from the initial and final regulatory
flexibility analysis requirements of
sections 603 and 604.
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Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic
Assistance number and title for the
program affected by this document is
64.103, Life Insurance for Veterans.
List of Subjects in 38 CFR Part 9
Life insurance, Military Personnel,
Veterans.
Signing Authority
The Secretary of Veterans Affairs, or
designee, approved this document and
authorized the undersigned to sign and
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16:20 Jun 25, 2019
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submit the document to the Office of the
Federal Register for publication
electronically as an official document of
the Department of Veterans Affairs.
Robert L. Wilkie, Secretary, Department
of Veterans Affairs, approved this
document on May 3, 2019, for
publication.
AGENCY:
elements of State Implementation Plan
(SIP) submissions from Iowa
Department of Natural Resources (IDNR)
and Nebraska Department of
Environmental Quality (NDEQ) for the
2012 Annual Fine Particulate Matter
(PM2.5) National Ambient Air Quality
Standard (NAAQS). The Clean Air Act
(CAA) requires that each state adopt and
submit a SIP that provides for the
implementation, maintenance, and
enforcement of each NAAQS
promulgated by EPA, commonly
referred to as ‘‘infrastructure’’ SIPs. In
this action EPA is proposing to approve
the interstate transportation obligations
of the State’s 2012 PM2.5 NAAQS
infrastructure SIP submittals.
DATES: Comments must be received on
or before July 26, 2019.
ADDRESSES: Submit your comments,
identified by Docket ID No. EPA–R07–
OAR–2019–0332, to 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
making effective comments, please visit
https://www2.epa.gov/dockets/
commenting-epa-dockets.
FOR FURTHER INFORMATION CONTACT:
Lachala Kemp, Environmental
Protection Agency, Region 7 Office, Air
Quality Planning Branch, 11201 Renner
Boulevard, Lenexa, Kansas 66219 at
(913) 551–7214, or by email at
kemp.lachala@epa.gov.
SUPPLEMENTARY INFORMATION:
Throughout this document ‘‘we,’’ ‘‘us,’’
and ‘‘our’’ refer to EPA. This section
provides additional information by
addressing the following:
The Environmental Protection
Agency (EPA) is proposing to approve
I. Written Comments
II. What is being addressed in this document?
III. Have the requirements for approval of a
SIP revision been met?
IV. Background
Date: June 21, 2019.
Luvenia Potts,
Program Specialist, Office of Regulation
Policy & Management, Office of the Secretary,
Department of Veterans Affairs.
For the reasons stated in the
preamble, VA proposes to amend 38
CFR part 9 as set forth below:
PART 9—SERVICEMEMBERS’ GROUP
LIFE INSURANCE AND VETERANS’
GROUP LIFE INSURANCE
1. The authority citation for part 9
continues to read as follows:
■
Authority: 38 U.S.C. 501, 1965–1980A,
unless otherwise noted.
2. Amend § 9.1 by revising paragraph
(k)(1) to read as follows:
■
§ 9.1
Definitions.
*
*
*
*
*
(k)(1) The term member’s stillborn
child means a member’s biological
child—
(i) Whose death occurs before
expulsion, extraction, or delivery; and
(ii) Whose—
(A) Fetal weight is 350 grams or more;
or
(B) Duration in utero is 20 completed
weeks of gestation or more, calculated
from the date the last normal menstrual
period began to the date of expulsion,
extraction, or delivery.
*
*
*
*
*
[FR Doc. 2019–13553 Filed 6–25–19; 8:45 am]
BILLING CODE 8320–01–P
ENVIRONMENTAL PROTECTION
AGENCY
40 CFR Part 52
[EPA–R07–OAR–2019–0332; FRL–9995–31–
Region 7]
Approval of Iowa and Nebraska Air
Quality Implementation Plans;
Infrastructure SIP Requirements for
the 2012 Annual Fine Particulate Matter
(PM2.5) National Ambient Air Quality
Standard Interstate Transport
Environmental Protection
Agency (EPA).
ACTION: Proposed rule.
SUMMARY:
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]]>Agencies
[Federal Register Volume 84, Number 123 (Wednesday, June 26, 2019)]
[Proposed Rules]
[Pages 30060-30062]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-13553]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 9
RIN 2900-AQ49
Service Members Group Life Insurance--Definition of Stillborn
Child for Purposes of Coverage
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) proposes to amend the
regulation defining ``member's stillborn child'' for purposes of the
Servicemembers' Group Life Insurance (SGLI) program. The current
definition of a ``member's stillborn child'' is that a fetus must weigh
at least 350 grams or, if the fetal weight is unknown, duration in
utero is at least 20 completed weeks of gestation. VA proposes to amend
the definition to allow reliance upon the fetus' gestational age even
if the fetus' weight is known. As a result, a fetus whose duration in
utero is 20 completed weeks of gestation but who weighs less than 350
grams would qualify as a ``member's stillborn child.''
DATES: Comments must be received on or before August 26, 2019.
ADDRESSES: Written comments may be submitted through https://www.Regulations.gov; by mail or hand-delivery to: Director, Office of
Regulation Policy and Management (00REG), Department of Veterans
Affairs, 810 Vermont Ave. NW, Room 1064, Washington, DC 20420; or by
fax to (202) 273-9026. (This is not a toll-free telephone number.)
Comments should indicate that they are submitted in response to ``RIN
2900-AQ49--Servicemembers' Group Life Insurance, Definition of
Stillborn Child.''
All comments received will be available for public inspection in
the Office of Regulation Policy and Management, Room 1064, between the
hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except
holidays). Please call (202) 461-4902 for an appointment. (This is not
a toll-free telephone number.) In addition, comments may be viewed
online through the Federal Docket Management System (FDMS) at https://www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT: Ruth Berkheimer, Insurance Specialist,
Department of Veterans Affairs Insurance Center (310/290B), 5000
Wissahickon Avenue, Philadelphia, PA 19144, (215) 842-2000, ext. 4275.
(This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: The Veterans' Survivor Benefits Improvements
Act of 2001, Public Law 107-14, 4, 115 Stat. 25, 26-28, authorized
automatic insurance coverage for spouses and dependent children of
servicemembers (hereinafter ``servicemembers'' or ``members'') enrolled
in Servicemembers' Group Life Insurance (SGLI). This insurance is
referred to as Family Servicemembers' Group Life Insurance (FSGLI),
which provides a maximum of $100,000 of coverage for a spouse, not to
exceed the servicemember's SGLI coverage amount, and $10,000 for each
dependent child. The servicemember pays the premium for spousal
coverage, while dependent children are insured at no cost. Members
cannot decline or reduce coverage for dependent children if the member
is insured under SGLI. See 38 U.S.C. 1967(a)(3)(B). Dependent child
coverage begins on the date of birth or, ``if the child is not the
natural child of the member, the date on which the child acquires
status as an insurable dependent of the member.'' 38 U.S.C.
1967(a)(5)(F).
Section 402 of the Veterans' Benefits Improvement Act of 2008,
Public Law 110-389, 122 Stat. 4145, 4174, expanded the definition of
``insurable dependent'' for SGLI purposes to include a ``member's
stillborn child.'' On November 18, 2009, VA added paragraph (k)(1) to
38 CFR 9.1 to define the term ``member's stillborn child'' for purposes
of SGLI coverage to mean:
A member's natural child--
(i) Whose death occurs before expulsion, extraction, or delivery;
and
(ii) Whose--
(A) Fetal weight is 350 grams or more; or
(B) If fetal weight is unknown, duration in utero is 20 completed
weeks of gestation or more, calculated from the date the last normal
menstrual period began to the date of expulsion, extraction, or
delivery.
74 FR 59,478, 59,479 (Nov. 18, 2009). (The word ``natural'' was changed
to ``biological'' in 2012. 77 FR 70374, 70376 (Nov. 26, 2012)). VA
promulgated this definition pursuant to S. Rep. No. 110-449, at 41
(2008), which stated that the ``Committee expects VA to . . . define
the term [``stillborn child''] . . .
[[Page 30061]]
consistent with the 1992 recommended reporting requirements'' of fetal
deaths of the Model State Vital Statistics Act and Regulations as
drafted by the Centers for Disease Control and Prevention's National
Center for Health Statistics. Id. at 59,478. Since the rule was
promulgated in 2009, VA has been asked to reevaluate the stillbirth
standard by servicemembers whose claims have been denied because the
fetus did not meet the minimum weight of 350 grams but was 20 weeks or
more in gestation.
Although the 1992 Model Act recommended the reporting requirements
for fetal death, states have the authority enact their own reporting
requirements, and as a result, the reporting criteria for fetal death
enacted by states vary as to birth weight and gestational age.
MacDorman MF, Fetal and Perinatal Mortality: United States, 2013. Natl
Vital Stat Rep 2015 Jul; 64(8), Table I. We believe that only three
states, Delaware, Montana, and Texas, currently use the criteria for
reporting fetal deaths in the 1992 Model Act. Del. Code Ann. tit. 16,
Sec. 3124 (2019); Mont. Code Ann Sec. 50-15-403(1) (2019); 25 Tex.
Admin. Code Sec. 181.7(a) (2019). We note that, nonetheless, Montana
defines a ``stillbirth'' as a fetal death occurring after 20 weeks of
gestation. Mont. Code Ann Sec. 50-15-101(15) (2019). Most states
require either that a death be reported if a fetus is 20 weeks of
gestation or 350 grams, or if it is 20 weeks of gestation. Fetal and
Perinatal Mortality: United States, 2013, Table I. In addition, the
American Academy of Pediatrics (AAP) Committee on Fetus and Newborn,
uses the term ``stillborn'' to describe fetal deaths at 20 weeks'
gestation or more, without regard to a fetus' weight. Barfield WD,
Committee on Fetus and Newborn. Clinical Reports--Standard Terminology
for Fetal, Infant, and Perinatal Deaths. Pediatrics 2011 Jul; 128(1):
177-81.
The cutoff of 350 grams is the 50th percentile for weight at 20
weeks of gestation. American College of Obstetricians & Gynecologists
(ACOG) Practice Bulletin No. 102: Management of Stillbirth. Obstet
Gynecol. 2009 Mar; 113(3):748-6. There are many variables that may
account for a fetus' gestational weight, e.g., mother's health,
nutrition, height, weight, parity, race, ethnicity, tobacco use, and
congenital anomalies. Buck Louis GM, Racial/Ethnic Standards for Fetal
Growth, the NICHD Fetal Growth Studies. Am J Obstet Gynecol 2015 Oct.;
213(4): 449.e1-449.e41; Gardosi J, A customized standard to assess
fetal growth in a US population. Am J Obstet Gynecol 2009 Jul; 201:
25.e1-7; Diego MA, Prenatal depression restricts fetal growth. Early
Hum Dev. 2009 Jan.; 85(1): 65-70; Alexander GR, 1994-1996 U.S.
Singleton Birth Weight Percentiles for Gestational Age by Race,
Hispanic Origin, and Gender. Matern Child Health J 1999; 3(4) 225-31.
We believe that reliance on a fetus' gestation only in cases in which
the fetus' weight is unknown creates inequities because a fetus may
weigh less than 350 grams due to these factors but nonetheless be 20
weeks of gestation. We therefore propose to amend the criteria in Sec.
9.20(k)(1) to include a larger cohort of stillborn children.
As part of VA's research, VA contacted obstetrics and gynecology
professionals about the FSGLI stillbirth criteria to obtain their
input. The organizations contacted were the American Board of
Obstetrics and Gynecology (ACOG), VA Women's Health Services,
Children's Hospital of Philadelphia, VA Palo Alto Health Care System,
and Stanford University School of Medicine. The responses received
indicated that revising the portion of the current definition of
stillborn child in 38 CFR 9.1(k)(1)(ii) to provide that either a weight
of 350 grams or a gestation period of 20 weeks or greater in utero
irrespective of the fetus' weight would be in keeping with current,
sound medical understanding of pre-term infants. A physician from the
ACOG stated that ``VA offers a valuable benefit to families who
experienced a stillbirth, and I encourage VA to use a more expansive
definition to determine which fetal loss would be covered.'' Similarly,
medical professionals from the Children's Hospital of Philadelphia,
Division of Neonatology, stated that, ``using either the weight
criteria or the gestational age criteria . . . to qualify is very
reasonable as those targets would capture a lower limit of viability.''
Given that the vast majority of states require reporting the death
of a fetus at 20 weeks of gestation without regard to weight; the AAP
describes the term ``stillbirth'' as fetal deaths of 20 weeks of
gestation or more; and the inequities that result from reliance on a
fetus' gestation only in cases in which the fetus' weight is unknown,
VA proposes to eliminate the requirement in 38 CFR 9.1(k)(1)(ii)(B)
that VA may rely on a fetus' gestational period only in cases in which
the fetus' weight is unknown. Section 9.1(k)(1) would instead provide
that a member's biological child whose death occurs before expulsion,
extraction, or delivery and who meets either component of the
definition, i.e., fetal weight is at least 350 grams or a gestation
period of 20 completed weeks or greater in utero, calculated from the
date the last normal menstrual period began to the date of expulsion,
extraction, or delivery will satisfy the definition of a member's
stillborn child.
Effect of Rulemaking
Title 38 of the Code of Federal Regulations, as proposed to be
revised by this proposed rulemaking, would represent the exclusive
legal authority on this subject. Other than future amendments to this
regulation or governing statutes, no contrary guidance or procedures
would be authorized. All existing or subsequent VA guidance would be
read to conform with this rulemaking if possible or, if not possible,
such guidance would be superseded by this rulemaking.
Paperwork Reduction Act
This notice of proposed rulemaking contains no provisions
constituting a collection of information under the Paperwork Reduction
Act of 1995 (44 U.S.C. 3501-3521).
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.
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). 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
[[Page 30062]]
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 proposed regulatory action have been examined and
it has been determined to be a significant regulatory action under
Executive Order 12866, because it may 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'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 subject to the
requirements of EO13771 because this proposed rule is expected to
result in no more than de minimis costs.
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. Therefore, pursuant to 5 U.S.C. 605(b), this proposed
rulemaking is exempt from the initial and final regulatory flexibility
analysis requirements of sections 603 and 604.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic Assistance number and title for the
program affected by this document is 64.103, Life Insurance for
Veterans.
List of Subjects in 38 CFR Part 9
Life insurance, Military Personnel, 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. Robert L.
Wilkie, Secretary, Department of Veterans Affairs, approved this
document on May 3, 2019, for publication.
Date: June 21, 2019.
Luvenia Potts,
Program Specialist, Office of Regulation Policy & Management, Office of
the Secretary, Department of Veterans Affairs.
For the reasons stated in the preamble, VA proposes to amend 38 CFR
part 9 as set forth below:
PART 9--SERVICEMEMBERS' GROUP LIFE INSURANCE AND VETERANS' GROUP
LIFE INSURANCE
0
1. The authority citation for part 9 continues to read as follows:
Authority: 38 U.S.C. 501, 1965-1980A, unless otherwise noted.
0
2. Amend Sec. 9.1 by revising paragraph (k)(1) to read as follows:
Sec. 9.1 Definitions.
* * * * *
(k)(1) The term member's stillborn child means a member's
biological child--
(i) Whose death occurs before expulsion, extraction, or delivery;
and
(ii) Whose--
(A) Fetal weight is 350 grams or more; or
(B) Duration in utero is 20 completed weeks of gestation or more,
calculated from the date the last normal menstrual period began to the
date of expulsion, extraction, or delivery.
* * * * *
[FR Doc. 2019-13553 Filed 6-25-19; 8:45 am]
BILLING CODE 8320-01-P
