Notice of Asset and Infrastructure Review (AIR) Commission Foreword and Criteria, 28932-28935 [2021-11398]
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28932
Federal Register / Vol. 86, No. 102 / Friday, May 28, 2021 / Notices
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0545]
Agency Information Collection Activity
Under OMB Review: Report of Medical,
Legal and Other Expenses Incident to
Recovery for Injury or Death
Veterans Benefits
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
In compliance with the
Paperwork Reduction Act (PRA) of
1995, this notice announces that the
Veterans Benefits Administration,
Department of Veterans Affairs, will
submit the collection of information
abstracted below to the Office of
Management and Budget (OMB) for
review and comment. The PRA
submission describes the nature of the
information collection and its expected
cost and burden and it includes the
actual data collection instrument.
DATES: Written comments and
recommendations for the proposed
information collection should be sent
within 30 days of publication of this
notice to www.reginfo.gov/public/do/
PRAMain. Find this particular
information collection by selecting
‘‘Currently under 30-day Review—Open
for Public Comments’’ or by using the
search function. Refer to ‘‘OMB Control
No. 2900–0545’’.
FOR FURTHER INFORMATION CONTACT:
Maribel Aponte, Office of Enterprise
and Integration, Data Governance
Analytics (008), 1717 H Street NW,
Washington, DC 20006, (202) 266–4688
or email maribel.aponte@va.gov. Please
refer to ‘‘OMB Control No. 2900–0545’’
in any correspondence.
SUPPLEMENTARY INFORMATION:
Authority: 38 U.S.C 1503; 38 CFR
3.262, 3.271, 3.272.
Title: Report of Medical, Legal and
Other Expenses Incident to Recovery for
Injury or Death (VA Form 21P–8416b).
OMB Control Number: 2900–0545.
Type of Review: Extension of a
currently approved collection.
Abstract: A claimant’s eligibility for
needs-based pension programs are
determined in part by countable family
income and certain deductible
expenses. When a claimant is awarded
compensation by another entity or
government agency based on personal
injury or death, the compensation is
usually countable income for VA
purposes (38 CFR 3.262(i)). However,
medical, legal or other expenses
incident to the injury or death, or
incident to the collection or recovery of
SUMMARY:
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Jkt 253001
compensation, may be deducted from
the amount of the award or settlement
(38 CFR 3.271(g) and 3.272(g)). In these
situations, VBA uses VA Form 21P–
8416b Report of Medical, Legal and
Other Expenses Incident to Recovery for
Injury or Death, to gather information
that is necessary to determine eligibility
for income-based benefits and the rate
payable; without this information,
determination of eligibility would not
be possible. In an effort to safeguard
Veterans and their beneficiaries from
financial exploitation, the instructions
on VA Form 21P–8416b were amended
to include information regarding VAaccredited attorneys or agents charging
fees in connection with a proceeding
before the Department of Veterans
Affairs with respect to a claim.
An agency may not conduct or
sponsor, and a person is not required to
respond to a collection of information
unless it displays a currently valid OMB
control number. The Federal Register
Notice with a 60-day comment period
soliciting comments on this collection
of information was published on March
17, 2021, page 14686.
Affected Public: Individuals or
Households.
Estimated Annual Burden: 1,125
hours.
Estimated Average Burden per
Respondent: 45 minutes.
Frequency of Response: Once.
Estimated Number of Respondents:
1,500.
By direction of the Secretary.
Dorothy Glasgow,
(Alternate) VA PRA Clearance Officer, Office
of Enterprise and Integration, Data
Governance Analytics, Department of
Veterans Affairs.
[FR Doc. 2021–11372 Filed 5–27–21; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
Notice of Asset and Infrastructure
Review (AIR) Commission Foreword
and Criteria
Department of Veterans Affairs.
Notice of Final Action
AGENCY:
ACTION:
The Secretary of the
Department of Veterans Affairs (VA) is
required to develop criteria that will be
used in making recommendations
regarding the modernization or
realignment of Veterans Health
Administration (VHA) facilities. This
notice provides the required final
selection criteria.
FOR FURTHER INFORMATION CONTACT:
Valerie Mattison Brown, Chief Strategy
SUMMARY:
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Officer, Veterans Health Administration,
Department of Veterans Affairs, 810
Vermont Avenue NW, Washington, DC
20420, (202) 461–7100.
SUPPLEMENTARY INFORMATION: Subtitle A
of Title II of the Maintaining Internal
Systems and Strengthening Integrated
Outside Networks (MISSION) Act of
2018 (Pub. L. 115–182), requires VA to
develop criteria that will be used to
assess and make recommendations
regarding the modernization or
realignment of Veterans Health
Administration (VHA) facilities
(‘‘Selection Criteria’’). In 2019, VHA
began working with various
stakeholders and experts to identify
factors to consider in developing the
criteria. VHA solicited feedback from
Veterans Service Organizations (VSOs),
Community Veteran Engagement Boards
(CVEBs) and a wide range of
interdisciplinary VA leaders. Six criteria
and associated sub-criteria were
developed through these engagements.
VA will use these criteria to evaluate
potential market opportunities for
submission to the statutorily mandated
Asset and Infrastructure Review (AIR)
Commission.
On February 2, 2021, VA published a
Federal Register Notice (FRN),
requesting public comment on the draft
Selection Criteria as required by Section
203 of the MISSION Act (86 FR 7921).
The public comment period closed on
May 1, 2021. VA received a total of 122
comments on the FRN from Veterans,
caregivers, VSOs, legislative partners,
research partners, business partners,
and other stakeholders. Of the 122
comments, 31 comments specifically
referenced the draft Section Criteria,
and 14 out of those 31 comments
recommended specific changes or
considerations be applied to the draft
Section Criteria. These 14 comments
were further reviewed and considered
by VA for inclusion into the final
Section Criteria.
The FRN comments are publicly
available online at www.regulations.gov.
Copies of the comments are also
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 (exception
holidays). Please call (202) 461–4902
(this is not a toll-free number) for an
appointment.
Foreword
The Department of Veterans Affairs
(‘‘VA’’) is honored to deliver
exceptional health care and services to
more than 9 million Veterans. As we
look to the future, VA remains
committed to a core set of immutable
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Federal Register / Vol. 86, No. 102 / Friday, May 28, 2021 / Notices
values that empower, strengthen, and
encourage a vibrant and healthy Veteran
community. At the forefront of every
decision VA makes is a commitment to
serving as an integrated system to
provide coordinated, lifelong, worldclass health care and services that
leverage cutting-edge research and
equitable access to the Nation’s top
academic and medical professionals.
VA’s vision is built on a foundation of
inclusion, honor, and respect for every
Veteran’s unique experience. As VA
transforms to optimize resources and
modernize infrastructure and systems,
the Department will remain committed
to its role as the primary provider and
coordinator of Veteran care. By
expanding our work with communities,
caregivers, and strategic partners VA
will achieve outcomes that empower
Veterans for generations to come.
As the unprecedented COVID–19
public health crisis consumed the
Nation and the globe, VA rose to the
challenge, demonstrating the strength of
our nationwide, integrated system, and
solidifying our position at the leading
edge of U.S. health care on behalf of
those we serve. We employed each of
our four health-related missions—health
care, education, research, and
emergency response—to lead the Nation
forward beside our interagency and
strategic partners. As demonstrated
during the pandemic, these missions
complement one another and together
are vital elements of a complete VA
transformation vision. Many U.S.
healthcare leaders expect that health
care delivery trends post-pandemic will
incorporate adaptations that worked
well for many patients, including
Veterans. In particular, a national
survey of U.S. adults reported that 3 in
10 had at least one virtual visit during
the pandemic.1 VA recognizes that a
‘new normal’ with more virtual options
for care and services may have
significant implications for the way
future health care delivery systems are
designed. VA intends to stay at the
leading edge of this type of personcentered innovation, employing the full
complement of our core missions.
As Veteran needs, preferences, and
demographics shift over the coming
decades, VA’s top priority will be to
design an integrated system of care and
benefits that is outcomes-based, and
values-driven. As an integrated system,
VA will ensure reliable access to
meaningful care coordination that
includes expanding availability of
1 Link to survey: https://www.urban.org/sites/
default/files/publication/103457/one-in-threeadults-used-telehealth-during-the-first-six-monthsof-the-pandemic-but-unmet-needs-for-carepersisted_1.pdf.
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digital health care services and
maintaining capacity to serve as the
backstop to the national health care
system. VA will strengthen its
partnerships with a growing network of
public and private-sector allies and
strive to lead the nation in Veteranrelevant research and innovation. At
every turn, VA will remain committed
to evidence-based policymaking and
effective governance that always puts
the Veteran first.
In line with VA’s vision, VA submits
the following set of Selection Criteria for
making recommendations regarding the
modernization or realignment of VHA
facilities as required by Section 203 of
the MISSION Act of 2018. The Selection
Criteria are designed to keep Veterans’
needs at the center of the decisionmaking process, assuring that each
Veteran can receive the integrated care
they have earned and deserve.
Criteria
VA’s vision for the future of VA
health care is an integrated system that
honors America’s Veterans by providing
lifelong, world-class care and benefits,
while leveraging cutting-edge research
and equitable access to the Nation’s top
health, academic, and research
professionals. The market assessments
required by Section 203 of the MISSION
Act of 2018 were designed and being
conducted in support of this vision. The
assessments provide VA with the ability
to plan for the continuing evolution of
Veteran health care, incorporating major
trends and events in the national and
global health ecosystem (e.g., the
COVID–19 pandemic and telehealth).
Each assessment will identify strategic
opportunities to position VA to increase
health care access points in locations
where the demand for VA health care
services is not being met, enhance
Veteran experience, account for social
determinants,2 consider health equity
factors 3 and serve as the coordinator of
Veteran health care and services.
Through thoughtful and constructive
engagements with internal and external
stakeholders, the following criteria were
developed to ensure opportunities
2 Social determinants as defined by the
Department of Health and Human Services (HHS)—
are ‘‘conditions in the environments in which
people are born, live, learn, work, play, worship,
and age that affect a wide range of health,
functioning, and quality-of-life outcomes and
risks.’’ Link: https://www.hrsa.gov/about/
organization/bureaus/ohe/.
3 Health equity as defined by HHS—is ‘‘the
absence of disparities or avoidable differences
among socioeconomic and demographic groups or
geographical areas in health status and health
outcomes such as disease, disability, or mortality.
Link: https://www.hrsa.gov/about/organization/
bureaus/ohe/.
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identified for VA Market 4
recommendations 5 support VA’s goal in
designing high performing integrated
networks through VHA realignment and
modernization opportunities.
The Secretary will use the Selection
Criteria to make recommendations to
the AIR Commission regarding the
modernization and realignment of VHA
facilities. Recommendations submitted
to the AIR Commission will focus on
creating Veteran-centric outcomes that
maintain or improve health care
services through the most equitable
modalities and at locations that are most
beneficial to those VA serves. The
recommendations will then go through
the AIR Commission review process as
outlined in the MISSION Act.
The Selection Criteria are broken out
into six domains, each of which
complement the others. The ordering of
the domains follows as they appear in
the MISSION Act legislation. Each
criterion begins with a commitment
statement, outlining VA’s philosophy
and commitment to current and future
Veterans, followed by the criterion
statement, sub-criteria, and explanatory
statement:
Veterans’ Need for Care & Services and
the Market’s Capacity To Provide Them
(Demand)
Commitment Statement: VA is
committed to providing Veterans the
full range of integrated care and services
needed and desired throughout their
lifetime, to include preventive, acute
and chronic care. These services will be
carefully balanced to meet Veterans’
needs and preferences with the capacity
available through VA’s direct care
system, our Community Care Network
(CCN), and government, academic, and
other strategic partners. VA intends to
ensure Veterans receive the
personalized care they have earned. VA
will do this by matching the services
and support Veterans may need with
VA’s ability to provide those services in
a timely manner.
Demand Criterion: The
recommendation aligns VA’s high
performing integrated network resources
to effectively meet the future health care
demand of the Veteran enrollee
population with the capacity in the
Market.
Demand Sub-Criteria:
The recommendation:
4 A VA Market is comprised of VA owned and/
or operated facilities, as well as Department of
Defense (DoD), Tribal, other federal agency,
academic affiliates, and other community partners.
5 A VA Market recommendation is comprised of
multifaceted, interdependent strategic opportunities
across the continuum of care within a Market.
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Æ Aligns the quality and delivery of
integrated care and services with
projected Veteran demand across
demographics and geography;
Æ Retains or improves VA’s ability to
meet projected demand; and
Æ Incorporates trends in the evolution
of U.S. health care.
When applying the demand criterion,
VA will consider how a
recommendation will impact VA’s
ability to meet the needs of Veterans in
the future. An assessment of the existing
health services available in the Market
will aide in determining market
adjustments. VA will consider what
Veterans may need through
understanding of the services that
Veterans have accessed in the past and
are projected to need and prefer in the
future. VA will also consider how and
where Veterans wish to receive services,
including in ambulatory settings,
hospitals, in the community, through
telehealth, and through innovative
models and modalities.
Accessibility of Care for Veterans
(Access)
Commitment Statement: VA intends
to provide Veterans with an accessible,
whole health experience, with services
thoughtfully designed to meet their
needs. VA will do this by making the
services and support Veterans need
accessible through locations, models,
and modalities that most benefit them
and match their needs and preferences.
Access Criterion: The
recommendation maintains or improves
Veteran access to care.
Access Sub-Criteria:
The recommendation:
Æ Aligns VA points of care and
services with projected Veteran need
across demographics and geography;
Æ Ensures Veterans are provided a
range of integrated health care options
and the opportunity to choose the care
they trust throughout their lifetime;
Æ Enables VA to serve as the
coordinator of each Veteran’s health
care, whether provided within or
beyond VA;
Æ Considers health equity, defined as
the absence of disparities or avoidable
differences among socioeconomic and
demographic groups or geographical
areas in health status and health
outcomes such as disease, disability, or
mortality;
Æ Reflects consideration of factors
underpinning observed access patterns
regarding conditions in the environment
in which people are born, live, learn,
work, play, worship, and age that affect
a wide range of health functioning, and
quality-of-life outcomes and risks; and
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Æ Incorporates trends in the evolution
of U.S. health care.
When applying the ‘access’ criterion,
VA will consider how a
recommendation will impact the
convenience and experience of care
provided to Veterans in the future. Key
components of access include the time
it takes to receive care in the VA system
and in the community and the barriers
and accelerators to receiving care, such
as distance or availability of technology
or availability of culturally competent
experience in the community.
Impact on Mission
Commitment Statement: VA is
committed to delivering best-in-class
care throughout Veterans’ lifetimes.
This means positioning VA health care
system at the leading edge of the health
care industry in education, research,
and national emergency preparedness.
Impact on Mission Criterion: The
recommendation provides for VA’s
second, third, and fourth health related
statutory missions of education,
research, and emergency preparedness.
Impact on Mission Sub-Criteria:
The recommendation:
Æ Aligns resources to VA’s education,
research, and emergency preparedness
missions across demographics and
geography;
Æ Education: 6 Maintains or enhances
VA’s ability to execute its education
mission;
Æ Research: 7 Maintains or enhances
VA’s ability to execute its research
mission;
Æ Emergency 8 Preparedness:
Maintains or enhances VA’s ability to
execute its emergency preparedness
mission; and
Æ Incorporates trends in the evolution
of U.S. health care.
The ‘impact on mission’ criterion
allows VA to consider how a
recommendation will impact VA’s
ability to execute our statutory missions
of education, research, and emergency
preparedness in support of Veterans
and the Nation.
6 VA’s education mission has a profound impact
on VA’s human capital requirements as well as the
future healthcare workforce (70% of US physicians
received some training in a VA health care facility).
7 VA’s research mission is grounded in care
delivery to Veterans and focuses on health issues
that affect Veterans.
8 VA’s strong emergency preparedness mission
has provided broad support to Veterans and focuses
on health issues that affect Veterans. Nation during
multiple public health emergencies, including but
not limited to COVID (e.g., for Hurricane Maria VA
was THE source of ‘boots on the ground’ for all
relief efforts).
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Providing the Highest Quality Whole
Health Care (Quality)
Commitment Statement: VA is
committed to providing Veterans with a
high-quality, whole health care system
that delivers an excellent experience of
care and optimal health outcomes. VA
will deliver the same high quality,
evidence-based standards of care
regardless of where, or by which
modality, their care is received.
Quality Criterion: The
recommendation considers the quality
and delivery of health care services
available to Veterans, including the
experience, safety, and appropriateness
of care.
Quality Sub-Criteria:
The recommendation:
Æ Ensures the highest possible quality
of care across demographics and
geography;
Æ Promotes recruitment of top clinical
and non-clinical talent;
Æ Maintains or enhances Veteran
experience; and
Æ Incorporates trends in the evolution
of U.S. health care.
When applying the ‘quality’ criterion,
VA will consider how a
recommendation will impact the quality
of care for Veterans. Quality in health
care is measured through metrics and
ratings assessed by federal and
commercial health care entities. VA will
consider the care needs and preferences
of Veterans in order to provide optimal
experience, safety, and outcomes.
Effective Use of Resources for Veteran
Care (Cost Effectiveness)
Commitment Statement: VA is
committed to optimizing the Veteran
health care system through the effective
and sustainable use and sharing of
taxpayer resources, including staffing,
space, infrastructure, and funding, with
the goal of providing Veterans with the
best health care and outcomes. VA will
actively and mindfully manage
resources, allowing VA to provide
services and support that effectively
match Veterans’ needs and preferences
while putting their health and
empowerment at the center of system
design.
Cost Effectiveness Criterion: The
recommendation provides a costeffective means by which to provide
Veterans with modern health care.
Cost Effectiveness Sub-Criteria:
The recommendation:
Æ Reflects stewardship of taxpayer
dollars by optimizing investments and
resources to achieve advancements in
access and outcomes for Veterans;
Æ Recognizes potential savings or
efficiencies that may free resources for
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Federal Register / Vol. 86, No. 102 / Friday, May 28, 2021 / Notices
more impactful investment for Veterans;
and
Æ Considers the value of Veteran and
employee experience, innovation, and
other intangible elements of value.
When applying the ‘cost effectiveness’
criterion, VA will consider whether a
recommendation optimizes funding for
Veteran care.
Ensuring a Safe and Welcoming Health
Care Environment of Care
(Sustainability)
Commitment Statement: VA is
committed to providing Veterans a safe
and welcoming health care
environment. Our goal is for Veterans to
feel safe physically, mentally, socially,
and emotionally when receiving care
with access to a full range of experts and
specialists. VA is committed to
providing standard and complementary
types of care for our unique Veteran
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population in an equitable and inclusive
environment. VA will do this by
ensuring points of care are modern and
inviting, with an expert workforce and
care options designed to meet Veterans
where they are in their health journey.
Sustainability Criterion: The
recommendation creates a sustainable
health care delivery system for Veterans.
Sustainability Sub-Criteria:
The recommendation:
Æ Aligns investment in care and
services with projected Veteran care
needs across demographics and
geography;
Æ Reflects stewardship of taxpayer
dollars by creating a sustainable
infrastructure system for Veterans;
Æ Enables recruitment and retention of
top clinical and non-clinical talent; and
Æ Incorporates trends in the evolution
of U.S. health care.
When applying the ‘sustainability’
criterion, VA will consider how a
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recommendation impacts our ability to
offer Veterans a welcoming and safe
care environment that meets modern
health care standards and ensures
sustainability for future generations of
Veterans.
Signing Authority:
Denis McDonough, Secretary of
Veterans Affairs, approved this
document on May 25, 2021, 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.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy
& Management, Office of the Secretary,
Department of Veterans Affairs.
[FR Doc. 2021–11398 Filed 5–27–21; 8:45 am]
BILLING CODE 8320–01–P
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]]>Agencies
[Federal Register Volume 86, Number 102 (Friday, May 28, 2021)]
[Notices]
[Pages 28932-28935]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-11398]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
Notice of Asset and Infrastructure Review (AIR) Commission
Foreword and Criteria
AGENCY: Department of Veterans Affairs.
ACTION: Notice of Final Action
-----------------------------------------------------------------------
SUMMARY: The Secretary of the Department of Veterans Affairs (VA) is
required to develop criteria that will be used in making
recommendations regarding the modernization or realignment of Veterans
Health Administration (VHA) facilities. This notice provides the
required final selection criteria.
FOR FURTHER INFORMATION CONTACT: Valerie Mattison Brown, Chief Strategy
Officer, Veterans Health Administration, Department of Veterans
Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202) 461-7100.
SUPPLEMENTARY INFORMATION: Subtitle A of Title II of the Maintaining
Internal Systems and Strengthening Integrated Outside Networks
(MISSION) Act of 2018 (Pub. L. 115-182), requires VA to develop
criteria that will be used to assess and make recommendations regarding
the modernization or realignment of Veterans Health Administration
(VHA) facilities (``Selection Criteria''). In 2019, VHA began working
with various stakeholders and experts to identify factors to consider
in developing the criteria. VHA solicited feedback from Veterans
Service Organizations (VSOs), Community Veteran Engagement Boards
(CVEBs) and a wide range of interdisciplinary VA leaders. Six criteria
and associated sub-criteria were developed through these engagements.
VA will use these criteria to evaluate potential market opportunities
for submission to the statutorily mandated Asset and Infrastructure
Review (AIR) Commission.
On February 2, 2021, VA published a Federal Register Notice (FRN),
requesting public comment on the draft Selection Criteria as required
by Section 203 of the MISSION Act (86 FR 7921). The public comment
period closed on May 1, 2021. VA received a total of 122 comments on
the FRN from Veterans, caregivers, VSOs, legislative partners, research
partners, business partners, and other stakeholders. Of the 122
comments, 31 comments specifically referenced the draft Section
Criteria, and 14 out of those 31 comments recommended specific changes
or considerations be applied to the draft Section Criteria. These 14
comments were further reviewed and considered by VA for inclusion into
the final Section Criteria.
The FRN comments are publicly available online at
www.regulations.gov. Copies of the comments are also 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 (exception holidays). Please call (202) 461-4902 (this is not a
toll-free number) for an appointment.
Foreword
The Department of Veterans Affairs (``VA'') is honored to deliver
exceptional health care and services to more than 9 million Veterans.
As we look to the future, VA remains committed to a core set of
immutable
[[Page 28933]]
values that empower, strengthen, and encourage a vibrant and healthy
Veteran community. At the forefront of every decision VA makes is a
commitment to serving as an integrated system to provide coordinated,
lifelong, world-class health care and services that leverage cutting-
edge research and equitable access to the Nation's top academic and
medical professionals. VA's vision is built on a foundation of
inclusion, honor, and respect for every Veteran's unique experience. As
VA transforms to optimize resources and modernize infrastructure and
systems, the Department will remain committed to its role as the
primary provider and coordinator of Veteran care. By expanding our work
with communities, caregivers, and strategic partners VA will achieve
outcomes that empower Veterans for generations to come.
As the unprecedented COVID-19 public health crisis consumed the
Nation and the globe, VA rose to the challenge, demonstrating the
strength of our nationwide, integrated system, and solidifying our
position at the leading edge of U.S. health care on behalf of those we
serve. We employed each of our four health-related missions--health
care, education, research, and emergency response--to lead the Nation
forward beside our interagency and strategic partners. As demonstrated
during the pandemic, these missions complement one another and together
are vital elements of a complete VA transformation vision. Many U.S.
healthcare leaders expect that health care delivery trends post-
pandemic will incorporate adaptations that worked well for many
patients, including Veterans. In particular, a national survey of U.S.
adults reported that 3 in 10 had at least one virtual visit during the
pandemic.\1\ VA recognizes that a `new normal' with more virtual
options for care and services may have significant implications for the
way future health care delivery systems are designed. VA intends to
stay at the leading edge of this type of person-centered innovation,
employing the full complement of our core missions.
---------------------------------------------------------------------------
\1\ Link to survey: https://www.urban.org/sites/default/files/publication/103457/one-in-three-adults-used-telehealth-during-the-first-six-months-of-the-pandemic-but-unmet-needs-for-care-persisted_1.pdf.
---------------------------------------------------------------------------
As Veteran needs, preferences, and demographics shift over the
coming decades, VA's top priority will be to design an integrated
system of care and benefits that is outcomes-based, and values-driven.
As an integrated system, VA will ensure reliable access to meaningful
care coordination that includes expanding availability of digital
health care services and maintaining capacity to serve as the backstop
to the national health care system. VA will strengthen its partnerships
with a growing network of public and private-sector allies and strive
to lead the nation in Veteran-relevant research and innovation. At
every turn, VA will remain committed to evidence-based policymaking and
effective governance that always puts the Veteran first.
In line with VA's vision, VA submits the following set of Selection
Criteria for making recommendations regarding the modernization or
realignment of VHA facilities as required by Section 203 of the MISSION
Act of 2018. The Selection Criteria are designed to keep Veterans'
needs at the center of the decision-making process, assuring that each
Veteran can receive the integrated care they have earned and deserve.
Criteria
VA's vision for the future of VA health care is an integrated
system that honors America's Veterans by providing lifelong, world-
class care and benefits, while leveraging cutting-edge research and
equitable access to the Nation's top health, academic, and research
professionals. The market assessments required by Section 203 of the
MISSION Act of 2018 were designed and being conducted in support of
this vision. The assessments provide VA with the ability to plan for
the continuing evolution of Veteran health care, incorporating major
trends and events in the national and global health ecosystem (e.g.,
the COVID-19 pandemic and telehealth). Each assessment will identify
strategic opportunities to position VA to increase health care access
points in locations where the demand for VA health care services is not
being met, enhance Veteran experience, account for social
determinants,\2\ consider health equity factors \3\ and serve as the
coordinator of Veteran health care and services. Through thoughtful and
constructive engagements with internal and external stakeholders, the
following criteria were developed to ensure opportunities identified
for VA Market \4\ recommendations \5\ support VA's goal in designing
high performing integrated networks through VHA realignment and
modernization opportunities.
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\2\ Social determinants as defined by the Department of Health
and Human Services (HHS)--are ``conditions in the environments in
which people are born, live, learn, work, play, worship, and age
that affect a wide range of health, functioning, and quality-of-life
outcomes and risks.'' Link: https://www.hrsa.gov/about/organization/bureaus/ohe/.
\3\ Health equity as defined by HHS--is ``the absence of
disparities or avoidable differences among socioeconomic and
demographic groups or geographical areas in health status and health
outcomes such as disease, disability, or mortality. Link: https://www.hrsa.gov/about/organization/bureaus/ohe/.
\4\ A VA Market is comprised of VA owned and/or operated
facilities, as well as Department of Defense (DoD), Tribal, other
federal agency, academic affiliates, and other community partners.
\5\ A VA Market recommendation is comprised of multifaceted,
interdependent strategic opportunities across the continuum of care
within a Market.
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The Secretary will use the Selection Criteria to make
recommendations to the AIR Commission regarding the modernization and
realignment of VHA facilities. Recommendations submitted to the AIR
Commission will focus on creating Veteran-centric outcomes that
maintain or improve health care services through the most equitable
modalities and at locations that are most beneficial to those VA
serves. The recommendations will then go through the AIR Commission
review process as outlined in the MISSION Act.
The Selection Criteria are broken out into six domains, each of
which complement the others. The ordering of the domains follows as
they appear in the MISSION Act legislation. Each criterion begins with
a commitment statement, outlining VA's philosophy and commitment to
current and future Veterans, followed by the criterion statement, sub-
criteria, and explanatory statement:
Veterans' Need for Care & Services and the Market's Capacity To Provide
Them (Demand)
Commitment Statement: VA is committed to providing Veterans the
full range of integrated care and services needed and desired
throughout their lifetime, to include preventive, acute and chronic
care. These services will be carefully balanced to meet Veterans' needs
and preferences with the capacity available through VA's direct care
system, our Community Care Network (CCN), and government, academic, and
other strategic partners. VA intends to ensure Veterans receive the
personalized care they have earned. VA will do this by matching the
services and support Veterans may need with VA's ability to provide
those services in a timely manner.
Demand Criterion: The recommendation aligns VA's high performing
integrated network resources to effectively meet the future health care
demand of the Veteran enrollee population with the capacity in the
Market.
Demand Sub-Criteria:
The recommendation:
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[cir] Aligns the quality and delivery of integrated care and
services with projected Veteran demand across demographics and
geography;
[cir] Retains or improves VA's ability to meet projected demand;
and
[cir] Incorporates trends in the evolution of U.S. health care.
When applying the demand criterion, VA will consider how a
recommendation will impact VA's ability to meet the needs of Veterans
in the future. An assessment of the existing health services available
in the Market will aide in determining market adjustments. VA will
consider what Veterans may need through understanding of the services
that Veterans have accessed in the past and are projected to need and
prefer in the future. VA will also consider how and where Veterans wish
to receive services, including in ambulatory settings, hospitals, in
the community, through telehealth, and through innovative models and
modalities.
Accessibility of Care for Veterans (Access)
Commitment Statement: VA intends to provide Veterans with an
accessible, whole health experience, with services thoughtfully
designed to meet their needs. VA will do this by making the services
and support Veterans need accessible through locations, models, and
modalities that most benefit them and match their needs and
preferences.
Access Criterion: The recommendation maintains or improves Veteran
access to care.
Access Sub-Criteria:
The recommendation:
[cir] Aligns VA points of care and services with projected Veteran
need across demographics and geography;
[cir] Ensures Veterans are provided a range of integrated health
care options and the opportunity to choose the care they trust
throughout their lifetime;
[cir] Enables VA to serve as the coordinator of each Veteran's
health care, whether provided within or beyond VA;
[cir] Considers health equity, defined as the absence of
disparities or avoidable differences among socioeconomic and
demographic groups or geographical areas in health status and health
outcomes such as disease, disability, or mortality;
[cir] Reflects consideration of factors underpinning observed
access patterns regarding conditions in the environment in which people
are born, live, learn, work, play, worship, and age that affect a wide
range of health functioning, and quality-of-life outcomes and risks;
and
[cir] Incorporates trends in the evolution of U.S. health care.
When applying the `access' criterion, VA will consider how a
recommendation will impact the convenience and experience of care
provided to Veterans in the future. Key components of access include
the time it takes to receive care in the VA system and in the community
and the barriers and accelerators to receiving care, such as distance
or availability of technology or availability of culturally competent
experience in the community.
Impact on Mission
Commitment Statement: VA is committed to delivering best-in-class
care throughout Veterans' lifetimes. This means positioning VA health
care system at the leading edge of the health care industry in
education, research, and national emergency preparedness.
Impact on Mission Criterion: The recommendation provides for VA's
second, third, and fourth health related statutory missions of
education, research, and emergency preparedness.
Impact on Mission Sub-Criteria:
The recommendation:
[cir] Aligns resources to VA's education, research, and emergency
preparedness missions across demographics and geography;
[cir] Education: \6\ Maintains or enhances VA's ability to execute
its education mission;
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\6\ VA's education mission has a profound impact on VA's human
capital requirements as well as the future healthcare workforce (70%
of US physicians received some training in a VA health care
facility).
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[cir] Research: \7\ Maintains or enhances VA's ability to execute
its research mission;
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\7\ VA's research mission is grounded in care delivery to
Veterans and focuses on health issues that affect Veterans.
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[cir] Emergency \8\ Preparedness: Maintains or enhances VA's
ability to execute its emergency preparedness mission; and
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\8\ VA's strong emergency preparedness mission has provided
broad support to Veterans and focuses on health issues that affect
Veterans. Nation during multiple public health emergencies,
including but not limited to COVID (e.g., for Hurricane Maria VA was
THE source of `boots on the ground' for all relief efforts).
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[cir] Incorporates trends in the evolution of U.S. health care.
The `impact on mission' criterion allows VA to consider how a
recommendation will impact VA's ability to execute our statutory
missions of education, research, and emergency preparedness in support
of Veterans and the Nation.
Providing the Highest Quality Whole Health Care (Quality)
Commitment Statement: VA is committed to providing Veterans with a
high-quality, whole health care system that delivers an excellent
experience of care and optimal health outcomes. VA will deliver the
same high quality, evidence-based standards of care regardless of
where, or by which modality, their care is received.
Quality Criterion: The recommendation considers the quality and
delivery of health care services available to Veterans, including the
experience, safety, and appropriateness of care.
Quality Sub-Criteria:
The recommendation:
[cir] Ensures the highest possible quality of care across
demographics and geography;
[cir] Promotes recruitment of top clinical and non-clinical talent;
[cir] Maintains or enhances Veteran experience; and
[cir] Incorporates trends in the evolution of U.S. health care.
When applying the `quality' criterion, VA will consider how a
recommendation will impact the quality of care for Veterans. Quality in
health care is measured through metrics and ratings assessed by federal
and commercial health care entities. VA will consider the care needs
and preferences of Veterans in order to provide optimal experience,
safety, and outcomes.
Effective Use of Resources for Veteran Care (Cost Effectiveness)
Commitment Statement: VA is committed to optimizing the Veteran
health care system through the effective and sustainable use and
sharing of taxpayer resources, including staffing, space,
infrastructure, and funding, with the goal of providing Veterans with
the best health care and outcomes. VA will actively and mindfully
manage resources, allowing VA to provide services and support that
effectively match Veterans' needs and preferences while putting their
health and empowerment at the center of system design.
Cost Effectiveness Criterion: The recommendation provides a cost-
effective means by which to provide Veterans with modern health care.
Cost Effectiveness Sub-Criteria:
The recommendation:
[cir] Reflects stewardship of taxpayer dollars by optimizing
investments and resources to achieve advancements in access and
outcomes for Veterans;
[cir] Recognizes potential savings or efficiencies that may free
resources for
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more impactful investment for Veterans; and
[cir] Considers the value of Veteran and employee experience,
innovation, and other intangible elements of value.
When applying the `cost effectiveness' criterion, VA will consider
whether a recommendation optimizes funding for Veteran care.
Ensuring a Safe and Welcoming Health Care Environment of Care
(Sustainability)
Commitment Statement: VA is committed to providing Veterans a safe
and welcoming health care environment. Our goal is for Veterans to feel
safe physically, mentally, socially, and emotionally when receiving
care with access to a full range of experts and specialists. VA is
committed to providing standard and complementary types of care for our
unique Veteran population in an equitable and inclusive environment. VA
will do this by ensuring points of care are modern and inviting, with
an expert workforce and care options designed to meet Veterans where
they are in their health journey.
Sustainability Criterion: The recommendation creates a sustainable
health care delivery system for Veterans.
Sustainability Sub-Criteria:
The recommendation:
[cir] Aligns investment in care and services with projected Veteran
care needs across demographics and geography;
[cir] Reflects stewardship of taxpayer dollars by creating a
sustainable infrastructure system for Veterans;
[cir] Enables recruitment and retention of top clinical and non-
clinical talent; and
[cir] Incorporates trends in the evolution of U.S. health care.
When applying the `sustainability' criterion, VA will consider how
a recommendation impacts our ability to offer Veterans a welcoming and
safe care environment that meets modern health care standards and
ensures sustainability for future generations of Veterans.
Signing Authority:
Denis McDonough, Secretary of Veterans Affairs, approved this
document on May 25, 2021, 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.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
the Secretary, Department of Veterans Affairs.
[FR Doc. 2021-11398 Filed 5-27-21; 8:45 am]
BILLING CODE 8320-01-P
