Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, 13806-13844 [2022-04477]

Download as PDF 13806 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 78 RIN 2900–AR16 Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program Department of Veterans Affairs. Interim final rule. AGENCY: ACTION: The Department of Veterans Affairs (VA) is issuing this interim final rule to implement a new authority requiring VA to implement a three-year community-based grant program to award grants to eligible entities to provide or coordinate the provision of suicide prevention services to eligible individuals and their families for the purpose of reducing veteran suicide. This rulemaking specifies grant eligibility criteria, application requirements, scoring criteria, constraints on the allocation and use of the funds, and other requirements necessary to implement this grant program. DATES: Effective date: This interim final rule is effective on April 11, 2022. Comments: Comments must be received on or before May 9, 2022. ADDRESSES: Comments must be submitted through www.Regulations.gov. Comments received will be available at regulations.gov for public viewing, inspection or copies. FOR FURTHER INFORMATION CONTACT: Sandra Foley, Supervisory Grants Manager—Suicide Prevention Program, Office of Mental Health and Suicide Prevention, 11MHSP, 810 Vermont Avenue NW, Washington, DC 20420, 202–502–0002 (This is not a toll-free telephone number), VASSGFoxGrants@ va.gov. SUMMARY: khammond on DSKJM1Z7X2PROD with RULES2 SUPPLEMENTARY INFORMATION: Background on Governing Statute and Public Input On October 17, 2020, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, Public Law (Pub. L.) 116–171 (the Act), was enacted in law. Section 201 of the Act, codified as a note to section 1720F of title 38, United States Code (U.S.C.), mandated VA establish the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP), a community-based grant program that would support certain eligible entities to provide or coordinate the provision of suicide prevention services to eligible individuals and their VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 families. Section 201 of the Act specified which entities are eligible for grants and those individuals eligible to receive suicide prevention services, defined the suicide prevention services that may be provided, described grant application requirements, and explained instances in which eligible entities must refer individuals to VA for additional care, among other requirements. This grant program is authorized for a period of three years starting on the date on which the first grant is awarded. The maximum amount per grant is capped by section 201(c)(2) of the Act at $750,000 per fiscal year. Section 201 of the Act required that VA consult with certain entities to assist in developing a plan for the design and implementation of the provision of grants; establishing criteria for the selection of eligible entities; developing a framework for collecting and sharing information about grantees; and developing measures and metrics to be used by grantees to determine the effectiveness of programming provided pursuant to the suicide prevention services grant. Section 201(h)(3) of the Act specifically required VA consult with the following entities: (1) Veterans service organizations; (2) National organizations (including national organizations that advocate for the needs of individuals with or at risk of behavioral health conditions; and those that represent mayors, unions, first responders, chiefs of police and sheriffs, governors, a territory of the United States, or a Tribal alliance) representing potential community partners of eligible entities in providing supportive services to address the needs of eligible individuals and their families; (3) National organizations representing members of the Armed Forces; (4) National organizations that represent counties; (5) Organizations with which VA has a current memorandum of agreement or understanding related to mental health or suicide prevention; (6) State departments of veterans affairs; (7) National organizations representing members of the Reserve Components of the Armed Forces; (8) National organizations representing members of the Coast Guard; (9) Organizations, including institutions of higher education, with experience in creating measurement tools for purposes of advising the Secretary on the most appropriate existing measurement tool or protocol for VA to utilize; (10) The National Alliance on Mental Illness; (11) A labor organization (as such term is defined in section 7103(a)(4) of title 5, U.S.C.); (12) The Centers for Disease Control and Prevention (CDC), the PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 Substance Abuse and Mental Health Services Administration (SAMHSA), and the President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS) Task Force; and such other organizations as the Secretary deems appropriate. On April 1, 2021, VA published a Notice of Request for Information on the Department of Veterans Affairs’ Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (RIN 2900– AR16) in the Federal Register (FR), requesting information and comments from the public to meet the requirements for consultation in the Act. 86 FR 17268 (April 1, 2021). Through this notice, VA asked the public, including those organizations listed in the previous paragraph, to comment on various aspects of the suicide prevention services grant program, such as distribution and selection of grants; administration of the grant program, including development of measures and metrics; training and technical assistance; referrals for care; degrees of risk of suicide and processes for determining degrees of risk of suicide; and nontraditional and innovative approaches and treatment practices that may be appropriate under this grant program. VA directly contacted various organizations that met the categories of organizations listed under section 201(h)(3) of the Act to notify them that VA was seeking input through this FR notice. VA received 124 comments, including comments outside the scope of the questions posed. Many commenters expressed support for awarding grants to entities with prior relevant experience. Many commenters also provided suggestions for training and technical assistance related to suicide prevention, evaluation and reporting requirements, and referrals to VA for further care. Additionally, numerous commenters provided suggestions for non-traditional and innovative treatment and services under this grant program. The comments received from this notice are publicly available online at www.regulations.gov. On May 11, 2021, VA published a Notice of Listening Sessions on the Department of Veterans Affairs Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (RIN 2900– AR16) in the FR notifying the public of two related listening sessions, which were held on May 25, 2021 and May 26, 2021. 86 FR 25938 (May 11, 2021). The topics for the first listening session included distribution and selection of grants, administration of the grant program, and training and technical assistance. The topics for the second listening session included referrals for E:\FR\FM\10MRR2.SGM 10MRR2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations khammond on DSKJM1Z7X2PROD with RULES2 care, risk of suicide, and suicide prevention services. Similar to the April 1, 2021 notice, this second notice included specific questions for the public to consider and upon which to comment at the listening session. VA directly contacted various organizations that met the categories of organizations listed under section 201(h)(3) of the Act to notify them that VA was seeking input through these listening sessions. Thirty-two individuals presented oral comments at these listening sessions. Many of these comments were similar to those received in response to the April 1, 2021 notice. Commenters expressed support for awarding grants to entities with demonstrated experiences and capacity to implement evidence-based programs. Commenters also expressed support for awarding grants to entities that have experience working with veterans at risk of suicide and have or plan to have culturally competent care. Additionally, commenters supported awarding grants to entities that utilized validated assessment tools and entities that had area partnerships (including at local, regional, and national levels) as well as with VA. Many commenters also provided suggestions for training and for assessment tools. Additionally, numerous commenters provided suggestions for non-traditional and innovative treatment and services under this grant program. The transcript for these listening sessions is publicly available online at www.regulations.gov. VA appreciates the time and attention from commenters who shared their opinions on how to implement section 201 of the Act. In developing this interim final rule, VA considered the feedback received from the April 1, 2021, Notice of Request for Information on the Department of Veterans Affairs’ Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (RIN 2900–AR16) and the listening sessions held on May 25, 2021, and May 26, 2021. Part 78 of Title 38, Code of Federal Regulations Through this interim final rule, VA is establishing and implementing, in new part 78 of title 38, Code of Federal Regulations (CFR), SSG Fox SPGP required by section 201 of the Act. Establishment of this new part ensures organization and clarity for implementation of this new grant program. The interim final rule is establishing regulations authorizing VA to award suicide prevention services grants to eligible entities who will provide or coordinate the provision of suicide prevention services to eligible individuals and their families. VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 Consistent with section 201 of the Act, part 78 is titled the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program. 78.0 Purpose and Scope Section 78.0 of this IFR explains the purpose and scope of new part 78. Paragraph (a) states that this part implements SSG Fox SPGP with the purpose of reducing veteran suicide by expanding suicide prevention programs for veterans through the award of suicide prevention services grants to eligible entities to provide or coordinate the provision of suicide prevention services to eligible individuals and their families. This purpose is consistent with section 201(a)(1) and (b) of the Act. Section 201(a)(1) states that its purpose is to reduce veteran suicide through a community-based grant program to award grants to eligible entities to provide or coordinate suicide prevention services to eligible individuals and their families. Section 201(b) states that the Secretary shall provide financial assistance through grants to eligible entities to provide or coordinate the provision of services to eligible individuals and their families to reduce the risk of suicide. Paragraph (b) states that suicide prevention services covered by this part are those services that address the needs of eligible individuals and their families and are necessary for improving the mental health status and wellbeing and reducing the suicide risk of eligible individuals and their families. This broadly defines the intended effects of the program, is consistent with the intent of the law, and ensures that those services authorized under this grant program are those that meet the purpose of this grant program—to reduce suicide risk. 78.5 Definitions Section 78.5 contains the definitions for key terms that apply to new part 78 and to any Notice of Funding Opportunity (NOFO) for this grant program. The definitions are listed in alphabetical order, beginning with the definition of applicant. VA is defining applicant to mean an eligible entity that submits an application for a suicide prevention services grant announced in a NOFO. VA is defining applicant in this manner since only an eligible entity (as that term is defined later in this rulemaking) that submits an application for a suicide prevention services grant under part 78 will be able to apply for such a grant. This is based on a plain language understanding of the term ‘‘applicant’’ and is consistent with how VA defines PO 00000 Frm 00003 Fmt 4701 Sfmt 4700 13807 this in the Supportive Services for Veteran Families (SSVF) Program. See 38 CFR 62.2. As explained in § 78.15, VA will require submission of an application similar to other grant programs that VA administers. Direct Federal financial assistance means Federal financial assistance received by an entity selected by the Government or a pass-through entity as defined in 38 CFR 50.1(d) to provide or carry out a service (e.g., by contract, grant, or cooperative agreement). This is used for purposes of § 78.130 and is consistent with how VA defines this in the Homeless Providers Grant and Per Diem Program and the SSVF Program (see §§ 61.64(b)(2) and 62.62, respectively). Eligible child care provider is defined to mean a provider of child care services for compensation, including a provider of care for a school-age child during non-school hours, that (1) is licensed, regulated, registered, or otherwise legally operating, under State and local law; and (2) satisfies the State and local requirements, applicable to the child care services the provider provides. This is consistent with the definition of eligible child care provider that VA uses in the SSVF Program. See 38 CFR 62.2. This definition of eligible child care provider is also consistent with the broader definition used by the Department of Health and Human Services (HHS) for its Child Care and Development Block grant. See 42 U.S.C. 9859(2). This term is used for purposes of § 78.80(h), which includes among suicide prevention services certain child care services. Pursuant to section 201(q)(11)(A)(ix)(VIII) of the Act, child care services (not to exceed $5,000 per family of an eligible individual per fiscal year) are authorized as assistance with emergent needs under this grant program, and VA explains in § 78.80(h) the limitations on such services and payments. Eligible entity is defined to mean an entity that meets the definition of an eligible entity in section 201(q) of Public Law 116–171. VA refers to section 201(q) of Public Law 116–171 rather than include the exact definition from subsection (q)(3) of section 201, as this would allow VA to immediately implement any changes made by Congress to that definition without requiring amendment to these regulations. Currently, under section 201(q)(3) of the Act, an eligible entity must be one of the following: (1) An incorporated private institution or foundation (i) no part of the net earnings of which incurs to the benefit of any member, founder, contributor, or E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13808 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations individual, and (ii) that has a governing board that would be responsible for the operation of the suicide prevention services provided under this part; (2) a corporation wholly owned and controlled by an organization meeting the requirements of clauses (i) and (ii) above; (3) an Indian tribe; (4) a community-based organization that can effectively network with local civic organizations, regional health systems, and other settings where eligible individuals and their families are likely to have contact; or (5) a State or local government. Eligible individual is defined to mean an individual that meets the requirements of § 78.10(a). As discussed later in this rulemaking, § 78.10(a) describes the eligibility criteria to be an eligible individual under part 78. These criteria are consistent with section 201(q)(4) of the Act. Family is defined to mean any of the following: A parent, spouse, child, sibling, step-family member, extended family member, and any other individual who lives with the eligible individual. This is consistent with section 201(q)(6) of the Act. Grantee is defined to mean an eligible entity that is awarded a suicide prevention services grant under part 78. This is consistent with how VA defines grantee for other VA grant programs and the plain meaning of this term. See, e.g., 38 CFR 62.2; 38 CFR 61.1. Indian tribe is defined to mean an Indian tribe as defined in 25 U.S.C. 4103. Section 4103(13)(A) of title 25, U.S.C., defines Indian tribe in general to mean a tribe that is a Federally or a State recognized tribe. Section 4103(13)(B) of title 25, U.S.C., further defines Federally recognized tribe to mean any Indian tribe, band, nation, or other organized group or community of Indians, including any Alaska Native village or regional or village corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.), that is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). Section 4103(13)(C) of title 25, U.S.C., also defines State recognized tribe to mean any tribe, band, nation, pueblo, village, or community—(1) that has been recognized as an Indian tribe by any State; and (2) for which an Indian Housing Authority has, before the effective date under section 705, entered into a contract with the Secretary of Housing and Urban Development pursuant to the United States Housing VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 Act of 1937 (42 U.S.C. 1437 et seq.) for housing for Indian families and has received funding pursuant to such contract within the 5-year period ending upon such effective date. This definition also includes certain conditions set forth in 25 U.S.C. 4103(13)(C)(ii). This definition of Indian tribe is consistent with section 201(q)(7) of the Act. Indirect Federal financial assistance means Federal financial assistance in which a service provider receives program funds through a voucher, certificate, agreement or other form of disbursement, as a result of the genuine, independent choice of a participant. This is used for purposes of § 78.130 and is consistent with how VA defines this in the VA Homeless Providers Grant and Per Diem Program and the SSVF Program. See §§ 61.64(b)(2) and 62.62, respectively. Section 201(d)(1)(A)(iv) of the Act authorizes VA to prioritize distribution of grants to medically underserved areas. While section 201 of the Act does not define medically underserved areas, VA is defining medically underserved areas consistent with the definition of medically underserved population that is set forth in other Federal law. Section 254b(b)(3)(A) of 42 U.S.C. defines medically underserved population to mean the population of an urban or rural area designated by the HHS Secretary as an area with a shortage of personal health services or a population group designated by the HHS Secretary as having a shortage of such services. While section 254b(b)(3)(A) uses the term medically underserved population, section 254b(b)(3) generally establishes a process for identifying medically underserved areas that are designated by the United States Health Resources and Services Administration (HRSA), the HHS sub-agency responsible for issuing data and maps on medically underserved populations and areas in a combined manner. See HRSA’s maps on medically underserved areas/ populations at https://www.hrsa.gov/ maps/quick-maps?config=mapconfig/ MUA.jsondevelops. See also, https:// data.hrsa.gov/tools/shortage-area/muafind. Because 42 U.S.C. 254b(b)(3) may be amended in the future, VA is not incorporating the actual definition in proposed § 78.5. Rather, VA is defining medically underserved areas to mean an area that is designated as a medically underserved population under 42 U.S.C. 254b(b)(3). This term is defined consistently with its use in 38 U.S.C. 7601 note, and is widely known, commonplace, and established. It also allows VA to defer to the expertise of another agency that specializes in PO 00000 Frm 00004 Fmt 4701 Sfmt 4700 analyzing and identifying medically underserved areas and populations. VA is defining Notice of Funding Opportunity (NOFO) to mean a Notice of Funding Opportunity published on grants.gov in accordance with § 78.110. This is consistent with how VA defines a similar term, Notice of Funding Availability (NOFA), in other grant regulations and with the plain meaning of this term. This definition references § 78.110, which explains that VA will publish a NOFO when funds for suicide prevention services grants are available and indicates the type of information that must be included in the application for this program. Pursuant to 2 CFR 200.203, all NOFOs must be posted on grants.gov. Participant is defined to mean an eligible individual or their family who is receiving suicide prevention services for which they are eligible from a grantee. This definition is necessary for purposes of understanding part 78 and SSG Fox SPGP. VA is defining rural communities to mean those communities considered rural according to the Rural-Urban Commuting Area (RUCA) system as determined by the United States Department of Agriculture (USDA). This is consistent with section 201(q)(9) of the Act. VA will use this term and its definition in § 78.30 for purposes of prioritizing the distribution of grants to rural communities pursuant to section 201(d)(1)(A)(i) of the Act. For more information on RUCA, please refer to https://www.ers.usda.gov/dataproducts/rural-urban-commuting-areacodes/. VA is defining State to mean any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments. This is identical to most of the definition of the same term for the SSVF Program (see § 62.2), except that we do not include here the exception that is present in the SSVF regulations to public and Indian housing agencies under the United States Housing Act of 1937, as that portion of the definition is not relevant to the suicide prevention grant program established under these regulations. This definition is understood by VA and grantees. Suicide prevention services is defined consistent with the definition of this term in section 201(q)(11) of the Act. VA is setting forth each of the suicide prevention services in their own individual sections (see 38 CFR 78.45 through 78.90) for clarity. Thus, VA is defining suicide prevention services to E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations include the following services provided to address the needs of a participant: (1) Outreach as specified under § 78.45, (2) baseline mental health screening as specified under § 78.50, (3) education as specified under § 78.55, (4) clinical services for emergency treatment as specified under § 78.60, (5) case management services as specified under § 78.65, (6) peer support services as specified under § 78.70, (7) assistance in obtaining VA benefits as specified under § 78.75, (8) assistance in obtaining and coordinating other public benefits and assistance with emergent needs as specified under § 78.80, (9) nontraditional and innovative approaches and treatment practices as specified under § 78.85, and (10) other services as specified under § 78.90. VA is defining suicide prevention services grant to mean a grant awarded under part 78. This definition is based on the plain language understanding of this term. VA is defining suicide prevention services grant agreement to mean the agreement executed between VA and a grantee as specified under § 78.115. This definition is based on the plain language understanding of this term and is consistent with the definition of similar terms in other VA regulations. See § 62.2. Suspension is defined to mean an action by VA that temporarily withdraws VA funding under a suicide prevention services grant, pending corrective action by the grantee or pending a decision to terminate the suicide prevention services grant by VA. Suspension of a suicide prevention services grant is a separate action from suspension under VA regulations or guidance implementing Executive Orders 12549 and 12689, ‘‘Debarment and Suspension.’’ This definition is consistent with the SSVF grant program’s definition for this term. See § 62.2. However, with regards to implementing Executive Orders 12549 and 12689, VA has added the language, guidance, as not all of VA’s implementations of Executive Orders are regulatory. Territories is defined to mean the territories of the United States, including Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands. This is consistent with how the Federal government commonly describes U.S. territories (in comparison to States). This term is necessary to define as it is used in the Act, although not defined within section 201, and in § 78.30. VA is defining this term as VA has authority under section 201(d)(1)(A)(iii) of the Act to prioritize distribution of grants to VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 territories of the United States. As explained in § 78.30, VA may prioritize territories, along with other areas such as medically underserved areas and tribal lands, for purposes of this grant program. While there is some overlap between this definition and the definition of State above—all territories are considered States under part 78 (as provided for under 38 U.S.C. 101(20)), but not all States are territories—the specific application of this potential priority under § 78.30(d)(2)(iii) reflects the only meaningful distinction between the two terms. Veteran is defined to mean veteran under 38 U.S.C. 101(2). This is based on section 201(q)(4)(A) of the Act. Section 101 of title 38, U.S.C., defines veteran as a person who served in the active military, naval, air, or space service, and who was discharged or released therefrom under conditions other than dishonorable. This term is used for purposes of peer support services in part 78. The term Veterans Crisis Line is defined to mean the toll-free hotline for veterans in crisis and their families and friends established under 38 U.S.C. 1720F(h). This is consistent with section 201(q)(12) of the Act. This term is used in § 78.30(d)(2)(vi) for purposes of prioritizing selection of applicants for this grant program. VA is defining withholding to mean that payment of a suicide prevention services grant will not be paid until such time as VA determines that the grantee provides sufficiently adequate documentation and/or actions to correct a deficiency for the suicide prevention services grant. This term is defined in this manner, as it is intended to provide a general description of how this term is used in 2 CFR part 200, which governs VA grant programs including the SSG Fox SPGP. This term relates to withholding payment of a suicide prevention services grant pursuant to § 78.160, described later in this rulemaking. 78.10 Eligible Individuals Section 78.10 explains the criteria for determining the eligibility of individuals under part 78 consistent with the definition of eligible individual in section 201(q)(4) of the Act. As explained in the definitions section, an eligible individual is an individual that meets the requirements of § 78.10(a). Paragraph (a) states that to be an eligible individual under this part, a person must meet criteria that determine that person is at risk of suicide and further meet the definition of eligible individual in section 201 of Public Law 116–171. VA refers to PO 00000 Frm 00005 Fmt 4701 Sfmt 4700 13809 section 201(q) of Public Law 116–171 rather than include the exact definition from subsection (q)(4), as this would allow VA to immediately implement any changes made by Congress to that definition without requiring amendment to these regulations. Subsection (q)(4) of section 201 currently states that an eligible individual must be one of the following: (1) A veteran as defined in 38 U.S.C. 101, (2) an individual described in 38 U.S.C. 1720I(b), or (3) an individual described in 38 U.S.C. 1712A(a)(1)(C)(i) through (iv). Section 101(2) of title 38, U.S.C. defines veteran as a person who served in the active military, naval, air, or space service, and who was discharged or released therefrom under conditions other than dishonorable. Section 1720I(b) requires VA furnish to certain former member of the Armed Forces (1) an initial mental health assessment and (2) mental health care or behavioral health care services authorized under 38 U.S.C. chapter 17 that are required to treat the mental or behavioral health care needs of these former service members, including risk of suicide or harming others. Such former members of the Armed Forces, including reserve components, are those who (1) while serving in the active military, naval, air, or space service, were discharged or released therefrom under a condition that is not honorable but not a dishonorable discharge or a discharge by court-martial; (2) are not enrolled in VA health care; and either served in the Armed Forces for a period of more than 100 cumulative days and were deployed in a theater of combat operations, in support of a contingency operation, or in an area at a time during which hostilities were occurring in that area during such service, including by controlling an unmanned aerial vehicle from a location other than such theater or area; or (3) while serving in the Armed Forces, were the victim of a physical assault of a sexual nature, a battery of a sexual nature, or sexual harassment. Section 1712A details the individuals to whom VA is required to furnish readjustment counseling. These include any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who served on active duty in a theater of combat operations or an area at a time during which hostilities occurred in that area; any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who provided direct emergency medical or mental health care, or mortuary services to the E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13810 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations causalities of combat operations or hostilities, but who at the time was located outside the theater of combat operations or area of hostilities; any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who engaged in combat with an enemy of the United States or against an opposing military force in a theater of combat operations or an area at a time during which hostilities occurred in that area by remotely controlling an unmanned aerial vehicle, notwithstanding whether the physical location of such veteran or member during such combat was within such theater of combat operations or area; and any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who served on active service in response to a national emergency or major disaster declared by the President or in the National Guard of a State under orders of the chief executive of that State in response to a disaster or civil disorder in such State. For purposes of eligible individuals, paragraph (b) defines risk of suicide. Consistent with section 201(q)(8) of the Act, risk of suicide means exposure to, or the existence of, any of the following factors, to any degree, that increase the risk of suicidal ideation and/or behaviors: (1) Health risk factors, including mental health challenges, substance use disorder, serious or chronic health conditions or pain, and traumatic brain injury; (2) environmental risk factors, including prolonged stress, stressful life events, unemployment, homelessness, recent loss, and legal or financial challenges; and (3) historical risk factors, including previous suicide attempts, family history of suicide, and history of abuse, neglect or trauma, including military sexual trauma. While section 201(q)(8) uses the language, substance abuse, VA instead uses the language, substance use disorder, in paragraph (b) to reduce stigma and discrimination related to substance use. For purposes of paragraph (b), an individual will not be required to have a diagnosis of substance use disorder. This definition is necessary to meet the intent and purpose of the program to provide grants to eligible entities to provide or coordinate the provision of suicide prevention services to eligible individuals who are considered at risk of suicide and is consistent with feedback received from commenters during consultation. This provision is thus used for determining eligibility of eligible individuals for receipt of VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 suicide prevention services under this grant program. VA notes that this definition is overly inclusive, as to define this term otherwise could exclude individuals who may need these critical services prior to a crisis. Section 201(q)(8)(iii)(III) includes a history of trauma as a potential historical risk factor for suicide. VA interprets this, for purposes of this grant program, to include military sexual trauma. VA notes that survivors of military sexual trauma are at higher risk of suicide. See the National Military and Veteran Suicide Prevention Strategy (https://www.whitehouse.gov/wpcontent/uploads/2021/11/Military-andVeteran-Suicide-PreventionStrategy.pdf). This reference is not intended to exclude other forms of trauma, but rather serves as an example of how this language is interpreted by VA. As noted in the previous paragraph, section 201(q)(8) of the Act defines risk of suicide based on exposure to, or the existence of, certain factors, to a degree determined by the Secretary pursuant to regulations. Thus, section 201(q)(8)(A) of the Act authorized VA to determine the degree required for these risk factors, and VA will require that grantees use the health, environmental, and historical risk factors just described and the impact thereof to determine the degree of risk of suicide for eligible individuals. This is explained in a note to paragraph (b). The note also explains that the degree of risk depends on the presence of one or more suicide risk factors and the impact of those factors on an individual’s mental health and wellbeing. VA will require grantees determine an individual’s degree of risk of suicide through the use of a screening tool approved by the Department. To assist grantees in determining risk of suicide (and thus an individual’s eligibility for suicide prevention services), VA will provide grantees with a screening tool that will determine the presence of suicide risk. This tool will be a validated tool that can be administered by non-clinical staff and/or a self-report tool such as the Columbia Suicide Severity Rating Scale. See https:// cssrs.columbia.edu. VA is not identifying the specific tool in regulation, as the screening tool may change due to an evolving field of study and VA may approve the use of several tools. This tool is subject to the Paperwork Reduction Act because it is an information collection. As such, the public may comment on this screening tool as part of the information collections associated with this rulemaking, and VA welcomes public PO 00000 Frm 00006 Fmt 4701 Sfmt 4700 comment on use of this screening tool. VA will ensure that grantees are provided this tool before providing or coordinating suicide prevention services under this grant program and have access to publicly available training materials to support the grantees’ use of this tool. VA would not require a clinical tool to be used to determine eligibility because many of the authorized suicide prevention services are not clinical in nature. To require a clinical tool to determine the degree of risk of suicide would severely limit the number of applicants and grantees for this grant program, which VA does not believe was the intent of section 201 of the Act. This screening tool is not the same as the tool that will be used for purposes of the baseline mental health screening conduct pursuant to § 78.50, which is described later in this discussion. This screening tool will assess health, environmental, and historical risk factors and the impact thereof. An individual’s degree of risk of suicide can vary hour to hour, day to day, and thus, requiring a certain degree of risk of suicide to be eligible for services could result in the ineligibility of individuals whom this program was intended to cover. This is a non-clinical tool that will be used by grantees regardless of whether their staff are licensed, independent clinical providers. 78.15 Applications for Suicide Prevention Services Grants Under § 78.15(a), applicants must submit a complete application package for a suicide prevention services grant under this new part 78, as described in the NOFO. Paragraph (a) also explains the information that must be included in the application to be considered a complete suicide prevention services grant application package. This list of items described in paragraph (a) is derived from section 201(d)(2), (f), and (h)(2) of the Act, and it ensures that VA can adequately evaluate applicants for the purposes of this grant program (that is, to provide or coordinate the provision of suicide prevention services to reduce the risk of suicide among eligible individuals). The following information must be included in the application package: (1) Documentation evidencing the experience of the applicant and any identified community partners in providing or coordinating the provision of suicide prevention services to eligible individuals and their families; (2) a description of the suicide prevention services proposed to be provided by the applicant and the identified need for those services; (3) a detailed plan E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations describing how the applicant proposes to coordinate or deliver suicide prevention services to eligible individuals, including (i) if the applicant is a State or local government or an Indian tribe, an identification of the community partners, if any, with which the applicant proposes to work in delivering such services, (ii) a description of the arrangements currently in place between the applicant and such partners with regard to the provision or coordination of the provision of suicide prevention services, (iii) an identification of how long such arrangements have been in place, (iv) a description of the suicide prevention services provided by such partners that the applicant must coordinate, if any, and (v) an identification of local VA suicide prevention coordinators and a description of how the applicant will communicate with local VA suicide prevention coordinators; (4) a description of the location and population of eligible individuals and their families proposed to be provided suicide prevention services; (5) an estimate of the number of eligible individuals at risk of suicide and their families proposed to be provided suicide prevention services, including the percentage of those eligible individuals who are not currently receiving care furnished by VA; (6) evidence of measurable outcomes related to reductions in suicide risk and mood-related symptoms utilizing validated instruments by the applicant (and the proposed partners of the applicant, if any) in providing suicide prevention services to individuals at risk of suicide, particularly to eligible individuals and their families; (7) a description of the managerial and technological capacity of the applicant to (i) coordinate the provision of suicide prevention services with the provision of other services, (ii) assess on an ongoing basis the needs of eligible individuals and their families for suicide prevention services, (iii) coordinate the provision of suicide prevention services with VA services for which eligible individuals are also eligible, (iv) tailor (i.e., provide individualized) suicide prevention services to the needs of eligible individuals and their families, (v) seek continuously new sources of assistance to ensure the continuity of suicide prevention services for eligible individuals and their families as long as the eligible individuals are determined to be at risk of suicide, and (vi) measure the effects of suicide prevention services provided by the applicant or partner organization on the lives of eligible VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 individuals and their families who receive such services provided by the organization using pre- and postevaluations on validated measures of suicide risk and mood-related symptoms; (8) clearly defined objectives for the provision of suicide prevention services; (9) a description and physical address of the primary location of the applicant; (10) a description of the geographic area the applicant plans to serve during the grant award period for which the application applies; (11) if the applicant is a State or local government or an Indian tribe, the amount of grant funds proposed to be made available to community partners, if any, through agreements; (12) a description of how the applicant will assess the effectiveness of the provision of grants under this part; (13) an agreement to use the measures and metrics provided by VA for the purposes of measuring the effectiveness of the programming to be provided in improving mental health status, wellbeing, and reducing suicide risk and suicide deaths of eligible individuals and their families; (14) an agreement to comply with and implement the requirements of this part throughout the term of the suicide prevention services grant; and (15) any additional information as deemed appropriate by VA. The items in paragraph (a) generally are consistent with requirements in section 201(f) and (h)(2) of the Act and are necessary for VA to properly evaluate whether applicants will be able to meet the requirements in this part to provide or coordinate suicide prevention services if they are awarded a grant under this new part 78. While language similar to paragraph (a)(1) does not appear in section 201(f) or (h)(2) of the Act, it does appear in section 201(d)(2) of the Act, where VA is instructed to give preference to eligible entities that have demonstrated the ability to provide or coordinate suicide prevention services. Paragraph (a)(14) similarly does not appear explicitly in section 201(f) or (h)(2) of the Act, but section 201(f)(1) authorizes the Secretary to include such commitments as the Secretary considers necessary to carry out this section. Compliance with the requirements of the new part 78 is such a commitment. Section 201(f)(2)(M) also authorizes the Secretary to include additional application criteria as the Secretary considers appropriate. Again, an agreement to comply with the requirements of this part is an appropriate obligation. VA notes that technical assistance with completing PO 00000 Frm 00007 Fmt 4701 Sfmt 4700 13811 applications will be available for applicants, including how to determine the required estimates under paragraph (a)(5). For purposes of paragraph (a)(7)(iv), VA notes that tailoring (i.e., providing individualized) suicide prevention services to the needs of eligible individuals and their families, includes how services would be tailored (provided) to priority sub-populations, including but not limited to survivors of military sexual trauma, women veterans under the age of 35, and other groups identified in the National Military and Veteran Suicide Prevention Strategy. See, https://www.whitehouse.gov/wpcontent/uploads/2021/11/Military-andVeteran-Suicide-PreventionStrategy.pdf. Such services may include but not be limited to care and support with military sexual trauma, employment, and housing. For purposes of paragraphs (a)(4) and (a)(10) of this section, as well as for other sections of this rule, VA is requiring applicants to provide information regarding the location of eligible individuals and a description of the geographic area the applicant plans to serve. Section 201(d)(1)(C) of the Act permits VA to provide grants to eligible entities that furnish services to eligible individuals and their families in geographically dispersed areas; this authority is discretionary. At this time, VA is choosing not to exercise this authority. While there may be some applicants who desire to serve a population that is geographically dispersed, it would be logistically difficult for such organizations to provide necessary services, and a number of other provisions in section 201 of the Act clearly state requirements related to geographic locations. For example, section 201(d)(1)(A) and (B) of the Act permit and require, respectively, VA to prioritize grants to geographic areas, such as rural communities, Tribal lands, territories of the United States, medically underserved areas, areas with a high number or percentage of minority veterans or women veterans, areas with a high number or percentage of calls to the Veterans Crisis Line, and areas that have experienced high rates of suicide by eligible individuals. Each of these descriptions clearly requires a geographic description or scope. Other provisions of section 201 of the Act also clearly refer to geographic areas. For example, section 201(f)(2)(I) requires applicants to provide ‘‘a description of the geographic area the eligible entity plans to serve during the grant award period for which the application applies.’’ Section 201(h)(2)(A) requires the Secretary to develop a framework for E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13812 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations collecting and sharing information about grantees for purposes of improving the services available for eligible individuals and their families set forth by locality, among other factors. Section 201(q)(11)(A)(iv), which defines suicide prevention services, includes the provision of clinical services for emergency treatment as a suicide prevention service, and these services would generally need to be furnished in-person. Additionally, applicants seeking grant funds to support non-geographically focused populations would likely have higher overhead and administrative costs due to the need to conduct outreach across a broader area, maintain information and connections with more VA facilities and other entities, and deliver services in different locations. Higher overhead costs mean fewer available resources dedicated to the delivery of suicide prevention services, which, given the population being served by this program, would be less than ideal as those resources could be better utilized elsewhere to serve this unique population. Given the short period of time in which VA is authorized to operate this program, only three years from the date of the first grant award (see section 201(j) of the Act), it would be prudent to ensure these resources are used to maximal effect. This does not prohibit organizations that function at a national level or in multiple geographic areas from applying for a grant in one or more location as long as they meet the requirements necessary to implement suicide prevention services for the specific geographic area. However, VA notes that many of the suicide prevention services, particularly emergent services for those at immediate risk of suicide, could not be furnished by entities without a physical presence in the area or could only be furnished at a greater risk of the loss of life of a participant and the services required by law and by the targeted population require engagement with local VA medical centers and community. Paragraph (b) states that subject to funding availability, grantees may submit an application for renewal of a suicide prevention services grant if the grantee’s program will remain substantially the same. To apply for renewal of a suicide prevention services grant, a grantee must submit to VA a complete suicide prevention services grant renewal application package, as described in the NOFO. This is consistent with how VA administers the SSVF Program under part 62 and will allow VA to renew grants in an efficient and timely manner so that there will be VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 no lapse in the provision or coordination of the provision of suicide prevention services by grantees to participants from year to year. Paragraph (c) establishes that VA may request in writing that an applicant or grantee, as applicable, submit other information or documentation relevant to the suicide prevention services grant application. This is authorized by section 201(f)(1) of the Act, which permits VA to require such commitments and information as the Secretary considers necessary to carry out this section. This provides VA with the authority to request additional information that may not be in the initial or renewal application but will be necessary for VA to properly evaluate the applicant or grantee for a suicide prevention services grant. 78.20 Threshold Requirements Prior To Scoring Suicide Prevention Services Grant Applicants Pursuant to section 201(h) of the Act, VA, in consultation with various entities listed in the Act, is required to establish selection criteria for this new grant program. As explained earlier in this rulemaking, VA conducted this consultation through an FR notice and through listening sessions. See 86 FR 17268 (April 1, 2021); 86 FR 25938 (May 11, 2021). Section 78.20 sets forth the threshold requirements for further scoring applicants pursuant to § 78.25. Section 78.20 explains that VA will only score applicants for suicide prevention services grants if they meet certain threshold requirements as set forth in paragraphs (a) through (g). These threshold requirements in paragraphs (a) through (g) include that the application is filed within the time period established in the NOFO, and any additional information or documentation requested by VA under § 78.15(c) is provided within the time frame established by VA; the application is completed in all parts; the activities for which the suicide prevention services grant is requested are eligible for funding under this part; the applicant’s proposed participants are eligible to receive suicide prevention services under this part; the applicant agrees to comply with the requirements of this part; the applicant does not have an outstanding obligation to the Federal government that is in arrears and does not have an overdue or unsatisfactory response to an audit; and the applicant is not in default by failing to meet the requirements for any previous Federal assistance. These are minimum requirements that must be met before VA will score applications, and applicants will be able PO 00000 Frm 00008 Fmt 4701 Sfmt 4700 to understand whether they meet these threshold requirements in advance of application submission. VA anticipates this will reduce the amount of time and resources that VA will dedicate to evaluating and scoring applicants for suicide prevention services grants. These requirements are authorized by section 201(f)(1) of the Act, which permits VA to include such commitments and information as the Secretary considers necessary to carry out section 201. These threshold requirements are consistent with other VA grant programs, such as the Homeless Providers Grant and Per Diem Program and the SSVF Program (See §§ 61.12 and 62.21, respectively). 78.25 Scoring Criteria for Awarding Grants Section 201(h)(1) of the Act requires the VA Secretary to establish criteria for the selection of eligible entities that have submitted applications for a suicide prevention services grant. Consistent with that authority, in § 78.25, VA sets forth the criteria to be used to score applicants who are applying for a suicide prevention services grant, as the amount of funds available for grants each year will be limited and VA may receive a higher number of applicants than there are available grant funds. Scoring criteria will allow VA to award grants to those who are most qualified and will ensure that VA administers grants in a manner consistent with the intent and purpose of SSG Fox SPGP. The scoring criteria were developed based on the scoring criteria used for other VA grant programs, such as the SSVF Program (38 CFR 62.22) and Homeless Providers Grant and Per Diem Program (38 CFR 61.13), but tailored to the purpose and requirements of section 201 of the Act. These criteria are consistent with feedback received from commenters during consultation that expressed support for awarding grants to entities with prior experience working with veterans, including those at risk of suicide, entities that had partnerships within the area and with VA, and entities that have or plan to have culturally competent care related to veterans. While this section does not include specific point values for each criterion, the regulation provides that such point values will be set forth in the NOFO. This will allow VA to retain flexibility in determining those point values each year of the grant program in the event that such point values need to change. At all times, VA will comply with the requirements in section 201(d) of the Act regarding prioritization of and E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations preference for certain applicants. VA will establish in each NOFO a minimum number of points that an applicant must be awarded, both in each category and in total, to ensure that all applicants who are awarded a grant can perform all necessary elements of the program, and that their program as a whole is likely to be successful. These dual requirements will ensure that VA is giving preference to applicants that have demonstrated the ability to provide or coordinate suicide prevention services, as required by section 201(d)(2) of the Act. Paragraph (a) explains that VA will award points based on the background, qualifications, experience, and past performance, of the applicant and any community partners identified by the applicant in the suicide prevention services grant application, as demonstrated by the following: (1) Background and organizational history, (2) staff qualifications, and (3) organizational qualifications and past performance, including experience with veterans services. These scoring criteria are important to determine whether applicants have the necessary and relevant background and experience to administer a suicide prevention services program consistent with section 201 of the Act and 38 CFR part 78. In scoring an applicant’s background and organizational history under paragraph (a)(1), VA will consider the applicant’s, and any identified community partners’, background and organizational history that are relevant to the program; whether the applicant, and any identified community partners, maintain organizational structures with clear lines of reporting and defined responsibilities; and whether the applicant, and any identified community partners, have a history of complying with agreements and not defaulting on financial obligations. Under paragraph (a)(2), VA will score applications based on staff qualifications. This includes determining the applicant’s staff’s, and any identified community partners’ staff’s, experience providing to, or coordinating services for, eligible individuals and their families; and the applicant’s staff’s, and any identified community partners’ staff’s, experience administering programs similar to SSG Fox SPGP. VA will score applicants’ organizational qualifications and past performance, including experience with veterans services, under paragraph (a)(3) based on the applicant’s, and any identified community partners’, organizational experience providing suicide prevention services to or VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 coordinating suicide prevention services for eligible individuals and their families; the applicant’s, and any identified community partners’, organizational experience coordinating services for eligible individuals and their families among multiple organizations and Federal, State, local, and tribal governmental entities; the applicant’s, and any identified community partners’, organizational experience administering a program similar in type and scale to SSG Fox SPGP to eligible individuals and their families; and the applicant’s, and any identified community partners’, organizational experience working with veterans and their families. Examples of experience VA will consider under paragraph (a) may include but are not limited to participation in VA–SAMHSA’s Governors’ and Mayors’ Challenges to Prevent Suicide among service members, veterans, and their families; endorsement by a local or State public health agency or State Department of Veterans Affairs recognizing care coordination experience; and participation in the SSVF Program and Homeless Providers Grant and Per Diem Program. While experience providing suicide prevention services to eligible individuals and their families is an important scoring criterion, we acknowledge that some organizations may not have such experience. However, they may have experience working with veterans and their families (other than those eligible under this grant program) for purposes other than those related to this grant program. Having an understanding of the veteran population as a whole and demonstrating related military cultural competency is critical for ensuring that the needs of eligible individuals and their families are met through this grant program. This is consistent with the feedback received through consultation as described earlier. This also allows VA the ability to award points at various levels (local, regional, State) since the types of experience entities at those levels may have can vary. Thus, pursuant to paragraph (a), VA will score applicants not only based on their experience administering similar programs to the suicide prevention grant programs and providing or coordinating services to eligible individuals, but also based on their experience working with veterans and their families. Paragraph (b) explains that VA will award points based on the applicant’s program concept and suicide prevention services plan. The scoring criteria under this paragraph are important for VA to PO 00000 Frm 00009 Fmt 4701 Sfmt 4700 13813 use to determine whether the applicant has a fully developed program concept and plan that will meet the requirements of section 201 of the Act and 38 CFR part 78. VA will award points based on the applicant’s program concept and suicide prevention services plan, as demonstrated by the (1) need for the program, (2) outreach and screening plan, (3) program concept, (4) program implementation timeline, (5) coordination with VA, (6) ability to meet VA’s requirements, goals and objectives for SSG Fox SPGP, and (7) capacity to undertake the program. VA will score the need for the program under paragraph (b)(1) based on whether the applicant has shown a need amongst eligible individuals and their families in the area where the program will be based and whether the applicant demonstrates an understanding of the unique needs for suicide prevention services of eligible individuals and their families. VA will score the outreach and screening plan under paragraph (b)(2) based on whether the applicant has a feasible plan for outreach, consistent with § 78.45, and referral to identify and assist individuals and their families that may be eligible for suicide prevention services and are most in need of suicide prevention services, has a feasible plan to process and receive participant referrals, and has a feasible plan to assess and accommodate the needs of incoming participants. As part of scoring the application based on whether the applicant has a feasible plan to assess and accommodate the needs of incoming participants, VA notes that this may include but not be limited to addressing language assistance needs of limited English proficient individuals, physical accommodation needs, and transportation needs. Pursuant to paragraph (b)(3), VA will score the program concept based on whether the applicant’s program concept, size, scope, and staffing plan are feasible; and that the applicant’s program is designed to meet the needs of eligible individuals and their families. VA will score the program implementation timeline under paragraph (b)(4) based on whether the applicant’s program will be implemented in a timely manner and suicide prevention services will be delivered to participants as quickly as possible and within a specified timeline. VA will also score this based on whether the applicant has a feasible staffing plan in place to meet the E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13814 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations applicant’s program timeline or has existing staff to meet such timeline. Pursuant to paragraph (b)(5), VA will score applications based on whether the applicant has a feasible plan to coordinate outreach and services with local VA facilities. In paragraph (b)(6), scoring criteria will include the applicant’s ability to meet VA’s requirements, goals, and objectives for SSG Fox SPGP. This will be based on whether the applicant demonstrates commitment to ensuring that its program meets VA’s requirements, goals, and objectives for SSG Fox SPGP as identified in this part and the NOFO. Under paragraph (b)(7), VA will score the applicant’s capacity, including staff resources, to undertake its program. Paragraph (c) states that VA will award points based on the applicant’s quality assurance and evaluation plan, as demonstrated by (1) program evaluation, (2) monitoring, (3) remediation, and (4) management and reporting. This scoring criterion is important to ensure that applicants can meet any requirements for evaluation, monitoring, and reporting contained in section 201 of the Act and in 38 CFR part 78, will help VA ensure that grant funds are being used appropriately, and will assist in the overall assessment of the grant program. Pursuant to paragraph (c)(1), VA will evaluate whether the applicant has created clear, realistic, and measurable goals that reflect SSG Fox SPGP’s aim of reducing and preventing suicide among veterans against which the applicant’s program performance can be evaluated; and the applicant has a clear plan to continually assess the program. The scoring criterion regarding monitoring in paragraph (c)(2) will be based on whether the applicant has adequate controls in place to regularly monitor the program, including any community partners, for compliance with all applicable laws, regulations, and guidelines; whether the applicant has adequate financial and operational controls in place to ensure the proper use of suicide prevention services grant funds; and the applicant has a feasible plan for ensuring that the applicant’s staff and any community partners are appropriately trained and stay informed of SSG Fox SPGP policy, evidenceinformed suicide prevention practices, and the requirements of 38 CFR part 78. Paragraph (c)(3) includes the scoring criterion of remediation. This will be based on whether the applicant has an appropriate plan to establish a system to remediate non-compliant aspects of the program if and when they are identified. VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 Under paragraph (c)(4), VA will score the applicant’s management and reporting, based on whether the applicant’s program management team has the capability and a system in place to provide to VA timely and accurate reports at the frequency set by VA. Paragraph (d) explains that VA will award points based on the applicant’s financial capability and plan, as demonstrated by (1) organizational finances (based on whether the applicant, and any identified community partners, are financially stable); and (2) financial feasibility of the program (based on whether the applicant has a realistic plan for obtaining all funding required to operate the program for the time period of the suicide prevention services grant; and whether the applicant’s program is costeffective and can be effectively implemented on-budget). These are important to ensure that funds are not provided to an applicant that is financially unstable and that the applicant has considered the costs and necessary funding for administering a suicide prevention services program. Paragraph (e) states that VA will award points based on the applicant’s area linkages and relations, as demonstrated by the (1) area linkages, (2) past working relationships, (3) local presence and knowledge, and (4) integration of linkages and program concept. This is important for ensuring success of the suicide prevention services program. VA acknowledges that applicants may not have these existing linkages and relationships, but they may develop them over time. VA also acknowledges that certain applicants without these existing linkages and relationships may obtain them through community partners with which they enter into agreements (to the extent permitted under section 201 of the Act). Area linkages under paragraph (e)(1) will include whether the applicant has a feasible plan for developing or relying on existing linkages with Federal (including VA), State, local, and tribal government agencies, and private entities for the purposes of providing additional services to participants within a given geographic area. Past working relationships under paragraph (e)(2) will include whether the applicant (or applicant’s staff), and any identified community partners (or community partners’ staff), have fostered similar and successful working relationships and linkages with public and private organizations providing services to veterans or their families in need of services. These may include but not be limited to housing assistance non-profits and agencies, housing crisis PO 00000 Frm 00010 Fmt 4701 Sfmt 4700 centers, local food banks, employment assistance non-profits and agencies, rape crisis centers, and sexual assault and domestic violence programs with a history of serving veterans and militaryconnected victims of sexual trauma and abuse. Local presence and knowledge under paragraph (e)(3) will be based on whether the applicant has a presence in the area to be served by the applicant and understands the dynamics of the area to be served by the applicant. This presence and knowledge does not necessarily mean the applicant has an address or physical office in the area, but rather that they are operating in the area such that they have sufficient knowledge of the area and that their staff has a presence in the area. For example, staff may travel from a nearby area to serve eligible individuals in the targeted area, or a national organization may have a local office through which it intends to make services available. Evaluation of whether an applicant understands the dynamics of the area to be served by the applicant will be based on information including but not limited to the applicant’s description of the area, including mental health centers, and relationships with local mental health centers. These criteria under paragraph (e)(3) may be met through letters of support and documented coordination of care. Integration of linkages and program concept under paragraph (e)(4) will be based on whether the applicant’s linkages to the area to be served by the applicant enhance the effectiveness of the applicant’s program. 78.30 Selection of Grantees Section 201(c) of the Act requires the VA Secretary to award a grant to each eligible entity for which the Secretary has approved an application to provide or coordinate the provision of suicide prevention services. Section 201(d) of the Act sets forth how VA may and shall distribute grants based on certain priorities, areas, and geography. Section 201(d)(2) requires the Secretary give preference to eligible entities that have demonstrated the ability to provide or coordinate suicide prevention services. Section 201(h) of the Act requires the Secretary to establish criteria for the selection of eligible entities that have submitted applications for a suicide prevention services grant. In accordance with these subsections of section 201 of the Act, 38 CFR 78.30 sets forth the process for selecting applicants for suicide prevention services grants, which will be a process similar to that of the SSVF Program (38 CFR 62.23) and the Homeless Providers Grant and Per E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations Diem Program (38 CFR 61.14 and 61.94). However, the selection process under § 78.30 will also incorporate preference, priority, and distribution requirements from section 201(d) of the Act. As part of the process for selecting applicants to receive suicide prevention services grants, paragraph (a) explains that VA will first score all applicants that meet the threshold requirements set forth in § 78.20 using the scoring criteria set forth in § 78.25. Next, paragraph (b) states that VA will group applicants within the applicable funding priorities if any are set forth in the NOFO. As funding priorities can change annually, VA will set forth any funding priorities in the NOFO, which will allow VA flexibility in updating priorities in a quick and efficient manner every year that funds are available under this grant program. Then, as set forth in paragraph (c), VA will rank those applicants that receive at least the minimum amount of total points and points per category set forth in the NOFO, within their respective funding priority group, if any. As noted above, VA will set forth the minimum amount of total points and points per category in the NOFO as these can change annually. Setting forth these points in the NOFO will provide VA flexibility in updating the minimum amount of points in an efficient and quick manner. The applicants will be ranked in order from highest to lowest scores, within their respective funding priority group, if any. Paragraph (d) explains that VA will use the applicant’s ranking as the primary basis for selection for funding. However, consistent with section 201(d)(1) and (d)(2) of the Act, paragraph (d) further explains that VA: (1) Will give preference to applicants that have demonstrated the ability to provide or coordinate suicide prevention services; (2) may prioritize the distribution of suicide prevention services grants to rural communities, Tribal lands, territories of the United States, medically underserved areas, areas with a high number or percentage of minority veterans or women veterans, and areas with a high number or percentage of calls to the Veterans Crisis Line; and (3) to the extent practicable, will ensure that suicide prevention services grants are distributed to provide services in areas of the United States that have experienced high rates of suicide by eligible individuals, including suicide attempts, to eligible entities that can assist eligible individuals at risk of suicide who are not currently receiving health care furnished by VA, and to ensure services VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 are provided in as many areas as possible. As explained above, pursuant to section 201(d)(2) of the Act, in paragraph (d)(1), VA will give preference to applicants that have demonstrated the ability to provide or coordinate suicide prevention services. This preference may be met by such experience that includes but is not limited to entities that are part of VA– SAMHSA’s Governors’ and Mayors’ Challenge to Prevent Suicide among service members, veterans, and their families; entities that are part of local or State coalitions for suicide prevention; and entities that support suicide prevention services through receipt of local, State, and Federal funding. Additionally, entities may demonstrate this ability if they are currently providing or coordinating suicide prevention services that align with the National Strategy for Preventing Veteran Suicide, VA-Department of Defense (DoD) Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide, or CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices. This is consistent with feedback received from commenters during consultation in which several commenters suggested awarding grants, or providing preference for grants, to entities with prior experience providing or coordinating suicide prevention services and programs, including those who are part of Governors’ Challenges. Pursuant to section 201(d)(1), VA has discretionary authority to prioritize the distribution of grants to rural communities, Tribal lands, territories of the United States, medically underserved areas, areas with a high number or percentage of minority veterans or women veterans, and areas with a high number or percentage of calls to the Veterans Crisis Line. This will be a consideration for the distribution of grants, as described in paragraph (d)(2), and is consistent with feedback received from commenters during consultation. Due to funding limitations, VA may choose to utilize this discretionary authority in distributing grants. However, VA does not want to mandate use of this discretionary authority because it is important to ensure that grants can be distributed equitably across the country and provided to areas where the grants may be best utilized. If VA prioritized these areas for all awarded grants for this program, it may exhaust all of its funding annually with none of the grants being distributed to any other grantees that may also be deserving. VA does not want to limit PO 00000 Frm 00011 Fmt 4701 Sfmt 4700 13815 itself by mandating this, but rather retain the discretion to distribute to these areas as warranted. As explained in paragraph (b) of § 78.35 and in § 78.110, VA would establish any priorities in a NOFO. For purposes of this discretionary authority, VA will use the definitions for rural communities, Tribal lands, territories of the United States, and medically underserved areas in § 78.5. In determining areas with a high number or percentage of minority veterans or women veterans, VA will base such determinations on the veteran population data from VA’s National Center for Veterans Analysis and Statistics (NCVAS). VA will use the most recent data that NCVAS has published, which is made publicly available at https://www.va.gov/vetdata/ veteran_population.asp. In determining areas with a high number or percentage of calls to the Veterans Crisis Line, VA will use internal data that VA maintains to determine where these areas are and will consider the most recent data VA has for purposes of using this discretionary authority when making these annual funding determinations. VA anticipates making this information available to the public and through technical assistance to grantees. Consistent with section 201(d)(1)(B) of the Act, paragraph (d)(3) explains that to the extent practicable, VA will ensure that suicide prevention services grants are distributed to (1) provide services in areas of the United States that have experienced high rates of suicide by eligible individuals, including suicide attempts; and to (2) applicants that can assist eligible individuals at risk of suicide who are not currently receiving health care furnished by VA. Paragraph (d)(3) also explains that to the extent practicable, VA will ensure that suicide prevention services grants are distributed to ensure services are provided in as many areas as possible. While the Act requires, to the extent practicable, distribution of grants to provide services in areas with high rates of suicide, including suicide attempts, by eligible individuals, VA notes that data on suicide attempts is generally insufficient, incomplete, and generally unavailable for purposes of determining areas with high rates of suicide. This is because this data is collected only when veterans report suicide attempts, and there is no requirement to report such attempts. Given the issues with the data on suicide attempts as explained above, for purposes of implementing section 201(d)(1)(B), VA will not utilize data on suicide attempts solely. If such data become available in a sufficient and complete manner, VA will utilize such E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13816 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations data to determine areas with high rates of suicide attempts. Until and if such data become available, in order to meet the requirement of section 201(d)(1)(B) of the Act, VA will determine areas with high rates of suicide based on VA’s most recently published National Veteran Suicide Prevention Annual Report, which is based on CDC’s mortality and death index. This report is published annually, and the most recent report will be utilized by VA for purposes of paragraph (d)(3)(i). For purposes of paragraph (d)(3)(ii) and determining whether applicants can assist eligible individuals at risk of suicide who are not currently receiving VA health care, VA will consider the information included in applicants’ applications for this grant program. Such information could include, but not be limited to, existing arrangements (such as Memorandums of Understanding) with, or linkages to, VA and/or community partners in providing services to these individuals, plans on how the entity would coordinate with local VA medical facilities to identify these individuals, and plans to include these individuals as part of the population to be provided suicide prevention services if awarded a grant. VA will consider past and current actions as well as future plans to serve these individuals when determining whether to distribute a grant to an applicant that can assist eligible individuals at risk of suicide who are not currently receiving health care furnished by VA. Paragraph (d)(3)(iii) allows VA, to the extent practicable, to ensure grants are distributed to provide services in as many areas as possible. This will allow VA to consider geographic location, in some cases, when determining distribution of grant awards. VA anticipates receiving applications from numerous applicants in the same location or serving the same population, and VA will not be able to award grants to every applicant due to funding limitations. If VA received five highscoring applications from applicants proposing to serve eligible individuals in the same location, but one of those applicants alone can provide or coordinate suicide prevention services to the eligible population in that location, VA will be able to use this discretionary authority to distribute grants to applicants in other locations that can provide or coordinate services to eligible individuals and their families. This will allow VA to ensure that as many veterans as possible throughout the country are able to VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 receive services under this grant program. VA notes that suicide prevention services grant applications must include applicants’ identification of the target populations and the area the applicant proposes to serve. VA will use this information in determining the distribution of suicide prevention services grants consistent with paragraph (d). Paragraph (e) explains that subject to paragraph (d) of this section, which sets forth the preference and distribution requirements and considerations, VA will fund the highest-ranked applicants for which funding is available, within the highest funding priority group, if any. Under § 78.110 (discussed later in this interim final rule), in order to meet the requirements of section 201 of the Act and the goals of SSG Fox SPGP, VA will be able to choose to include funding priorities in the NOFO. If VA establishes funding priorities in the NOFO, to the extent funding is available and subject to paragraph (d) of this section, VA will select applicants in the next highest funding priority group based on their rank within that group. Similar to existing processes in other VA grant programs, such as the Homeless Providers Grant and Per Diem Program (38 CFR 61.63) and the SSVF Program (38 CFR 62.61), paragraph (f) authorizes VA to select an applicant for funding if that applicant is not selected because of a procedural error by VA. An applicant would not be required to submit a new application in this situation. This will ease any administrative burden on applications and could be used in situations where there is no material change in the information that would have resulted in the applicant’s selection for a grant under this part. 78.35 Scoring Criteria for Grantees Applying for Renewal of Suicide Prevention Services Grants Section 201(h) of the Act requires the VA Secretary to establish criteria for the selection of eligible entities that have submitted applications for a suicide prevention services grant. Based on this requirement, § 78.35 describes the criteria that VA will use to score those grantees who are applying for renewal of a grant. Such criteria will assist with VA’s review and evaluation of grantees to ensure that those grantees have successful existing programs using the previously awarded grant funds and that they have complied with the requirements of this part and section 201 of the Act. The criteria in paragraphs (a) through (c) ensure that renewals of grants are awarded based on PO 00000 Frm 00012 Fmt 4701 Sfmt 4700 the grantee’s program’s success, costeffectiveness, and compliance with VA goals and requirements for this grant program. This is consistent with how VA awards renewals of grants in the SSVF Program (38 CFR 62.24). While this section does not include specific point values for the criteria, such point values will be set forth in the NOFO. This will allow VA to retain flexibility in determining those point values each year of the grant program. Under paragraph (a), VA will award points based on the success of the grantee’s program, as demonstrated by the following: (1) The grantee made progress in reducing veteran suicide deaths and attempts, reducing all-cause mortality, reducing suicidal ideation, increasing financial stability; improving mental health status, well-being, and social supports; and, engaging in best practices for suicide prevention services; (2) participants were satisfied with the suicide prevention services provided or coordinated by the grantee, as reflected by the satisfaction survey conducted under § 78.95(d); (3) the grantee implemented the program by delivering or coordinating suicide prevention services to participants in a timely manner, consistent with SSG Fox SPGP policy, the NOFO, and the grant agreement; and (4) the grantee was effective in conducting outreach to eligible individuals and their families and increasing engagement of eligible individuals and their families in suicide prevention services, as assessed through an SSG Fox SPGP grant evaluation. VA notes that for purposes of paragraph (a)(1), best practices for suicide prevention services will include, but not be limited to, best practices recommended by the National Strategy for Preventing Veteran Suicide, VA-DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide VA, CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices, and the Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention. Paragraph (b) states that points will be awarded based on the cost-effectiveness of the grantee’s program, as demonstrated by the following: The cost per participant was reasonable and the grantee’s program was effectively implemented on-budget. This criterion is important as it will assist with VA’s review and evaluation of grantees to ensure that grantees have been fiscally responsible. This is also consistent with similar criterion used in the SSVF program. See 38 CFR 62.24. E:\FR\FM\10MRR2.SGM 10MRR2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations khammond on DSKJM1Z7X2PROD with RULES2 Paragraph (c) states that VA will award points based on the extent to which the grantee’s program complies with SSG Fox SPGP goals and requirements, as demonstrated by the following: The grantee’s program was administered in accordance with VA’s goals for SSG Fox SPGP as noted in the NOFO; the grantee’s program was administered in accordance with all applicable laws, regulations, and guidelines; and the grantee’s program was administered in accordance with the grantee’s suicide prevention services grant agreement. This criterion is important to ensure that renewals of grants are awarded to those who comply with VA’s goals and requirements for SSG Fox SPGP and who have shown competence regarding grant program implementation. This criterion is consistent with how VA awards renewals in the SSVF program. See 38 CFR 62.24. 78.40 Selection of Grantees for Renewal of Suicide Prevention Services Grants Section 201(c) of the Act requires the VA Secretary to award a grant to each eligible entity for which the Secretary has approved an application to provide or coordinate the provision of suicide prevention services. Section 201(h) of the Act requires the Secretary to establish criteria for the selection of eligible entities that have submitted applications for a suicide prevention services grant. Based on these sections of the Act, section 78.40 describes the process for selecting grantees that have received suicide prevention services grants and are applying for renewal of such grants. It is important to note that this is a simpler process than awarding the initial grant. This is consistent with how VA awards renewals of grants in the SSVF Program (38 CFR 62.25). Paragraph (a) explains that so long as grantees meet the threshold requirements in § 78.20, VA will score the grantee using the scoring criteria set forth in § 78.35. This ensures that grantees are still eligible to participate in the program. Under paragraph (b), VA will rank those grantees who receive at least the minimum amount of total points and points per category set forth in the NOFO, and such grantees will be ranked in order from highest to lowest scores. Paragraph (c) explains that VA will use the grantee’s ranking as the basis for selection for funding, and that VA will fund the highest-ranked grantees for which funding is available. In paragraph (d), at its discretion, VA may award any non-renewed funds to an applicant or existing grantee. If VA VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 chooses to award non-renewed funds to an applicant or existing grantee, VA will first offer to award the non-renewed funds to the applicant or grantee with the highest grant score under the relevant NOFO that applies for, or is awarded a renewal grant in, the same area as, or a proximate area to, the affected area if available. Such applicant or grantee will be required to have the capacity and agree to provide prompt services to the affected area. Under § 78.40, the relevant NOFO is the most recently published NOFO that covers the affected area, or for multi-year grant awards, the NOFO for which the grantee, who is offered the additional funds, received the multi-year award. If the first such applicant or grantee offered the non-renewed funds refuses the funds, VA will then offer to award the funds to the next highest-ranked such applicant or grantee, per the criteria in paragraph (d)(1) of this section, and continue in rank order until the non-renewed funds are awarded. VA notes that it does not anticipate offering multi-year awards at this time, but may choose to do so at a later point. To avoid the need for further rulemaking to authorize multi-year awards, such language is included now to allow for future flexibility. Similar to existing processes in other VA grant programs, such as the Homeless Providers Grant and Per Diem Program (38 CFR 61.63) and the SSVF Program (38 CFR 62.61), paragraph (e) authorizes VA to select an existing grantee for available funding, based on the grantee’s previously submitted renewal application, if that grantee is not selected for renewal because of a procedural error by VA. A grantee would not be required to submit a new renewal application in this situation. This will ease any administrative burden on grantees and could be used in situations where there is no material change in the renewal application that would have resulted in the grantee’s selection for renewal of a grant under this part. 78.45 Suicide Prevention Services: Outreach As indicated in the definition of suicide prevention services, there are ten categories of suicide prevention services that can be provided or coordinated under this grant program. Each one has its own separate section in this regulation, and each will be discussed subsequently for clarity and readability. In accordance with section 201(q)(11)(A)(i) of the Act, 38 CFR 78.45 describes outreach, which is the first of ten sections describing the types of PO 00000 Frm 00013 Fmt 4701 Sfmt 4700 13817 suicide prevention services that grantees may be approved to provide or coordinate the provision of through this grant program. In paragraph (a), grantees providing or coordinating the provision of outreach must use their best efforts to ensure that eligible individuals, including those who are at highest risk of suicide or who are not receiving health care or other services furnished by VA, and their families are identified, engaged, and provided suicide prevention services. This is consistent with how outreach services are addressed in the definition of suicide prevention services in section 201(q)(11)(A)(i) of the Act. Based on the assessment of suicide risk conducted by grantees to determine eligibility for services, eligible individuals that should be considered at highest risk of suicide are those with a recent suicide attempt, an active plan or preparatory behavior for suicide, or a recent hospitalization for suicidality. Paragraph (b) explains that outreach must include active liaison with local VA facilities; State, local, or tribal government (if any); and private agencies and organizations providing suicide prevention services to eligible individuals and their families in the area to be served by the grantee. This can include, for example, local mental health and emergency or urgent care departments in local hospitals or clinics. Paragraph (b) effectively requires grantees to have a presence in the area to meet with individuals and organizations to create referral processes to the grantee, similar to VA’s suicide prevention coordinators. This section is consistent with how VA defines outreach in the SSVF Program (38 CFR 62.30). Outreach is important for ensuring that eligible individuals and families receive suicide prevention services to reduce the risk of suicide. Outreach also ensures that grantees are able to identify participants that may be eligible and in need of suicide prevention services. Working with local entities, including VA, that serve eligible individuals and their families can help grantees identify and reach potential participants. 78.50 Suicide Prevention Services: Baseline Mental Health Screening In accordance with section 201(q)(11)(A)(ii) of the Act, under § 78.50(a), grantees must provide or coordinate the provision of a baseline mental health screening to all participants they serve at the time those services begin. For purposes of this grant program, all grantees will be required to provide, or coordinate the provision of, a baseline mental E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13818 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations screening to participants. This baseline mental health screening ensures that participants’ mental health needs can be properly determined, and that suicide prevention services can be further tailored to meet the individual’s needs. This baseline mental health screening must be provided using a validated screening tool that assesses suicide risk and mental and behavioral health conditions. Information on the specific tools to be used will be included in the NOFO, as the tools VA will approve for baseline mental health screenings may vary from year to year as the screening tools may evolve over time due to emerging evidence through research. VA will provide these tools to grantees providing or coordinating the provision of baseline mental health screenings. These tools will be those that a nonclinician can administer, as many grantees may not be clinicians and may not be able to administer a clinical screening for suicide risk and mental or behavioral health conditions. These tools will also indicate when a participant must be referred for additional care, as explained in paragraph (b) of this section. These tools will ensure consistent screening and reporting of suicide risk and the need for referral for additional care or care coordination. It is also important to note that this is consistent with feedback VA received through consultation. These tools used to conduct the baseline mental health screening are different than the tool used to determine risk of suicide for purposes of eligibility and will be administered to participants after they have been deemed an eligible individual pursuant to § 78.10. Paragraph (b) states that if an eligible individual is at risk of suicide or other mental or behavioral health condition pursuant to the baseline mental health screening conducted under paragraph (a) of this section, the grantee must refer such individual to VA for care. If the eligible individual refuses the grantee’s referral to VA, any ongoing clinical services provided to the eligible individual by the grantee is at the expense of the grantee. This is based on section 201(m)(1) and (3) of the Act, which explain that if a grantee determines that an eligible individual is at-risk of suicide or other mental or behavioral health condition pursuant to a baseline mental health screening, the grantee must refer the eligible individual to VA for additional care as authorized under the Act or any other provision of law, and if the eligible individual refuses the referral, any ongoing clinical services provided to the individual by the grantee will be at the grantee’s expense. It is important to note VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 that this is only required for eligible individuals and not the family of eligible individuals. Section 201(m)(1) of the Act requires referral when the grantee determines that an eligible individual is at-risk of suicide or other mental health or behavioral health condition, consistent with the language in paragraph (b). This reflects Congressional intent that these referrals for care be required for those eligible individuals who are not only at risk of suicide but also those who have additional needs that require further evaluation by VA for additional care. Whether an eligible individual has additional needs that require referral for further evaluation by VA for additional care will be determined pursuant to the baseline mental health screening conducted under paragraph (a). For example, should the baseline mental health screening indicate a potential mental health disorder related to depression, the participant would need to be referred for further evaluation for diagnosis and treatment. This baseline mental health screening will be performed by grantees using various VA-approved validated tools. These tools will indicate to the grantee if the eligible individual must be referred for additional evaluation and care based on the outcome of the screening for mental or behavioral health and suicide risk. When referrals are made by grantees to VA, to the extent practicable, those referrals are required to be a ‘‘warm hand-off’’ to ensure that the eligible individual receives necessary care. This ‘‘warm hand-off’’ may include providing any necessary transportation to the nearest VA facility, assisting the eligible individual with scheduling an appointment with VA, and any other similar activities that may be necessary to ensure the eligible individual receives necessary care in a timely manner. This is consistent with feedback received from commenters during consultation. This ‘‘warm handoff’’ is also consistent with other suicide prevention services that grantees may provide, such as assistance in obtaining any VA benefits and assistance with emergent needs, authorized under section 201(q)(11)(A)(vii) and (ix), respectively. To the extent that a veteran referred to VA for care is eligible for care in the community through VA’s Community Care Program, that veteran may elect to receive care in the community under VA’s Community Care Program regulations located at 38 CFR 17.4000 through 17.4040. For purposes of section 201(m)(3), this election would PO 00000 Frm 00014 Fmt 4701 Sfmt 4700 not be considered a refusal to receive care from VA. Paragraph (b) further explains that if an eligible individual refuses referral to VA for care by a grantee, any ongoing clinical services provided to the eligible individual by the grantee are at the grantee’s expense. This is based on section 201(m)(3) of the Act and ensures that grantees understand their responsibilities regarding the baseline mental health screening of an eligible individual. Similar to the language in paragraph (b), paragraph (c) explains that if a participant other than an eligible individual is at risk of suicide or other mental or behavioral health condition pursuant to the baseline mental health screening conducted under paragraph (a) of this section, the grantee must refer such participant to appropriate health care services in the area. To the extent that the grantee is able to furnish such appropriate health care services on an ongoing basis and has available funding separate from funds provided under this grant program to do so, they would be able to furnish such services using those non-VA funds without being required to refer such participants to other services. VA requires that grantees refer those individuals (that is, families of eligible individuals) for further care as appropriate and will codify this in paragraph (c) to ensure that grantees do so. This ensures that those individuals’ needs can be met by further care as needed. Under paragraph (d), except as provided for under § 78.60(a), funds provided under this grant program may not be used to provide clinical services to participants, and any clinical services provided to such individuals by the grantee are at the expense of the grantee. Paragraph (d) explicitly states that any clinical services provided by the grantee are at its expense and not VA’s. Further, this language in the Act and in the regulation clarifies that grantees may not charge, bill, or otherwise hold liable eligible individuals for the receipt of such care or services; we interpret the phrase ‘‘at the expense of the entity’’ in section 201(m)(3) to bar the entity from billing, charging, or holding liable eligible individuals for the receipt of such care or services. This will also ensure that the relationship between the grantee and the eligible individual is not adversely affected through collections or other efforts. It also provides an incentive for grantees to work with eligible individuals to refer them to VA for their health care needs. While grantees that provide participants ongoing clinical services pursuant to paragraphs (b) and (c) do so E:\FR\FM\10MRR2.SGM 10MRR2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations khammond on DSKJM1Z7X2PROD with RULES2 at their own expense, this does not preclude the grantee from seeking to cover those expenses through other sources of funding and existing agreements. For example, a grantee that provides a participant with ongoing clinical services may bill a third-party payor, such as the participant’s other health insurance, for the ongoing clinical services provided by the grantee. However, as explained in the previous paragraph, the grantee may not charge, bill, or otherwise hold liable participants for the receipt of ongoing clinical services under § 78.50. In the instance that a grantee bills a third-party payor (e.g., health insurance) for ongoing clinical services provided to the participant, certain cost-sharing, such as copayments, imposed on the participant by a third-party payor, may be covered by the grantee at its discretion. VA does not interpret the language ‘‘at the expense of the entity’’ in section 201(m)(3) to preclude grantees from covering such copayments for participants for ongoing clinical services. VA would not require that grantees cover such costs, but rather, would permit grantees to do so if it chooses and has the funds to do so. However, as noted above, section 201(m)(3) bars the entity from billing, charging, or holding liable eligible individuals for the receipt of such care or services. Pursuant to § 78.50(a), the grantee would be unable to use grant funds to cover such costs. VA notes that while section 201(m)(3) is specific to eligible individuals, paragraph (d) applies to all participants because this would ensure that the potential liabilities of a family member would not deter a veteran from seeking services from a grantee and to make administration easier. VA has authority to extend this protection to include participants other than eligible individuals pursuant to section 201(f)(1) of the Act, which authorizes VA to require grantees to make such commitments as the Secretary considers necessary to carry out this section. 78.55 Suicide Prevention Services: Education In accordance with section 201(q)(11)(A)(iii), under § 78.55, grantees providing or coordinating the provision of education must provide or coordinate the provision of suicide prevention education programs to educate communities, veterans, and families on how to identify those at risk of suicide, how and when to make referrals for care, and the types of suicide prevention resources available within the area. Education can include gatekeeper training, lethal means safety VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 training, or specific education programs that assist with identification, assessment, or prevention of suicide. Gatekeeper training generally refers to programs that seek to develop individuals’ knowledge, attitudes, and skills to prevent suicide. Gatekeeper training is an educational course designed to teach clinical and nonclinical professionals or gatekeepers the warning signs of a suicide crisis and how to respond and refer individuals for care. For more information, see: https:// www.sprc.org/sites/default/files/ migrate/library/SPRC_Gatekeeper_ matrix_Jul2013update.pdf. Defining education in this manner is consistent with how education is administered in the community and is commonly understood by those in the community who work in the area of suicide prevention. Education is important because learning the signs of suicide risk, how to reduce access to lethal means, and to connect those at risk of suicide to care can improve understanding of suicide and has the potential to reduce suicide. 78.60 Suicide Prevention Services: Clinical Services for Emergency Treatment In accordance with section 201(q)(11)(A)(iv) of the Act, § 78.60(a) requires that grantees providing or coordinating the provision of clinical services for emergency treatment must provide or coordinate the provision of clinical services for emergency treatment of a participant. Consistent with section 201(m)(2) and (3) of the Act, paragraph (b) explains that if an eligible individual is furnished clinical services for emergency treatment under paragraph (a) of this section and the grantee determines that the eligible individual requires ongoing services, the grantee must refer the eligible individual to VA for additional care. If the eligible individual refuses the grantee’s referral to VA, any ongoing clinical services provided to the eligible individual by the grantee is at the expense of the grantee. This aligns with section 201(m)(2) of the Act, which explains that if a grantee furnishes clinical services for emergency treatment to an eligible individual and determines ongoing services are required, the grantee must refer the eligible individual to VA for additional care as authorized under the Act or any other provision of law. VA notes that this is only required for eligible individuals, not the family of eligible individuals. To the extent that an eligible individual referred to VA for care is eligible for care in the community through VA’s Community PO 00000 Frm 00015 Fmt 4701 Sfmt 4700 13819 Care Program, that eligible individual may elect to receive care in the community under VA’s Community Care Program regulations located at 38 CFR 17.4000 through 17.4040. As stated above, such election is not considered a refusal to receive care from VA. Subsection (m)(3) of section 201 of the Act further states that if an eligible individual refuses a referral by a grantee, any ongoing clinical services provided to the eligible individual by the grantee is at the grantee’s expense. That is codified in paragraph (b) to ensure that grantees understand their responsibilities regarding clinical services of an eligible individual. Paragraph (b) further includes the same language as § 78.50(d) regarding limitations on charging, billing, or otherwise holding liable eligible individuals for the receipt of such care. As explained in the discussion on § 78.50(d), a grantee is not precluded from seeking to cover those expenses through other sources of funding and existing agreements. In paragraph (c), if a participant other than an eligible individual (that is, the family member of an eligible individual) is furnished clinical services for emergency treatment under paragraph (a) of this section and the grantee determines that the participant requires ongoing services, the grantee must refer the participant to appropriate health care services in the area for additional care. Except as provided for under paragraph (a) of this section, funds provided under this grant program may not be used to provide ongoing clinical services to family, and any ongoing clinical services provided to the family by the grantee is at the expense of the grantee. VA expects that grantees will refer those participants for further care as appropriate and is codifying this requirement in this paragraph to ensure that grantees do so. This ensures that these participants’ needs can be met by further care as needed. Except as provided for under § 78.60(a), funds provided under this grant program may not be used to provide clinical services to such participants, and any ongoing clinical services provided to the participant by the grantee is at the expense of the grantee. This is because VA does not have authority to cover such expenses under this grant program. However, to the extent that a grantee can and desires to provide ongoing clinical services to such participants, they may do so, but it will be at their expense. As explained in discussion on § 78.50(d), this language does not preclude the grantee from seeking to cover those expenses through other sources of funding and existing E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13820 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations agreements (for example, billing a participant’s health insurance). Grantees also are not precluded from covering any copayments imposed on participants by their health insurance for ongoing clinical services provided by the grantee if the grantee so chooses and has the funds to cover such costs. However, the grantee may not charge, bill, or otherwise hold liable such participants for the receipt of such care or services. This is consistent with similar language in paragraph (b) relating to eligible individuals. Consistent with section 201(q)(5) of the Act, paragraph (d) explains that for purposes of this section, emergency treatment means medical services, professional services, ambulance services, ancillary care and medication (including a short course of medication related to and necessary for the treatment of the emergency condition that is provided directly to or prescribed for the patient for use after the emergency condition is stabilized and the patient is discharged) was rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. This standard is met by an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. The description and standard are consistent with VA’s description of medical emergency for purposes of payment or reimbursement for emergency treatment furnished by nonVA providers to certain veterans with service-connected disabilities pursuant to 38 CFR 17.120 and for nonserviceconnected disabilities pursuant to 38 CFR 17.1000 et seq. It is important to note that emergency medical conditions includes emergency mental health conditions. Paragraph (e) explains that the direct provision of clinical services for emergency treatment by grantees under this section is not prohibited by § 78.80(a). As explained later in this discussion, § 78.80(a) prohibits grantees from directly providing health care services, which include health insurance and referral to a governmental entity or grantee that provides certain services. As clinical services for VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 emergency treatment under § 78.60 are considered health care services and section 201 of the Act specifically authorizes the provision of clinical services for emergency treatment, paragraph (e) clarifies that such services do not fall under the prohibition in § 78.80(a). VA acknowledges that while some grantees may not be able to provide these services directly, others will. This ensures that if a grantee is capable of furnishing emergency treatment and needs to do so, there will be no delay in the delivery of such services. 78.65 Suicide Prevention Services: Case Management Services In accordance with section 201(q)(11)(A)(v), case management services are described in § 78.65. These definitions are similar to case management services in the SSVF Program (see 38 CFR 62.31), but they are focused on suicide prevention to effectively assist participants at risk of suicide. The SSVF Program derived its definition from similar definitions of case management services provided in other Federal programs, such as the Department of Health and Human Services’ Medicare and Medicaid Services Program, the Department of Housing and Urban Development’s Congregate Housing Services Program, and the Housing and Urban Development—Veterans Affairs Supported Housing (see 42 CFR 440.169 and 24 CFR 700.105). 75 FR 24514, 24518 (May 5, 2010). This description of case management services is also consistent with VA-DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide (see https:// www.healthquality.va.gov/guidelines/ MH/srb/VADoDSuicideRisk FullCPGFinal5088212019.pdf). Grantees providing or coordinating the provision of case management services must provide or coordinate the provision of such services that include, at a minimum: (a) Performing a careful assessment of participants, and developing and monitoring case plans in coordination with a formal assessment of suicide prevention services needed, including necessary follow-up activities, to ensure that the participant’s needs are adequately addressed; (b) establishing linkages with appropriate agencies and service providers in the area to help participants obtain needed suicide prevention services; (c) providing referrals to participants and related activities (such as scheduling appointments for participants) to help participants obtain needed suicide PO 00000 Frm 00016 Fmt 4701 Sfmt 4700 prevention services, such as medical, social, and educational assistance or other suicide prevention services to address participants’ identified needs and goals; (d) deciding how resources and services are allocated to participants on the basis of need; (e) educating participants on issues, including, but not limited to, suicide prevention services availability and participant rights; and, (f) other activities, as approved by VA, to serve the comprehensive needs of participants for the purpose of reducing suicide risk. This list ensures that grantees have the same understanding of what activities are considered case management services, but it also provides VA authority to approve other activities that may be considered case management services. Such other activities will be included in any NOFO published as well as incorporated into any agreement with grantees. 78.70 Suicide Prevention Services: Peer Support Services Consistent with section 201(q)(11)(A)(vi) of the Act, 38 CFR 78.70 explains the peer support services authorized under this grant program. Paragraph (a) explains that grantees providing or coordinating the provision of peer support services must provide or coordinate the provision of peer support services to help participants understand what resources and supports are available in their area for suicide prevention. Peer support services must be provided by veterans trained in peer support with similar lived experiences related to suicide or mental health. Peer support specialists serve as role models and a resource to assist participants with their mental health recovery. Peer support specialists function as interdisciplinary team members, assisting physicians and other professional and non-professional personnel in a rehabilitation treatment program. This is consistent with how VA defines peer support services for its programs, including its peer support program pursuant to 38 U.S.C. 1720F(j). Paragraph (b) further explains that each grantee providing or coordinating the provision of peer support services must ensure that veterans providing such services to participants meet the requirements of 38 U.S.C. 7402(b)(13) and meet qualification standards for appointment or have completed peer support training, are pursuing credentials to meet the minimum qualification standards for appointment, and are under the supervision of an individual who meets the requirements of 38 U.S.C. 7402(b)(13). Section 7402(b)(13) establishes standards for E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations appointment as a VA peer support specialist. Qualification standards include that the individual is (1) a veteran who has recovered or is recovering from a mental health condition, and (2) certified by (i) a notfor-profit entity engaged in peer support specialist training as having met such criteria as the Secretary shall establish for a peer support specialist position, or (ii) a State as having satisfied relevant State requirements for a peer support specialist position. VA has further set forth qualifications for its peer support specialists in VA Handbook 5005, Staffing (last updated July 17, 2012). See https://vaww.va.gov/OHRM/DirectivesHandbooks/Documents/5005.pdf. Meeting minimum qualification standards for appointment under 38 U.S.C. 7402(b)(13) ensures that participants receive peer support services in a safe and effective manner consistent with VA’s standards and with those required by law. However, VA would also allow grantees to provide peer support services through veterans who have completed peer support training, are pursuing credentials to meet the minimum qualification standards for appointment, and are under the supervision of an individual who meets the minimum qualification standards. VA would allow this as a way to build capacity in the community for peer support services, particularly as there are individuals who may be supervised and working toward meeting the requirements of 38 U.S.C. 7402(b)(13), but who have not yet met those conditions. Grant funds may be used to provide education and training for employees of the grantee or the community partner who provide peer support services based on the terms set forth in the grant agreement. VA believes the use of these funds to support education and training for peer support specialists is authorized by section 201(b) of the Act, which directs VA to provide financial assistance to eligible entities approved under this section to provide or coordinate the provision of suicide prevention services to eligible individuals and their families. Because the requirements to be a VA peer support specialist, as generally described above, are more specific than many community organizations might require, we believe the use of grant funds to support education and training is appropriate as it may be necessary to ensure these services are provided by appropriately qualified individuals. VA would set forth conditions regarding the use of funds, such as any limits on the amount of funds that may be used for these VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 purposes or documentation requirements, in the NOFO and terms of the grant agreement. These appointment requirements for those veterans providing peer support services would be included in the NOFO so that those applicants who apply to provide peer support services understand and know the applicable requirements for purposes of providing or coordinating such services. These requirements would also be included in any program guides developed for purposes of administering services under this grant program. 78.75 Suicide Prevention Services: Assistance in Obtaining VA Benefits In accordance with section 201(q)(11)(A)(vii), § 78.75 sets forth the requirements associated with suicide prevention services authorized under this grant program related to assistance in obtaining VA benefits. The provision of this assistance will provide grantees with additional means by which VA can notify participants of available VA benefits and is consistent with the SSVF Program (see 38 CFR 62.32). Paragraph (a) requires grantees assisting participants in obtaining VA benefits to assist participants in obtaining any benefits from VA for which the participants are eligible. Such benefits include but are not limited to: (1) Vocational and rehabilitation counseling; (2) supportive services for homeless veterans; (3) employment and training services; (4) educational assistance; and, (5) health care services. Under paragraph (b), grantees will not be permitted to represent participants before VA with respect to a claim for VA benefits unless they are recognized for that purpose pursuant to 38 U.S.C. 5902. Employees and members of grantees are not permitted to provide such representation unless the individual providing representation is accredited pursuant to 38 U.S.C. chapter 59. Consistent with 38 U.S.C. 5902, VA does not interpret section 201 of the Act to allow grantees to represent veterans in benefit claims before VA unless they are recognized under 38 U.S.C. 5902. VA also does not interpret section 201 of the Act as requiring that grantees become recognized organizations pursuant to 38 U.S.C. 5092 or that their employees or members become accredited service organization representatives, claims agents, or attorneys. Instead, assistance in obtaining benefits may include providing information about available benefits, helping individuals locate a recognized veterans services organization or other accredited individual, and other services short of PO 00000 Frm 00017 Fmt 4701 Sfmt 4700 13821 actual representation before VA, unless the grantee is accredited pursuant to 38 CFR 14.629 (that is, VA’s regulation implementing 38 U.S.C. 5902), which sets forth requirements for accreditation of service organization representatives, agents, and attorneys. 78.80 Suicide Prevention Services: Assistance in Obtaining and Coordinating Other Public Benefits and Assistance With Emergent Needs Consistent with section 201(q)(11)(A)(viii) and (ix) of the Act, under § 78.80, grantees assisting in obtaining and coordinating other public benefits or assisting with emergent needs will be required to assist participants to obtain and coordinate the provision of other public benefits. For purposes of this section, VA considers other public benefits and emergent needs to be the same types of benefits. At a minimum, grantees are required to assist participants in obtaining and coordinating the provision of benefits listed in paragraphs (a) through (h) of § 78.80 that are being provided by Federal, State, local, or tribal agencies, or any other grantee in the area served by the grantee by referring the participant to and coordinating with such entity. If a public benefit is not being provided by Federal, State, local, or tribal agencies, or any other grantee in the area, the grantee is not required to obtain, coordinate, or provide such public benefit. Grantees may elect to provide directly to participants the public benefits identified in paragraphs (c) through (h) of § 78.80. In accordance with section 201(q)(11)(A)(ix)(I) of the Act, paragraph (a) describes health care services, which include: (1) Health insurance, and (2) referral to a governmental entity or grantee that provides any of the following services: (i) Hospital care, nursing home care, outpatient care, mental health care, preventive care, habilitative and rehabilitative care, case management, respite care, and home care; (ii) the training of any eligible individual’s family in the care of any eligible individual; and (iii) the provision of pharmaceuticals, supplies, equipment, devices, appliances, and assistive technology. This is consistent with how VA administers the SSVF Program (see 38 CFR 62.33(a)). VA believes services in paragraph (a) should not be provided directly by grantees as these services are commonly available in the area, including at VA. It also would be cost-prohibitive for grantees to provide these directly and would thus impact grantees’ ability to provide E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13822 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations suicide prevention services to participants. In accordance with section 201(q)(11)(A)(ix)(II) of the Act, paragraph (b) describes referral of a participant, as appropriate, to an entity that provides daily living services relating to the functions or tasks for selfcare usually performed in the normal course of a day, including, but not limited to, eating, bathing, grooming, dressing, and home management activities. This is identical to how VA administers the SSVF Program (See 38 CFR 62.33(b)). VA believes that daily living services should not be provided directly by grantees as these services are commonly available in the community, including at VA. It also would be costprohibitive for grantees to provide these directly and would thus impact grantees’ ability to provide suicide prevention services to participants. Thus, referrals for these services would be appropriate. In accordance with section 201(q)(11)(A)(ix)(III) of the Act, paragraph (c) describes personal financial planning services, which include, at a minimum, providing recommendations regarding day-to-day finances and achieving long-term budgeting and financial goals. Grant funds may pay for credit counseling and other services necessary to assist participants with critical skills related to household budgeting, managing money, accessing a free personal credit report, and resolving credit problems. This is consistent with how VA administers the SSVF Program (see 38 CFR 62.33(c)). In accordance with section 201(q)(11)(A)(ix)(IV) of the Act, paragraph (d) describes transportation services. Paragraph (d)(1) explains that the grantee may provide temporary transportation services directly to participants if the grantee determines such assistance is necessary; however, the preferred method of direct provision of transportation services is the provision of tokens, vouchers, or other appropriate instruments so that participants may use available public transportation options. Paragraph (d)(2) explains that if public transportation options are not sufficient within an area, costs related to the lease of vehicle(s) may be included in a suicide prevention services grant application if the applicant or grantee, as applicable, agrees that: (i) The vehicle(s) will be safe, accessible, and equipped to meet the needs of the participants; (ii) the vehicle(s) will be maintained in accordance with the manufacturer’s recommendations; and (iii) all transportation personnel (employees VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 and community partners) will be licensed, insured, and trained in managing any special needs of participants and handling emergency situations. This is consistent with how VA administers the SSVF Program (see 38 CFR 62.33(d)). However, unlike § 62.33(d) which refers to subcontractors, VA refers to community partners under paragraph (d)(2)(iii). Paragraph (d)(3) permits grantees to provide transportation services through reimbursement for transportation furnished through ride-sharing services, taxi services, or other similar sources if two conditions are met: First, the participant must lack any other means of transportation, including transportation or reimbursement for transportation from VA under part 70 of this title, and second, the grantee must document the participant’s lack of other means. Such documentation would be maintained as part of the participant’s case file, and consistent with the recordkeeping requirements in § 78.150. VA includes this provision to allow for flexibility in situations where transportation options may be limited, but the two conditions are intended to limit this support as a matter of last resort given that the expenses for such transportation are likely higher than other methods of transportation, and VA does not believe it would be an optimal use of grant funds. If beneficiary travel under subpart A of part 70 of title 38, Code of Federal Regulations, or transportation through the Veterans Transportation Service under subpart B of part 70 of title 38, Code of Federal Regulations, are available to the participant, the participant would be ineligible for assistance under paragraph (d)(3). In accordance with section 201(q)(11)(A)(ix)(V) of the Act, paragraph (e) describes temporary income support services, which may consist of providing assistance in obtaining other Federal, State, tribal, and local assistance, in the form of, but not limited to, mental health benefits, food assistance, housing assistance, employment counseling, medical assistance, veterans’ benefits, and income support assistance. This is consistent with how VA administers the SSVF Program (see 38 CFR 62.33(e)). However, unlike the SSVF Program, this suicide prevention services grant program will include food assistance because of the correlation between food insecurity and mental health issues including suicide risk. See Bergmans, R.S., Jannausch, M. and Ilgen, M.A. (2020), Prevalence of suicide ideation, planning and attempts among Supplemental Nutrition Assistance PO 00000 Frm 00018 Fmt 4701 Sfmt 4700 Program participants in the United States. Journal of Affective Disorders, 277, 99–103. The suicide prevention services grant program also expressly includes housing assistance, which does not appear in § 62.33(e) because part 62 is designed in general to provide housing assistance and supportive services for very low-income veteran families who are occupying permanent housing. In accordance with section 201(q)(11)(A)(ix)(VI) of the Act, paragraph (f) describes fiduciary and representative payee services, which may consist of acting on behalf of a participant by receiving the participant’s paychecks, benefits or other income, and using those funds for the current and foreseeable needs of the participant and saving any remaining funds for the participant’s future use in an interest-bearing account or saving bonds. This is consistent with how VA administers the SSVF Program (see 38 CFR 62.33(f)). In accordance with section 201(q)(11)(A)(ix)(VII) of the Act, paragraph (g) explains that legal services includes those services to assist an eligible individual with issues that may contribute to the risk of suicide, including issues that interfere with the eligible individual’s ability to obtain or retain permanent housing, cover basic needs such as food, transportation, medical care, and issues that affect the eligible individual’s employability and financial security (such as debt, credit problems, and the lack of a driver’s license). These bio-psychosocial stressors are suicide risk factors noted within the VA/DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide. See https://www.health quality.va.gov/guidelines/MH/srb/ VADoDSuicideRiskFullCPGFinal508821 2019.pdf. However, with the exception of legal assistance with resolving outstanding warrants, fines, expungements, and drivers’ license revocations symptomatic of reentry obstacles in employment or housing, authorized legal services do not include legal assistance with criminal matters nor matters in which the eligible individual is taking or has taken any adversarial legal action against the United States (that is, the Federal government). Authorized legal services also do not include legal assistance with matters in which the United States (that is, the Federal government) is prosecuting an eligible individual. Thus, even with respect to the limited legal assistance for certain criminal matters otherwise permitted (for example, legal assistance E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations with resolving outstanding warrants), legal services do not include legal assistance in those criminal matters in which the United States is prosecuting the eligible individual. Legal services under § 78.80(g) are described in this manner to include those types of services VA believes are most relevant and applicable to the legal needs of eligible individuals. VA will limit these legal services to issues that contribute to the risk of suicide, which is consistent with the overall intent of this grant program. VA will authorize those services that support the legal needs of the eligible individual to address those issues that contribute to their risk of suicide, such as issues with housing, employability, and financial security. With certain exceptions as noted and explained above, VA excludes legal assistance with most criminal matters and excludes all matters in which the eligible individual is taking or has taken any adversarial legal action against the United States, as VA does not believe it is reasonable to expect VA to pay for such services, especially for those situations in which an eligible individual takes adversarial legal action against the Federal government, including VA and other Federal agencies or in situations in which the Federal government is prosecuting an eligible individual. If VA covered such legal services, it could result in conflicts of interest. This restriction does not include non-adversarial legal assistance provided in pursuit of VA benefits or appeals to the Board of Veterans’ Appeals. If legal assistance is needed with a matter for which grant funds are not authorized, the grantee should make referrals to other organizations, such as Legal Aid and local Bar Associations, to ensure that legal needs can be met. In accordance with section 201(q)(11)(A)(ix)(VIII) of the Act, paragraph (h) describes the provision of child care, consistent with how VA administers these services in the SSVF Program (see 38 CFR 62.33(h)). Child care will be authorized for children under the age of 13, unless the child is disabled. Disabled children must be under the age of 18 to receive assistance under this paragraph. This is consistent with the SSVF Program’s regulations at § 62.33(h) as well as similar regulations issued by the Department of Housing and Urban Development. See 24 CFR 576.102(a)(1)(ii). Child care includes the: (1) Referral of a participant, as appropriate, to an eligible child care provider that provides child care with sufficient hours of operation and serves appropriate ages, as needed by the VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 participant; and (2) payment by a grantee on behalf of a participant for child care by an eligible child care provider. Consistent with the financial cap in section 201(q)(11)(A)(ix)(VIII) of the Act, payment may not exceed $5,000 per family of an eligible individual per Federal fiscal year. In paragraphs (h)(2)(i) through (iii), certain limitations for payments for child care services are identified, which is consistent with the SSVF Program’s regulations at 38 CFR 62.33(h). Pursuant to paragraph (h)(2)(i), payments for child care services must be paid by the grantee directly to an eligible child care provider. Unlike § 62.33(h), VA would not include the language that payments for child care services cannot exceed a maximum of 6 months in a 12-month period, and 10 months during a 2-year period. As payments are capped at $5,000 per family per Federal fiscal year under section 201(q)(11)(A)(ix)(VIII) of the Act, VA believes the financial cap imposed by the statute is a sufficient constraint to ensure proper use of resources for these services. Under paragraph (h)(2)(ii), payments for child care services will not be provided on behalf of participants for the same period of time and for the same cost types that are being provided through another Federal (including VA), State or local subsidy program. The reference to the ‘‘same period of time’’ means the same dates and times in which child care benefits are being provided under another program. For example, a participant may be eligible for Arkansas’s Child Care Assistance Program, which provides financial assistance for quality child care to certain individuals. If that participant was using those benefits under Arkansas’s Child Care Assistance Program on a specific date and time, it would not render the participant ineligible for child care support generally under the suicide prevention services grant program. The only result would be that the individual could not receive a subsidy under VA’s program for the same period of time for which child care services were being provided under the Arkansas program. Paragraph (h)(2)(iii) further explains that as a condition of providing payments for child care services, the grantee must help the participant develop a reasonable plan to address the participant’s future ability to pay for child care services. Grantees must assist the participant to implement such plan by providing any necessary assistance or helping the participant to obtain any necessary public or private benefits or services. Because the payments for child care services provided under paragraph PO 00000 Frm 00019 Fmt 4701 Sfmt 4700 13823 (h) are intended to be temporary, VA would require that grantees assist in developing and implementing such plan to ensure that participants are able to plan for such services in the long-term as needed. 78.85 Suicide Prevention Services: Nontraditional and Innovative Approaches and Treatment Practices Section 78.85 explains that grantees providing or coordinating the provision of nontraditional and innovative approaches and treatment practices may provide or coordinate the provision of nontraditional and innovative approaches and treatment, including but not limited to complementary or alternative interventions with some evidence for effectiveness of improving mental health or mitigating a risk factor for suicidal thoughts and behavior, as set forth in the NOFO or as approved by VA that are consistent with SSG Fox SPGP. Applicants may propose nontraditional and innovative approaches and treatment practices in their suicide prevention services grant application, and grantees may propose these additional approaches and treatment practices by submitting a written request to modify the suicide prevention services grant in accordance with § 78.125. VA is authorized under section 201(f)(1) of the Act to include such commitments as it considers necessary to carry out this section. VA is exercising this authority here by reserving the right to approve or disapprove nontraditional and innovative approaches and treatment practices to be provided or coordinated to be provided using funds authorized under SSG Fox SPGP. These approaches and treatment practices can evolve, and by maintaining the right to approve or disapprove these treatment practices or approaches, VA can ensure that participants receive approaches and treatment practices that are safe and effective. VA is not providing a broad list of approved innovative approaches and treatment practices to allow for emerging services with some evidence in suicide risk reduction the opportunity for review and selection. It is also important for VA to note that any approaches and treatment practices approved will need to be consistent with applicable Federal law. For example, the use of grant funds to provide or coordinate the provision of marijuana to eligible individuals and their families will be prohibited, as marijuana is currently illegal under Federal law. E:\FR\FM\10MRR2.SGM 10MRR2 13824 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations khammond on DSKJM1Z7X2PROD with RULES2 78.90 Suicide Prevention Services: Other Services The definition of suicide prevention services in section 201(q)(11)(A)(xi) of the Act includes other services necessary for improving the mental health status and wellbeing and reducing the suicide risk of eligible individuals and their families as the Secretary considers appropriate. Consistent with section 201(q)(11)(A)(xi) of the Act, section 78.90(a) explains general suicide prevention assistance that may be provided under this grant program. Pursuant to paragraph (a), a grantee may pay directly to a third party (and not to a participant), in an amount not to exceed $750 per participant during any 1-year period, beginning on the date that the grantee first submits a payment to a third party, the following types of expenses: (i) Expenses associated with gaining or keeping employment, such as uniforms, tools, certificates, and licenses; and (ii) expenses associated with lethal means safety and secure storage, such as gun locks and locked medication storage. A limit of $750 per participant per year is an appropriate amount because such items as gun storage and locks can cost anywhere from $20 to several hundred dollars. Similarly, for purposes of employment, licenses and uniforms can range from several dollars to several hundred dollars. The amount of $750 per year also is consistent with the amount of similar assistance authorized under the SSVF program of $1,500 every 2 years. See 38 CFR 62.34(e)(2). VA would allow payment for expenses associated with gaining or keeping employment as extended unemployment may lead to mental health issues and financial hardship. See Haw, C., K. Hawton, D. Gunnell, and S. Platt. 2015. Economic recession and suicidal behavior: Possible mechanisms and ameliorating factors. International Journal of Social Psychiatry 61, no. 1:73–81. Thus, it would be appropriate to cover these as other services as these would be necessary for improving the mental health status and wellbeing and reducing the suicide risk of eligible individuals and their families. VA would also allow payment for expenses associated with lethal means safety and secure storage, as these would also be services necessary for improving the wellbeing and reducing the suicide risk of eligible individuals and their families. In 2018, 68.2 percent of Veteran suicide deaths were due to a self-inflicted firearm injury, while 48.2 percent of non-Veteran adult suicides VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 resulted from a firearm injury. In 2018, 69.4 percent of male veteran suicide deaths and 41.9 percent of female veteran suicide deaths resulted from a firearm injury. In 2018, firearms were used in 41.9 percent of suicide deaths among women veterans, compared to 31.7 percent of suicide deaths among non-veteran women. See VA’s 2020 National Veteran Suicide Prevention Annual Report. (Available online: https://www.mentalhealth.va.gov/docs/ data-sheets/2020/2020-NationalVeteran-Suicide-Prevention-AnnualReport-11-2020-508.pdf.) Research has shown that when lethal means are made less accessible or lethal, suicide rates by those means decline. See, Gunnell D and Eddleston M. Suicide by intentional ingestion of pesticides: A continuing tragedy in developing countries. International Journal of Epidemiology. 2003;32:902–909; Gunnell D, Fernando R, Hewagama M, Priyangika WD, Konradsen F, Eddleston M. The impact of pesticide regulations on suicide in Sri Lanka. Int J Epidemiol. 2007;36(6):1235–42; Kreitman N. The coal gas story. United Kingdom suicide rates, 1960–71. Br J Prev Soc Med. 1976 Jun;30(2):86–93; Hawton K. United Kingdom legislation on pack sizes of analgesics: Background, rationale, and effects on suicide and deliberate selfharm. Suicide and Life-Threatening Behavior. 2002;32(3):223–229. Furthermore, increasing time and space between individuals facing a suicidal crisis and a firearm has been shown to prevent suicide. Lubin, G., Werbeloff, N., Halperin, D., Shmushkevitch, M., Weise, M, & Knobler, H. (2010), Suicide & Life-Threatening Behavior, 40(5), 421– 424. Thus, VA believes it is appropriate to allow payment for expenses associated with lethal means safety and secure storage, as these would also be services necessary for improving the wellbeing and reducing the suicide risk of eligible individuals and their families. Paragraph (b) explains that grantees providing or coordinating the provision of other suicide prevention services may provide or coordinate the provision of other services as set forth in the NOFO or as approved by VA that are consistent with SSG Fox SPGP. Applicants may propose additional services in their suicide prevention services grant application, and grantees may propose additional services by submitting a written request to modify the suicide prevention services grant program in accordance with § 78.125. VA reserves the right to approve or disapprove other suicide prevention services to be provided or coordinated to be provided PO 00000 Frm 00020 Fmt 4701 Sfmt 4700 using funds authorized under SSG Fox SPGP. This is consistent with how VA authorizes additional services for the SSVF Program (see 38 CFR 62.34) and is authorized by the statute as noted above. Section 201(q)(11)(A)(xi) includes as examples of services the Secretary may include adaptive sports, equine assisted therapy, or in-place or outdoor recreational therapy; substance use reduction programming; individual, group, or family counseling; and relationship coaching. VA is not identifying these services as expressly covered in its regulations, but applicants may propose these services in their grant application. VA believes Congress included these as examples of other services to ensure that applicants proposing to furnish these services would be able to do so if VA determines that such services are appropriate and likely for the purpose of reducing veteran suicide. VA believes the list in section 201(q)(11)(A)(xi) also is indicative of the types of other services that may be approved. VA believes the intent of this section of law is to provide flexibility for different approaches; thus, VA is not regulating these services further to preserve that flexibility. Paragraph (b) will control the disposition of any requests by applicants and grantees to offer these or other services. 78.95 General Operation Requirements In § 78.95, VA establishes requirements for the general operation of suicide prevention services programs. Paragraph (a) explains that prior to providing suicide prevention services, grantees must verify, document, and classify each participant’s eligibility for suicide prevention services and determine and document each participant’s degree of risk of suicide using tools identified in the suicide prevention services grant agreement. Such documentation must be maintained consistent with § 78.150. This ensures that grantees are providing services and using grant funds for those who are eligible for such services under this grant program and consistent with the Act. Paragraph (b) explains that prior to services ending, grantees must provide or coordinate the provision of a mental health screening to all participants they serve, when possible. This screening must be conducted with the same tool used to conduct the baseline mental health screening under § 78.50. Having this screening occur at the beginning (pursuant to § 78.50) and prior to services ending is important in evaluating the effectiveness of the E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations services provided, when possible. VA acknowledges that some participants may leave services early or opt out of screening so meeting this requirement may not always be possible. Thus, the language ‘‘when possible’’ is included in paragraph (b). Under paragraph (c), for each participant who receives suicide prevention services from the grantee, the grantee must document the suicide prevention services provided or coordinated, how such services are provided or coordinated, the duration of the services provided or coordinated, and any goals for the provision or coordination of such services. Such documentation must be maintained consistent with § 78.150. This is information eligible entities typically maintain regarding the provision or coordination of these or similar services. Additionally, this information may be requested by VA for purposes of monitoring the grantee’s operation and compliance with these regulations (under §§ 78.135 and 78.145), will be collected as part of the grantee’s reporting requirements in § 78.145, and will be required to be maintained for at least three years (consistent with the recordkeeping requirements in § 78.150), and may be requested by VA for auditing and evaluation purposes. Consistent with section 201(e) of the Act, in paragraph (d)(1), prior to initially providing or coordinating suicide prevention services to an eligible individual and their family, the grantee is required to notify each eligible individual and their family that the suicide prevention services are being paid for, in whole or in part, by VA; the suicide prevention services available to the eligible individual and their family through the grantee’s program; any conditions or restrictions on the receipt of suicide prevention services by the eligible individual and their family; and in the instance of an eligible individual who receives assistance from the grantee under this program, that the eligible individual is able to apply for enrollment in VA health care pursuant to 38 CFR 17.36. If the eligible individual wishes to enroll in VA health care, the grantee must inform the eligible individual of a VA point of contact for assistance in enrollment. These requirements concerning information about enrollment are consistent with section 201(e)(3) of the Act. While not every eligible individual may be able to enroll in VA health care under § 17.36, they can apply to determine their eligibility. It may not be possible to know at the time the eligible individual expresses an interest in enrolling in VA health care VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 whether or not the person is a veteran under 38 U.S.C. 101(2), so VA is using the term eligible individual, as it is more inclusive and potentially a more accurate description of the person at the point of time this information is provided. Other than members of the Armed Forces who are included as an eligible individual through reference to 38 U.S.C. 1712A(a)(1)(C)(i)–(iv), eligible individuals may be able to enroll in VA health care. Consequently, VA includes an exception in paragraph (d)(1)(iv) stating that the requirements in this clause do not apply to eligible individuals who are members of the Armed Forces described in section 1712A(a)(1)(C)(i)–(iv) of title 38, United States Code. In paragraph (d)(2), grantees must provide each participant with a satisfaction survey, which the participant can submit directly to VA, within 30 days of such participant’s pending exit from the grantee’s program. This is required to assist VA in evaluating grantees’ performance and participants’ satisfaction with the suicide prevention services they receive. This is consistent with the SSVF Program (see 38 CFR 62.36(c)(2)). Paragraph (e) requires that grantees regularly assess how suicide prevention services grant funds can be used in conjunction with other available funds and services to assist participants. This is consistent with the SSVF Program (see § 62.36(d)) and encourages grantees to leverage other financial resources to ensure continuity of program operations and assistance to participants. Paragraph (f) requires that for each participant, grantees must develop and document an individualized a plan with respect to the provision of suicide prevention services provided under this part. Consistent with section 201(e)(2) of the Act, this plan must be developed in consultation with the participant and must be maintained consistent with § 78.150. This requirement would ensure that a plan is developed to address the needs of participants. Such plan would include, but not be limited to, the suicide prevention services needed, the goals and objectives of the plan, and the applicable services. This plan would allow grantees and VA to monitor the delivery of suicide prevention services to participants. VA would include information about the suicide prevention services plan in the program guide developed for grantees. This requirement for a suicide prevention services plan is also authorized under section 201(f)(1) of the Act, as VA has authority to include such commitments as it considers necessary to carry out this section. PO 00000 Frm 00021 Fmt 4701 Sfmt 4700 13825 In paragraph (g), VA requires grantees to coordinate with VA with respect to the provision of health care and other services to eligible individuals under 38 U.S.C. Chapters 17 and 20. This is consistent with the requirements in section 201(e)(3)(A), (m), and (n) of the Act. VA expects that grantees will work with local VA facilities on a regular basis to coordinate care when needed for eligible individuals. Consistent with section 201(e)(4) of the Act, VA requires in paragraph (h) that the grantee submit to VA a description of the tools and assessments the grantee uses or will use to determine the effectiveness of the suicide prevention services furnished by the grantee. These include any measures and metrics developed and provided by VA for the purposes of measuring the effectiveness of the programming to be provided in improving mental health status and wellbeing, and reducing suicide risk and suicide deaths of eligible individuals. While the Act uses the phrase ‘‘completed suicides’’, VA uses the term ‘‘suicide deaths’’, as that is the terminology commonly used by VA. VA recognizes that messaging and language around suicide attempts and suicide death has an impact on beliefs and attitudes related to suicide. Thus, VA has developed a Safe Messaging Best Practices guide for public use regarding this topic. See https://www.mental health.va.gov/suicide_prevention/docs/ OMH-086-VA-OMHSP-Safe-MessagingFactsheet-4-9-2019.pdf. Consistent with section 201(o) of the Act, under paragraph (i), only grantees that are a State or local government or an Indian tribe are able to use grant funds to enter into an agreement with a community partner under which the grantee may provide funds to the community partner for the provision of suicide prevention services to eligible individuals and their families. Paragraph (j) explains that grantees may enter into contracts for goods or services under this part. Section 201(o)(2) of the Act states that the ability of a grantee to provide grant funds to a community partner is limited to grantees that are a State or local government or an Indian tribe. VA does not interpret section 201(o)(2) of the Act to prohibit a grantee from using funds provided under this part to pay vendors or contractors for certain services, as VA does not interpret the term ‘‘community partner’’ to limit such arrangements. Indeed, VA believes that if the term ‘‘community partner’’ prohibited the use of grant funds to be used to pay vendors and other contractors, section 201(o)(2) of the Act would effectively bar any entity that was not a State or local E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13826 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations government, or an Indian tribe, from participating in the grant program, or at least from providing many of the suicide prevention services defined in this rule. VA understands that the intent behind section 201(o)(2) of the Act was to clarify that only State or local governments and Indian tribes are able to provide sub-grants to community partners. VA’s interpretation, which permits grantees to use grant funds to pay vendors and contractors for goods and services, is consistent with this intent and is necessary for effective operation of the program. No nongovernmental entity, and likely no governmental entity, would be able to provide the full range of services identified as suicide prevention services in section 201(q)(11) of the Act absent the ability to pay vendors and contractors for goods and services. For example, assistance with emergent needs related to transportation services under section 201(q)(11)(A)(ix) often involves the provision of tokens or vouchers for use of transportation services such as buses or rail. However, no non-governmental entity, and few governmental entities, actually operate the transportation systems that would be needed to provide this assistance, so any effort to provide support with transportation services would require the use of grant funds to obtain goods or services from another party that is not a community partner. Similarly, Congress authorized up to $5,000 in assistance per family of an eligible individual per fiscal year for child care in section 201(q)(11)(A)(ix)(VIII) of the Act. Including a cap on the amount of funds that could be used for such services would not make sense unless Congress intended for grantees to be able to use grant funds to purchase goods and services like child care. Taken to its logical extreme, if section 201(o)(2) of the Act were to prohibit non-governmental grantees from providing any grant funds to any other party, these grantees would be prohibited from using grant funds to pay their utility bills, purchase office supplies, or pay rent. VA does not believe that such a result could possibly have been intended by Congress. VA further believes that existing Federal regulations concerning the use of grants, set forth in 2 CFR part 200, support VA’s interpretation. For example, 2 CFR 200.1 provides definitions applicable to the uniform administrative requirements, cost principles, and audit requirements for Federal awards. These regulations define the term ‘‘contract’’, for purposes of Federal financial assistance, as a legal VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 instrument by which a recipient or subrecipient purchases property or services needed to carry out the project or program under a Federal award. This is clearly distinguished from a subaward, which is an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a Federal award received by the pass-through entity; subawards do not include payments to a contractor or payments to an individual that is a beneficiary of a Federal program. In this context, VA interprets section 201(o)(2) of the Act as limiting the use of subawards but not contracts by grantees. Grantees may choose to enter into contracts because in some situations, resources may be more readily available at a lower cost, or they may only be available, from another party in the community. Lastly, in paragraph (k), VA requires grantees to ensure that suicide prevention services grants are administered in accordance with the requirements of part 78, the suicide prevention services grant agreement, and other applicable Federal, State, and local laws and regulations, including Federal civil rights laws. Grantees must ensure that any community partners carry out activities in compliance with this part. This is consistent with how VA administers the SSVF Program (see § 62.36(e)). 78.100 Fee Prohibition In § 78.100, VA prohibits grantees from charging a fee to participants for providing suicide prevention services that are funded with amounts from a suicide prevention services grant. VA believes this prohibition is appropriate because charging a fee could be a barrier to receiving care and services. There may be eligible individuals who may not be able to afford to pay any fees or those who do not otherwise seek care and services under this grant program because they do not want to pay a fee. Because of the importance of the services, including referrals to VA care as appropriate, provided under this grant program to eligible individuals at risk of suicide, VA does not want financial liability for fees to result in an eligible individual not receiving such critical services that may save such individual’s life, as doing so would be inconsistent with the purpose of this grant program under section 201 of the Act to reduce suicide among veterans. This prohibition is authorized by section 201(f)(1) of the Act, which permits VA to include such commitments as the Secretary considers necessary to carry out this section. This is also similar to other prohibitions that PO 00000 Frm 00022 Fmt 4701 Sfmt 4700 have been implemented for other, similar grant programs, such as the SSVF Program (see 38 CFR 62.37). VA also notes that collecting and processing fees would increase administrative costs and time for the grantee, which would negatively affect the provision of services to eligible individuals. 78.105 Ineligible Activities Section 78.105 sets forth certain activities for which grantees will not be authorized to use suicide prevention services grant funds. Pursuant to section 201(q)(11)(B) of the Act, direct cash assistance to participants is prohibited, which is reflected in paragraph (a). Other prohibited activities are set forth in paragraphs (b) through (d) to include those legal services prohibited pursuant to § 78.80(g); medical or dental care and medicines except for clinical services for emergency treatment authorized pursuant to § 78.60; and any activities considered illegal under Federal law. Some of the items on this list of ineligible activities are consistent with those prohibited under the SSVF Program (see 38 CFR 62.38). However, VA does not feel it is necessary to include all of the activities that are ineligible under the SSVF program as these programs have distinct purposes, and many of those ineligible activities (for example, mortgage costs) are not necessarily applicable to the suicide prevention grant program. If VA wanted to include any of those activities under this grant program, such activities would be subject to § 78.90. Similarly, VA does not think it is necessary to list every ineligible activity as all activities would be subject to the requirements in part 78. VA also notes that 2 CFR part 200 prohibits the use of grant awards for certain activities, such as entertainment. Such prohibitions are applicable to suicide prevention services grants awarded under part 78. However, it is unnecessary to include that language in § 78.105 because 2 CFR part 200 controls the administration of these grants regardless of whether explicit language exists in part 78. 78.110 Notice of Funding Opportunity Consistent with existing processes for other VA grant programs, VA will notify the public, through a NOFO, when funds for this grant program are available. Section 78.110 explains that when funds are available for the grant program, VA will publish a NOFO on grants.gov. It also describes the information that will be included in such NOFO, including the location for obtaining suicide prevention services grant applications; the date, time, and place for submitting completed suicide E:\FR\FM\10MRR2.SGM 10MRR2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations khammond on DSKJM1Z7X2PROD with RULES2 prevention services grant applications; the estimated amount and type of suicide prevention services grant funding available; any priorities for or exclusions from funding to meet the statutory mandates of section 201 of the Act and VA’s goals for SSG Fox SPGP; the length of term for the suicide prevention services grant award; the minimum number of total points and points per category that an applicant or grantee, as applicable, must receive for a suicide prevention services grant to be funded; any maximum uses of suicide prevention services grant funds for specific suicide prevention services; the timeframes and manner for payments under the suicide prevention services grant; and other information necessary for the suicide prevention services grant application process as determined by VA. This is consistent with the requirements and recommendations within 2 CFR part 200 regarding notices of funding opportunity (see 2 CFR 200.204). 78.115 Suicide Prevention Services Grant Agreements Consistent with other the SSVF Program (see 38 CFR 62.50) and 2 CFR 200.201, section 78.115 explains that VA and the selected applicant will enter into an agreement prior to obligating funds under part 78 and sets forth requirements that will be included in such agreement. Section 200.201 requires that Federal awarding agencies must decide on the appropriate instrument for Federal awards. Such appropriate instruments include grant agreements, which VA uses for the SSVF Program (see 38 CFR 62.50). This is also authorized by section 201(f)(1) of the Act, which permits VA to include such commitments as the Secretary considers necessary to carry out this section. This agreement will be enforceable against the grantee, providing VA assurance that the grantee will use the suicide prevention services grant funds in the manner described in the application and in accordance with the requirements of part 78. Paragraph (a) states that after an applicant is selected for a suicide prevention services grant in accordance with § 78.30, VA will draft a suicide prevention services grant agreement to be executed by VA and the applicant. Upon execution of the suicide prevention services grant agreement, VA will obligate suicide prevention services grant funds to cover the amount of the approved suicide prevention services grant, subject to the availability of funding. Such agreement will provide VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 that the grantee agrees, and will ensure that each community partner agrees, to operate the program in accordance with the provisions of part 78 and the applicant’s suicide prevention services grant application; comply with such other terms and conditions, including recordkeeping and reports for program monitoring and evaluation purposes, as VA may establish for purposes of carrying out SSG Fox SPGP, in an effective and efficient manner; and provide such additional information as deemed appropriate by VA. Paragraph (b) explains that after a grantee is selected for renewal of a suicide prevention services grant in accordance with § 78.40, VA will draft a suicide prevention services grant agreement to be executed by VA and the grantee. Upon execution of the suicide prevention services grant agreement, VA will obligate suicide prevention services grant funds to cover the amount of the approved suicide prevention services grant, subject to the availability of funding. Such grant agreement will contain the same provisions described in paragraph (a) of this section. Pursuant to paragraph (c), no funds provided under part 78 may be used to replace Federal, State, tribal, or local funds previously used, or designated for use, to assist eligible individuals and their families. 78.120 Amount and Payment of Grants Consistent with section 201(c)(2)(A) of the Act, § 78.120(a) states that the maximum funding that a grantee may be awarded under part 78 is $750,000 per fiscal year. VA may provide less than $750,000 per award per its discretion under section 201 of the Act. As explained in § 78.110, the NOFO will identify the estimated amount of grant funding available. However, because of the statutory restriction, VA will not provide more than $750,000 per grantee per fiscal year. Section 78.120(b) explains that grantees are to be paid in accordance with the timeframes and manner set forth in the NOFO. Section 201(c)(2)(B) of the Act authorizes VA to establish intervals of payment for purposes of this grant program, and VA will do so in the NOFO, which is consistent with how VA establishes payment in other grant programs. See 38 CFR 62.51. Including such information in the NOFO provides VA with the flexibility to determine the time and manner of payment for suicide prevention services grants that is appropriate for each funding cycle. PO 00000 Frm 00023 Fmt 4701 Sfmt 4700 13827 78.125 Program or Budget Changes and Corrective Action Plans Section 78.125 sets forth the requirements if there are changes to the program or budget that alter the grantee’s suicide prevention services grant program. This section is consistent with 2 CFR 200.308 which establishes policy and processes for revision of budget and program plans for Federal awards. These requirements are authorized by section 201(f)(1) of the Act, which permits VA to include such commitments as the Secretary considers necessary to carry out this section. These requirements are also consistent with how VA handles program and budget changes and corrective action plans in the SSVF Program (see 62 CFR 62.60) and allow VA to ensure that grant funds are used appropriately and to maintain control over the quality of suicide prevention services provided by the grantee. Paragraph (a) states that a grantee must submit to VA a written request to modify a suicide prevention services grant for any proposed significant change that will alter the suicide prevention services grant program. It further explains that if VA approves such change, it will issue a written amendment to the suicide prevention services grant agreement. A grantee must receive VA’s approval prior to implementing a significant change. Significant changes include, but are not limited to, a change in the grantee or any community partners identified in the suicide prevention services grant agreement; a change in the area served by the grantee; additions or deletions of suicide prevention services provided by the grantee; a change in category of participants to be served; and a change in budget line items that are more than 10 percent of the total suicide prevention services grant award. VA’s approval of changes will be contingent upon the grantee’s amended application retaining a sufficient rank to have been competitively selected for funding in the year that the application was granted, and each suicide prevention services grant modification request will be required to contain a description of, and justification for, the revised proposed use of suicide prevention services grant funds. Under paragraph (b), VA may require that the grantee initiate, develop, and submit to VA for approval a Corrective Action Plan (CAP) if, on a quarterly basis, actual suicide prevention services grant expenditures vary from the amount disbursed to a grantee for that same quarter or actual suicide prevention services grant activities vary E:\FR\FM\10MRR2.SGM 10MRR2 13828 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations khammond on DSKJM1Z7X2PROD with RULES2 from the grantee’s program description provided in the suicide prevention services grant agreement. Paragraph (b) also sets forth specific requirements related to the CAP. These include that the CAP must identify the expenditure or activity source that has caused the deviation, describe the reason(s) for the variance, provide specific proposed corrective action(s), and provide a timetable for accomplishment of the corrective action. After receipt of the CAP, VA will send a letter to the grantee indicating that the CAP is approved or disapproved. If disapproved, VA will make beneficial suggestions to improve the proposed CAP and request resubmission or take other actions in accordance with this part. Paragraph (c) explains that grantees are required to inform VA in writing of any key personnel changes (e.g., new executive director, suicide prevention services grant program director, or chief financial officer) and grantee address changes within 30 days of the change. 78.130 Faith-Based Organizations As VA anticipates that religious or faith-based organizations may apply for grants under part 78, § 78.130 explains that religious or faith-based organizations are eligible for suicide prevention services grants and describes the conditions for use of these grants as they relate to religious activities. This is similar to the language used in the Homeless Providers Grant and Per Diem Program (38 CFR 61.64) and the SSVF Program (38 CFR 61.62). However, VA has moved the definitions of indirect financial assistance and direct federal financial assistance to the definitions section of part 78. Under paragraph (a), organizations that are faith-based will be eligible, on the same basis as any other organization, to participate in SSG Fox SPGP under part 78. Decisions about awards of Federal financial assistance must be free from political interference or even the appearance of such interference and must be made on the basis of merit, not on the basis of religion or religious belief or lack thereof. Paragraph (b)(1) states that no organization may use direct financial assistance from VA under this part to pay for any of the following: (i) Explicitly religious activities such as, religious worship, instruction, or proselytization; or (ii) equipment or supplies to be used for any of those activities. Paragraph (b)(2) states that references to financial assistance are deemed to be references to direct Federal financial assistance, unless the referenced assistance meets the VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 definition of indirect Federal financial assistance in part 78. Under paragraph (c), organizations that engage in explicitly religious activities, such as worship, religious instruction, or proselytization, must offer those services separately in time or location from any programs or services funded with direct financial assistance from VA under this part, and participation in any of the organization’s explicitly religious activities must be voluntary for the participants in a program or service funded by direct financial assistance from VA under part 78. Paragraph (d) states that a faith-based organization that participates in SSG Fox SPGP under part 78 will retain its independence from Federal, State, or local governments. It further states that such organizations may continue to carry out its mission, including the definition, practice and expression of its religious beliefs, so long as the organization does not use direct financial assistance from VA under part 78 to support any explicitly religious activities, such as worship, religious instruction, or proselytization. Faithbased organizations may use space in their facilities to provide VA-funded services under part 78, without concealing, removing, or altering religious art, icons, scripture, or other religious symbols. In addition, a VAfunded faith-based organization retains its authority over its internal governance, and it may retain religious terms in its organization’s name, select its board members and otherwise govern itself on a religious basis, and include religious reference in its organization’s mission statements and other governing documents. Under paragraph (e), an organization that participates in a VA program under this part must not, in providing direct program assistance, discriminate against a program participant or prospective program participant on the basis of religion or religious belief. Under paragraph (f), if a State or local government voluntarily contributes its own funds to supplement Federally funded activities, the State or local government has the option to segregate the Federal funds or commingle them. However, if the funds are commingled, this provision applies to all of the commingled funds. Under paragraph (g), to the extent otherwise permitted by Federal law, the restrictions on explicitly religious activities set forth in this section do not apply where VA funds are provided to faith-based organizations through indirect assistance as a result of a genuine and independent private choice PO 00000 Frm 00024 Fmt 4701 Sfmt 4700 of a participant, provided the faithbased organizations otherwise satisfy the requirements of this part. A faithbased organization may receive such funds as the result of a participant’s genuine and independent choice if, for example, a participant redeems a voucher, coupon, or certificate, allowing the participant to direct where funds are to be paid, or a similar funding mechanism provided to that participant and designed to give that participant a choice among providers. 78.135 Visits to Monitor Operation and Compliance Section 78.135(a) authorizes VA, at all reasonable times, to make visits to all grantee locations where a grantee is using suicide prevention services grant funds to review grantee accomplishments and management control systems and to provide such technical assistance as may be required. VA may also conduct inspections of all program locations and records of a grantee at such times as are deemed necessary to determine compliance with the provisions of this part. In the event that a grantee delivers services in a participant’s home, or at a location away from the grantee’s place of business, VA may accompany the grantee. If the grantee’s visit is to the participant’s home, VA will only accompany the grantee with the consent of the participant. If any visit is made by VA on the premises of the grantee or a community partner under the suicide prevention services grant, the grantee must provide, and must require its community partners to provide, all reasonable facilities and assistance for the safety and convenience of the VA representatives in the performance of their duties. All visits and evaluations will be performed in such a manner as will not unduly delay services. Paragraph (b) explains that the authority to inspect carries with it no authority over the management or control of any applicant or grantee under this part. These provisions are critical for VA oversight over suicide prevention services grants and are consistent with how VA administers other grant programs (see 38 CFR 61.65 and 62.63). These provisions are authorized by section 201(f)(1) and 201(g) of the Act, which authorize VA to require eligible entities seeking grants to provide such commitments and information as VA considers necessary and require VA to provide training and technical assistance to eligible entities in receipt of grants. These provisions are also consistent with 2 CFR 200.329 regarding E:\FR\FM\10MRR2.SGM 10MRR2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations khammond on DSKJM1Z7X2PROD with RULES2 monitoring and reporting program performance for Federal awards. 78.140 Financial Management and Administrative Costs Section 78.140 sets forth requirements with which grantees must comply and ensures that grantees are aware of these requirements. These requirements are consistent with other grant programs, such as the SSVF Program (see 38 CFR 62.70) and the Homeless Providers Grant and Per Diem Program (see 38 CFR 61.66). Paragraph (a) requires grantees to comply with applicable requirements of the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards under 2 CFR part 200. Part 200 of 2 CFR establishes the uniform administrative requirements, cost principles, and audit requirements for Federal awards to nonFederal entities. Paragraph (b) requires grantees use a financial management system that provides adequate fiscal control and accounting records and meets the requirements set forth in 2 CFR part 200. Under paragraph (c), payment up to the amount specified in the suicide prevention services grant must be made only for allowable, allocable, and reasonable costs in conducting the work under the suicide prevention services grant, and the determination of allowable costs must be made in accordance with the applicable Federal Cost Principles set forth in 2 CFR part 200. Paragraph (d) prohibits costs for administration by a grantee from exceeding 10 percent of the total amount of the suicide prevention services grant. Administrative costs include all costs associated with the management of the program and include the administrative costs of community partners. VA has determined this limitation on administrative costs to be reasonable and consistent with the purpose of SSG Fox SPGP, as VA believes it is important that almost all of funding provided by VA goes towards providing services for participants. This requirement ensures that the vast majority of suicide prevention services grant funds (at least 90 percent) are used to provide suicide prevention services to participants. These requirements are also consistent with the SSVF Program, which allows only 10 percent of the grant funds to be used for specified administrative costs. See 38 CFR 62.10. VA has not identified any issues with this limitation in the context of the SSVF program. VA believes that 10 percent is a reasonable VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 maximum for administrative costs, and any additional funds needed by grantees to administer the suicide prevention services should be provided by non-VA funds. 78.145 Grantee Reporting Requirements Section 78.145 sets forth reporting requirements regarding the projects carried out using grant funds provided under part 78. Such reporting requirements ensure that grants funds are being properly used in accordance with the Act and with part 78, and that VA is being a good fiscal steward of the taxpayer dollar. These reporting requirements are consistent with subsections (e)(5) and (k) of section 201 of the Act. Section 201(e)(5)(A) mandates that VA require each entity receiving a suicide prevention services grant to submit to VA an annual report that describes the projects carried out with such grant during the year covered by the report. Section 201(e)(5)(C) further authorizes VA to require each such entity to submit to VA such additional reports as VA considers appropriate. Section 201(k) of the Act requires VA to submit an interim report and final report on the provision of grants to eligible entities under part 78 to the appropriate committees of Congress. Subsection (k)(1)(C) further provides VA with the authority to require eligible entities to provide to Congress such information as VA determines necessary regarding certain information that must be included in such reports. These provisions of section 201 of the Act are implemented in paragraphs (b) and (c), as explained in more detail below. Additionally, these reporting requirements are consistent with how VA administers the SSVF Program. See 38 CFR 62.71. In paragraph (a), VA reserves the right to require grantees to provide, in any form as may be prescribed, such reports or answers in writing to specific questions, surveys, or questionnaires as VA determines necessary to carry out SSG Fox SPGP. Consistent with section 201(e)(5)(A) of the Act, paragraph (b) requires that at least once per year, each grantee must submit to VA a report that describes the projects carried out with such grant during the year covered by the report; and information relating to operational effectiveness, fiscal responsibility, suicide prevention services grant agreement compliance, and legal and regulatory compliance, including a description of the use of suicide prevention grant funds, the number of participants assisted, the types of suicide prevention services provided, PO 00000 Frm 00025 Fmt 4701 Sfmt 4700 13829 and any other information that VA may request. The information gathered in this report should also support VA in carrying out its responsibilities under section 201(k) of the Act in providing necessary information to Congress to facilitate its oversight of this program. Under paragraph (c), VA retains the discretion to request additional reports or information to be able to fully assess the provision or coordination of the provision of suicide prevention services under part 78. This is a catch-all provision to allow VA to request additional reports or information that it may need to further assess the project and the pilot program. These will vary on a case-by-case basis dependent on the project and its progression. Additionally, if VA is required to submit additional reports to Congress on this pilot program, VA reserves the right under this paragraph to request such information as needed to respond to Congress. This also provides a safeguard in instances where there may be confusing, misleading, inconsistent, or unclear statements in submitted reports. VA reserves the right to request additional reports to clarify any such information it receives in other reports that are submitted by a grantee. This requirement is authorized by section 201(f)(1) of the Act, which authorizes VA to require applicants to provide such commitments and information as VA considers necessary, and by section 201(e)(5)(C) of the Act, which authorizes VA to require eligible entities to submit to VA such additional reports as VA considers appropriate. Paragraph (d) requires that all pages of the reports must cite the assigned suicide prevention services grant number and be submitted in a timely manner as set forth in the grant agreement. Including the assigned grant number on each page of the report is important for tracking reports and to ensure that all pages of the relevant report are received by VA for each grant. Paragraph (e) further requires that grantees provide VA with consent to post information from reports on the internet and use such information in other ways deemed appropriate by VA. Grantees shall clearly mark information that is confidential to individual participants. This is consistent with the SSVF program (see 38 CFR 62.71(f)). 78.150 Recordkeeping Section 78.150 requires grantees, consistent with 2 CFR 200.334, to keep records and maintain such records for at least a three-year period, to document compliance with SSG Fox SPGP requirements in part 78. Grantees will need to produce these records at VA’s E:\FR\FM\10MRR2.SGM 10MRR2 13830 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations request. This will assist VA in providing oversight of grantees and is consistent with section 201(k)(1)(B)(i) of the Act, which requires VA to assess the effectiveness of this grant program, as well as the requirements for recordkeeping in 2 CFR 200.334. khammond on DSKJM1Z7X2PROD with RULES2 78.155 Technical Assistance Consistent with section 201(g) of the Act, § 78.155 explains that VA will provide technical assistance, as necessary, to applicants and grantees to meet the requirements of part 78. Section 201(g) of the Act specifically requires VA to provide training and technical assistance, in coordination with the Centers for Disease Control and Prevention (CDC), to grantees regarding (1) suicide risk identification and management, (2) the data required to be collected and shared with VA, (3) the means of data collection and sharing, (4) familiarization with and appropriate use of any tool to be used to measure the effectiveness of the use of grants, and (5) the requirements for reporting on services provided via such grants. Section 78.155 further explains that such technical assistance will be provided either directly by VA or through contracts with appropriate public or non-profit private entities. Technical assistance may consist of activities related to the planning, development, and provision of suicide prevention services to participants. In addition to other forms of technical assistance that will be provided, such as training and assistance with the five categories described above, VA will develop a program guide to be used by applicants, grantees, VA staff members, and other interested third parties to assist with understanding and implementing SSG Fox SPGP. This technical assistance will be conducted in coordination with the CDC, as required by section 201(g)(1) of the Act. CDC will be available on technical assistance calls, including those relating to the availability of data on suicide in grantees’ local areas. This is consistent with the technical assistance VA provides in the SSVF Program. See 38 CFR 62.73. 78.160 Withholding, Suspension, Deobligation, Termination, and Recovery of Funds by VA Section 78.160 explains that VA will enforce part 78 through such actions as may be appropriate. Appropriate actions include withholding, suspension, deobligation, termination, recovery of funds by VA, and actions in accordance with 2 CFR part 200. As suicide prevention services grants are subject to the requirements of 2 CFR VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 part 200, VA explicitly references 2 CFR part 200 in § 78.160 to ensure that grantees understand and know where to locate these requirements related to withholding, suspension, deobligation, termination, and recovery of funds. The specific sections of 2 CFR part 200 on withholding, suspension, deobligation, termination, and recovery of funds are 2 CFR 200.208, 200.305, and 200.339 through 200.343, and 200.346, respectively. VA refers to 2 CFR part 200 rather than include those requirements in this section as those requirements in 2 CFR part 200 may change. Referencing 2 CFR part 200 provides VA the ability to implement those changes without having to conduct further rulemaking. VA acknowledges that when certain actions (such as suspension and termination) are taken against grantees pursuant to this section and 2 CFR part 200, a disruption in services to participants may occur. While VA is not regulating responsibilities for grantees to continue to provide services or to coordinate the transfer of participants to other sources of support, VA will include such requirements and responsibilities in the grant agreement that VA and the grantee enter into pursuant to this part. This will ensure that the disruption and impact upon participants is minimized as much as possible. 78.165 Suicide Prevention Services Grant Closeout Procedures Section 78.165 explains that suicide prevention services grants will be closed out in accordance with 2 CFR part 200. Procedures for closing out Federal awards are currently located at 2 CFR 200.344 and 200.345. As suicide prevention services grants are subject to the requirements of 2 CFR part 200, VA explicitly references 2 CFR part 200 in § 78.165 to ensure that grantees understand and know where to locate these requirements. VA refers to 2 CFR part 200 rather than include those requirements in this section as those requirements in 2 CFR part 200 may change, and referencing 2 CFR part 200 provides VA ability to implement those changes without having to conduct further rulemaking. Administrative Procedure Act The Administrative Procedure Act (APA), codified in part at 5 U.S.C. 553, generally requires agencies publish substantive rules in the Federal Register for notice and comment. These notice and comment requirements generally do not apply to ‘‘a matter relating to agency management or personnel or to public property, loans, grants, benefits or PO 00000 Frm 00026 Fmt 4701 Sfmt 4700 contracts.’’ 5 U.S.C. 553(a)(2). However, 38 U.S.C. 501(d) requires VA comply with the notice and comment requirements in 5 U.S.C. 553 for matters relating to grants, notwithstanding section 553(a)(2). Thus, as this rulemaking relates to the grant program required by section 201 of the Act, VA is required to comply with the notice and comment requirements of 5 U.S.C. 553. However, pursuant to 5 U.S.C. 553(b)(B), general notice and the opportunity for public comment are not required with respect to a rulemaking when an ‘‘agency for good cause finds (and incorporates the finding and a brief statement of reasons therefor in the rules issued) that notice and public procedure thereon are impracticable, unnecessary, or contrary to the public interest.’’ In accordance with 5 U.S.C. 553(b)(B), the Secretary has concluded that there is good cause to publish this rule without prior opportunity for public comment. This rule implements the mandates of section 201 of the Act to establish a new suicide prevention services grant program. This new grant program, SSG Fox SPGP, will provide eligible individuals and their families with suicide prevention services that will aim to reduce and prevent suicide by providing outreach, mental health screenings, education on suicide risk and prevention, clinical services for emergency treatment, case management services, peer support services, and assistance with obtaining VA and other government benefits, among other services. Suicide is a national public health concern, and it is preventable. The rate of veteran suicide in the United States remains high, despite great effort. It is critical that this rulemaking publish without delay, as these grants will result in increased engagement with a specific population at risk of suicide, which is especially needed during the Coronavirus Disease–2019 (COVID–19) pandemic and the immediate period following this pandemic. The COVID– 19 pandemic has caused significant psychological distress related to economic hardships, physical safety concerns, illness, and death of family and friends, uncertainty about the future, and isolation from social supports. See Panchal, N., Kamal, R., Orgera, K., Cox, C., Garfield, R., Hamel, L., Mun˜ana, C. & Chidambaram, P. (2021). The implications of COVID–19 for mental health and substance use. Kaiser Family Foundation. https:// www.kff.org/coronavirus-covid-19/ issuebrief/the-implications-of-covid-19for-mental-health-and-substance-use; E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations See also, Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G.J., (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet, 395, 912–920. COVID–19 has had a detrimental effect on mental health in the United States. See id.; see also, Czeisler, ME´, Lane, RI, Petroski, E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID–19 Pandemic— United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049; See also, National Center for Health Statistics (2021). Anxiety and depression: Household Pulse Survey. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/ covid19/pulse/mental-health.htm (Last accessed May 17, 2021). According to a recent CDC report, more Americans are reporting negative mental health impacts, including higher rates of suicidal thoughts, during the COVID–19 pandemic. Czeisler ME´, Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID–19 Pandemic— United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: https:// dx.doi.org/10.15585/mmwr.mm6932a1. While this report examined the general population of America, there is also evidence of increased distress among the veteran population. For instance, there has been an increase in call volume to the Veterans Crisis Line (VCL). In fiscal year (FY) 2019, VCL answered an average daily call volume of 1590.67 calls compared with 1765.02 FY 2020 and 1807.52 in FY 2021, with VCL call volume increasing over 22% in direct-date comparisons from FY 2019 to FY 2021. Veterans, in particular, may be uniquely vulnerable to negative mental health effects of the pandemic such as suicidality due to their older age, previous trauma exposures, and higher pre-pandemic prevalence of physical and psychiatric risk factors and conditions. Na, P.J., Tsai, J., Hill, M.L., Nichter, B., Norman, S.B., Southwick, S.M., & Pietrzak, R.H. (2021). Prevalence, risk and protective factors associated with suicidal ideation during the COVID–19 pandemic in U.S. military veterans with pre-existing psychiatric conditions. Journal of Psychiatric Research, 137, 351–359. In an analysis of data from the National Health and Resilience in Veterans Study, researchers found that 19.2% of veterans screened positive for suicidal ideation peri-pandemic, and such veterans had lower income, were more likely to have been infected with VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 COVID–19, reported greater COVID–19related financial and social restriction stress, and increases in psychiatric symptoms and loneliness during the pandemic when compared to veterans without suicidal ideation. Id. Additionally, they found that among veterans who were infected with COVID–19, those aged 45 or older and who reported lower purpose in life were more likely to endorse suicidal ideation. Id. These researchers noted that monitoring for suicide risk and worsening psychiatric symptoms in older veterans who have been infected with COVID–19 may be important, and that interventions that enhance purpose in life may help protect against suicidal ideation in this population. Consistent with the recommendations of this research, SSG Fox SPGP will support monitoring for suicide risk and worsening psychiatric symptoms by providing support to more organizations who can reach veterans who do not seek or obtain care through VA. Through this grant program, organizations’ efforts can also help protect this population against suicidal ideation by enhancing purpose in life. Furthermore, studies have shown increased suicide after pandemics such as the 1918 Influenza (H1N1) pandemic and the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, in which increased risk factors associated with negative impacts of epidemics were believed to contribute to suicide. See Wasserman IM. The impact of epidemic, war, prohibition and media on suicide: United States, 1910–1920. Suicide Life Threat Behav. 1992 Summer;22(2):240– 54. PMID: 1626335.; See also, Cheung YT., Chau PH., and Yip PS. A revisit on older adults suicides and severe acute respiratory syndrome (SARS) epidemic in Hong Kong. Int J Geriatr Psychiatry. 2008; 23: 1231–1238. Thus, increased suicide death could occur after the COVID–19 pandemic unless action is taken. See Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur, N., Khan, M., O’Connor, R.C., & Pirkis, J. (2020). Suicide risk and prevention during the COVID–19 pandemic. The Lancet Psychiatry, 7(6), 468–471. It is therefore critical that VA publish this rulemaking without delay to ensure the services provided through this grant program will assist the growing number of eligible individuals who are suffering from mental health concerns and may be at risk of suicide as a result of the COVID–19 pandemic, particularly as the period immediately following a pandemic can result in elevated risk of suicide. Publishing this rulemaking without delay will help ensure that PO 00000 Frm 00027 Fmt 4701 Sfmt 4700 13831 services under this grant program can be provided to eligible individuals during the pandemic or in the immediate aftermath of it when they can have the most impact. As noted earlier in this section, efforts and actions supported through this grant program will be consistent with recent findings and recommendations on the impact of the COVID–19 pandemic on veterans and can help protect this population against suicidal ideation. See, Na, P.J., Tsai, J., Hill, M.L., Nichter, B., Norman, S.B., Southwick, S.M., & Pietrzak, R.H. (2021). Prevalence, risk and protective factors associated with suicidal ideation during the COVID–19 pandemic in U.S. military veterans with pre-existing psychiatric conditions. Journal of Psychiatric Research, 137, 351–359. VA believes that increased engagement with veterans and their families from VA and community partners through this grant program will help prevent veteran suicide. As detailed in VA’s 2021 National Veteran Suicide Prevention Annual Report, the average number of veteran suicide deaths per day in 2019 was 17.2. (Available online: https://www.mental health.va.gov/docs/data-sheets/2021/ 2021-National-Veteran-SuicidePrevention-Annual-Report-FINAL-9-821.pdf). Of those, 6.8 were veterans who recently used VA health care (that is, these veterans had received VA health care services within the preceding two years) and 10.4 were veterans who had not recently used VA health care. See id. Furthermore, from 2005 to 2018, suicide rates fell among veterans with depression, anxiety, and substance use disorders who were in VA care. See VA’s 2020 National Veteran Suicide Prevention Annual Report. (Available online: https://www.mentalhealth. va.gov/docs/data-sheets/2020/2020National-Veteran-Suicide-PreventionAnnual-Report-11-2020-508.pdf. In addition to VA engagement and services reducing suicide rates, studies have shown that community-based and public health suicide prevention have been effective in reducing suicide rates in diverse communities. See Hegerl, U., Althaus, D., Schmidtke, A., & Niklewski, G. (2006); The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychological Medicine, 36(9), 1225–1233. These statistics and studies support VA’s contention that increased engagement from VA and community partners through this grant program can help reduce suicide risk among eligible individuals by providing critical E:\FR\FM\10MRR2.SGM 10MRR2 13832 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations services connecting veterans with VA care and services. Additionally, this rulemaking is not entirely without public input. VA reiterates that as described earlier in this document, VA published a request for information on this rulemaking and held multiple listening sessions to obtain input from the public as part of the consultation required by section 201 of the Act. Conducting consultation in this manner is consistent with VA’s past practice and interpretation of consultation requirements under Federal law. VA received 124 comments in response to the request for information and had 32 speakers at the listening sessions. This public input has been reviewed and incorporated, as appropriate, into this rulemaking. For these reasons, the Secretary has concluded that ordinary notice and comment procedures would be impracticable and contrary to the public interest and is accordingly issuing this rule as an interim final rule. The Secretary will consider and address comments that are received within 60 days after the date that this interim final rule is published in the Federal Register and address them in a subsequent Federal Register document announcing a final rule incorporating any changes made in response to the public comments. khammond on DSKJM1Z7X2PROD with RULES2 Executive Orders 12866 and 13563 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. The Office of Information and Regulatory Affairs has determined that this rule is a significant regulatory action under Executive Order 12866. The Regulatory Impact Analysis associated with this rulemaking can be found as a supporting document at www.regulations.gov. Regulatory Flexibility Act The Regulatory Flexibility Act, 5 U.S.C. 601–612, is not applicable to this rulemaking because notice of proposed rulemaking is not required. 5 U.S.C. 601(2), 603(a), 604(a). VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 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 interim final rule will have no such effect on State, local, and tribal governments, or on the private sector. Paperwork Reduction Act This interim final rule includes provisions constituting new collections of information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501– 3521) that require approval by the Office of Management and Budget (OMB). Accordingly, under 44 U.S.C. 3507(d), VA has submitted a copy of this rulemaking action to OMB for review. OMB assigns control numbers to collections of information it approves. VA 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. Sections 78.10, 78.15, 78.95, 78.125, 78.145 contain new collections of information under the Paperwork Reduction Act of 1995. If OMB does not approve the collections of information as requested, VA will immediately remove the provisions containing a collection of information or take such other action as is directed by OMB. Comments on the new collection of information contained in this rulemaking should be submitted through www.regulations.gov. Comments should indicate that they are submitted in response to ‘‘RIN 2900– AR16—Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program’’ and should be sent within 30 days of publication of this rulemaking. The collection of information associated with this rulemaking can be viewed at: www.reginfo.gov/public/do/PRAMain. A comment to OMB is best assured of having its full effect if OMB receives it within 30 days of publication. This does not affect the deadline for the public to comment on the interim final rule. The Department considers comments by the public on proposed collections of information in— • Evaluating whether the proposed collections of information are necessary for the proper performance of the functions of the Department, including whether the information will have practical utility; • Evaluating the accuracy of the Department’s estimate of the burden of PO 00000 Frm 00028 Fmt 4701 Sfmt 4700 the proposed collections of information, including the validity of the methodology and assumptions used; • Enhancing the quality, usefulness, and clarity of the information to be collected; and • Minimizing the burden of the collections of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses. The collections of information contained in 38 CFR 78.10, 78.15, 78.95, 78.125, and 78.145 are described immediately following this paragraph, under their respective titles. Title: Eligibility Screening. OMB Control No: 2900–TBD (New). CFR Provision: 38 CFR 78.10. • Summary of collection of information: This new collection of information in 38 CFR 78.10 requires grantees to determine eligibility for purposes of this grant program using screening tools. • Description of need for information and proposed use of information: This collection of information is necessary to evaluate and determine eligibility for suicide prevention services and ensure that VA resources are directed at the intended population, in an efficient equitable method. • Description of likely respondents: Grantees. • Estimated number of respondents: 90. • Estimated frequency of responses: 67. • Estimated average burden per response: 30 minutes. • Estimated total annual reporting and recordkeeping burden: 3,015 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $81,616.05. Title: Suicide Risk Screening. OMB Control No: 2900–TBD (New). CFR Provision: 38 CFR 78.10. • Summary of collection of information: This new collection of information in 38 CFR 78.10 requires grantees to use screening tools to assess risk of suicide among program participants for purposes of implementing this grant program. • Description of need for information and proposed use of information: This collection of information is necessary to assess risk of suicide and ensure that VA resources are directed at the intended population, in an efficient equitable method. • Description of likely respondents: Grantees. E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations • Estimated number of respondents: 90. • Estimated frequency of responses: 67. • Estimated average burden per response: 15 minutes. • Estimated total annual reporting and recordkeeping burden: 1,507.5 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $40,808.03. Title: Application Provisions for the Staff Sergeant Gordon Parker Fox Suicide Prevention Grant Program. OMB Control No: 2900–TBD (New). CFR Provision: 38 CFR 78.15. • Summary of collection of information: The new collection of information in 38 CFR 78.15 requires applications be submitted to be evaluated and considered for a grant under this new part 78. Applications require specific information so that VA can properly evaluate such applications for grants. • Description of need for information and proposed use of information: This collection of information is necessary to award suicide prevention services grants to eligible entities. • Description of likely respondents: Eligible entities. • Estimated number of respondents: 250. • Estimated frequency of responses: 1. • Estimated average burden per response: 2,100 minutes. • Estimated total annual reporting and recordkeeping burden: 8,750 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $236,862.50. Title: Suicide Prevention Services Grant Renewal Applications. OMB Control No: 2900–TBD (New). CFR Provision: 38 CFR 78.15. • Summary of collection of information: The new collection of information in 38 CFR 78.15 requires that renewal applications be submitted to be evaluated and receive a renewal of a grant under this new part 78. Applications require specific information so that VA can properly evaluate such applications for renewal of grants. • Description of need for information and proposed use of information: This collection of information is necessary to award suicide prevention services grants to eligible entities. • Description of likely respondents: Grantees that seek renewal of their grants. • Estimated number of respondents: 90. VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 • Estimated frequency of responses: 1. • Estimated average burden per response: 600 minutes. • Estimated total annual reporting and recordkeeping burden: 900 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $24,363. Title: Participant Satisfaction Surveys. OMB Control No: 2900–TBD (New). CFR Provision: 38 CFR 78.95. • Summary of collection of information: The new collection of information in 38 CFR 78.95 requires grantees to conduct satisfaction surveys from participants. • Description of need for information and proposed use of information: The collection of information is necessary to evaluate whether participants are satisfied with the suicide prevention services provided by the grantee and the effectiveness of such services. • Description of likely respondents: Eligible individuals and their families who receive suicide prevention services. • Estimated number of respondents: 5,000. • Estimated frequency of responses: 1. • Estimated average burden per response: 15 minutes. • Estimated total annual reporting and recordkeeping burden: 1,250 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $33,837.50. Title: Intake Form. OMB Control No: 2900–TBD (New). CFR Provision: 38 CFR 78.95. • Summary of collection of information: The new collection of information in 38 CFR 78.95 requires grantees to use tools and assessments (that is, an intake form) to determine the effectiveness of the suicide prevention services furnished by the grantee. • Description of need for information and proposed use of information: The collection of information is necessary to ensure that the appropriate services are offered to participants, and the data collected will be used by VA to determine the participant’s baseline with regards to mood-related symptoms, overall wellbeing, and financial stressors and social supports. This will enable VA to measure the effectiveness of the programming provided in improving mental health status, wellbeing, and reducing suicide risk and suicide deaths of eligible individuals. • Description of likely respondents: Grantees. • Estimated number of respondents: 90. PO 00000 Frm 00029 Fmt 4701 Sfmt 4700 13833 • Estimated frequency of responses: 67. • Estimated average burden per response: 30 minutes. • Estimated total annual reporting and recordkeeping burden: 3,015 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $81,616.05. Title: Program Exit Checklist. OMB Control No: 2900–TBD (New). CFR Provision: 38 CFR 78.95. • Summary of collection of information: The new collection of information in 38 CFR 78.95 requires grantees to use tools and assessments (that is, a program exit checklist) to determine the effectiveness of the suicide prevention services furnished by the grantee. • Description of need for information and proposed use of information: The collection of information is necessary to determine whether there was a reduction of the participant’s moodrelated symptoms, an overall improved wellbeing, and mitigation of any financial and social support stressors. This will enable VA to measure the effectiveness of the programming provided in improving mental health status, wellbeing, and reducing suicide risk and suicide deaths of eligible individuals. • Description of likely respondents: Grantees. • Estimated number of respondents: 90. • Estimated frequency of responses: 67. • Estimated average burden per response: 30 minutes. • Estimated total annual reporting and recordkeeping burden: 3,015 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $81,616.05. Title: Program and Budget Changes. OMB Control No: 2900–TBD (New). CFR Provision: 38 CFR 78.125. • Summary of collection of information: The new collection of information in 38 CFR 78.125 requires certain grantees to provide VA with program and/or budget changes. • Description of need for information and proposed use of information: Reporting of program/budget changes is necessary for VA to approve and ensure that such changes are consistent with proposed 38 CFR part 78 and the goals and intent of the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program. These collections are not required of every grantee and are needed only in limited instances. • Description of likely respondents: Grantees. E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13834 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations • Estimated number of respondents: 90. • Estimated frequency of responses: 2. • Estimated average burden per response: 15 minutes. • Estimated total annual reporting and recordkeeping burden: 45 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $1,218.15. Title: Annual Performance Compliance Reports for Suicide Prevention Services Program. OMB Control No: 2900–TBD (New). CFR Provision: 38 CFR 78.145. • Summary of collection of information: The new collection of information in 38 CFR 78.145 requires grantees to provide annual reports to assess the provision of services under this grant program. • Description of need for information and proposed use of information: The collection of information is necessary to determining compliance with the requirements for a suicide prevention services grant and to assess the provision of services under this grant program. • Description of likely respondents: Grantees. • Estimated number of respondents: 90. • Estimated frequency of responses: 1. • Estimated average burden per response: 45 minutes. • Estimated total annual reporting and recordkeeping burden: 67.50 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $1,827.23. Title: Other Performance Compliance Reports for Suicide Prevention Services Program. OMB Control No.: 2900–TBD (New). CFR Provision: 38 CFR 78.145. • Summary of collection of information: The new collection of information in 38 CFR 78.145 requires grantees to provide two performance reports to assess the provision of services under this grant program. • Description of need for information and proposed use of information: The collection of information is necessary to determining compliance with the requirements for a suicide prevention services grant and to assess the provision of services under this grant program. • Description of likely respondents: Grantees. • Estimated number of respondents: 90. • Estimated frequency of responses: 2. VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 • Estimated average burden per response: 30 minutes. • Estimated total annual reporting and recordkeeping burden: 90 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $2,436.30. Title: Other Financial Compliance Reports for Suicide Prevention Services Program. OMB Control No.: 2900–TBD (New). CFR Provision: 38 CFR 78.145. • Summary of collection of information: The new collection of information in 38 CFR 78.145 requires grantees to provide two reports to assess financial compliance under this grant program. • Description of need for information and proposed use of information: The collection of information is necessary to determining compliance with the financial requirements for a suicide prevention services grant. • Description of likely respondents: Grantees. • Estimated number of respondents: 90. • Estimated frequency of responses: 2. • Estimated average burden per response: 30 minutes. • Estimated total annual reporting and recordkeeping burden: 90 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $2,436.30. Title: Annual Financial Expenditure Reports for Suicide Prevention Services Program. OMB Control No.: 2900–TBD (New). CFR Provision: 38 CFR 78.145. • Summary of collection of information: The new collection of information in 38 CFR 17.145 requires grantees to provide annual reports to assess financial expenditure compliance under this grant program. • Description of need for information and proposed use of information: The collection of information is necessary to determining compliance with the financial expenditure requirements for a suicide prevention services grant. • Description of likely respondents: Grantees. • Estimated number of respondents: 90. • Estimated frequency of responses: 1. • Estimated average burden per response: 45 minutes. • Estimated total annual reporting and recordkeeping burden: 67.5 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $1,827.23. Title: Compliance—Corrective Action Plan. PO 00000 Frm 00030 Fmt 4701 Sfmt 4700 OMB Control No.: 2900–TBD (New). CFR Provision: 38 CFR 17.145. • Summary of collection of information: The new collection of information in 38 CFR 78.145 requires grantees to provide ad hoc compliance corrective action plans under this grant program. • Description of need for information and proposed use of information: The collection of information is necessary to determining compliance with any necessary corrective action plans for a suicide prevention services grant. • Description of likely respondents: Grantees. • Estimated number of respondents: 25. • Estimated frequency of responses: 1. • Estimated average burden per response: 30 minutes. • Estimated total annual reporting and recordkeeping burden: 12.5 hours. • * Estimated annual cost to respondents for the hour burdens for collections of information: $338.38. * To estimate the total information collection burden cost, VA used the Bureau of Labor Statistics (BLS) median hourly wage for hourly wage for ‘‘all occupations’’ of $27.07 per hour. This information is available at https:// www.bls.gov/oes/current/oes_ nat.htm#13-0000. Assistance Listing The Assistance Listing number and title for the program affected by this document is 64.009, Veterans Medical Care Benefits. Congressional Review Act Pursuant to Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996, also known as the Congressional Review Act (5 U.S.C. 801 et seq.), the Office of Information and Regulatory Affairs designated this rule as not a major rule, as defined by 5 U.S.C. 804(2). List of Subjects in 38 CFR Part 78 Administrative practice and procedure; Grant programs—health; Grant programs—veterans; Health care; Mental health programs; Reporting and recordkeeping requirements; Veterans. Signing Authority Denis McDonough, Secretary of Veterans Affairs, approved this document on November 24, 2021, and authorized the undersigned to sign and submit the document to the Office of the Federal Register for publication E:\FR\FM\10MRR2.SGM 10MRR2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations electronically as an official document of the Department of Veterans Affairs. Jeffrey M. Martin, Assistant Director, Office of Regulation Policy & Management, Office of General Counsel, Department of Veterans Affairs. For the reasons stated in the preamble, the Department of Veterans Affairs amends 38 CFR chapter I by adding part 78 to read as follows: ■ khammond on DSKJM1Z7X2PROD with RULES2 PART 78—STAFF SERGEANT PARKER GORDON FOX SUICIDE PREVENTION GRANT PROGRAM Sec. 78.0 Purpose and scope. 78.5 Definitions. 78.10 Eligible individuals. 78.15 Applications for suicide prevention services grants. 78.20 Threshold requirements prior to scoring suicide prevention services grant applicants. 78.25 Scoring criteria for awarding grants. 78.30 Selection of grantees. 78.35 Scoring criteria for grantees applying for renewal of suicide prevention services grants. 78.40 Selection of grantees for renewal of suicide prevention services grants. 78.45 Suicide prevention services: Outreach. 78.50 Suicide prevention services: Baseline mental health screening. 78.55 Suicide prevention services: Education. 78.60 Suicide prevention services: Clinical services for emergency treatment. 78.65 Suicide prevention services: Case management services. 78.70 Suicide prevention services: Peer support services. 78.75 Suicide prevention services: Assistance in obtaining VA benefits. 78.80 Suicide prevention services: Assistance in obtaining and coordinating other public benefits and assistance with emergent needs. 78.85 Suicide prevention services: Nontraditional and innovative approaches and treatment practices. 78.90 Suicide prevention services: Other services. 78.95 General operation requirements. 78.100 Fee prohibition. 78.105 Ineligible activities. 78.110 Notice of Funding Opportunity. 78.115 Suicide prevention services grant agreements. 78.120 Amount and payment of grants. 78.125 Program or budget changes and corrective action plans. 78.130 Faith-based organizations. 78.135 Visits to monitor operation and compliance. 78.140 Financial management and administrative costs. 78.145 Grantee reporting requirements. 78.150 Recordkeeping. 78.155 Technical assistance. 78.160 Withholding, suspension, deobligation, termination, and recovery of funds by VA. VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 78.165 Suicide prevention services grant closeout procedures. Authority: 38 U.S.C. 501, 38 U.S.C. 1720F (note), sec. 201, Pub. L. 116–171, and as noted in specific sections. § 78.0 Purpose and scope. (a) Purpose. This part implements the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP) with the purpose of reducing veteran suicide by expanding suicide prevention programs for veterans through the award of suicide prevention services grants to eligible entities to provide or coordinate the provision of suicide prevention services to eligible individuals and their families. (b) Scope. Suicide prevention services covered by this part are those services that address the needs of eligible individuals and their families and are necessary for improving the mental health status and wellbeing and reducing the suicide risk of eligible individuals and their families. § 78.5 Definitions. For purposes of this part and any Notice of Funding Opportunity (NOFO) issued under this part: Applicant means an eligible entity that submits an application for a suicide prevention services grant announced in a NOFO. Direct Federal financial assistance means Federal financial assistance received by an entity selected by the Government or a pass-through entity as defined in 38 CFR 50.1(d) to provide or carry out a service (e.g., by contract, grant, or cooperative agreement). Eligible child care provider means a provider of child care services for compensation, including a provider of care for a school-age child during nonschool hours, that— (1) Is licensed, regulated, registered, or otherwise legally operating, under State and local law; and (2) Satisfies the State and local requirements, applicable to the child care services the provider providers. Eligible entity means an entity that meets the definition of an eligible entity in section 201(q) of Public Law 116– 171. Eligible individual means an individual that meets the requirements of § 78.10(a). Family means any of the following: A parent, spouse, child, sibling, stepfamily member, extended family member, and any other individual who lives with the eligible individual. Grantee means an eligible entity that is awarded a suicide prevention services grant under this part. Indian tribe means an Indian tribe as defined in 25 U.S.C. 4103. PO 00000 Frm 00031 Fmt 4701 Sfmt 4700 13835 Indirect Federal financial assistance means Federal financial assistance in which a service provider receives program funds through a voucher, certificate, agreement or other form of disbursement, as a result of the genuine, independent choice of a participant. Medically underserved area means an area that is designated as a medically underserved population under 42 U.S.C. 254b(b)(3). Notice of Funding Opportunity (NOFO) means a Notice of Funding Opportunity published on grants.gov in accordance with § 78.110. Participant means an eligible individual or their family who is receiving suicide prevention services for which they are eligible from a grantee. Rural communities means those communities considered rural according to the Rural-Urban Commuting Area (RUCA) system as determined by the United States Department of Agriculture. State means any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments. Suicide prevention services includes the following services provided to address the needs of a participant: (1) Outreach as specified under § 78.45. (2) Baseline mental health screening as specified under § 78.50. (3) Education as specified under § 78.55. (4) Clinical services for emergency treatment as specified under § 78.60. (5) Case management services as specified under § 78.65. (6) Peer support services as specified under § 78.70. (7) Assistance in obtaining VA benefits as specified under § 78.75. (8) Assistance in obtaining and coordinating other public benefits and assistance with emergent needs as specified under § 78.80. (9) Nontraditional and innovative approaches and treatment practices as specified under § 78.85. (10) Other services as specified under § 78.90. Suicide prevention services grant means a grant awarded under this part. Suicide prevention services grant agreement means the agreement executed between VA and a grantee as specified under § 78.115. Suspension means an action by VA that temporarily withdraws VA funding under a suicide prevention services grant, pending corrective action by the grantee or pending a decision to E:\FR\FM\10MRR2.SGM 10MRR2 13836 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations terminate the suicide prevention services grant by VA. Suspension of a suicide prevention services grant is a separate action from suspension under VA regulations or guidance implementing Executive Orders 12549 and 12689, ‘‘Debarment and Suspension.’’ Territories means the territories of the United States, including Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands. Veterans means a veteran as defined under 38 U.S.C. 101(2). Veterans Crisis Line means the tollfree hotline for veterans in crisis and their families and friends established under 38 U.S.C. 1720F(h). Withholding means that payment of a suicide prevention services grant will not be paid until such time as VA determines that the grantee provides sufficiently adequate documentation and/or actions to correct a deficiency for the suicide prevention services grant. § 78.10 Eligible individuals. khammond on DSKJM1Z7X2PROD with RULES2 (a) To be an eligible individual under this part, a person must be at risk of suicide and further meet the definition of eligible individual in section 201(q) of Public Law 116–171. (b) For purposes of paragraph (a) of this section, risk of suicide means exposure to, or the existence of, any of the following factors, to any degree, that increase the risk for suicidal ideation and/or behaviors: (1) Health risk factors, including mental health challenges, substance use disorder, serious or chronic health conditions or pain, and traumatic brain injury. (2) Environmental risk factors, including prolonged stress, stressful life events, unemployment, homelessness, recent loss, and legal or financial challenges. (3) Historical risk factors, including previous suicide attempts, family history of suicide, and history of abuse, neglect, or trauma, including military sexual trauma. Note 1 to paragraph (b): Grantees must use these risk factors and the impact thereof to determine the degree of risk of suicide for eligible individuals using a screening tool approved by the Department. The degree of risk depends on the presence of one or more suicide risk factors and the impact of those factors on an individual’s mental health and wellbeing. (The Office of Management and Budget has approved the information collection provisions in this section under control number 2900–TBD.) VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 § 78.15 Applications for suicide prevention services grants. (a) To apply for a suicide prevention services grant, an applicant must submit to VA a complete suicide prevention services grant application package, as described in the NOFO. A complete suicide prevention services grant application package includes the following: (1) Documentation evidencing the experience of the applicant and any identified community partners in providing or coordinating the provision of suicide prevention services to eligible individuals and their families. (2) A description of the suicide prevention services proposed to be provided or coordinated by the applicant and the identified need for those services. (3) A detailed plan describing how the applicant proposes to coordinate or deliver suicide prevention services to eligible individuals, including: (i) If the applicant is a State or local government or an Indian tribe, an identification of the community partners, if any, with which the applicant proposes to work in delivering such services; (ii) A description of the arrangements currently in place between the applicant and such partners with regard to the provision or coordination the provision of suicide prevention services; (iii) An identification of how long such arrangements have been in place; (iv) A description of the suicide prevention services provided by such partners that the applicant must coordinate, if any; and (v) An identification of local VA suicide prevention coordinators and a description of how the applicant will communicate with local VA suicide prevention coordinators. (4) A description of the location and population of eligible individuals and their families proposed to be provided suicide prevention services. (5) An estimate of the number of eligible individuals at risk of suicide and their families proposed to be provided suicide prevention services, including the percentage of those eligible individuals who are not currently receiving care furnished by VA. (6) Evidence of measurable outcomes related to reductions in suicide risk and mood-related symptoms utilizing validated instruments by the applicant (and the proposed partners of the applicant, if any) in providing suicide prevention services to individuals at risk of suicide, particularly to eligible individuals and their families. PO 00000 Frm 00032 Fmt 4701 Sfmt 4700 (7) A description of the managerial and technological capacity of the applicant to: (i) Coordinate the provision of suicide prevention services with the provision of other services; (ii) Assess on an ongoing basis the needs of eligible individuals and their families for suicide prevention services; (iii) Coordinate the provision of suicide prevention services with VA services for which eligible individuals are also eligible; (iv) Tailor (i.e., provide individualized) suicide prevention services to the needs of eligible individuals and their families; (v) Seek continuously new sources of assistance to ensure the continuity of suicide prevention services for eligible individuals and their families as long as the eligible individuals are determined to be at risk of suicide; and (vi) Measure the effects of suicide prevention services provided by applicant or partner organization on the lives of eligible individuals and their families who receive such services provided by the organization using preand post-evaluations on validated measures of suicide risk and moodrelated symptoms. (8) Clearly defined objectives for the provision of suicide prevention services. (9) A description and physical address of the primary location of the applicant. (10) A description of the geographic area the applicant plans to serve during the grant award period for which the application applies. (11) If the applicant is a State or local government or an Indian tribe, the amount of grant funds proposed to be made available to community partners, if any, through agreements. (12) A description of how the applicant will assess the effectiveness of the provision of grants under this part. (13) An agreement to use the measures and metrics provided by VA for the purposes of measuring the effectiveness of the programming to be provided in improving mental health status, wellbeing, and reducing suicide risk and suicide deaths of eligible individuals and their families. (14) An agreement to comply with and implement the requirements of this part throughout the term of the suicide prevention services grant. (15) Any additional information as deemed appropriate by VA. (b) Subject to funding availability, grantees may submit an application for renewal of a suicide prevention services grant if the grantee’s program will remain substantially the same. To apply for renewal of a suicide prevention E:\FR\FM\10MRR2.SGM 10MRR2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations services grant, a grantee must submit to VA a complete suicide prevention services grant renewal application package, as described in the NOFO. (c) VA may request in writing that an applicant or grantee, as applicable, submit other information or documentation relevant to the suicide prevention services grant application. (The Office of Management and Budget has approved the information collection provisions in this section under control number 2900–TBD.) § 78.20 Threshold requirements prior to scoring suicide prevention services grant applicants. VA will only score applicants who meet the following threshold requirements: (a) The application is filed within the time period established in the NOFO, and any additional information or documentation requested by VA under § 78.15(c) is provided within the time frame established by VA; (b) The application is completed in all parts; (c) The activities for which the suicide prevention services grant is requested are eligible for funding under this part; (d) The applicant’s proposed participants are eligible to receive suicide prevention services under this part; (e) The applicant agrees to comply with the requirements of this part; (f) The applicant does not have an outstanding obligation to the Federal government that is in arrears and does not have an overdue or unsatisfactory response to an audit; and (g) The applicant is not in default by failing to meet the requirements for any previous Federal assistance. khammond on DSKJM1Z7X2PROD with RULES2 § 78.25 Scoring criteria for awarding grants. VA will score applicants who are applying for a suicide prevention services grant. VA will set forth specific point values to be awarded for each criterion in the NOFO. VA will use the following criteria to score these applicants: (a) VA will award points based on the background, qualifications, experience, and past performance of the applicant, and any community partners identified by the applicant in the suicide prevention services grant application, as demonstrated by the following: (1) Background and organizational history. (i) Applicant’s, and any identified community partners’, background and organizational history are relevant to the program. (ii) Applicant, and any identified community partners, maintain VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 organizational structures with clear lines of reporting and defined responsibilities. (iii) Applicant, and any identified community partners, have a history of complying with agreements and not defaulting on financial obligations. (2) Staff qualifications. (i) Applicant’s staff, and any identified community partners’ staff, have experience providing services to, or coordinating services for, eligible individuals and their families. (ii) Applicant’s staff, and any identified community partners’ staff, have experience administering programs similar to SSG Fox SPGP. (3) Organizational qualifications and past performance, including experience with veterans services. (i) Applicant, and any identified community partners, have organizational experience providing suicide prevention services to, or coordinating suicide prevention services for, eligible individuals and their families. (ii) Applicant, and any identified community partners, have organizational experience coordinating services for eligible individuals and their families among multiple organizations, and Federal, State, local and tribal governmental entities. (iii) Applicant, and any identified community partners, have organizational experience administering a program similar in type and scale to SSG Fox SPGP to eligible individuals and their families. (iv) Applicant, and any identified community partners, have organizational experience working with veterans and their families. (b) VA will award points based on the applicant’s program concept and suicide prevention services plan, as demonstrated by the following: (1) Need for program. (i) Applicant has shown a need amongst eligible individuals and their families in the area where the program will be based. (ii) Applicant demonstrates an understanding of the unique needs for suicide prevention services of eligible individuals and their families. (2) Outreach and screening plan. (i) Applicant has a feasible plan for outreach, consistent with § 78.45, and referral to identify and assist individuals and their families that may be eligible for suicide prevention services and are most in need of suicide prevention services. (ii) Applicant has a feasible plan to process and receive participant referrals. (iii) Applicant has a feasible plan to assess and accommodate the needs of incoming participants, including PO 00000 Frm 00033 Fmt 4701 Sfmt 4700 13837 language assistance needs of limited English proficient individuals. (3) Program concept. (i) Applicant’s program concept, size, scope, and staffing plan are feasible. (ii) Applicant’s program is designed to meet the needs of eligible individuals and their families. (4) Program implementation timeline. (i) Applicant’s program will be implemented in a timely manner and suicide prevention services will be delivered to participants as quickly as possible and within a specified timeline. (ii) Applicant has a feasible staffing plan in place to meet the applicant’s program timeline or has existing staff to meet such timeline. (5) Coordination with VA. Applicant has a feasible plan to coordinate outreach and services with local VA facilities. (6) Ability to meet VA’s requirements, goals, and objectives for SSG Fox SPGP. Applicant demonstrates commitment to ensuring that its program meets VA’s requirements, goals, and objectives for SSG Fox SPGP as identified in this part and the NOFO. (7) Capacity to undertake program. Applicant has sufficient capacity, including staff resources, to undertake the program. (c) VA will award points based on the applicant’s quality assurance and evaluation plan, as demonstrated by the following: (1) Program evaluation. (i) Applicant has created clear, realistic, and measurable goals that reflect SSG Fox SPGP’s aim of reducing and preventing suicide among veterans against which the applicant’s program performance can be evaluated. (ii) Applicant has a clear plan to continually assess the program. (2) Monitoring. (i) Applicant has adequate controls in place to regularly monitor the program, including any community partners, for compliance with all applicable laws, regulations, and guidelines. (ii) Applicant has adequate financial and operational controls in place to ensure the proper use of suicide prevention services grant funds. (iii) Applicant has a feasible plan for ensuring that the applicant’s staff and any community partners are appropriately trained and stay informed of SSG Fox SPGP policy, evidenceinformed suicide prevention practices, and the requirements of this part. (3) Remediation. Applicant has an appropriate plan to establish a system to remediate non-compliant aspects of the program if and when they are identified. E:\FR\FM\10MRR2.SGM 10MRR2 13838 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations (4) Management and reporting. Applicant’s program management team has the capability and a system in place to provide to VA timely and accurate reports at the frequency set by VA. (d) VA will award points based on the applicant’s financial capability and plan, as demonstrated by the following: (1) Organizational finances. Applicant, and any identified community partners, are financially stable. (2) Financial feasibility of program. (i) Applicant has a realistic plan for obtaining all funding required to operate the program for the time period of the suicide prevention services grant. (ii) Applicant’s program is costeffective and can be effectively implemented on-budget. (e) VA will award points based on the applicant’s area linkages and relations, as demonstrated by the following: (1) Area linkages. Applicant has a feasible plan for developing or relying on existing linkages with Federal (including VA), State, local, and tribal government agencies, and private entities for the purposes of providing additional services to participants within a given geographic area. (2) Past working relationships. Applicant (or applicant’s staff), and any identified community partners (or community partners’ staff), have fostered similar and successful working relationships and linkages with public and private organizations providing services to veterans or their families in need of services. (3) Local presence and knowledge. (i) Applicant has a presence in the area to be served by the applicant. (ii) Applicant understands the dynamics of the area to be served by the applicant. (4) Integration of linkages and program concept. Applicant’s linkages to the area to be served by the applicant enhance the effectiveness of the applicant’s program. khammond on DSKJM1Z7X2PROD with RULES2 § 78.30 Selection of grantees. VA will use the following process to select applicants to receive suicide prevention services grants: (a) VA will score all applicants that meet the threshold requirements set forth in § 78.20 using the scoring criteria set forth in § 78.25. (b) VA will group applicants within the applicable funding priorities if funding priorities are set forth in the NOFO. (c) VA will rank those applicants that receive at least the minimum amount of total points and points per category set forth in the NOFO, within their respective funding priority group, if VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 any. The applicants will be ranked in order from highest to lowest scores, within their respective funding priority group, if any. (d) VA will use the applicant’s ranking as the primary basis for selection for funding. However, VA will also use the following considerations to select applicants for funding: (1) VA will give preference to applicants that have demonstrated the ability to provide or coordinate suicide prevention services; (2) VA may prioritize the distribution of suicide prevention services grants to: (i) Rural communities; (ii) Tribal lands; (iii) Territories of the United States; (iv) Medically underserved areas; (v) Areas with a high number or percentage of minority veterans or women veterans; and (vi) Areas with a high number or percentage of calls to the Veterans Crisis Line. (3) To the extent practicable, VA will ensure that suicide prevention services grants are distributed to: (i) Provide services in areas of the United States that have experienced high rates of suicide by eligible individuals, including suicide attempts; and (ii) Applicants that can assist eligible individuals at risk of suicide who are not currently receiving health care furnished by VA. (iii) Ensure services are provided in as many areas as possible. (e) Subject to paragraph (d) of this section, VA will fund the highestranked applicants for which funding is available, within the highest funding priority group, if any. If funding priorities have been established, to the extent funding is available and subject to paragraph (d) of this section, VA will select applicants in the next highest funding priority group based on their rank within that group. (f) If an applicant would have been selected but for a procedural error committed by VA, VA may select that applicant for funding when sufficient funds become available if there is no material change in the information that would have resulted in the applicant’s selection. A new application will not be required for this purpose. § 78.35 Scoring criteria for grantees applying for renewal of suicide prevention service grants. VA will score grantees who are applying for a renewal of suicide prevention services grant. VA will set forth specific point values to be awarded for each criterion in the NOFO. VA will use the following criteria to PO 00000 Frm 00034 Fmt 4701 Sfmt 4700 score grantees applying for renewal of a suicide prevention services grant: (a) VA will award points based on the success of the grantee’s program, as demonstrated by the following: (1) The grantee made progress in reducing veteran suicide deaths and attempts, reducing all-cause mortality, reducing suicidal ideation, increasing financial stability; improving mental health status, well-being, and social supports; and engaging in best practices for suicide prevention services. (2) Participants were satisfied with the suicide prevention services provided or coordinated by the grantee, as reflected by the satisfaction survey conducted under § 78.95(d). (3) The grantee implemented the program by delivering or coordinating suicide prevention services to participants in a timely manner consistent with SSG Fox SPGP policy, the NOFO, and the grant agreement. (4) The grantee was effective in conducting outreach to eligible individuals and their families and increasing engagement of eligible individuals and their families in suicide prevention services, as assessed through SSG Fox SPGP grant evaluation. (b) VA will award points based on the cost-effectiveness of the grantee’s program, as demonstrated by the following: (1) The cost per participant was reasonable. (2) The grantee’s program was effectively implemented on-budget. (c) VA will award points based on the extent to which the grantee’s program complies with SSG Fox SPGP goals and requirements, as demonstrated by the following: (1) The grantee’s program was administered in accordance with VA’s goals for SSG Fox SPGP as noted in the NOFO. (2) The grantee’s program was administered in accordance with all applicable laws, regulations, and guidelines. (3) The grantee’s program was administered in accordance with the grantee’s suicide prevention services grant agreement. § 78.40 Selection of grantees for renewal of suicide prevention services grants. VA will use the following process to select grantees applying for renewal of suicide prevention services grants: (a) So long as the grantee continues to meet the threshold requirements set forth in § 78.20, VA will score the grantee using the scoring criteria set forth in § 78.35. (b) VA will rank those grantees who receive at least the minimum amount of E:\FR\FM\10MRR2.SGM 10MRR2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations total points and points per category set forth in the NOFO. The grantees will be ranked in order from highest to lowest scores. (c) VA will use the grantee’s ranking as the basis for selection for funding. VA will fund the highest-ranked grantees for which funding is available. (d) At its discretion, VA may award any non-renewed funds to an applicant or existing grantee. If VA chooses to award non-renewed funds to an applicant or existing grantee, funds will be awarded as follows: (1) VA will first offer to award the non-renewed funds to the applicant or grantee with the highest grant score under the relevant NOFO that applies for, or is awarded a renewal grant in, the same area as, or a proximate area to, the affected area if available. Such applicant or grantee must have the capacity and agree to provide prompt services to the affected area. Under this section, the relevant NOFO is the most recently published NOFO which covers the affected area, or for multi-year grant awards, the NOFO for which the grantee, who is offered the additional funds, received the multi-year award. (2) If the first such applicant or grantee offered the non-renewed funds refuses the funds, VA will offer to award the funds to the next highest-ranked such applicant or grantee, per the criteria in paragraph (d)(1) of this section, and continue on in rank order until the non-renewed funds are awarded. (e) If an applicant would have been selected but for a procedural error committed by VA, VA may select that applicant for funding when sufficient funds become available if there is no material change in the information that would have resulted in the applicant’s selection. A new application will not be required for this purpose. khammond on DSKJM1Z7X2PROD with RULES2 § 78.45 Suicide prevention services: Outreach. (a) Grantees providing or coordinating the provision of outreach must use their best efforts to ensure that eligible individuals, including those who are at highest risk of suicide or who are not receiving health care or other services furnished by VA, and their families are identified, engaged, and provided suicide prevention services. (b) Outreach must include active liaison with local VA facilities; State, local, or tribal government (if any); and private agencies and organizations providing suicide prevention services to eligible individuals and their families in the area to be served by the grantee. VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 § 78.50 Suicide prevention services: Baseline mental health screening. (a) Grantees must provide or coordinate the provision of a baseline mental health screening to all participants they serve at the time those services begin. This mental health screening must be provided using a validated screening tool that assesses suicide risk and mental and behavioral health conditions. Information on the specific tool or tools to be used will be included in the NOFO. (b) If an eligible individual is at risk of suicide or other mental or behavioral health condition pursuant to the baseline mental health screening conducted under paragraph (a) of this section, the grantee must refer such individual to VA for care. If the eligible individual refuses the grantee’s referral to VA, any ongoing clinical services provided to the eligible individual by the grantee is at the expense of the grantee. (c) If a participant other than an eligible individual is at risk of suicide or other mental or behavioral health condition pursuant to the baseline mental health screening conducted under paragraph (a) of this section, the grantee must refer such participant to appropriate health care services in the area unless the grantee is capable of furnishing such care. Any ongoing clinical services provided to the participant by the grantee is at the expense of the grantee. (d) Except as provided for under § 78.60(a), funds provided under this grant program may not be used to provide clinical services to participants, and any ongoing clinical services provided to such individuals by the grantee is at the expense of the grantee. The grantee may not charge, bill, or otherwise hold liable participants for the receipt of such care or services. § 78.55 Suicide prevention services: Education. Grantees providing or coordinating the provision of education must provide or coordinate the provision of suicide prevention education programs to educate communities, veterans, and families on how to identify those at risk of suicide, how and when to make referrals for care, and the types of suicide prevention resources available within the area. Education can include gatekeeper training, lethal means safety training, or specific educations programs that assist with identification, assessment, or prevention of suicide. PO 00000 Frm 00035 Fmt 4701 Sfmt 4700 13839 § 78.60 Suicide prevention services: Clinical services for emergency treatment. (a) Grantees providing or coordinating the provision of clinical services for emergency treatment must provide or coordinate the provision of clinical services for emergency treatment of a participant. (b) If an eligible individual is furnished clinical services for emergency treatment under paragraph (a) of this section and the grantee determines that the eligible individual requires ongoing services, the grantee must refer the eligible individual to VA for additional care. If the eligible individual refuses the grantee’s referral to VA, any ongoing clinical services provided to the eligible individual by the grantee is at the expense of the grantee. The grantee may not charge, bill, or otherwise hold liable eligible individuals for the receipt of such care or services. (c) If a participant other than an eligible individual is furnished clinical services for emergency treatment under paragraph (a) of this section and the grantee determines that the participant requires ongoing services, the grantee must refer the participant to appropriate health care services in the area for additional care. Except as provided for under paragraph (a) of this section, funds provided under this grant program may not be used to provide ongoing clinical services to such participants, and any ongoing clinical services provided to the participant by the grantee is at the expense of the grantee. The grantee may not charge, bill, or otherwise hold liable such participants for the receipt of such care or services. (d) For purposes of this section, emergency treatment means medical services, professional services, ambulance services, ancillary care and medication (including a short course of medication related to and necessary for the treatment of the emergency condition that is provided directly to or prescribed for the patient for use after the emergency condition is stabilized and the patient is discharged) was rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. This standard is met by an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing E:\FR\FM\10MRR2.SGM 10MRR2 13840 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. (e) The direct provision of clinical services for emergency treatment by grantees under this section is not prohibited by § 78.80(a). § 78.65 Suicide prevention services: Case management services. Grantees providing or coordinating the provision of case management services must provide or coordinate the provision of case management services that include, at a minimum: (a) Performing a careful assessment of participants, and developing and monitoring case plans in coordination with a formal assessment of suicide prevention services needed, including necessary follow-up activities, to ensure that the participant’s needs are adequately addressed; (b) Establishing linkages with appropriate agencies and service providers in the area to help participants obtain needed suicide prevention services; (c) Providing referrals to participants and related activities (such as scheduling appointments for participants) to help participants obtain needed suicide prevention services, such as medical, social, and educational assistance or other suicide prevention services to address participants’ identified needs and goals; (d) Deciding how resources and services are allocated to participants on the basis of need; (e) Educating participants on issues, including, but not limited to, suicide prevention services availability and participant rights; and (f) Other activities, as approved by VA, to serve the comprehensive needs of participants for the purpose of reducing suicide risk. khammond on DSKJM1Z7X2PROD with RULES2 § 78.70 Suicide prevention services: Peer support services. (a) Grantees providing or coordinating the provision of peer support services must provide or coordinate the provision of peer support services to help participants understand what resources and supports are available in their area for suicide prevention. Peer support services must be provided by veterans trained in peer support with similar lived experiences related to suicide or mental health. Peer support specialists serve as role models and a resource to assist participants with their mental health recovery. (b) Each grantee providing or coordinating the provision of peer support services must ensure that VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 veterans providing such services to participants meet the requirements of 38 U.S.C. 7402(b)(13) and meet qualification standards for appointment; or have completed peer support training, are pursuing credentials to meet the minimum qualification standards for appointment, and are under the supervision of an individual who meets the requirements of 38 U.S.C. 7402(b)(13). Grant funds may be used to provide education and training for employees of the grantee or the community partner who provide peer support services consistent with the terms set forth in the grant agreement. § 78.75 Suicide prevention services: Assistance in obtaining VA benefits. (a) Grantees assisting participants in obtaining VA benefits must assist participants in obtaining any benefits from VA for which the participants are eligible. Such benefits include but are not limited to: (1) Vocational and rehabilitation counseling; (2) Supportive services for homeless veterans; (3) Employment and training services; (4) Educational assistance; and (5) Health care services. (b) Grantees are not permitted to represent participants before VA with respect to a claim for VA benefits unless they are recognized for that purpose pursuant to 38 U.S.C. 5902. Employees and members of grantees are not permitted to provide such representation unless the individual providing representation is accredited pursuant to 38 U.S.C. chapter 59. § 78.80 Suicide prevention services: Assistance in obtaining and coordinating other public benefits and assistance with emergent needs. Grantees assisting in obtaining and coordinating other public benefits or assisting with emergent needs must assist participants with obtaining and coordinating the provision of other public benefits, including at a minimum those listed in paragraphs (a) through (h) of this section, that are being provided by Federal, State, local, or tribal agencies, or any other grantee in the area served by the grantee by referring the participant to and coordinating with such entity. If a public benefit is not being provided by Federal, State, local, or tribal agencies, or any other grantee in the area, the grantee is not required to obtain, coordinate, or provide such public benefit. Grantees may elect to provide directly to participants the public benefits identified in paragraphs (c) through (h) of this section. PO 00000 Frm 00036 Fmt 4701 Sfmt 4700 (a) Health care services, which include: (1) Health insurance; and (2) Referral to a governmental entity or grantee that provides any of the following services: (i) Hospital care, nursing home care, outpatient care, mental health care, preventive care, habilitative and rehabilitative care, case management, respite care, and home care; (ii) The training of any eligible individual’s family in the care of any eligible individual; and (iii) The provision of pharmaceuticals, supplies, equipment, devices, appliances, and assistive technology. (b) Referral of a participant, as appropriate, to an entity that provides daily living services relating to the functions or tasks for self-care usually performed in the normal course of a day, including, but not limited to, eating, bathing, grooming, dressing, and home management activities. (c) Personal financial planning services, which include, at a minimum, providing recommendations regarding day-to-day finances and achieving longterm budgeting and financial goals. Grant funds may pay for credit counseling and other services necessary to assist participants with critical skills related to household budgeting, managing money, accessing a free personal credit report, and resolving credit problems. (d) Transportation services: (1) The grantee may provide temporary transportation services directly to participants if the grantee determines such assistance is necessary; however, the preferred method of direct provision of transportation services is the provision of tokens, vouchers, or other appropriate instruments so that participants may use available public transportation options. (2) If public transportation options are not sufficient within an area, costs related to the lease of vehicle(s) may be included in a suicide prevention services grant application if the applicant or grantee, as applicable, agrees that: (i) The vehicle(s) will be safe, accessible, and equipped to meet the needs of the participants; (ii) The vehicle(s) will be maintained in accordance with the manufacturer’s recommendations; and (iii) All transportation personnel (employees and community partners) will be licensed, insured, and trained in managing any special needs of participants and handling emergency situations. (3) Transportation services furnished under this paragraph may include E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations reimbursement for transportation furnished through ride sharing services, taxi services, or similar sources, but only if: (i) The participant lacks any other means of transportation, including transportation or reimbursement for transportation from the Department under part 70 of this title; and (ii) The grantee documents the participant’s lack of other means. (e) Temporary income support services, which may consist of providing assistance in obtaining other Federal, State, tribal and local assistance, in the form of, but not limited to, mental health benefits, food assistance, housing assistance, employment counseling, medical assistance, veterans’ benefits, and income support assistance. (f) Fiduciary and representative payee services, which may consist of acting on behalf of a participant by receiving the participant’s paychecks, benefits or other income, and using those funds for the current and foreseeable needs of the participant and saving any remaining funds for the participant’s future use in an interest bearing account or saving bonds. (g) Legal services to assist eligible individuals with issues that may contribute to the risk of suicide. This may include issues that interfere with the eligible individual’s ability to obtain or retain permanent housing, cover basic needs such as food, transportation, medical care, and issues that affect the eligible individual’s employability and financial security (such as debt, credit problems, and lacking a driver’s license). (1) Except for legal assistance with resolving outstanding warrants, fines, expungements, and drivers’ license revocations symptomatic of reentry obstacles in employment or housing, legal services do not include legal assistance with criminal matters nor matters in which the eligible individual is taking or has taken any adversarial legal action against the United States. (2) Legal services do not include matters in which the United States is prosecuting an eligible individual. (h) Child care for children under the age of 13, unless the child is disabled. Disabled children must be under the age of 18 to receive assistance under this paragraph. Child care includes the: (1) Referral of a participant, as appropriate, to an eligible child care provider that provides child care with sufficient hours of operation and serves appropriate ages, as needed by the participant; and (2) Payment by a grantee on behalf of a participant for child care by an eligible VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 child care provider. Payment may not exceed $5,000 per family of an eligible individual per Federal fiscal year. (i) Payments for child care services must be paid by the grantee directly to an eligible child care provider. (ii) Payments for child care services cannot be provided on behalf of participants for the same period of time and for the same cost types that are being provided through another Federal (including VA), State or local subsidy program. (iii) As a condition of providing payments for child care services, the grantee must help the participant develop a reasonable plan to address the participant’s future ability to pay for child care services. Grantees must assist the participant to implement such plan by providing any necessary assistance or helping the participant to obtain any necessary public or private benefits or services. § 78.85 Suicide prevention services: Nontraditional and innovative approaches and treatment practices. Grantees providing or coordinating the provision of nontraditional and innovative approaches and treatment practices may provide or coordinate the provision of nontraditional and innovative approaches and treatment, including but not limited to complementary or alternative interventions with some evidence for effectiveness of improving mental health or mitigating a risk factor for suicidal thoughts and behaviors, as set forth in the NOFO or as approved by VA that are consistent with SSG Fox SPGP. Applicants may propose nontraditional and innovative approaches and treatment practices in their suicide prevention services grant application, and grantees may propose these additional approaches and treatment practices by submitting a written request to modify the suicide prevention services grant in accordance with § 78.125. VA reserves the right to approve or disapprove nontraditional and innovative approaches and treatment practices to be provided or coordinate to be provided using funds authorized under SSG Fox SPGP. VA will only approve approaches and treatment practices consistent with applicable Federal law. § 78.90 Suicide prevention services: Other services. (a) General suicide prevention assistance. A grantee may pay directly to a third party (and not to a participant), in an amount not to exceed $750 per participant during any 1-year period, beginning on the date that the PO 00000 Frm 00037 Fmt 4701 Sfmt 4700 13841 grantee first submits a payment to a third party, the following types of expenses: (i) Expenses associated with gaining or keeping employment, such as uniforms, tools, certificates, and licenses. (ii) Expenses associated with lethal means safety and secure storage, such as gun locks and locked medication storage. (b) Other. Grantees providing or coordinating the provision of other suicide prevention services may provide or coordinate the provision of the other services as set forth in the NOFO or as approved by VA that are consistent with SSG Fox SPGP. Applicants may propose additional services in their suicide prevention services grant application, and grantees may propose additional services by submitting a written request to modify the suicide prevention services grant program in accordance with § 78.125. VA reserves the right to approve or disapprove other suicide prevention services to be provided or coordinate to be provided using funds authorized under SSG Fox SPGP. § 78.95 General operation requirements. (a) Eligibility documentation. Prior to providing suicide prevention services, grantees must verify, document, and classify each participant’s eligibility for suicide prevention services, and determine and document each participant’s degree of risk of suicide using tools identified in the suicide prevention services grant agreement. Documentation must be maintained consistent with § 78.150. (b) Required screening prior to services ending. Prior to services ending, grantees must provide or coordinate the provision of a mental health screening using the screening tool described in § 78.50(a) to all participants they serve, when possible. (c) Suicide prevention services documentation. For each participant who receives suicide prevention services from the grantee, the grantee must document the suicide prevention services provided or coordinated, how such services are provided or coordinated, the duration of the services provided or coordinated, and any goals for the provision or coordination of such services. Such documentation must be maintained consistent with § 78.150. (d) Notifications to participants. (1) Prior to initially providing or coordinating suicide prevention services to an eligible individual and their family, the grantee must notify each eligible individual and their family of the following: E:\FR\FM\10MRR2.SGM 10MRR2 khammond on DSKJM1Z7X2PROD with RULES2 13842 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations (i) The suicide prevention services are being paid for, in whole or in part, by VA; (ii) The suicide prevention services available to the eligible individual and their family through the grantee’s program; (iii) Any conditions or restrictions on the receipt of suicide prevention services by the eligible individual and their family; and (iv) In the instance of an eligible individual who receives assistance from the grantee under this program, that the eligible individual is able to apply for enrollment in VA health care pursuant to 38 CFR 17.36. If the eligible individual wishes to enroll in VA health care, the grantee must inform the eligible individual of a VA point of contact for assistance with enrollment. The requirements in this clause do not apply to eligible individuals who are members of the Armed Forces described in 38 U.S.C. 1712A(a)(1)(C)(i)–(iv). (2) The grantee must provide each participant with a satisfaction survey, which the participant can submit directly to VA, within 30 days of such participant’s pending exit from the grantee’s program. (e) Assessment of funds. Grantees must regularly assess how suicide prevention services grant funds can be used in conjunction with other available funds and services to assist participants. (f) Development of a suicide prevention services plan. For each participant, grantees must develop and document an individualized plan with respect to the provision of suicide prevention services provided under this part. This plan must be developed in consultation with the participant and must be maintained consistent with § 78.150. (g) Coordination with VA. The grantee will coordinate with VA with respect to the provision of health care and other services to eligible individuals pursuant to 38 U.S.C. chapters 17 and 20. (h) Measurement and monitoring. The grantee will submit to VA a description of the tools and assessments the grantee uses or will use to determine the effectiveness of the suicide prevention services furnished by the grantee. These will include any measures and metrics developed and provided by VA for the purposes of measuring the effectiveness of the programming to be provided in improving mental health status, wellbeing, and reducing suicide risk and suicide deaths of eligible individuals. (i) Agreements with community partners. Only grantees that are a State or local government or an Indian tribe may use grant funds to enter into an VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 agreement with a community partner under which the grantee may provide funds to the community partner for the provision of suicide prevention services to eligible individuals and their families. (j) Contracts for goods and services under this part. Grantees may enter into contracts for good or services under this part. (k) Administration of suicide prevention services grants. Grantees must ensure that suicide prevention services grants are administered in accordance with the requirements of this part, the suicide prevention services grant agreement, and other applicable Federal, State, and local laws and regulations, including Federal civil rights laws. Grantees are responsible for ensuring that any community partners carry out activities in compliance with this part. (The Office of Management and Budget has approved the information collection provisions in this section under control number 2900–TBD.) § 78.100 Fee prohibition. Grantees must not charge a fee to participants for providing suicide prevention services that are funded with amounts from a suicide prevention services grant. § 78.105 Ineligible activities. Notwithstanding any other section in this part, grantees are not authorized to use suicide prevention services grant funds to pay for the following: (a) Direct cash assistance to participants. (b) Those legal services prohibited pursuant to § 78.80(g). (c) Medical or dental care and medicines except for clinical services authorized pursuant to § 78.60. (d) Any activities considered illegal under Federal law. § 78.110 Notice of Funding Opportunity. When funds are available for suicide prevention services grants, VA will publish a NOFO on grants.gov. The NOFO will identify: (a) The location for obtaining suicide prevention services grant applications; (b) The date, time, and place for submitting completed suicide prevention services grant applications; (c) The estimated amount and type of suicide prevention services grant funding available; (d) Any priorities for or exclusions from funding to meet the statutory mandates of section 201 of Public Law 116–171 and VA’s goals for SSG Fox SPGP; (e) The length of term for the suicide prevention services grant award; PO 00000 Frm 00038 Fmt 4701 Sfmt 4700 (f) The minimum number of total points and points per category that an applicant or grantee, as applicable, must receive for a suicide prevention services grant to be funded; (g) Any maximum uses of suicide prevention services grant funds for specific suicide prevention services; (h) The timeframes and manner for payments under the suicide prevention services grant; and (i) Other information necessary for the suicide prevention services grant application process as determined by VA. § 78.115 Suicide prevention services grant agreements. (a) After an applicant is selected for a suicide prevention services grant in accordance with § 78.30, VA will draft a suicide prevention services grant agreement to be executed by VA and the applicant. Upon execution of the suicide prevention services grant agreement, VA will obligate suicide prevention services grant funds to cover the amount of the approved suicide prevention services grant, subject to the availability of funding. The suicide prevention services grant agreement will provide that the grantee agrees, and will ensure that each community partner agrees, to: (1) Operate the program in accordance with the provisions of this part and the applicant’s suicide prevention services grant application; (2) Comply with such other terms and conditions, including recordkeeping and reports for program monitoring and evaluation purposes, as VA may establish for purposes of carrying out SSG Fox SPGP, in an effective and efficient manner; and (3) Provide such additional information as deemed appropriate by VA. (b) After a grantee is selected for renewal of a suicide prevention services grant in accordance with § 78.40, VA will draft a suicide prevention services grant agreement to be executed by VA and the grantee. Upon execution of the suicide prevention services grant agreement, VA will obligate suicide prevention services grant funds to cover the amount of the approved suicide prevention services grant, subject to the availability of funding. The suicide prevention services grant agreement will contain the same provisions described in paragraph (a) of this section. (c) No funds provided under this part may be used to replace Federal, State, tribal, or local funds previously used, or designated for use, to assist eligible individuals and their families. E:\FR\FM\10MRR2.SGM 10MRR2 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations § 78.120 Amount and payment of grants. (a) Amount of grants. The maximum funding that a grantee may be awarded under this part is $750,000 per fiscal year. (b) Payment of grants. Grantees are to be paid in accordance with the timeframes and manner set forth in the NOFO. khammond on DSKJM1Z7X2PROD with RULES2 § 78.125 Program or budget changes and corrective action plans. (a) A grantee must submit to VA a written request to modify a suicide prevention services grant for any proposed significant change that will alter the suicide prevention services grant program. If VA approves such change, VA will issue a written amendment to the suicide prevention services grant agreement. A grantee must receive VA’s approval prior to implementing a significant change. Significant changes include, but are not limited to, a change in the grantee or any community partners identified in the suicide prevention services grant agreement; a change in the area served by the grantee; additions or deletions of suicide prevention services provided by the grantee; a change in category of participants to be served; and a change in budget line items that are more than 10 percent of the total suicide prevention services grant award. (1) VA’s approval of changes is contingent upon the grantee’s amended application retaining a sufficient rank to have been competitively selected for funding in the year that the application was granted. (2) Each suicide prevention services grant modification request must contain a description of, and justification for, the revised proposed use of suicide prevention services grant funds. (b) VA may require that the grantee initiate, develop, and submit to VA for approval a Corrective Action Plan (CAP) if, on a quarterly basis, actual suicide prevention services grant expenditures vary from the amount disbursed to a grantee for that same quarter or actual suicide prevention services grant activities vary from the grantee’s program description provided in the suicide prevention services grant agreement. (1) The CAP must identify the expenditure or activity source that has caused the deviation, describe the reason(s) for the variance, provide specific proposed corrective action(s), and provide a timetable for accomplishment of the corrective action. (2) After receipt of the CAP, VA will send a letter to the grantee indicating that the CAP is approved or VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 disapproved. If disapproved, VA will make beneficial suggestions to improve the proposed CAP and request resubmission or take other actions in accordance with this part. (c) Grantees must inform VA in writing of any key personnel changes (e.g., new executive director, the suicide prevention services grant program director, or chief financial officer) and grantee address changes within 30 days of the change. (The Office of Management and Budget has approved the information collection provisions in this section under control number 2900–TBD.) § 78.130 Faith-based organizations. (a) Organizations that are faith-based are eligible, on the same basis as any other organization, to participate in SSG Fox SPGP under this part. Decisions about awards of Federal financial assistance must be free from political interference or even the appearance of such interference and must be made on the basis of merit, not on the basis of religion or religious belief or lack thereof. (b)(1) No organization may use direct financial assistance from VA under this part to pay for any of the following: (i) Explicitly religious activities such as, religious worship, instruction, or proselytization; or (ii) Equipment or supplies to be used for any of those activities. (2) References to ‘‘financial assistance’’ will be deemed to be references to direct Federal financial assistance, unless the referenced assistance meets the definition of ‘‘indirect Federal financial assistance’’ in this part. (c) Organizations that engage in explicitly religious activities, such as worship, religious instruction, or proselytization, must offer those services separately in time or location from any programs or services funded with direct financial assistance from VA under this part, and participation in any of the organization’s explicitly religious activities must be voluntary for the participants of a program or service funded by direct financial assistance from VA under this part. (d) A faith-based organization that participates in SSG Fox SPGP under this part will retain its independence from Federal, State, or local governments and may continue to carry out its mission, including the definition, practice and expression of its religious beliefs, provided that it does not use direct financial assistance from VA under this part to support any explicitly religious activities, such as worship, religious PO 00000 Frm 00039 Fmt 4701 Sfmt 4700 13843 instruction, or proselytization. Among other things, faith-based organizations may use space in their facilities to provide VA-funded services under this part, without concealing, removing, or altering religious art, icons, scripture, or other religious symbols. In addition, a VA-funded faith-based organization retains its authority over its internal governance, and it may retain religious terms in its organization’s name, select its board members and otherwise govern itself on a religious basis, and include religious reference in its organization’s mission statements and other governing documents. (e) An organization that participates in a VA program under this part must not, in providing direct program assistance, discriminate against a program participant or prospective program participant on the basis of religion or religious belief. (f) If a State or local government voluntarily contributes its own funds to supplement Federally funded activities, the State or local government has the option to segregate the Federal funds or commingle them. However, if the funds are commingled, this provision applies to all of the commingled funds. (g) To the extent otherwise permitted by Federal law, the restrictions on explicitly religious activities set forth in this section do not apply where VA funds are provided to faith-based organizations through indirect assistance as a result of a genuine and independent private choice of a participant, provided the faith-based organizations otherwise satisfy the requirements of this part. A faith-based organization may receive such funds as the result of a participant’s genuine and independent choice if, for example, a participant redeems a voucher, coupon, or certificate, allowing the participant to direct where funds are to be paid, or a similar funding mechanism provided to that participant and designed to give that participant a choice among providers. § 78.135 Visits to monitor operation and compliance. (a) VA has the right, at all reasonable times, to make visits to all grantee locations where a grantee is using suicide prevention services grant funds to review grantee accomplishments and management control systems and to provide such technical assistance as may be required. VA may conduct inspections of all program locations and records of a grantee at such times as are deemed necessary to determine compliance with the provisions of this part. In the event that a grantee delivers services in a participant’s home, or at a E:\FR\FM\10MRR2.SGM 10MRR2 13844 Federal Register / Vol. 87, No. 47 / Thursday, March 10, 2022 / Rules and Regulations location away from the grantee’s place of business, VA may accompany the grantee. If the grantee’s visit is to the participant’s home, VA will only accompany the grantee with the consent of the participant. If any visit is made by VA on the premises of the grantee or a community partner under the suicide prevention services grant, the grantee must provide, and must require its community partners to provide, all reasonable facilities and assistance for the safety and convenience of the VA representatives in the performance of their duties. All visits and evaluations will be performed in such a manner as will not unduly delay services. (b) The authority to inspect carries with it no authority over the management or control of any applicant or grantee under this part. § 78.140 Financial management and administrative costs. khammond on DSKJM1Z7X2PROD with RULES2 (a) Grantees must comply with applicable requirements of the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards under 2 CFR part 200. (b) Grantees must use a financial management system that provides adequate fiscal control and accounting records and meets the requirements set forth in 2 CFR part 200. (c) Payment up to the amount specified in the suicide prevention services grant must be made only for allowable, allocable, and reasonable costs in conducting the work under the suicide prevention services grant. The determination of allowable costs must be made in accordance with the applicable Federal Cost Principles set forth in 2 CFR part 200. VerDate Sep<11>2014 16:25 Mar 09, 2022 Jkt 256001 (d) Costs for administration by a grantee must not exceed 10 percent of the total amount of the suicide prevention services grant. Administrative costs will consist of all costs associated with the management of the program. These costs will include the administrative costs of community partners. § 78.145 Grantee reporting requirements. (a) VA may require grantees to provide, in any form as may be prescribed, such reports or answers in writing to specific questions, surveys, or questionnaires as VA determines necessary to carry out SSG Fox SPGP. (b) At least once per year, each grantee must submit to VA a report that describes the projects carried out with such grant during the year covered by the report; and information relating to operational effectiveness, fiscal responsibility, suicide prevention services grant agreement compliance, and legal and regulatory compliance, including a description of the use of suicide prevention grant funds, the number of participants assisted, the types of suicide prevention services provided, and any other information that VA may request. (c) VA may request additional reports or information to allow VA to fully assess the provision or coordination of the provision of suicide prevention services under this part. (d) All pages of the reports must cite the assigned suicide prevention services grant number and be submitted in a timely manner as set forth in the grant agreement. (e) Grantees must provide VA with consent to post information from reports PO 00000 Frm 00040 Fmt 4701 Sfmt 9990 on the internet and use such information in other ways deemed appropriate by VA. Grantees shall clearly mark information that is confidential to individual participants. (The Office of Management and Budget has approved the information collection provisions in this section under control number 2900–TBD.) § 78.150 Recordkeeping. Grantees must ensure that records are maintained for at least a 3-year period to document compliance with this part. Grantees must produce such records at VA’s request. § 78.155 Technical assistance. VA will provide technical assistance, as necessary, to applicants and grantees to meet the requirements of this part. Such technical assistance will be provided either directly by VA or through contracts with appropriate public or non-profit private entities. § 78.160 Withholding, suspension, deobligation, termination, and recovery of funds by VA. VA will enforce this part through such actions as may be appropriate. Appropriate actions include withholding, suspension, deobligation, termination, recovery of funds by VA, and actions in accordance with 2 CFR part 200. § 78.165 Suicide prevention services grant closeout procedures. Suicide prevention services grants will be closed out in accordance with 2 CFR part 200. [FR Doc. 2022–04477 Filed 3–9–22; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\10MRR2.SGM 10MRR2

Agencies

[Federal Register Volume 87, Number 47 (Thursday, March 10, 2022)]
[Rules and Regulations]
[Pages 13806-13844]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-04477]



[[Page 13805]]

Vol. 87

Thursday,

No. 47

March 10, 2022

Part II





Department of Veterans Affairs





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





38 CFR Part 78





Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program; 
Final Rule

Federal Register / Vol. 87 , No. 47 / Thursday, March 10, 2022 / 
Rules and Regulations

[[Page 13806]]


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

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 78

RIN 2900-AR16


Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program

AGENCY: Department of Veterans Affairs.

ACTION: Interim final rule.

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

SUMMARY: The Department of Veterans Affairs (VA) is issuing this 
interim final rule to implement a new authority requiring VA to 
implement a three-year community-based grant program to award grants to 
eligible entities to provide or coordinate the provision of suicide 
prevention services to eligible individuals and their families for the 
purpose of reducing veteran suicide. This rulemaking specifies grant 
eligibility criteria, application requirements, scoring criteria, 
constraints on the allocation and use of the funds, and other 
requirements necessary to implement this grant program.

DATES: 
    Effective date: This interim final rule is effective on April 11, 
2022.
    Comments: Comments must be received on or before May 9, 2022.

ADDRESSES: Comments must be submitted through www.Regulations.gov. 
Comments received will be available at regulations.gov for public 
viewing, inspection or copies.

FOR FURTHER INFORMATION CONTACT: Sandra Foley, Supervisory Grants 
Manager--Suicide Prevention Program, Office of Mental Health and 
Suicide Prevention, 11MHSP, 810 Vermont Avenue NW, Washington, DC 
20420, 202-502-0002 (This is not a toll-free telephone number), 
[email protected].

SUPPLEMENTARY INFORMATION:

Background on Governing Statute and Public Input

    On October 17, 2020, the Commander John Scott Hannon Veterans 
Mental Health Care Improvement Act of 2019, Public Law (Pub. L.) 116-
171 (the Act), was enacted in law. Section 201 of the Act, codified as 
a note to section 1720F of title 38, United States Code (U.S.C.), 
mandated VA establish the Staff Sergeant Parker Gordon Fox Suicide 
Prevention Grant Program (SSG Fox SPGP), a community-based grant 
program that would support certain eligible entities to provide or 
coordinate the provision of suicide prevention services to eligible 
individuals and their families. Section 201 of the Act specified which 
entities are eligible for grants and those individuals eligible to 
receive suicide prevention services, defined the suicide prevention 
services that may be provided, described grant application 
requirements, and explained instances in which eligible entities must 
refer individuals to VA for additional care, among other requirements. 
This grant program is authorized for a period of three years starting 
on the date on which the first grant is awarded. The maximum amount per 
grant is capped by section 201(c)(2) of the Act at $750,000 per fiscal 
year.
    Section 201 of the Act required that VA consult with certain 
entities to assist in developing a plan for the design and 
implementation of the provision of grants; establishing criteria for 
the selection of eligible entities; developing a framework for 
collecting and sharing information about grantees; and developing 
measures and metrics to be used by grantees to determine the 
effectiveness of programming provided pursuant to the suicide 
prevention services grant.
    Section 201(h)(3) of the Act specifically required VA consult with 
the following entities: (1) Veterans service organizations; (2) 
National organizations (including national organizations that advocate 
for the needs of individuals with or at risk of behavioral health 
conditions; and those that represent mayors, unions, first responders, 
chiefs of police and sheriffs, governors, a territory of the United 
States, or a Tribal alliance) representing potential community partners 
of eligible entities in providing supportive services to address the 
needs of eligible individuals and their families; (3) National 
organizations representing members of the Armed Forces; (4) National 
organizations that represent counties; (5) Organizations with which VA 
has a current memorandum of agreement or understanding related to 
mental health or suicide prevention; (6) State departments of veterans 
affairs; (7) National organizations representing members of the Reserve 
Components of the Armed Forces; (8) National organizations representing 
members of the Coast Guard; (9) Organizations, including institutions 
of higher education, with experience in creating measurement tools for 
purposes of advising the Secretary on the most appropriate existing 
measurement tool or protocol for VA to utilize; (10) The National 
Alliance on Mental Illness; (11) A labor organization (as such term is 
defined in section 7103(a)(4) of title 5, U.S.C.); (12) The Centers for 
Disease Control and Prevention (CDC), the Substance Abuse and Mental 
Health Services Administration (SAMHSA), and the President's Roadmap to 
Empower Veterans and End a National Tragedy of Suicide (PREVENTS) Task 
Force; and such other organizations as the Secretary deems appropriate.
    On April 1, 2021, VA published a Notice of Request for Information 
on the Department of Veterans Affairs' Staff Sergeant Parker Gordon Fox 
Suicide Prevention Grant Program (RIN 2900-AR16) in the Federal 
Register (FR), requesting information and comments from the public to 
meet the requirements for consultation in the Act. 86 FR 17268 (April 
1, 2021). Through this notice, VA asked the public, including those 
organizations listed in the previous paragraph, to comment on various 
aspects of the suicide prevention services grant program, such as 
distribution and selection of grants; administration of the grant 
program, including development of measures and metrics; training and 
technical assistance; referrals for care; degrees of risk of suicide 
and processes for determining degrees of risk of suicide; and 
nontraditional and innovative approaches and treatment practices that 
may be appropriate under this grant program. VA directly contacted 
various organizations that met the categories of organizations listed 
under section 201(h)(3) of the Act to notify them that VA was seeking 
input through this FR notice. VA received 124 comments, including 
comments outside the scope of the questions posed. Many commenters 
expressed support for awarding grants to entities with prior relevant 
experience. Many commenters also provided suggestions for training and 
technical assistance related to suicide prevention, evaluation and 
reporting requirements, and referrals to VA for further care. 
Additionally, numerous commenters provided suggestions for non-
traditional and innovative treatment and services under this grant 
program. The comments received from this notice are publicly available 
online at www.regulations.gov.
    On May 11, 2021, VA published a Notice of Listening Sessions on the 
Department of Veterans Affairs Staff Sergeant Parker Gordon Fox Suicide 
Prevention Grant Program (RIN 2900-AR16) in the FR notifying the public 
of two related listening sessions, which were held on May 25, 2021 and 
May 26, 2021. 86 FR 25938 (May 11, 2021). The topics for the first 
listening session included distribution and selection of grants, 
administration of the grant program, and training and technical 
assistance. The topics for the second listening session included 
referrals for

[[Page 13807]]

care, risk of suicide, and suicide prevention services. Similar to the 
April 1, 2021 notice, this second notice included specific questions 
for the public to consider and upon which to comment at the listening 
session. VA directly contacted various organizations that met the 
categories of organizations listed under section 201(h)(3) of the Act 
to notify them that VA was seeking input through these listening 
sessions. Thirty-two individuals presented oral comments at these 
listening sessions. Many of these comments were similar to those 
received in response to the April 1, 2021 notice. Commenters expressed 
support for awarding grants to entities with demonstrated experiences 
and capacity to implement evidence-based programs. Commenters also 
expressed support for awarding grants to entities that have experience 
working with veterans at risk of suicide and have or plan to have 
culturally competent care. Additionally, commenters supported awarding 
grants to entities that utilized validated assessment tools and 
entities that had area partnerships (including at local, regional, and 
national levels) as well as with VA. Many commenters also provided 
suggestions for training and for assessment tools. Additionally, 
numerous commenters provided suggestions for non-traditional and 
innovative treatment and services under this grant program. The 
transcript for these listening sessions is publicly available online at 
www.regulations.gov.
    VA appreciates the time and attention from commenters who shared 
their opinions on how to implement section 201 of the Act. In 
developing this interim final rule, VA considered the feedback received 
from the April 1, 2021, Notice of Request for Information on the 
Department of Veterans Affairs' Staff Sergeant Parker Gordon Fox 
Suicide Prevention Grant Program (RIN 2900-AR16) and the listening 
sessions held on May 25, 2021, and May 26, 2021.

Part 78 of Title 38, Code of Federal Regulations

    Through this interim final rule, VA is establishing and 
implementing, in new part 78 of title 38, Code of Federal Regulations 
(CFR), SSG Fox SPGP required by section 201 of the Act. Establishment 
of this new part ensures organization and clarity for implementation of 
this new grant program. The interim final rule is establishing 
regulations authorizing VA to award suicide prevention services grants 
to eligible entities who will provide or coordinate the provision of 
suicide prevention services to eligible individuals and their families.
    Consistent with section 201 of the Act, part 78 is titled the Staff 
Sergeant Parker Gordon Fox Suicide Prevention Grant Program.

78.0 Purpose and Scope

    Section 78.0 of this IFR explains the purpose and scope of new part 
78.
    Paragraph (a) states that this part implements SSG Fox SPGP with 
the purpose of reducing veteran suicide by expanding suicide prevention 
programs for veterans through the award of suicide prevention services 
grants to eligible entities to provide or coordinate the provision of 
suicide prevention services to eligible individuals and their families. 
This purpose is consistent with section 201(a)(1) and (b) of the Act. 
Section 201(a)(1) states that its purpose is to reduce veteran suicide 
through a community-based grant program to award grants to eligible 
entities to provide or coordinate suicide prevention services to 
eligible individuals and their families. Section 201(b) states that the 
Secretary shall provide financial assistance through grants to eligible 
entities to provide or coordinate the provision of services to eligible 
individuals and their families to reduce the risk of suicide.
    Paragraph (b) states that suicide prevention services covered by 
this part are those services that address the needs of eligible 
individuals and their families and are necessary for improving the 
mental health status and wellbeing and reducing the suicide risk of 
eligible individuals and their families. This broadly defines the 
intended effects of the program, is consistent with the intent of the 
law, and ensures that those services authorized under this grant 
program are those that meet the purpose of this grant program--to 
reduce suicide risk.

78.5 Definitions

    Section 78.5 contains the definitions for key terms that apply to 
new part 78 and to any Notice of Funding Opportunity (NOFO) for this 
grant program. The definitions are listed in alphabetical order, 
beginning with the definition of applicant.
    VA is defining applicant to mean an eligible entity that submits an 
application for a suicide prevention services grant announced in a 
NOFO. VA is defining applicant in this manner since only an eligible 
entity (as that term is defined later in this rulemaking) that submits 
an application for a suicide prevention services grant under part 78 
will be able to apply for such a grant. This is based on a plain 
language understanding of the term ``applicant'' and is consistent with 
how VA defines this in the Supportive Services for Veteran Families 
(SSVF) Program. See 38 CFR 62.2. As explained in Sec.  78.15, VA will 
require submission of an application similar to other grant programs 
that VA administers.
    Direct Federal financial assistance means Federal financial 
assistance received by an entity selected by the Government or a pass-
through entity as defined in 38 CFR 50.1(d) to provide or carry out a 
service (e.g., by contract, grant, or cooperative agreement). This is 
used for purposes of Sec.  78.130 and is consistent with how VA defines 
this in the Homeless Providers Grant and Per Diem Program and the SSVF 
Program (see Sec. Sec.  61.64(b)(2) and 62.62, respectively).
    Eligible child care provider is defined to mean a provider of child 
care services for compensation, including a provider of care for a 
school-age child during non-school hours, that (1) is licensed, 
regulated, registered, or otherwise legally operating, under State and 
local law; and (2) satisfies the State and local requirements, 
applicable to the child care services the provider provides. This is 
consistent with the definition of eligible child care provider that VA 
uses in the SSVF Program. See 38 CFR 62.2. This definition of eligible 
child care provider is also consistent with the broader definition used 
by the Department of Health and Human Services (HHS) for its Child Care 
and Development Block grant. See 42 U.S.C. 9859(2).
    This term is used for purposes of Sec.  78.80(h), which includes 
among suicide prevention services certain child care services. Pursuant 
to section 201(q)(11)(A)(ix)(VIII) of the Act, child care services (not 
to exceed $5,000 per family of an eligible individual per fiscal year) 
are authorized as assistance with emergent needs under this grant 
program, and VA explains in Sec.  78.80(h) the limitations on such 
services and payments.
    Eligible entity is defined to mean an entity that meets the 
definition of an eligible entity in section 201(q) of Public Law 116-
171. VA refers to section 201(q) of Public Law 116-171 rather than 
include the exact definition from subsection (q)(3) of section 201, as 
this would allow VA to immediately implement any changes made by 
Congress to that definition without requiring amendment to these 
regulations. Currently, under section 201(q)(3) of the Act, an eligible 
entity must be one of the following: (1) An incorporated private 
institution or foundation (i) no part of the net earnings of which 
incurs to the benefit of any member, founder, contributor, or

[[Page 13808]]

individual, and (ii) that has a governing board that would be 
responsible for the operation of the suicide prevention services 
provided under this part; (2) a corporation wholly owned and controlled 
by an organization meeting the requirements of clauses (i) and (ii) 
above; (3) an Indian tribe; (4) a community-based organization that can 
effectively network with local civic organizations, regional health 
systems, and other settings where eligible individuals and their 
families are likely to have contact; or (5) a State or local 
government.
    Eligible individual is defined to mean an individual that meets the 
requirements of Sec.  78.10(a). As discussed later in this rulemaking, 
Sec.  78.10(a) describes the eligibility criteria to be an eligible 
individual under part 78. These criteria are consistent with section 
201(q)(4) of the Act.
    Family is defined to mean any of the following: A parent, spouse, 
child, sibling, step-family member, extended family member, and any 
other individual who lives with the eligible individual. This is 
consistent with section 201(q)(6) of the Act.
    Grantee is defined to mean an eligible entity that is awarded a 
suicide prevention services grant under part 78. This is consistent 
with how VA defines grantee for other VA grant programs and the plain 
meaning of this term. See, e.g., 38 CFR 62.2; 38 CFR 61.1.
    Indian tribe is defined to mean an Indian tribe as defined in 25 
U.S.C. 4103. Section 4103(13)(A) of title 25, U.S.C., defines Indian 
tribe in general to mean a tribe that is a Federally or a State 
recognized tribe. Section 4103(13)(B) of title 25, U.S.C., further 
defines Federally recognized tribe to mean any Indian tribe, band, 
nation, or other organized group or community of Indians, including any 
Alaska Native village or regional or village corporation as defined in 
or established pursuant to the Alaska Native Claims Settlement Act (43 
U.S.C. 1601 et seq.), that is recognized as eligible for the special 
programs and services provided by the United States to Indians because 
of their status as Indians pursuant to the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.). Section 
4103(13)(C) of title 25, U.S.C., also defines State recognized tribe to 
mean any tribe, band, nation, pueblo, village, or community--(1) that 
has been recognized as an Indian tribe by any State; and (2) for which 
an Indian Housing Authority has, before the effective date under 
section 705, entered into a contract with the Secretary of Housing and 
Urban Development pursuant to the United States Housing Act of 1937 (42 
U.S.C. 1437 et seq.) for housing for Indian families and has received 
funding pursuant to such contract within the 5-year period ending upon 
such effective date. This definition also includes certain conditions 
set forth in 25 U.S.C. 4103(13)(C)(ii). This definition of Indian tribe 
is consistent with section 201(q)(7) of the Act.
    Indirect Federal financial assistance means Federal financial 
assistance in which a service provider receives program funds through a 
voucher, certificate, agreement or other form of disbursement, as a 
result of the genuine, independent choice of a participant. This is 
used for purposes of Sec.  78.130 and is consistent with how VA defines 
this in the VA Homeless Providers Grant and Per Diem Program and the 
SSVF Program. See Sec. Sec.  61.64(b)(2) and 62.62, respectively.
    Section 201(d)(1)(A)(iv) of the Act authorizes VA to prioritize 
distribution of grants to medically underserved areas. While section 
201 of the Act does not define medically underserved areas, VA is 
defining medically underserved areas consistent with the definition of 
medically underserved population that is set forth in other Federal 
law. Section 254b(b)(3)(A) of 42 U.S.C. defines medically underserved 
population to mean the population of an urban or rural area designated 
by the HHS Secretary as an area with a shortage of personal health 
services or a population group designated by the HHS Secretary as 
having a shortage of such services. While section 254b(b)(3)(A) uses 
the term medically underserved population, section 254b(b)(3) generally 
establishes a process for identifying medically underserved areas that 
are designated by the United States Health Resources and Services 
Administration (HRSA), the HHS sub-agency responsible for issuing data 
and maps on medically underserved populations and areas in a combined 
manner. See HRSA's maps on medically underserved areas/populations at 
https://www.hrsa.gov/maps/quick-maps?config=mapconfig/MUA.jsondevelops. 
See also, https://data.hrsa.gov/tools/shortage-area/mua-find. Because 
42 U.S.C. 254b(b)(3) may be amended in the future, VA is not 
incorporating the actual definition in proposed Sec.  78.5. Rather, VA 
is defining medically underserved areas to mean an area that is 
designated as a medically underserved population under 42 U.S.C. 
254b(b)(3). This term is defined consistently with its use in 38 U.S.C. 
7601 note, and is widely known, commonplace, and established. It also 
allows VA to defer to the expertise of another agency that specializes 
in analyzing and identifying medically underserved areas and 
populations.
    VA is defining Notice of Funding Opportunity (NOFO) to mean a 
Notice of Funding Opportunity published on grants.gov in accordance 
with Sec.  78.110. This is consistent with how VA defines a similar 
term, Notice of Funding Availability (NOFA), in other grant regulations 
and with the plain meaning of this term. This definition references 
Sec.  78.110, which explains that VA will publish a NOFO when funds for 
suicide prevention services grants are available and indicates the type 
of information that must be included in the application for this 
program. Pursuant to 2 CFR 200.203, all NOFOs must be posted on 
grants.gov.
    Participant is defined to mean an eligible individual or their 
family who is receiving suicide prevention services for which they are 
eligible from a grantee. This definition is necessary for purposes of 
understanding part 78 and SSG Fox SPGP.
    VA is defining rural communities to mean those communities 
considered rural according to the Rural-Urban Commuting Area (RUCA) 
system as determined by the United States Department of Agriculture 
(USDA). This is consistent with section 201(q)(9) of the Act. VA will 
use this term and its definition in Sec.  78.30 for purposes of 
prioritizing the distribution of grants to rural communities pursuant 
to section 201(d)(1)(A)(i) of the Act. For more information on RUCA, 
please refer to https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/.
    VA is defining State to mean any of the several States of the 
United States, the District of Columbia, the Commonwealth of Puerto 
Rico, any territory or possession of the United States, or any agency 
or instrumentality of a State exclusive of local governments. This is 
identical to most of the definition of the same term for the SSVF 
Program (see Sec.  62.2), except that we do not include here the 
exception that is present in the SSVF regulations to public and Indian 
housing agencies under the United States Housing Act of 1937, as that 
portion of the definition is not relevant to the suicide prevention 
grant program established under these regulations. This definition is 
understood by VA and grantees.
    Suicide prevention services is defined consistent with the 
definition of this term in section 201(q)(11) of the Act. VA is setting 
forth each of the suicide prevention services in their own individual 
sections (see 38 CFR 78.45 through 78.90) for clarity. Thus, VA is 
defining suicide prevention services to

[[Page 13809]]

include the following services provided to address the needs of a 
participant: (1) Outreach as specified under Sec.  78.45, (2) baseline 
mental health screening as specified under Sec.  78.50, (3) education 
as specified under Sec.  78.55, (4) clinical services for emergency 
treatment as specified under Sec.  78.60, (5) case management services 
as specified under Sec.  78.65, (6) peer support services as specified 
under Sec.  78.70, (7) assistance in obtaining VA benefits as specified 
under Sec.  78.75, (8) assistance in obtaining and coordinating other 
public benefits and assistance with emergent needs as specified under 
Sec.  78.80, (9) nontraditional and innovative approaches and treatment 
practices as specified under Sec.  78.85, and (10) other services as 
specified under Sec.  78.90.
    VA is defining suicide prevention services grant to mean a grant 
awarded under part 78. This definition is based on the plain language 
understanding of this term.
    VA is defining suicide prevention services grant agreement to mean 
the agreement executed between VA and a grantee as specified under 
Sec.  78.115. This definition is based on the plain language 
understanding of this term and is consistent with the definition of 
similar terms in other VA regulations. See Sec.  62.2.
    Suspension is defined to mean an action by VA that temporarily 
withdraws VA funding under a suicide prevention services grant, pending 
corrective action by the grantee or pending a decision to terminate the 
suicide prevention services grant by VA. Suspension of a suicide 
prevention services grant is a separate action from suspension under VA 
regulations or guidance implementing Executive Orders 12549 and 12689, 
``Debarment and Suspension.'' This definition is consistent with the 
SSVF grant program's definition for this term. See Sec.  62.2. However, 
with regards to implementing Executive Orders 12549 and 12689, VA has 
added the language, guidance, as not all of VA's implementations of 
Executive Orders are regulatory.
    Territories is defined to mean the territories of the United 
States, including Puerto Rico, Guam, the U.S. Virgin Islands, American 
Samoa, and the Northern Mariana Islands. This is consistent with how 
the Federal government commonly describes U.S. territories (in 
comparison to States). This term is necessary to define as it is used 
in the Act, although not defined within section 201, and in Sec.  
78.30. VA is defining this term as VA has authority under section 
201(d)(1)(A)(iii) of the Act to prioritize distribution of grants to 
territories of the United States. As explained in Sec.  78.30, VA may 
prioritize territories, along with other areas such as medically 
underserved areas and tribal lands, for purposes of this grant program. 
While there is some overlap between this definition and the definition 
of State above--all territories are considered States under part 78 (as 
provided for under 38 U.S.C. 101(20)), but not all States are 
territories--the specific application of this potential priority under 
Sec.  78.30(d)(2)(iii) reflects the only meaningful distinction between 
the two terms.
    Veteran is defined to mean veteran under 38 U.S.C. 101(2). This is 
based on section 201(q)(4)(A) of the Act. Section 101 of title 38, 
U.S.C., defines veteran as a person who served in the active military, 
naval, air, or space service, and who was discharged or released 
therefrom under conditions other than dishonorable. This term is used 
for purposes of peer support services in part 78.
    The term Veterans Crisis Line is defined to mean the toll-free 
hotline for veterans in crisis and their families and friends 
established under 38 U.S.C. 1720F(h). This is consistent with section 
201(q)(12) of the Act. This term is used in Sec.  78.30(d)(2)(vi) for 
purposes of prioritizing selection of applicants for this grant 
program.
    VA is defining withholding to mean that payment of a suicide 
prevention services grant will not be paid until such time as VA 
determines that the grantee provides sufficiently adequate 
documentation and/or actions to correct a deficiency for the suicide 
prevention services grant. This term is defined in this manner, as it 
is intended to provide a general description of how this term is used 
in 2 CFR part 200, which governs VA grant programs including the SSG 
Fox SPGP. This term relates to withholding payment of a suicide 
prevention services grant pursuant to Sec.  78.160, described later in 
this rulemaking.

78.10 Eligible Individuals

    Section 78.10 explains the criteria for determining the eligibility 
of individuals under part 78 consistent with the definition of eligible 
individual in section 201(q)(4) of the Act. As explained in the 
definitions section, an eligible individual is an individual that meets 
the requirements of Sec.  78.10(a).
    Paragraph (a) states that to be an eligible individual under this 
part, a person must meet criteria that determine that person is at risk 
of suicide and further meet the definition of eligible individual in 
section 201 of Public Law 116-171. VA refers to section 201(q) of 
Public Law 116-171 rather than include the exact definition from 
subsection (q)(4), as this would allow VA to immediately implement any 
changes made by Congress to that definition without requiring amendment 
to these regulations. Subsection (q)(4) of section 201 currently states 
that an eligible individual must be one of the following: (1) A veteran 
as defined in 38 U.S.C. 101, (2) an individual described in 38 U.S.C. 
1720I(b), or (3) an individual described in 38 U.S.C. 1712A(a)(1)(C)(i) 
through (iv).
    Section 101(2) of title 38, U.S.C. defines veteran as a person who 
served in the active military, naval, air, or space service, and who 
was discharged or released therefrom under conditions other than 
dishonorable. Section 1720I(b) requires VA furnish to certain former 
member of the Armed Forces (1) an initial mental health assessment and 
(2) mental health care or behavioral health care services authorized 
under 38 U.S.C. chapter 17 that are required to treat the mental or 
behavioral health care needs of these former service members, including 
risk of suicide or harming others. Such former members of the Armed 
Forces, including reserve components, are those who (1) while serving 
in the active military, naval, air, or space service, were discharged 
or released therefrom under a condition that is not honorable but not a 
dishonorable discharge or a discharge by court-martial; (2) are not 
enrolled in VA health care; and either served in the Armed Forces for a 
period of more than 100 cumulative days and were deployed in a theater 
of combat operations, in support of a contingency operation, or in an 
area at a time during which hostilities were occurring in that area 
during such service, including by controlling an unmanned aerial 
vehicle from a location other than such theater or area; or (3) while 
serving in the Armed Forces, were the victim of a physical assault of a 
sexual nature, a battery of a sexual nature, or sexual harassment. 
Section 1712A details the individuals to whom VA is required to furnish 
readjustment counseling. These include any individual who is a veteran 
or member of the Armed Forces, including a member of a reserve 
component of the Armed Forces, who served on active duty in a theater 
of combat operations or an area at a time during which hostilities 
occurred in that area; any individual who is a veteran or member of the 
Armed Forces, including a member of a reserve component of the Armed 
Forces, who provided direct emergency medical or mental health care, or 
mortuary services to the

[[Page 13810]]

causalities of combat operations or hostilities, but who at the time 
was located outside the theater of combat operations or area of 
hostilities; any individual who is a veteran or member of the Armed 
Forces, including a member of a reserve component of the Armed Forces, 
who engaged in combat with an enemy of the United States or against an 
opposing military force in a theater of combat operations or an area at 
a time during which hostilities occurred in that area by remotely 
controlling an unmanned aerial vehicle, notwithstanding whether the 
physical location of such veteran or member during such combat was 
within such theater of combat operations or area; and any individual 
who is a veteran or member of the Armed Forces, including a member of a 
reserve component of the Armed Forces, who served on active service in 
response to a national emergency or major disaster declared by the 
President or in the National Guard of a State under orders of the chief 
executive of that State in response to a disaster or civil disorder in 
such State.
    For purposes of eligible individuals, paragraph (b) defines risk of 
suicide. Consistent with section 201(q)(8) of the Act, risk of suicide 
means exposure to, or the existence of, any of the following factors, 
to any degree, that increase the risk of suicidal ideation and/or 
behaviors: (1) Health risk factors, including mental health challenges, 
substance use disorder, serious or chronic health conditions or pain, 
and traumatic brain injury; (2) environmental risk factors, including 
prolonged stress, stressful life events, unemployment, homelessness, 
recent loss, and legal or financial challenges; and (3) historical risk 
factors, including previous suicide attempts, family history of 
suicide, and history of abuse, neglect or trauma, including military 
sexual trauma.
    While section 201(q)(8) uses the language, substance abuse, VA 
instead uses the language, substance use disorder, in paragraph (b) to 
reduce stigma and discrimination related to substance use. For purposes 
of paragraph (b), an individual will not be required to have a 
diagnosis of substance use disorder. This definition is necessary to 
meet the intent and purpose of the program to provide grants to 
eligible entities to provide or coordinate the provision of suicide 
prevention services to eligible individuals who are considered at risk 
of suicide and is consistent with feedback received from commenters 
during consultation. This provision is thus used for determining 
eligibility of eligible individuals for receipt of suicide prevention 
services under this grant program. VA notes that this definition is 
overly inclusive, as to define this term otherwise could exclude 
individuals who may need these critical services prior to a crisis.
    Section 201(q)(8)(iii)(III) includes a history of trauma as a 
potential historical risk factor for suicide. VA interprets this, for 
purposes of this grant program, to include military sexual trauma. VA 
notes that survivors of military sexual trauma are at higher risk of 
suicide. See the National Military and Veteran Suicide Prevention 
Strategy (https://www.whitehouse.gov/wp-content/uploads/2021/11/Military-and-Veteran-Suicide-Prevention-Strategy.pdf). This reference 
is not intended to exclude other forms of trauma, but rather serves as 
an example of how this language is interpreted by VA.
    As noted in the previous paragraph, section 201(q)(8) of the Act 
defines risk of suicide based on exposure to, or the existence of, 
certain factors, to a degree determined by the Secretary pursuant to 
regulations. Thus, section 201(q)(8)(A) of the Act authorized VA to 
determine the degree required for these risk factors, and VA will 
require that grantees use the health, environmental, and historical 
risk factors just described and the impact thereof to determine the 
degree of risk of suicide for eligible individuals. This is explained 
in a note to paragraph (b). The note also explains that the degree of 
risk depends on the presence of one or more suicide risk factors and 
the impact of those factors on an individual's mental health and 
wellbeing.
    VA will require grantees determine an individual's degree of risk 
of suicide through the use of a screening tool approved by the 
Department. To assist grantees in determining risk of suicide (and thus 
an individual's eligibility for suicide prevention services), VA will 
provide grantees with a screening tool that will determine the presence 
of suicide risk. This tool will be a validated tool that can be 
administered by non-clinical staff and/or a self-report tool such as 
the Columbia Suicide Severity Rating Scale. See https://cssrs.columbia.edu. VA is not identifying the specific tool in 
regulation, as the screening tool may change due to an evolving field 
of study and VA may approve the use of several tools. This tool is 
subject to the Paperwork Reduction Act because it is an information 
collection. As such, the public may comment on this screening tool as 
part of the information collections associated with this rulemaking, 
and VA welcomes public comment on use of this screening tool. VA will 
ensure that grantees are provided this tool before providing or 
coordinating suicide prevention services under this grant program and 
have access to publicly available training materials to support the 
grantees' use of this tool.
    VA would not require a clinical tool to be used to determine 
eligibility because many of the authorized suicide prevention services 
are not clinical in nature. To require a clinical tool to determine the 
degree of risk of suicide would severely limit the number of applicants 
and grantees for this grant program, which VA does not believe was the 
intent of section 201 of the Act. This screening tool is not the same 
as the tool that will be used for purposes of the baseline mental 
health screening conduct pursuant to Sec.  78.50, which is described 
later in this discussion. This screening tool will assess health, 
environmental, and historical risk factors and the impact thereof. An 
individual's degree of risk of suicide can vary hour to hour, day to 
day, and thus, requiring a certain degree of risk of suicide to be 
eligible for services could result in the ineligibility of individuals 
whom this program was intended to cover. This is a non-clinical tool 
that will be used by grantees regardless of whether their staff are 
licensed, independent clinical providers.

78.15 Applications for Suicide Prevention Services Grants

    Under Sec.  78.15(a), applicants must submit a complete application 
package for a suicide prevention services grant under this new part 78, 
as described in the NOFO. Paragraph (a) also explains the information 
that must be included in the application to be considered a complete 
suicide prevention services grant application package. This list of 
items described in paragraph (a) is derived from section 201(d)(2), 
(f), and (h)(2) of the Act, and it ensures that VA can adequately 
evaluate applicants for the purposes of this grant program (that is, to 
provide or coordinate the provision of suicide prevention services to 
reduce the risk of suicide among eligible individuals).
    The following information must be included in the application 
package: (1) Documentation evidencing the experience of the applicant 
and any identified community partners in providing or coordinating the 
provision of suicide prevention services to eligible individuals and 
their families; (2) a description of the suicide prevention services 
proposed to be provided by the applicant and the identified need for 
those services; (3) a detailed plan

[[Page 13811]]

describing how the applicant proposes to coordinate or deliver suicide 
prevention services to eligible individuals, including (i) if the 
applicant is a State or local government or an Indian tribe, an 
identification of the community partners, if any, with which the 
applicant proposes to work in delivering such services, (ii) a 
description of the arrangements currently in place between the 
applicant and such partners with regard to the provision or 
coordination of the provision of suicide prevention services, (iii) an 
identification of how long such arrangements have been in place, (iv) a 
description of the suicide prevention services provided by such 
partners that the applicant must coordinate, if any, and (v) an 
identification of local VA suicide prevention coordinators and a 
description of how the applicant will communicate with local VA suicide 
prevention coordinators; (4) a description of the location and 
population of eligible individuals and their families proposed to be 
provided suicide prevention services; (5) an estimate of the number of 
eligible individuals at risk of suicide and their families proposed to 
be provided suicide prevention services, including the percentage of 
those eligible individuals who are not currently receiving care 
furnished by VA; (6) evidence of measurable outcomes related to 
reductions in suicide risk and mood-related symptoms utilizing 
validated instruments by the applicant (and the proposed partners of 
the applicant, if any) in providing suicide prevention services to 
individuals at risk of suicide, particularly to eligible individuals 
and their families; (7) a description of the managerial and 
technological capacity of the applicant to (i) coordinate the provision 
of suicide prevention services with the provision of other services, 
(ii) assess on an ongoing basis the needs of eligible individuals and 
their families for suicide prevention services, (iii) coordinate the 
provision of suicide prevention services with VA services for which 
eligible individuals are also eligible, (iv) tailor (i.e., provide 
individualized) suicide prevention services to the needs of eligible 
individuals and their families, (v) seek continuously new sources of 
assistance to ensure the continuity of suicide prevention services for 
eligible individuals and their families as long as the eligible 
individuals are determined to be at risk of suicide, and (vi) measure 
the effects of suicide prevention services provided by the applicant or 
partner organization on the lives of eligible individuals and their 
families who receive such services provided by the organization using 
pre- and post-evaluations on validated measures of suicide risk and 
mood-related symptoms; (8) clearly defined objectives for the provision 
of suicide prevention services; (9) a description and physical address 
of the primary location of the applicant; (10) a description of the 
geographic area the applicant plans to serve during the grant award 
period for which the application applies; (11) if the applicant is a 
State or local government or an Indian tribe, the amount of grant funds 
proposed to be made available to community partners, if any, through 
agreements; (12) a description of how the applicant will assess the 
effectiveness of the provision of grants under this part; (13) an 
agreement to use the measures and metrics provided by VA for the 
purposes of measuring the effectiveness of the programming to be 
provided in improving mental health status, wellbeing, and reducing 
suicide risk and suicide deaths of eligible individuals and their 
families; (14) an agreement to comply with and implement the 
requirements of this part throughout the term of the suicide prevention 
services grant; and (15) any additional information as deemed 
appropriate by VA.
    The items in paragraph (a) generally are consistent with 
requirements in section 201(f) and (h)(2) of the Act and are necessary 
for VA to properly evaluate whether applicants will be able to meet the 
requirements in this part to provide or coordinate suicide prevention 
services if they are awarded a grant under this new part 78. While 
language similar to paragraph (a)(1) does not appear in section 201(f) 
or (h)(2) of the Act, it does appear in section 201(d)(2) of the Act, 
where VA is instructed to give preference to eligible entities that 
have demonstrated the ability to provide or coordinate suicide 
prevention services. Paragraph (a)(14) similarly does not appear 
explicitly in section 201(f) or (h)(2) of the Act, but section 
201(f)(1) authorizes the Secretary to include such commitments as the 
Secretary considers necessary to carry out this section. Compliance 
with the requirements of the new part 78 is such a commitment. Section 
201(f)(2)(M) also authorizes the Secretary to include additional 
application criteria as the Secretary considers appropriate. Again, an 
agreement to comply with the requirements of this part is an 
appropriate obligation. VA notes that technical assistance with 
completing applications will be available for applicants, including how 
to determine the required estimates under paragraph (a)(5).
    For purposes of paragraph (a)(7)(iv), VA notes that tailoring 
(i.e., providing individualized) suicide prevention services to the 
needs of eligible individuals and their families, includes how services 
would be tailored (provided) to priority sub-populations, including but 
not limited to survivors of military sexual trauma, women veterans 
under the age of 35, and other groups identified in the National 
Military and Veteran Suicide Prevention Strategy. See, https://www.whitehouse.gov/wp-content/uploads/2021/11/Military-and-Veteran-Suicide-Prevention-Strategy.pdf. Such services may include but not be 
limited to care and support with military sexual trauma, employment, 
and housing.
    For purposes of paragraphs (a)(4) and (a)(10) of this section, as 
well as for other sections of this rule, VA is requiring applicants to 
provide information regarding the location of eligible individuals and 
a description of the geographic area the applicant plans to serve. 
Section 201(d)(1)(C) of the Act permits VA to provide grants to 
eligible entities that furnish services to eligible individuals and 
their families in geographically dispersed areas; this authority is 
discretionary. At this time, VA is choosing not to exercise this 
authority. While there may be some applicants who desire to serve a 
population that is geographically dispersed, it would be logistically 
difficult for such organizations to provide necessary services, and a 
number of other provisions in section 201 of the Act clearly state 
requirements related to geographic locations. For example, section 
201(d)(1)(A) and (B) of the Act permit and require, respectively, VA to 
prioritize grants to geographic areas, such as rural communities, 
Tribal lands, territories of the United States, medically underserved 
areas, areas with a high number or percentage of minority veterans or 
women veterans, areas with a high number or percentage of calls to the 
Veterans Crisis Line, and areas that have experienced high rates of 
suicide by eligible individuals. Each of these descriptions clearly 
requires a geographic description or scope. Other provisions of section 
201 of the Act also clearly refer to geographic areas. For example, 
section 201(f)(2)(I) requires applicants to provide ``a description of 
the geographic area the eligible entity plans to serve during the grant 
award period for which the application applies.'' Section 201(h)(2)(A) 
requires the Secretary to develop a framework for

[[Page 13812]]

collecting and sharing information about grantees for purposes of 
improving the services available for eligible individuals and their 
families set forth by locality, among other factors. Section 
201(q)(11)(A)(iv), which defines suicide prevention services, includes 
the provision of clinical services for emergency treatment as a suicide 
prevention service, and these services would generally need to be 
furnished in-person. Additionally, applicants seeking grant funds to 
support non-geographically focused populations would likely have higher 
overhead and administrative costs due to the need to conduct outreach 
across a broader area, maintain information and connections with more 
VA facilities and other entities, and deliver services in different 
locations. Higher overhead costs mean fewer available resources 
dedicated to the delivery of suicide prevention services, which, given 
the population being served by this program, would be less than ideal 
as those resources could be better utilized elsewhere to serve this 
unique population. Given the short period of time in which VA is 
authorized to operate this program, only three years from the date of 
the first grant award (see section 201(j) of the Act), it would be 
prudent to ensure these resources are used to maximal effect.
    This does not prohibit organizations that function at a national 
level or in multiple geographic areas from applying for a grant in one 
or more location as long as they meet the requirements necessary to 
implement suicide prevention services for the specific geographic area. 
However, VA notes that many of the suicide prevention services, 
particularly emergent services for those at immediate risk of suicide, 
could not be furnished by entities without a physical presence in the 
area or could only be furnished at a greater risk of the loss of life 
of a participant and the services required by law and by the targeted 
population require engagement with local VA medical centers and 
community.
    Paragraph (b) states that subject to funding availability, grantees 
may submit an application for renewal of a suicide prevention services 
grant if the grantee's program will remain substantially the same. To 
apply for renewal of a suicide prevention services grant, a grantee 
must submit to VA a complete suicide prevention services grant renewal 
application package, as described in the NOFO. This is consistent with 
how VA administers the SSVF Program under part 62 and will allow VA to 
renew grants in an efficient and timely manner so that there will be no 
lapse in the provision or coordination of the provision of suicide 
prevention services by grantees to participants from year to year.
    Paragraph (c) establishes that VA may request in writing that an 
applicant or grantee, as applicable, submit other information or 
documentation relevant to the suicide prevention services grant 
application. This is authorized by section 201(f)(1) of the Act, which 
permits VA to require such commitments and information as the Secretary 
considers necessary to carry out this section. This provides VA with 
the authority to request additional information that may not be in the 
initial or renewal application but will be necessary for VA to properly 
evaluate the applicant or grantee for a suicide prevention services 
grant.

78.20 Threshold Requirements Prior To Scoring Suicide Prevention 
Services Grant Applicants

    Pursuant to section 201(h) of the Act, VA, in consultation with 
various entities listed in the Act, is required to establish selection 
criteria for this new grant program. As explained earlier in this 
rulemaking, VA conducted this consultation through an FR notice and 
through listening sessions. See 86 FR 17268 (April 1, 2021); 86 FR 
25938 (May 11, 2021). Section 78.20 sets forth the threshold 
requirements for further scoring applicants pursuant to Sec.  78.25.
    Section 78.20 explains that VA will only score applicants for 
suicide prevention services grants if they meet certain threshold 
requirements as set forth in paragraphs (a) through (g).
    These threshold requirements in paragraphs (a) through (g) include 
that the application is filed within the time period established in the 
NOFO, and any additional information or documentation requested by VA 
under Sec.  78.15(c) is provided within the time frame established by 
VA; the application is completed in all parts; the activities for which 
the suicide prevention services grant is requested are eligible for 
funding under this part; the applicant's proposed participants are 
eligible to receive suicide prevention services under this part; the 
applicant agrees to comply with the requirements of this part; the 
applicant does not have an outstanding obligation to the Federal 
government that is in arrears and does not have an overdue or 
unsatisfactory response to an audit; and the applicant is not in 
default by failing to meet the requirements for any previous Federal 
assistance.
    These are minimum requirements that must be met before VA will 
score applications, and applicants will be able to understand whether 
they meet these threshold requirements in advance of application 
submission. VA anticipates this will reduce the amount of time and 
resources that VA will dedicate to evaluating and scoring applicants 
for suicide prevention services grants. These requirements are 
authorized by section 201(f)(1) of the Act, which permits VA to include 
such commitments and information as the Secretary considers necessary 
to carry out section 201. These threshold requirements are consistent 
with other VA grant programs, such as the Homeless Providers Grant and 
Per Diem Program and the SSVF Program (See Sec. Sec.  61.12 and 62.21, 
respectively).

78.25 Scoring Criteria for Awarding Grants

    Section 201(h)(1) of the Act requires the VA Secretary to establish 
criteria for the selection of eligible entities that have submitted 
applications for a suicide prevention services grant. Consistent with 
that authority, in Sec.  78.25, VA sets forth the criteria to be used 
to score applicants who are applying for a suicide prevention services 
grant, as the amount of funds available for grants each year will be 
limited and VA may receive a higher number of applicants than there are 
available grant funds. Scoring criteria will allow VA to award grants 
to those who are most qualified and will ensure that VA administers 
grants in a manner consistent with the intent and purpose of SSG Fox 
SPGP. The scoring criteria were developed based on the scoring criteria 
used for other VA grant programs, such as the SSVF Program (38 CFR 
62.22) and Homeless Providers Grant and Per Diem Program (38 CFR 
61.13), but tailored to the purpose and requirements of section 201 of 
the Act. These criteria are consistent with feedback received from 
commenters during consultation that expressed support for awarding 
grants to entities with prior experience working with veterans, 
including those at risk of suicide, entities that had partnerships 
within the area and with VA, and entities that have or plan to have 
culturally competent care related to veterans.
    While this section does not include specific point values for each 
criterion, the regulation provides that such point values will be set 
forth in the NOFO. This will allow VA to retain flexibility in 
determining those point values each year of the grant program in the 
event that such point values need to change. At all times, VA will 
comply with the requirements in section 201(d) of the Act regarding 
prioritization of and

[[Page 13813]]

preference for certain applicants. VA will establish in each NOFO a 
minimum number of points that an applicant must be awarded, both in 
each category and in total, to ensure that all applicants who are 
awarded a grant can perform all necessary elements of the program, and 
that their program as a whole is likely to be successful. These dual 
requirements will ensure that VA is giving preference to applicants 
that have demonstrated the ability to provide or coordinate suicide 
prevention services, as required by section 201(d)(2) of the Act.
    Paragraph (a) explains that VA will award points based on the 
background, qualifications, experience, and past performance, of the 
applicant and any community partners identified by the applicant in the 
suicide prevention services grant application, as demonstrated by the 
following: (1) Background and organizational history, (2) staff 
qualifications, and (3) organizational qualifications and past 
performance, including experience with veterans services. These scoring 
criteria are important to determine whether applicants have the 
necessary and relevant background and experience to administer a 
suicide prevention services program consistent with section 201 of the 
Act and 38 CFR part 78.
    In scoring an applicant's background and organizational history 
under paragraph (a)(1), VA will consider the applicant's, and any 
identified community partners', background and organizational history 
that are relevant to the program; whether the applicant, and any 
identified community partners, maintain organizational structures with 
clear lines of reporting and defined responsibilities; and whether the 
applicant, and any identified community partners, have a history of 
complying with agreements and not defaulting on financial obligations.
    Under paragraph (a)(2), VA will score applications based on staff 
qualifications. This includes determining the applicant's staff's, and 
any identified community partners' staff's, experience providing to, or 
coordinating services for, eligible individuals and their families; and 
the applicant's staff's, and any identified community partners' 
staff's, experience administering programs similar to SSG Fox SPGP.
    VA will score applicants' organizational qualifications and past 
performance, including experience with veterans services, under 
paragraph (a)(3) based on the applicant's, and any identified community 
partners', organizational experience providing suicide prevention 
services to or coordinating suicide prevention services for eligible 
individuals and their families; the applicant's, and any identified 
community partners', organizational experience coordinating services 
for eligible individuals and their families among multiple 
organizations and Federal, State, local, and tribal governmental 
entities; the applicant's, and any identified community partners', 
organizational experience administering a program similar in type and 
scale to SSG Fox SPGP to eligible individuals and their families; and 
the applicant's, and any identified community partners', organizational 
experience working with veterans and their families.
    Examples of experience VA will consider under paragraph (a) may 
include but are not limited to participation in VA-SAMHSA's Governors' 
and Mayors' Challenges to Prevent Suicide among service members, 
veterans, and their families; endorsement by a local or State public 
health agency or State Department of Veterans Affairs recognizing care 
coordination experience; and participation in the SSVF Program and 
Homeless Providers Grant and Per Diem Program.
    While experience providing suicide prevention services to eligible 
individuals and their families is an important scoring criterion, we 
acknowledge that some organizations may not have such experience. 
However, they may have experience working with veterans and their 
families (other than those eligible under this grant program) for 
purposes other than those related to this grant program. Having an 
understanding of the veteran population as a whole and demonstrating 
related military cultural competency is critical for ensuring that the 
needs of eligible individuals and their families are met through this 
grant program. This is consistent with the feedback received through 
consultation as described earlier. This also allows VA the ability to 
award points at various levels (local, regional, State) since the types 
of experience entities at those levels may have can vary. Thus, 
pursuant to paragraph (a), VA will score applicants not only based on 
their experience administering similar programs to the suicide 
prevention grant programs and providing or coordinating services to 
eligible individuals, but also based on their experience working with 
veterans and their families.
    Paragraph (b) explains that VA will award points based on the 
applicant's program concept and suicide prevention services plan. The 
scoring criteria under this paragraph are important for VA to use to 
determine whether the applicant has a fully developed program concept 
and plan that will meet the requirements of section 201 of the Act and 
38 CFR part 78.
    VA will award points based on the applicant's program concept and 
suicide prevention services plan, as demonstrated by the (1) need for 
the program, (2) outreach and screening plan, (3) program concept, (4) 
program implementation timeline, (5) coordination with VA, (6) ability 
to meet VA's requirements, goals and objectives for SSG Fox SPGP, and 
(7) capacity to undertake the program.
    VA will score the need for the program under paragraph (b)(1) based 
on whether the applicant has shown a need amongst eligible individuals 
and their families in the area where the program will be based and 
whether the applicant demonstrates an understanding of the unique needs 
for suicide prevention services of eligible individuals and their 
families.
    VA will score the outreach and screening plan under paragraph 
(b)(2) based on whether the applicant has a feasible plan for outreach, 
consistent with Sec.  78.45, and referral to identify and assist 
individuals and their families that may be eligible for suicide 
prevention services and are most in need of suicide prevention 
services, has a feasible plan to process and receive participant 
referrals, and has a feasible plan to assess and accommodate the needs 
of incoming participants. As part of scoring the application based on 
whether the applicant has a feasible plan to assess and accommodate the 
needs of incoming participants, VA notes that this may include but not 
be limited to addressing language assistance needs of limited English 
proficient individuals, physical accommodation needs, and 
transportation needs.
    Pursuant to paragraph (b)(3), VA will score the program concept 
based on whether the applicant's program concept, size, scope, and 
staffing plan are feasible; and that the applicant's program is 
designed to meet the needs of eligible individuals and their families.
    VA will score the program implementation timeline under paragraph 
(b)(4) based on whether the applicant's program will be implemented in 
a timely manner and suicide prevention services will be delivered to 
participants as quickly as possible and within a specified timeline. VA 
will also score this based on whether the applicant has a feasible 
staffing plan in place to meet the

[[Page 13814]]

applicant's program timeline or has existing staff to meet such 
timeline.
    Pursuant to paragraph (b)(5), VA will score applications based on 
whether the applicant has a feasible plan to coordinate outreach and 
services with local VA facilities.
    In paragraph (b)(6), scoring criteria will include the applicant's 
ability to meet VA's requirements, goals, and objectives for SSG Fox 
SPGP. This will be based on whether the applicant demonstrates 
commitment to ensuring that its program meets VA's requirements, goals, 
and objectives for SSG Fox SPGP as identified in this part and the 
NOFO.
    Under paragraph (b)(7), VA will score the applicant's capacity, 
including staff resources, to undertake its program.
    Paragraph (c) states that VA will award points based on the 
applicant's quality assurance and evaluation plan, as demonstrated by 
(1) program evaluation, (2) monitoring, (3) remediation, and (4) 
management and reporting. This scoring criterion is important to ensure 
that applicants can meet any requirements for evaluation, monitoring, 
and reporting contained in section 201 of the Act and in 38 CFR part 
78, will help VA ensure that grant funds are being used appropriately, 
and will assist in the overall assessment of the grant program.
    Pursuant to paragraph (c)(1), VA will evaluate whether the 
applicant has created clear, realistic, and measurable goals that 
reflect SSG Fox SPGP's aim of reducing and preventing suicide among 
veterans against which the applicant's program performance can be 
evaluated; and the applicant has a clear plan to continually assess the 
program.
    The scoring criterion regarding monitoring in paragraph (c)(2) will 
be based on whether the applicant has adequate controls in place to 
regularly monitor the program, including any community partners, for 
compliance with all applicable laws, regulations, and guidelines; 
whether the applicant has adequate financial and operational controls 
in place to ensure the proper use of suicide prevention services grant 
funds; and the applicant has a feasible plan for ensuring that the 
applicant's staff and any community partners are appropriately trained 
and stay informed of SSG Fox SPGP policy, evidence-informed suicide 
prevention practices, and the requirements of 38 CFR part 78.
    Paragraph (c)(3) includes the scoring criterion of remediation. 
This will be based on whether the applicant has an appropriate plan to 
establish a system to remediate non-compliant aspects of the program if 
and when they are identified.
    Under paragraph (c)(4), VA will score the applicant's management 
and reporting, based on whether the applicant's program management team 
has the capability and a system in place to provide to VA timely and 
accurate reports at the frequency set by VA.
    Paragraph (d) explains that VA will award points based on the 
applicant's financial capability and plan, as demonstrated by (1) 
organizational finances (based on whether the applicant, and any 
identified community partners, are financially stable); and (2) 
financial feasibility of the program (based on whether the applicant 
has a realistic plan for obtaining all funding required to operate the 
program for the time period of the suicide prevention services grant; 
and whether the applicant's program is cost-effective and can be 
effectively implemented on-budget). These are important to ensure that 
funds are not provided to an applicant that is financially unstable and 
that the applicant has considered the costs and necessary funding for 
administering a suicide prevention services program.
    Paragraph (e) states that VA will award points based on the 
applicant's area linkages and relations, as demonstrated by the (1) 
area linkages, (2) past working relationships, (3) local presence and 
knowledge, and (4) integration of linkages and program concept. This is 
important for ensuring success of the suicide prevention services 
program. VA acknowledges that applicants may not have these existing 
linkages and relationships, but they may develop them over time. VA 
also acknowledges that certain applicants without these existing 
linkages and relationships may obtain them through community partners 
with which they enter into agreements (to the extent permitted under 
section 201 of the Act).
    Area linkages under paragraph (e)(1) will include whether the 
applicant has a feasible plan for developing or relying on existing 
linkages with Federal (including VA), State, local, and tribal 
government agencies, and private entities for the purposes of providing 
additional services to participants within a given geographic area.
    Past working relationships under paragraph (e)(2) will include 
whether the applicant (or applicant's staff), and any identified 
community partners (or community partners' staff), have fostered 
similar and successful working relationships and linkages with public 
and private organizations providing services to veterans or their 
families in need of services. These may include but not be limited to 
housing assistance non-profits and agencies, housing crisis centers, 
local food banks, employment assistance non-profits and agencies, rape 
crisis centers, and sexual assault and domestic violence programs with 
a history of serving veterans and military-connected victims of sexual 
trauma and abuse.
    Local presence and knowledge under paragraph (e)(3) will be based 
on whether the applicant has a presence in the area to be served by the 
applicant and understands the dynamics of the area to be served by the 
applicant. This presence and knowledge does not necessarily mean the 
applicant has an address or physical office in the area, but rather 
that they are operating in the area such that they have sufficient 
knowledge of the area and that their staff has a presence in the area. 
For example, staff may travel from a nearby area to serve eligible 
individuals in the targeted area, or a national organization may have a 
local office through which it intends to make services available. 
Evaluation of whether an applicant understands the dynamics of the area 
to be served by the applicant will be based on information including 
but not limited to the applicant's description of the area, including 
mental health centers, and relationships with local mental health 
centers. These criteria under paragraph (e)(3) may be met through 
letters of support and documented coordination of care.
    Integration of linkages and program concept under paragraph (e)(4) 
will be based on whether the applicant's linkages to the area to be 
served by the applicant enhance the effectiveness of the applicant's 
program.

78.30 Selection of Grantees

    Section 201(c) of the Act requires the VA Secretary to award a 
grant to each eligible entity for which the Secretary has approved an 
application to provide or coordinate the provision of suicide 
prevention services. Section 201(d) of the Act sets forth how VA may 
and shall distribute grants based on certain priorities, areas, and 
geography. Section 201(d)(2) requires the Secretary give preference to 
eligible entities that have demonstrated the ability to provide or 
coordinate suicide prevention services. Section 201(h) of the Act 
requires the Secretary to establish criteria for the selection of 
eligible entities that have submitted applications for a suicide 
prevention services grant. In accordance with these subsections of 
section 201 of the Act, 38 CFR 78.30 sets forth the process for 
selecting applicants for suicide prevention services grants, which will 
be a process similar to that of the SSVF Program (38 CFR 62.23) and the 
Homeless Providers Grant and Per

[[Page 13815]]

Diem Program (38 CFR 61.14 and 61.94). However, the selection process 
under Sec.  78.30 will also incorporate preference, priority, and 
distribution requirements from section 201(d) of the Act.
    As part of the process for selecting applicants to receive suicide 
prevention services grants, paragraph (a) explains that VA will first 
score all applicants that meet the threshold requirements set forth in 
Sec.  78.20 using the scoring criteria set forth in Sec.  78.25.
    Next, paragraph (b) states that VA will group applicants within the 
applicable funding priorities if any are set forth in the NOFO. As 
funding priorities can change annually, VA will set forth any funding 
priorities in the NOFO, which will allow VA flexibility in updating 
priorities in a quick and efficient manner every year that funds are 
available under this grant program.
    Then, as set forth in paragraph (c), VA will rank those applicants 
that receive at least the minimum amount of total points and points per 
category set forth in the NOFO, within their respective funding 
priority group, if any. As noted above, VA will set forth the minimum 
amount of total points and points per category in the NOFO as these can 
change annually. Setting forth these points in the NOFO will provide VA 
flexibility in updating the minimum amount of points in an efficient 
and quick manner. The applicants will be ranked in order from highest 
to lowest scores, within their respective funding priority group, if 
any.
    Paragraph (d) explains that VA will use the applicant's ranking as 
the primary basis for selection for funding. However, consistent with 
section 201(d)(1) and (d)(2) of the Act, paragraph (d) further explains 
that VA: (1) Will give preference to applicants that have demonstrated 
the ability to provide or coordinate suicide prevention services; (2) 
may prioritize the distribution of suicide prevention services grants 
to rural communities, Tribal lands, territories of the United States, 
medically underserved areas, areas with a high number or percentage of 
minority veterans or women veterans, and areas with a high number or 
percentage of calls to the Veterans Crisis Line; and (3) to the extent 
practicable, will ensure that suicide prevention services grants are 
distributed to provide services in areas of the United States that have 
experienced high rates of suicide by eligible individuals, including 
suicide attempts, to eligible entities that can assist eligible 
individuals at risk of suicide who are not currently receiving health 
care furnished by VA, and to ensure services are provided in as many 
areas as possible.
    As explained above, pursuant to section 201(d)(2) of the Act, in 
paragraph (d)(1), VA will give preference to applicants that have 
demonstrated the ability to provide or coordinate suicide prevention 
services. This preference may be met by such experience that includes 
but is not limited to entities that are part of VA-SAMHSA's Governors' 
and Mayors' Challenge to Prevent Suicide among service members, 
veterans, and their families; entities that are part of local or State 
coalitions for suicide prevention; and entities that support suicide 
prevention services through receipt of local, State, and Federal 
funding. Additionally, entities may demonstrate this ability if they 
are currently providing or coordinating suicide prevention services 
that align with the National Strategy for Preventing Veteran Suicide, 
VA-Department of Defense (DoD) Clinical Practice Guideline for the 
Assessment and Management of Patients at Risk for Suicide, or CDC's 
Preventing Suicide: A Technical Package of Policy, Programs, and 
Practices. This is consistent with feedback received from commenters 
during consultation in which several commenters suggested awarding 
grants, or providing preference for grants, to entities with prior 
experience providing or coordinating suicide prevention services and 
programs, including those who are part of Governors' Challenges.
    Pursuant to section 201(d)(1), VA has discretionary authority to 
prioritize the distribution of grants to rural communities, Tribal 
lands, territories of the United States, medically underserved areas, 
areas with a high number or percentage of minority veterans or women 
veterans, and areas with a high number or percentage of calls to the 
Veterans Crisis Line. This will be a consideration for the distribution 
of grants, as described in paragraph (d)(2), and is consistent with 
feedback received from commenters during consultation.
    Due to funding limitations, VA may choose to utilize this 
discretionary authority in distributing grants. However, VA does not 
want to mandate use of this discretionary authority because it is 
important to ensure that grants can be distributed equitably across the 
country and provided to areas where the grants may be best utilized. If 
VA prioritized these areas for all awarded grants for this program, it 
may exhaust all of its funding annually with none of the grants being 
distributed to any other grantees that may also be deserving. VA does 
not want to limit itself by mandating this, but rather retain the 
discretion to distribute to these areas as warranted. As explained in 
paragraph (b) of Sec.  78.35 and in Sec.  78.110, VA would establish 
any priorities in a NOFO.
    For purposes of this discretionary authority, VA will use the 
definitions for rural communities, Tribal lands, territories of the 
United States, and medically underserved areas in Sec.  78.5. In 
determining areas with a high number or percentage of minority veterans 
or women veterans, VA will base such determinations on the veteran 
population data from VA's National Center for Veterans Analysis and 
Statistics (NCVAS). VA will use the most recent data that NCVAS has 
published, which is made publicly available at https://www.va.gov/vetdata/veteran_population.asp. In determining areas with a high number 
or percentage of calls to the Veterans Crisis Line, VA will use 
internal data that VA maintains to determine where these areas are and 
will consider the most recent data VA has for purposes of using this 
discretionary authority when making these annual funding 
determinations. VA anticipates making this information available to the 
public and through technical assistance to grantees.
    Consistent with section 201(d)(1)(B) of the Act, paragraph (d)(3) 
explains that to the extent practicable, VA will ensure that suicide 
prevention services grants are distributed to (1) provide services in 
areas of the United States that have experienced high rates of suicide 
by eligible individuals, including suicide attempts; and to (2) 
applicants that can assist eligible individuals at risk of suicide who 
are not currently receiving health care furnished by VA. Paragraph 
(d)(3) also explains that to the extent practicable, VA will ensure 
that suicide prevention services grants are distributed to ensure 
services are provided in as many areas as possible.
    While the Act requires, to the extent practicable, distribution of 
grants to provide services in areas with high rates of suicide, 
including suicide attempts, by eligible individuals, VA notes that data 
on suicide attempts is generally insufficient, incomplete, and 
generally unavailable for purposes of determining areas with high rates 
of suicide. This is because this data is collected only when veterans 
report suicide attempts, and there is no requirement to report such 
attempts. Given the issues with the data on suicide attempts as 
explained above, for purposes of implementing section 201(d)(1)(B), VA 
will not utilize data on suicide attempts solely. If such data become 
available in a sufficient and complete manner, VA will utilize such

[[Page 13816]]

data to determine areas with high rates of suicide attempts.
    Until and if such data become available, in order to meet the 
requirement of section 201(d)(1)(B) of the Act, VA will determine areas 
with high rates of suicide based on VA's most recently published 
National Veteran Suicide Prevention Annual Report, which is based on 
CDC's mortality and death index. This report is published annually, and 
the most recent report will be utilized by VA for purposes of paragraph 
(d)(3)(i).
    For purposes of paragraph (d)(3)(ii) and determining whether 
applicants can assist eligible individuals at risk of suicide who are 
not currently receiving VA health care, VA will consider the 
information included in applicants' applications for this grant 
program. Such information could include, but not be limited to, 
existing arrangements (such as Memorandums of Understanding) with, or 
linkages to, VA and/or community partners in providing services to 
these individuals, plans on how the entity would coordinate with local 
VA medical facilities to identify these individuals, and plans to 
include these individuals as part of the population to be provided 
suicide prevention services if awarded a grant. VA will consider past 
and current actions as well as future plans to serve these individuals 
when determining whether to distribute a grant to an applicant that can 
assist eligible individuals at risk of suicide who are not currently 
receiving health care furnished by VA.
    Paragraph (d)(3)(iii) allows VA, to the extent practicable, to 
ensure grants are distributed to provide services in as many areas as 
possible. This will allow VA to consider geographic location, in some 
cases, when determining distribution of grant awards. VA anticipates 
receiving applications from numerous applicants in the same location or 
serving the same population, and VA will not be able to award grants to 
every applicant due to funding limitations. If VA received five high-
scoring applications from applicants proposing to serve eligible 
individuals in the same location, but one of those applicants alone can 
provide or coordinate suicide prevention services to the eligible 
population in that location, VA will be able to use this discretionary 
authority to distribute grants to applicants in other locations that 
can provide or coordinate services to eligible individuals and their 
families. This will allow VA to ensure that as many veterans as 
possible throughout the country are able to receive services under this 
grant program.
    VA notes that suicide prevention services grant applications must 
include applicants' identification of the target populations and the 
area the applicant proposes to serve. VA will use this information in 
determining the distribution of suicide prevention services grants 
consistent with paragraph (d).
    Paragraph (e) explains that subject to paragraph (d) of this 
section, which sets forth the preference and distribution requirements 
and considerations, VA will fund the highest-ranked applicants for 
which funding is available, within the highest funding priority group, 
if any. Under Sec.  78.110 (discussed later in this interim final 
rule), in order to meet the requirements of section 201 of the Act and 
the goals of SSG Fox SPGP, VA will be able to choose to include funding 
priorities in the NOFO. If VA establishes funding priorities in the 
NOFO, to the extent funding is available and subject to paragraph (d) 
of this section, VA will select applicants in the next highest funding 
priority group based on their rank within that group.
    Similar to existing processes in other VA grant programs, such as 
the Homeless Providers Grant and Per Diem Program (38 CFR 61.63) and 
the SSVF Program (38 CFR 62.61), paragraph (f) authorizes VA to select 
an applicant for funding if that applicant is not selected because of a 
procedural error by VA. An applicant would not be required to submit a 
new application in this situation. This will ease any administrative 
burden on applications and could be used in situations where there is 
no material change in the information that would have resulted in the 
applicant's selection for a grant under this part.

78.35 Scoring Criteria for Grantees Applying for Renewal of Suicide 
Prevention Services Grants

    Section 201(h) of the Act requires the VA Secretary to establish 
criteria for the selection of eligible entities that have submitted 
applications for a suicide prevention services grant. Based on this 
requirement, Sec.  78.35 describes the criteria that VA will use to 
score those grantees who are applying for renewal of a grant. Such 
criteria will assist with VA's review and evaluation of grantees to 
ensure that those grantees have successful existing programs using the 
previously awarded grant funds and that they have complied with the 
requirements of this part and section 201 of the Act. The criteria in 
paragraphs (a) through (c) ensure that renewals of grants are awarded 
based on the grantee's program's success, cost-effectiveness, and 
compliance with VA goals and requirements for this grant program. This 
is consistent with how VA awards renewals of grants in the SSVF Program 
(38 CFR 62.24).
    While this section does not include specific point values for the 
criteria, such point values will be set forth in the NOFO. This will 
allow VA to retain flexibility in determining those point values each 
year of the grant program.
    Under paragraph (a), VA will award points based on the success of 
the grantee's program, as demonstrated by the following: (1) The 
grantee made progress in reducing veteran suicide deaths and attempts, 
reducing all-cause mortality, reducing suicidal ideation, increasing 
financial stability; improving mental health status, well-being, and 
social supports; and, engaging in best practices for suicide prevention 
services; (2) participants were satisfied with the suicide prevention 
services provided or coordinated by the grantee, as reflected by the 
satisfaction survey conducted under Sec.  78.95(d); (3) the grantee 
implemented the program by delivering or coordinating suicide 
prevention services to participants in a timely manner, consistent with 
SSG Fox SPGP policy, the NOFO, and the grant agreement; and (4) the 
grantee was effective in conducting outreach to eligible individuals 
and their families and increasing engagement of eligible individuals 
and their families in suicide prevention services, as assessed through 
an SSG Fox SPGP grant evaluation. VA notes that for purposes of 
paragraph (a)(1), best practices for suicide prevention services will 
include, but not be limited to, best practices recommended by the 
National Strategy for Preventing Veteran Suicide, VA-DoD Clinical 
Practice Guideline for the Assessment and Management of Patients at 
Risk for Suicide VA, CDC's Preventing Suicide: A Technical Package of 
Policy, Programs, and Practices, and the Surgeon General's Call to 
Action to Implement the National Strategy for Suicide Prevention.
    Paragraph (b) states that points will be awarded based on the cost-
effectiveness of the grantee's program, as demonstrated by the 
following: The cost per participant was reasonable and the grantee's 
program was effectively implemented on-budget. This criterion is 
important as it will assist with VA's review and evaluation of grantees 
to ensure that grantees have been fiscally responsible. This is also 
consistent with similar criterion used in the SSVF program. See 38 CFR 
62.24.

[[Page 13817]]

    Paragraph (c) states that VA will award points based on the extent 
to which the grantee's program complies with SSG Fox SPGP goals and 
requirements, as demonstrated by the following: The grantee's program 
was administered in accordance with VA's goals for SSG Fox SPGP as 
noted in the NOFO; the grantee's program was administered in accordance 
with all applicable laws, regulations, and guidelines; and the 
grantee's program was administered in accordance with the grantee's 
suicide prevention services grant agreement. This criterion is 
important to ensure that renewals of grants are awarded to those who 
comply with VA's goals and requirements for SSG Fox SPGP and who have 
shown competence regarding grant program implementation. This criterion 
is consistent with how VA awards renewals in the SSVF program. See 38 
CFR 62.24.

78.40 Selection of Grantees for Renewal of Suicide Prevention Services 
Grants

    Section 201(c) of the Act requires the VA Secretary to award a 
grant to each eligible entity for which the Secretary has approved an 
application to provide or coordinate the provision of suicide 
prevention services. Section 201(h) of the Act requires the Secretary 
to establish criteria for the selection of eligible entities that have 
submitted applications for a suicide prevention services grant. Based 
on these sections of the Act, section 78.40 describes the process for 
selecting grantees that have received suicide prevention services 
grants and are applying for renewal of such grants. It is important to 
note that this is a simpler process than awarding the initial grant. 
This is consistent with how VA awards renewals of grants in the SSVF 
Program (38 CFR 62.25).
    Paragraph (a) explains that so long as grantees meet the threshold 
requirements in Sec.  78.20, VA will score the grantee using the 
scoring criteria set forth in Sec.  78.35. This ensures that grantees 
are still eligible to participate in the program.
    Under paragraph (b), VA will rank those grantees who receive at 
least the minimum amount of total points and points per category set 
forth in the NOFO, and such grantees will be ranked in order from 
highest to lowest scores.
    Paragraph (c) explains that VA will use the grantee's ranking as 
the basis for selection for funding, and that VA will fund the highest-
ranked grantees for which funding is available.
    In paragraph (d), at its discretion, VA may award any non-renewed 
funds to an applicant or existing grantee. If VA chooses to award non-
renewed funds to an applicant or existing grantee, VA will first offer 
to award the non-renewed funds to the applicant or grantee with the 
highest grant score under the relevant NOFO that applies for, or is 
awarded a renewal grant in, the same area as, or a proximate area to, 
the affected area if available. Such applicant or grantee will be 
required to have the capacity and agree to provide prompt services to 
the affected area. Under Sec.  78.40, the relevant NOFO is the most 
recently published NOFO that covers the affected area, or for multi-
year grant awards, the NOFO for which the grantee, who is offered the 
additional funds, received the multi-year award. If the first such 
applicant or grantee offered the non-renewed funds refuses the funds, 
VA will then offer to award the funds to the next highest-ranked such 
applicant or grantee, per the criteria in paragraph (d)(1) of this 
section, and continue in rank order until the non-renewed funds are 
awarded. VA notes that it does not anticipate offering multi-year 
awards at this time, but may choose to do so at a later point. To avoid 
the need for further rulemaking to authorize multi-year awards, such 
language is included now to allow for future flexibility.
    Similar to existing processes in other VA grant programs, such as 
the Homeless Providers Grant and Per Diem Program (38 CFR 61.63) and 
the SSVF Program (38 CFR 62.61), paragraph (e) authorizes VA to select 
an existing grantee for available funding, based on the grantee's 
previously submitted renewal application, if that grantee is not 
selected for renewal because of a procedural error by VA. A grantee 
would not be required to submit a new renewal application in this 
situation. This will ease any administrative burden on grantees and 
could be used in situations where there is no material change in the 
renewal application that would have resulted in the grantee's selection 
for renewal of a grant under this part.

78.45 Suicide Prevention Services: Outreach

    As indicated in the definition of suicide prevention services, 
there are ten categories of suicide prevention services that can be 
provided or coordinated under this grant program. Each one has its own 
separate section in this regulation, and each will be discussed 
subsequently for clarity and readability.
    In accordance with section 201(q)(11)(A)(i) of the Act, 38 CFR 
78.45 describes outreach, which is the first of ten sections describing 
the types of suicide prevention services that grantees may be approved 
to provide or coordinate the provision of through this grant program.
    In paragraph (a), grantees providing or coordinating the provision 
of outreach must use their best efforts to ensure that eligible 
individuals, including those who are at highest risk of suicide or who 
are not receiving health care or other services furnished by VA, and 
their families are identified, engaged, and provided suicide prevention 
services. This is consistent with how outreach services are addressed 
in the definition of suicide prevention services in section 
201(q)(11)(A)(i) of the Act. Based on the assessment of suicide risk 
conducted by grantees to determine eligibility for services, eligible 
individuals that should be considered at highest risk of suicide are 
those with a recent suicide attempt, an active plan or preparatory 
behavior for suicide, or a recent hospitalization for suicidality.
    Paragraph (b) explains that outreach must include active liaison 
with local VA facilities; State, local, or tribal government (if any); 
and private agencies and organizations providing suicide prevention 
services to eligible individuals and their families in the area to be 
served by the grantee. This can include, for example, local mental 
health and emergency or urgent care departments in local hospitals or 
clinics. Paragraph (b) effectively requires grantees to have a presence 
in the area to meet with individuals and organizations to create 
referral processes to the grantee, similar to VA's suicide prevention 
coordinators.
    This section is consistent with how VA defines outreach in the SSVF 
Program (38 CFR 62.30). Outreach is important for ensuring that 
eligible individuals and families receive suicide prevention services 
to reduce the risk of suicide. Outreach also ensures that grantees are 
able to identify participants that may be eligible and in need of 
suicide prevention services. Working with local entities, including VA, 
that serve eligible individuals and their families can help grantees 
identify and reach potential participants.

78.50 Suicide Prevention Services: Baseline Mental Health Screening

    In accordance with section 201(q)(11)(A)(ii) of the Act, under 
Sec.  78.50(a), grantees must provide or coordinate the provision of a 
baseline mental health screening to all participants they serve at the 
time those services begin. For purposes of this grant program, all 
grantees will be required to provide, or coordinate the provision of, a 
baseline mental

[[Page 13818]]

screening to participants. This baseline mental health screening 
ensures that participants' mental health needs can be properly 
determined, and that suicide prevention services can be further 
tailored to meet the individual's needs.
    This baseline mental health screening must be provided using a 
validated screening tool that assesses suicide risk and mental and 
behavioral health conditions. Information on the specific tools to be 
used will be included in the NOFO, as the tools VA will approve for 
baseline mental health screenings may vary from year to year as the 
screening tools may evolve over time due to emerging evidence through 
research. VA will provide these tools to grantees providing or 
coordinating the provision of baseline mental health screenings. These 
tools will be those that a non-clinician can administer, as many 
grantees may not be clinicians and may not be able to administer a 
clinical screening for suicide risk and mental or behavioral health 
conditions. These tools will also indicate when a participant must be 
referred for additional care, as explained in paragraph (b) of this 
section. These tools will ensure consistent screening and reporting of 
suicide risk and the need for referral for additional care or care 
coordination. It is also important to note that this is consistent with 
feedback VA received through consultation. These tools used to conduct 
the baseline mental health screening are different than the tool used 
to determine risk of suicide for purposes of eligibility and will be 
administered to participants after they have been deemed an eligible 
individual pursuant to Sec.  78.10.
    Paragraph (b) states that if an eligible individual is at risk of 
suicide or other mental or behavioral health condition pursuant to the 
baseline mental health screening conducted under paragraph (a) of this 
section, the grantee must refer such individual to VA for care. If the 
eligible individual refuses the grantee's referral to VA, any ongoing 
clinical services provided to the eligible individual by the grantee is 
at the expense of the grantee. This is based on section 201(m)(1) and 
(3) of the Act, which explain that if a grantee determines that an 
eligible individual is at-risk of suicide or other mental or behavioral 
health condition pursuant to a baseline mental health screening, the 
grantee must refer the eligible individual to VA for additional care as 
authorized under the Act or any other provision of law, and if the 
eligible individual refuses the referral, any ongoing clinical services 
provided to the individual by the grantee will be at the grantee's 
expense. It is important to note that this is only required for 
eligible individuals and not the family of eligible individuals.
    Section 201(m)(1) of the Act requires referral when the grantee 
determines that an eligible individual is at-risk of suicide or other 
mental health or behavioral health condition, consistent with the 
language in paragraph (b). This reflects Congressional intent that 
these referrals for care be required for those eligible individuals who 
are not only at risk of suicide but also those who have additional 
needs that require further evaluation by VA for additional care. 
Whether an eligible individual has additional needs that require 
referral for further evaluation by VA for additional care will be 
determined pursuant to the baseline mental health screening conducted 
under paragraph (a). For example, should the baseline mental health 
screening indicate a potential mental health disorder related to 
depression, the participant would need to be referred for further 
evaluation for diagnosis and treatment.
    This baseline mental health screening will be performed by grantees 
using various VA-approved validated tools. These tools will indicate to 
the grantee if the eligible individual must be referred for additional 
evaluation and care based on the outcome of the screening for mental or 
behavioral health and suicide risk.
    When referrals are made by grantees to VA, to the extent 
practicable, those referrals are required to be a ``warm hand-off'' to 
ensure that the eligible individual receives necessary care. This 
``warm hand-off'' may include providing any necessary transportation to 
the nearest VA facility, assisting the eligible individual with 
scheduling an appointment with VA, and any other similar activities 
that may be necessary to ensure the eligible individual receives 
necessary care in a timely manner. This is consistent with feedback 
received from commenters during consultation. This ``warm hand-off'' is 
also consistent with other suicide prevention services that grantees 
may provide, such as assistance in obtaining any VA benefits and 
assistance with emergent needs, authorized under section 
201(q)(11)(A)(vii) and (ix), respectively.
    To the extent that a veteran referred to VA for care is eligible 
for care in the community through VA's Community Care Program, that 
veteran may elect to receive care in the community under VA's Community 
Care Program regulations located at 38 CFR 17.4000 through 17.4040. For 
purposes of section 201(m)(3), this election would not be considered a 
refusal to receive care from VA.
    Paragraph (b) further explains that if an eligible individual 
refuses referral to VA for care by a grantee, any ongoing clinical 
services provided to the eligible individual by the grantee are at the 
grantee's expense. This is based on section 201(m)(3) of the Act and 
ensures that grantees understand their responsibilities regarding the 
baseline mental health screening of an eligible individual.
    Similar to the language in paragraph (b), paragraph (c) explains 
that if a participant other than an eligible individual is at risk of 
suicide or other mental or behavioral health condition pursuant to the 
baseline mental health screening conducted under paragraph (a) of this 
section, the grantee must refer such participant to appropriate health 
care services in the area. To the extent that the grantee is able to 
furnish such appropriate health care services on an ongoing basis and 
has available funding separate from funds provided under this grant 
program to do so, they would be able to furnish such services using 
those non-VA funds without being required to refer such participants to 
other services. VA requires that grantees refer those individuals (that 
is, families of eligible individuals) for further care as appropriate 
and will codify this in paragraph (c) to ensure that grantees do so. 
This ensures that those individuals' needs can be met by further care 
as needed.
    Under paragraph (d), except as provided for under Sec.  78.60(a), 
funds provided under this grant program may not be used to provide 
clinical services to participants, and any clinical services provided 
to such individuals by the grantee are at the expense of the grantee. 
Paragraph (d) explicitly states that any clinical services provided by 
the grantee are at its expense and not VA's. Further, this language in 
the Act and in the regulation clarifies that grantees may not charge, 
bill, or otherwise hold liable eligible individuals for the receipt of 
such care or services; we interpret the phrase ``at the expense of the 
entity'' in section 201(m)(3) to bar the entity from billing, charging, 
or holding liable eligible individuals for the receipt of such care or 
services. This will also ensure that the relationship between the 
grantee and the eligible individual is not adversely affected through 
collections or other efforts. It also provides an incentive for 
grantees to work with eligible individuals to refer them to VA for 
their health care needs.
    While grantees that provide participants ongoing clinical services 
pursuant to paragraphs (b) and (c) do so

[[Page 13819]]

at their own expense, this does not preclude the grantee from seeking 
to cover those expenses through other sources of funding and existing 
agreements. For example, a grantee that provides a participant with 
ongoing clinical services may bill a third-party payor, such as the 
participant's other health insurance, for the ongoing clinical services 
provided by the grantee. However, as explained in the previous 
paragraph, the grantee may not charge, bill, or otherwise hold liable 
participants for the receipt of ongoing clinical services under Sec.  
78.50. In the instance that a grantee bills a third-party payor (e.g., 
health insurance) for ongoing clinical services provided to the 
participant, certain cost-sharing, such as copayments, imposed on the 
participant by a third-party payor, may be covered by the grantee at 
its discretion. VA does not interpret the language ``at the expense of 
the entity'' in section 201(m)(3) to preclude grantees from covering 
such copayments for participants for ongoing clinical services. VA 
would not require that grantees cover such costs, but rather, would 
permit grantees to do so if it chooses and has the funds to do so. 
However, as noted above, section 201(m)(3) bars the entity from 
billing, charging, or holding liable eligible individuals for the 
receipt of such care or services. Pursuant to Sec.  78.50(a), the 
grantee would be unable to use grant funds to cover such costs.
    VA notes that while section 201(m)(3) is specific to eligible 
individuals, paragraph (d) applies to all participants because this 
would ensure that the potential liabilities of a family member would 
not deter a veteran from seeking services from a grantee and to make 
administration easier. VA has authority to extend this protection to 
include participants other than eligible individuals pursuant to 
section 201(f)(1) of the Act, which authorizes VA to require grantees 
to make such commitments as the Secretary considers necessary to carry 
out this section.

78.55 Suicide Prevention Services: Education

    In accordance with section 201(q)(11)(A)(iii), under Sec.  78.55, 
grantees providing or coordinating the provision of education must 
provide or coordinate the provision of suicide prevention education 
programs to educate communities, veterans, and families on how to 
identify those at risk of suicide, how and when to make referrals for 
care, and the types of suicide prevention resources available within 
the area. Education can include gatekeeper training, lethal means 
safety training, or specific education programs that assist with 
identification, assessment, or prevention of suicide.
    Gatekeeper training generally refers to programs that seek to 
develop individuals' knowledge, attitudes, and skills to prevent 
suicide. Gatekeeper training is an educational course designed to teach 
clinical and non-clinical professionals or gatekeepers the warning 
signs of a suicide crisis and how to respond and refer individuals for 
care. For more information, see: https://www.sprc.org/sites/default/files/migrate/library/SPRC_Gatekeeper_matrix_Jul2013update.pdf.
    Defining education in this manner is consistent with how education 
is administered in the community and is commonly understood by those in 
the community who work in the area of suicide prevention. Education is 
important because learning the signs of suicide risk, how to reduce 
access to lethal means, and to connect those at risk of suicide to care 
can improve understanding of suicide and has the potential to reduce 
suicide.

78.60 Suicide Prevention Services: Clinical Services for Emergency 
Treatment

    In accordance with section 201(q)(11)(A)(iv) of the Act, Sec.  
78.60(a) requires that grantees providing or coordinating the provision 
of clinical services for emergency treatment must provide or coordinate 
the provision of clinical services for emergency treatment of a 
participant.
    Consistent with section 201(m)(2) and (3) of the Act, paragraph (b) 
explains that if an eligible individual is furnished clinical services 
for emergency treatment under paragraph (a) of this section and the 
grantee determines that the eligible individual requires ongoing 
services, the grantee must refer the eligible individual to VA for 
additional care. If the eligible individual refuses the grantee's 
referral to VA, any ongoing clinical services provided to the eligible 
individual by the grantee is at the expense of the grantee. This aligns 
with section 201(m)(2) of the Act, which explains that if a grantee 
furnishes clinical services for emergency treatment to an eligible 
individual and determines ongoing services are required, the grantee 
must refer the eligible individual to VA for additional care as 
authorized under the Act or any other provision of law. VA notes that 
this is only required for eligible individuals, not the family of 
eligible individuals. To the extent that an eligible individual 
referred to VA for care is eligible for care in the community through 
VA's Community Care Program, that eligible individual may elect to 
receive care in the community under VA's Community Care Program 
regulations located at 38 CFR 17.4000 through 17.4040. As stated above, 
such election is not considered a refusal to receive care from VA.
    Subsection (m)(3) of section 201 of the Act further states that if 
an eligible individual refuses a referral by a grantee, any ongoing 
clinical services provided to the eligible individual by the grantee is 
at the grantee's expense. That is codified in paragraph (b) to ensure 
that grantees understand their responsibilities regarding clinical 
services of an eligible individual. Paragraph (b) further includes the 
same language as Sec.  78.50(d) regarding limitations on charging, 
billing, or otherwise holding liable eligible individuals for the 
receipt of such care. As explained in the discussion on Sec.  78.50(d), 
a grantee is not precluded from seeking to cover those expenses through 
other sources of funding and existing agreements.
    In paragraph (c), if a participant other than an eligible 
individual (that is, the family member of an eligible individual) is 
furnished clinical services for emergency treatment under paragraph (a) 
of this section and the grantee determines that the participant 
requires ongoing services, the grantee must refer the participant to 
appropriate health care services in the area for additional care. 
Except as provided for under paragraph (a) of this section, funds 
provided under this grant program may not be used to provide ongoing 
clinical services to family, and any ongoing clinical services provided 
to the family by the grantee is at the expense of the grantee. VA 
expects that grantees will refer those participants for further care as 
appropriate and is codifying this requirement in this paragraph to 
ensure that grantees do so. This ensures that these participants' needs 
can be met by further care as needed. Except as provided for under 
Sec.  78.60(a), funds provided under this grant program may not be used 
to provide clinical services to such participants, and any ongoing 
clinical services provided to the participant by the grantee is at the 
expense of the grantee. This is because VA does not have authority to 
cover such expenses under this grant program. However, to the extent 
that a grantee can and desires to provide ongoing clinical services to 
such participants, they may do so, but it will be at their expense. As 
explained in discussion on Sec.  78.50(d), this language does not 
preclude the grantee from seeking to cover those expenses through other 
sources of funding and existing

[[Page 13820]]

agreements (for example, billing a participant's health insurance). 
Grantees also are not precluded from covering any copayments imposed on 
participants by their health insurance for ongoing clinical services 
provided by the grantee if the grantee so chooses and has the funds to 
cover such costs. However, the grantee may not charge, bill, or 
otherwise hold liable such participants for the receipt of such care or 
services. This is consistent with similar language in paragraph (b) 
relating to eligible individuals.
    Consistent with section 201(q)(5) of the Act, paragraph (d) 
explains that for purposes of this section, emergency treatment means 
medical services, professional services, ambulance services, ancillary 
care and medication (including a short course of medication related to 
and necessary for the treatment of the emergency condition that is 
provided directly to or prescribed for the patient for use after the 
emergency condition is stabilized and the patient is discharged) was 
rendered in a medical emergency of such nature that a prudent layperson 
would have reasonably expected that delay in seeking immediate medical 
attention would have been hazardous to life or health. This standard is 
met by an emergency medical condition manifesting itself by acute 
symptoms of sufficient severity (including severe pain) that a prudent 
layperson who possesses an average knowledge of health and medicine 
could reasonably expect the absence of immediate medical attention to 
result in placing the health of the individual in serious jeopardy, 
serious impairment to bodily functions, or serious dysfunction of any 
bodily organ or part.
    The description and standard are consistent with VA's description 
of medical emergency for purposes of payment or reimbursement for 
emergency treatment furnished by non-VA providers to certain veterans 
with service-connected disabilities pursuant to 38 CFR 17.120 and for 
nonservice-connected disabilities pursuant to 38 CFR 17.1000 et seq. It 
is important to note that emergency medical conditions includes 
emergency mental health conditions.
    Paragraph (e) explains that the direct provision of clinical 
services for emergency treatment by grantees under this section is not 
prohibited by Sec.  78.80(a). As explained later in this discussion, 
Sec.  78.80(a) prohibits grantees from directly providing health care 
services, which include health insurance and referral to a governmental 
entity or grantee that provides certain services. As clinical services 
for emergency treatment under Sec.  78.60 are considered health care 
services and section 201 of the Act specifically authorizes the 
provision of clinical services for emergency treatment, paragraph (e) 
clarifies that such services do not fall under the prohibition in Sec.  
78.80(a). VA acknowledges that while some grantees may not be able to 
provide these services directly, others will. This ensures that if a 
grantee is capable of furnishing emergency treatment and needs to do 
so, there will be no delay in the delivery of such services.

78.65 Suicide Prevention Services: Case Management Services

    In accordance with section 201(q)(11)(A)(v), case management 
services are described in Sec.  78.65. These definitions are similar to 
case management services in the SSVF Program (see 38 CFR 62.31), but 
they are focused on suicide prevention to effectively assist 
participants at risk of suicide. The SSVF Program derived its 
definition from similar definitions of case management services 
provided in other Federal programs, such as the Department of Health 
and Human Services' Medicare and Medicaid Services Program, the 
Department of Housing and Urban Development's Congregate Housing 
Services Program, and the Housing and Urban Development--Veterans 
Affairs Supported Housing (see 42 CFR 440.169 and 24 CFR 700.105). 75 
FR 24514, 24518 (May 5, 2010). This description of case management 
services is also consistent with VA-DoD Clinical Practice Guidelines 
for the Assessment and Management of Patients at Risk for Suicide (see 
https://www.healthquality.va.gov/guidelines/MH/srb/VADoDSuicideRiskFullCPGFinal5088212019.pdf).
    Grantees providing or coordinating the provision of case management 
services must provide or coordinate the provision of such services that 
include, at a minimum: (a) Performing a careful assessment of 
participants, and developing and monitoring case plans in coordination 
with a formal assessment of suicide prevention services needed, 
including necessary follow-up activities, to ensure that the 
participant's needs are adequately addressed; (b) establishing linkages 
with appropriate agencies and service providers in the area to help 
participants obtain needed suicide prevention services; (c) providing 
referrals to participants and related activities (such as scheduling 
appointments for participants) to help participants obtain needed 
suicide prevention services, such as medical, social, and educational 
assistance or other suicide prevention services to address 
participants' identified needs and goals; (d) deciding how resources 
and services are allocated to participants on the basis of need; (e) 
educating participants on issues, including, but not limited to, 
suicide prevention services availability and participant rights; and, 
(f) other activities, as approved by VA, to serve the comprehensive 
needs of participants for the purpose of reducing suicide risk. This 
list ensures that grantees have the same understanding of what 
activities are considered case management services, but it also 
provides VA authority to approve other activities that may be 
considered case management services. Such other activities will be 
included in any NOFO published as well as incorporated into any 
agreement with grantees.

78.70 Suicide Prevention Services: Peer Support Services

    Consistent with section 201(q)(11)(A)(vi) of the Act, 38 CFR 78.70 
explains the peer support services authorized under this grant program. 
Paragraph (a) explains that grantees providing or coordinating the 
provision of peer support services must provide or coordinate the 
provision of peer support services to help participants understand what 
resources and supports are available in their area for suicide 
prevention. Peer support services must be provided by veterans trained 
in peer support with similar lived experiences related to suicide or 
mental health. Peer support specialists serve as role models and a 
resource to assist participants with their mental health recovery. Peer 
support specialists function as interdisciplinary team members, 
assisting physicians and other professional and non-professional 
personnel in a rehabilitation treatment program. This is consistent 
with how VA defines peer support services for its programs, including 
its peer support program pursuant to 38 U.S.C. 1720F(j).
    Paragraph (b) further explains that each grantee providing or 
coordinating the provision of peer support services must ensure that 
veterans providing such services to participants meet the requirements 
of 38 U.S.C. 7402(b)(13) and meet qualification standards for 
appointment or have completed peer support training, are pursuing 
credentials to meet the minimum qualification standards for 
appointment, and are under the supervision of an individual who meets 
the requirements of 38 U.S.C. 7402(b)(13). Section 7402(b)(13) 
establishes standards for

[[Page 13821]]

appointment as a VA peer support specialist. Qualification standards 
include that the individual is (1) a veteran who has recovered or is 
recovering from a mental health condition, and (2) certified by (i) a 
not-for-profit entity engaged in peer support specialist training as 
having met such criteria as the Secretary shall establish for a peer 
support specialist position, or (ii) a State as having satisfied 
relevant State requirements for a peer support specialist position. VA 
has further set forth qualifications for its peer support specialists 
in VA Handbook 5005, Staffing (last updated July 17, 2012). See https://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf.
    Meeting minimum qualification standards for appointment under 38 
U.S.C. 7402(b)(13) ensures that participants receive peer support 
services in a safe and effective manner consistent with VA's standards 
and with those required by law. However, VA would also allow grantees 
to provide peer support services through veterans who have completed 
peer support training, are pursuing credentials to meet the minimum 
qualification standards for appointment, and are under the supervision 
of an individual who meets the minimum qualification standards. VA 
would allow this as a way to build capacity in the community for peer 
support services, particularly as there are individuals who may be 
supervised and working toward meeting the requirements of 38 U.S.C. 
7402(b)(13), but who have not yet met those conditions. Grant funds may 
be used to provide education and training for employees of the grantee 
or the community partner who provide peer support services based on the 
terms set forth in the grant agreement. VA believes the use of these 
funds to support education and training for peer support specialists is 
authorized by section 201(b) of the Act, which directs VA to provide 
financial assistance to eligible entities approved under this section 
to provide or coordinate the provision of suicide prevention services 
to eligible individuals and their families. Because the requirements to 
be a VA peer support specialist, as generally described above, are more 
specific than many community organizations might require, we believe 
the use of grant funds to support education and training is appropriate 
as it may be necessary to ensure these services are provided by 
appropriately qualified individuals. VA would set forth conditions 
regarding the use of funds, such as any limits on the amount of funds 
that may be used for these purposes or documentation requirements, in 
the NOFO and terms of the grant agreement.
    These appointment requirements for those veterans providing peer 
support services would be included in the NOFO so that those applicants 
who apply to provide peer support services understand and know the 
applicable requirements for purposes of providing or coordinating such 
services. These requirements would also be included in any program 
guides developed for purposes of administering services under this 
grant program.

78.75 Suicide Prevention Services: Assistance in Obtaining VA Benefits

    In accordance with section 201(q)(11)(A)(vii), Sec.  78.75 sets 
forth the requirements associated with suicide prevention services 
authorized under this grant program related to assistance in obtaining 
VA benefits. The provision of this assistance will provide grantees 
with additional means by which VA can notify participants of available 
VA benefits and is consistent with the SSVF Program (see 38 CFR 62.32).
    Paragraph (a) requires grantees assisting participants in obtaining 
VA benefits to assist participants in obtaining any benefits from VA 
for which the participants are eligible. Such benefits include but are 
not limited to: (1) Vocational and rehabilitation counseling; (2) 
supportive services for homeless veterans; (3) employment and training 
services; (4) educational assistance; and, (5) health care services.
    Under paragraph (b), grantees will not be permitted to represent 
participants before VA with respect to a claim for VA benefits unless 
they are recognized for that purpose pursuant to 38 U.S.C. 5902. 
Employees and members of grantees are not permitted to provide such 
representation unless the individual providing representation is 
accredited pursuant to 38 U.S.C. chapter 59. Consistent with 38 U.S.C. 
5902, VA does not interpret section 201 of the Act to allow grantees to 
represent veterans in benefit claims before VA unless they are 
recognized under 38 U.S.C. 5902. VA also does not interpret section 201 
of the Act as requiring that grantees become recognized organizations 
pursuant to 38 U.S.C. 5092 or that their employees or members become 
accredited service organization representatives, claims agents, or 
attorneys. Instead, assistance in obtaining benefits may include 
providing information about available benefits, helping individuals 
locate a recognized veterans services organization or other accredited 
individual, and other services short of actual representation before 
VA, unless the grantee is accredited pursuant to 38 CFR 14.629 (that 
is, VA's regulation implementing 38 U.S.C. 5902), which sets forth 
requirements for accreditation of service organization representatives, 
agents, and attorneys.

78.80 Suicide Prevention Services: Assistance in Obtaining and 
Coordinating Other Public Benefits and Assistance With Emergent Needs

    Consistent with section 201(q)(11)(A)(viii) and (ix) of the Act, 
under Sec.  78.80, grantees assisting in obtaining and coordinating 
other public benefits or assisting with emergent needs will be required 
to assist participants to obtain and coordinate the provision of other 
public benefits. For purposes of this section, VA considers other 
public benefits and emergent needs to be the same types of benefits. At 
a minimum, grantees are required to assist participants in obtaining 
and coordinating the provision of benefits listed in paragraphs (a) 
through (h) of Sec.  78.80 that are being provided by Federal, State, 
local, or tribal agencies, or any other grantee in the area served by 
the grantee by referring the participant to and coordinating with such 
entity. If a public benefit is not being provided by Federal, State, 
local, or tribal agencies, or any other grantee in the area, the 
grantee is not required to obtain, coordinate, or provide such public 
benefit. Grantees may elect to provide directly to participants the 
public benefits identified in paragraphs (c) through (h) of Sec.  
78.80.
    In accordance with section 201(q)(11)(A)(ix)(I) of the Act, 
paragraph (a) describes health care services, which include: (1) Health 
insurance, and (2) referral to a governmental entity or grantee that 
provides any of the following services: (i) Hospital care, nursing home 
care, outpatient care, mental health care, preventive care, 
habilitative and rehabilitative care, case management, respite care, 
and home care; (ii) the training of any eligible individual's family in 
the care of any eligible individual; and (iii) the provision of 
pharmaceuticals, supplies, equipment, devices, appliances, and 
assistive technology. This is consistent with how VA administers the 
SSVF Program (see 38 CFR 62.33(a)). VA believes services in paragraph 
(a) should not be provided directly by grantees as these services are 
commonly available in the area, including at VA. It also would be cost-
prohibitive for grantees to provide these directly and would thus 
impact grantees' ability to provide

[[Page 13822]]

suicide prevention services to participants.
    In accordance with section 201(q)(11)(A)(ix)(II) of the Act, 
paragraph (b) describes referral of a participant, as appropriate, to 
an entity that provides daily living services relating to the functions 
or tasks for self-care usually performed in the normal course of a day, 
including, but not limited to, eating, bathing, grooming, dressing, and 
home management activities. This is identical to how VA administers the 
SSVF Program (See 38 CFR 62.33(b)). VA believes that daily living 
services should not be provided directly by grantees as these services 
are commonly available in the community, including at VA. It also would 
be cost-prohibitive for grantees to provide these directly and would 
thus impact grantees' ability to provide suicide prevention services to 
participants. Thus, referrals for these services would be appropriate.
    In accordance with section 201(q)(11)(A)(ix)(III) of the Act, 
paragraph (c) describes personal financial planning services, which 
include, at a minimum, providing recommendations regarding day-to-day 
finances and achieving long-term budgeting and financial goals. Grant 
funds may pay for credit counseling and other services necessary to 
assist participants with critical skills related to household 
budgeting, managing money, accessing a free personal credit report, and 
resolving credit problems. This is consistent with how VA administers 
the SSVF Program (see 38 CFR 62.33(c)).
    In accordance with section 201(q)(11)(A)(ix)(IV) of the Act, 
paragraph (d) describes transportation services. Paragraph (d)(1) 
explains that the grantee may provide temporary transportation services 
directly to participants if the grantee determines such assistance is 
necessary; however, the preferred method of direct provision of 
transportation services is the provision of tokens, vouchers, or other 
appropriate instruments so that participants may use available public 
transportation options. Paragraph (d)(2) explains that if public 
transportation options are not sufficient within an area, costs related 
to the lease of vehicle(s) may be included in a suicide prevention 
services grant application if the applicant or grantee, as applicable, 
agrees that: (i) The vehicle(s) will be safe, accessible, and equipped 
to meet the needs of the participants; (ii) the vehicle(s) will be 
maintained in accordance with the manufacturer's recommendations; and 
(iii) all transportation personnel (employees and community partners) 
will be licensed, insured, and trained in managing any special needs of 
participants and handling emergency situations. This is consistent with 
how VA administers the SSVF Program (see 38 CFR 62.33(d)). However, 
unlike Sec.  62.33(d) which refers to subcontractors, VA refers to 
community partners under paragraph (d)(2)(iii).
    Paragraph (d)(3) permits grantees to provide transportation 
services through reimbursement for transportation furnished through 
ride-sharing services, taxi services, or other similar sources if two 
conditions are met: First, the participant must lack any other means of 
transportation, including transportation or reimbursement for 
transportation from VA under part 70 of this title, and second, the 
grantee must document the participant's lack of other means. Such 
documentation would be maintained as part of the participant's case 
file, and consistent with the recordkeeping requirements in Sec.  
78.150. VA includes this provision to allow for flexibility in 
situations where transportation options may be limited, but the two 
conditions are intended to limit this support as a matter of last 
resort given that the expenses for such transportation are likely 
higher than other methods of transportation, and VA does not believe it 
would be an optimal use of grant funds. If beneficiary travel under 
subpart A of part 70 of title 38, Code of Federal Regulations, or 
transportation through the Veterans Transportation Service under 
subpart B of part 70 of title 38, Code of Federal Regulations, are 
available to the participant, the participant would be ineligible for 
assistance under paragraph (d)(3).
    In accordance with section 201(q)(11)(A)(ix)(V) of the Act, 
paragraph (e) describes temporary income support services, which may 
consist of providing assistance in obtaining other Federal, State, 
tribal, and local assistance, in the form of, but not limited to, 
mental health benefits, food assistance, housing assistance, employment 
counseling, medical assistance, veterans' benefits, and income support 
assistance. This is consistent with how VA administers the SSVF Program 
(see 38 CFR 62.33(e)). However, unlike the SSVF Program, this suicide 
prevention services grant program will include food assistance because 
of the correlation between food insecurity and mental health issues 
including suicide risk. See Bergmans, R.S., Jannausch, M. and Ilgen, 
M.A. (2020), Prevalence of suicide ideation, planning and attempts 
among Supplemental Nutrition Assistance Program participants in the 
United States. Journal of Affective Disorders, 277, 99-103. The suicide 
prevention services grant program also expressly includes housing 
assistance, which does not appear in Sec.  62.33(e) because part 62 is 
designed in general to provide housing assistance and supportive 
services for very low-income veteran families who are occupying 
permanent housing.
    In accordance with section 201(q)(11)(A)(ix)(VI) of the Act, 
paragraph (f) describes fiduciary and representative payee services, 
which may consist of acting on behalf of a participant by receiving the 
participant's paychecks, benefits or other income, and using those 
funds for the current and foreseeable needs of the participant and 
saving any remaining funds for the participant's future use in an 
interest-bearing account or saving bonds. This is consistent with how 
VA administers the SSVF Program (see 38 CFR 62.33(f)).
    In accordance with section 201(q)(11)(A)(ix)(VII) of the Act, 
paragraph (g) explains that legal services includes those services to 
assist an eligible individual with issues that may contribute to the 
risk of suicide, including issues that interfere with the eligible 
individual's ability to obtain or retain permanent housing, cover basic 
needs such as food, transportation, medical care, and issues that 
affect the eligible individual's employability and financial security 
(such as debt, credit problems, and the lack of a driver's license). 
These bio-psychosocial stressors are suicide risk factors noted within 
the VA/DoD Clinical Practice Guidelines for the Assessment and 
Management of Patients at Risk for Suicide. See https://www.healthquality.va.gov/guidelines/MH/srb/VADoDSuicideRiskFullCPGFinal5088212019.pdf.
    However, with the exception of legal assistance with resolving 
outstanding warrants, fines, expungements, and drivers' license 
revocations symptomatic of reentry obstacles in employment or housing, 
authorized legal services do not include legal assistance with criminal 
matters nor matters in which the eligible individual is taking or has 
taken any adversarial legal action against the United States (that is, 
the Federal government). Authorized legal services also do not include 
legal assistance with matters in which the United States (that is, the 
Federal government) is prosecuting an eligible individual. Thus, even 
with respect to the limited legal assistance for certain criminal 
matters otherwise permitted (for example, legal assistance

[[Page 13823]]

with resolving outstanding warrants), legal services do not include 
legal assistance in those criminal matters in which the United States 
is prosecuting the eligible individual.
    Legal services under Sec.  78.80(g) are described in this manner to 
include those types of services VA believes are most relevant and 
applicable to the legal needs of eligible individuals. VA will limit 
these legal services to issues that contribute to the risk of suicide, 
which is consistent with the overall intent of this grant program. VA 
will authorize those services that support the legal needs of the 
eligible individual to address those issues that contribute to their 
risk of suicide, such as issues with housing, employability, and 
financial security.
    With certain exceptions as noted and explained above, VA excludes 
legal assistance with most criminal matters and excludes all matters in 
which the eligible individual is taking or has taken any adversarial 
legal action against the United States, as VA does not believe it is 
reasonable to expect VA to pay for such services, especially for those 
situations in which an eligible individual takes adversarial legal 
action against the Federal government, including VA and other Federal 
agencies or in situations in which the Federal government is 
prosecuting an eligible individual. If VA covered such legal services, 
it could result in conflicts of interest. This restriction does not 
include non-adversarial legal assistance provided in pursuit of VA 
benefits or appeals to the Board of Veterans' Appeals. If legal 
assistance is needed with a matter for which grant funds are not 
authorized, the grantee should make referrals to other organizations, 
such as Legal Aid and local Bar Associations, to ensure that legal 
needs can be met.
    In accordance with section 201(q)(11)(A)(ix)(VIII) of the Act, 
paragraph (h) describes the provision of child care, consistent with 
how VA administers these services in the SSVF Program (see 38 CFR 
62.33(h)). Child care will be authorized for children under the age of 
13, unless the child is disabled. Disabled children must be under the 
age of 18 to receive assistance under this paragraph. This is 
consistent with the SSVF Program's regulations at Sec.  62.33(h) as 
well as similar regulations issued by the Department of Housing and 
Urban Development. See 24 CFR 576.102(a)(1)(ii).
    Child care includes the: (1) Referral of a participant, as 
appropriate, to an eligible child care provider that provides child 
care with sufficient hours of operation and serves appropriate ages, as 
needed by the participant; and (2) payment by a grantee on behalf of a 
participant for child care by an eligible child care provider. 
Consistent with the financial cap in section 201(q)(11)(A)(ix)(VIII) of 
the Act, payment may not exceed $5,000 per family of an eligible 
individual per Federal fiscal year.
    In paragraphs (h)(2)(i) through (iii), certain limitations for 
payments for child care services are identified, which is consistent 
with the SSVF Program's regulations at 38 CFR 62.33(h). Pursuant to 
paragraph (h)(2)(i), payments for child care services must be paid by 
the grantee directly to an eligible child care provider. Unlike Sec.  
62.33(h), VA would not include the language that payments for child 
care services cannot exceed a maximum of 6 months in a 12-month period, 
and 10 months during a 2-year period. As payments are capped at $5,000 
per family per Federal fiscal year under section 
201(q)(11)(A)(ix)(VIII) of the Act, VA believes the financial cap 
imposed by the statute is a sufficient constraint to ensure proper use 
of resources for these services.
    Under paragraph (h)(2)(ii), payments for child care services will 
not be provided on behalf of participants for the same period of time 
and for the same cost types that are being provided through another 
Federal (including VA), State or local subsidy program. The reference 
to the ``same period of time'' means the same dates and times in which 
child care benefits are being provided under another program. For 
example, a participant may be eligible for Arkansas's Child Care 
Assistance Program, which provides financial assistance for quality 
child care to certain individuals. If that participant was using those 
benefits under Arkansas's Child Care Assistance Program on a specific 
date and time, it would not render the participant ineligible for child 
care support generally under the suicide prevention services grant 
program. The only result would be that the individual could not receive 
a subsidy under VA's program for the same period of time for which 
child care services were being provided under the Arkansas program.
    Paragraph (h)(2)(iii) further explains that as a condition of 
providing payments for child care services, the grantee must help the 
participant develop a reasonable plan to address the participant's 
future ability to pay for child care services. Grantees must assist the 
participant to implement such plan by providing any necessary 
assistance or helping the participant to obtain any necessary public or 
private benefits or services. Because the payments for child care 
services provided under paragraph (h) are intended to be temporary, VA 
would require that grantees assist in developing and implementing such 
plan to ensure that participants are able to plan for such services in 
the long-term as needed.

78.85 Suicide Prevention Services: Nontraditional and Innovative 
Approaches and Treatment Practices

    Section 78.85 explains that grantees providing or coordinating the 
provision of nontraditional and innovative approaches and treatment 
practices may provide or coordinate the provision of nontraditional and 
innovative approaches and treatment, including but not limited to 
complementary or alternative interventions with some evidence for 
effectiveness of improving mental health or mitigating a risk factor 
for suicidal thoughts and behavior, as set forth in the NOFO or as 
approved by VA that are consistent with SSG Fox SPGP. Applicants may 
propose nontraditional and innovative approaches and treatment 
practices in their suicide prevention services grant application, and 
grantees may propose these additional approaches and treatment 
practices by submitting a written request to modify the suicide 
prevention services grant in accordance with Sec.  78.125.
    VA is authorized under section 201(f)(1) of the Act to include such 
commitments as it considers necessary to carry out this section. VA is 
exercising this authority here by reserving the right to approve or 
disapprove nontraditional and innovative approaches and treatment 
practices to be provided or coordinated to be provided using funds 
authorized under SSG Fox SPGP. These approaches and treatment practices 
can evolve, and by maintaining the right to approve or disapprove these 
treatment practices or approaches, VA can ensure that participants 
receive approaches and treatment practices that are safe and effective. 
VA is not providing a broad list of approved innovative approaches and 
treatment practices to allow for emerging services with some evidence 
in suicide risk reduction the opportunity for review and selection. It 
is also important for VA to note that any approaches and treatment 
practices approved will need to be consistent with applicable Federal 
law. For example, the use of grant funds to provide or coordinate the 
provision of marijuana to eligible individuals and their families will 
be prohibited, as marijuana is currently illegal under Federal law.

[[Page 13824]]

78.90 Suicide Prevention Services: Other Services

    The definition of suicide prevention services in section 
201(q)(11)(A)(xi) of the Act includes other services necessary for 
improving the mental health status and wellbeing and reducing the 
suicide risk of eligible individuals and their families as the 
Secretary considers appropriate.
    Consistent with section 201(q)(11)(A)(xi) of the Act, section 
78.90(a) explains general suicide prevention assistance that may be 
provided under this grant program. Pursuant to paragraph (a), a grantee 
may pay directly to a third party (and not to a participant), in an 
amount not to exceed $750 per participant during any 1-year period, 
beginning on the date that the grantee first submits a payment to a 
third party, the following types of expenses: (i) Expenses associated 
with gaining or keeping employment, such as uniforms, tools, 
certificates, and licenses; and (ii) expenses associated with lethal 
means safety and secure storage, such as gun locks and locked 
medication storage.
    A limit of $750 per participant per year is an appropriate amount 
because such items as gun storage and locks can cost anywhere from $20 
to several hundred dollars. Similarly, for purposes of employment, 
licenses and uniforms can range from several dollars to several hundred 
dollars. The amount of $750 per year also is consistent with the amount 
of similar assistance authorized under the SSVF program of $1,500 every 
2 years. See 38 CFR 62.34(e)(2).
    VA would allow payment for expenses associated with gaining or 
keeping employment as extended unemployment may lead to mental health 
issues and financial hardship. See Haw, C., K. Hawton, D. Gunnell, and 
S. Platt. 2015. Economic recession and suicidal behavior: Possible 
mechanisms and ameliorating factors. International Journal of Social 
Psychiatry 61, no. 1:73-81. Thus, it would be appropriate to cover 
these as other services as these would be necessary for improving the 
mental health status and wellbeing and reducing the suicide risk of 
eligible individuals and their families.
    VA would also allow payment for expenses associated with lethal 
means safety and secure storage, as these would also be services 
necessary for improving the wellbeing and reducing the suicide risk of 
eligible individuals and their families. In 2018, 68.2 percent of 
Veteran suicide deaths were due to a self-inflicted firearm injury, 
while 48.2 percent of non-Veteran adult suicides resulted from a 
firearm injury. In 2018, 69.4 percent of male veteran suicide deaths 
and 41.9 percent of female veteran suicide deaths resulted from a 
firearm injury. In 2018, firearms were used in 41.9 percent of suicide 
deaths among women veterans, compared to 31.7 percent of suicide deaths 
among non-veteran women. See VA's 2020 National Veteran Suicide 
Prevention Annual Report. (Available online: https://www.mentalhealth.va.gov/docs/data-sheets/2020/2020-National-Veteran-Suicide-Prevention-Annual-Report-11-2020-508.pdf.) Research has shown 
that when lethal means are made less accessible or lethal, suicide 
rates by those means decline. See, Gunnell D and Eddleston M. Suicide 
by intentional ingestion of pesticides: A continuing tragedy in 
developing countries. International Journal of Epidemiology. 
2003;32:902-909; Gunnell D, Fernando R, Hewagama M, Priyangika WD, 
Konradsen F, Eddleston M. The impact of pesticide regulations on 
suicide in Sri Lanka. Int J Epidemiol. 2007;36(6):1235-42; Kreitman N. 
The coal gas story. United Kingdom suicide rates, 1960-71. Br J Prev 
Soc Med. 1976 Jun;30(2):86-93; Hawton K. United Kingdom legislation on 
pack sizes of analgesics: Background, rationale, and effects on suicide 
and deliberate self-harm. Suicide and Life-Threatening Behavior. 
2002;32(3):223-229. Furthermore, increasing time and space between 
individuals facing a suicidal crisis and a firearm has been shown to 
prevent suicide. Lubin, G., Werbeloff, N., Halperin, D., Shmushkevitch, 
M., Weise, M, & Knobler, H. (2010), Suicide & Life-Threatening 
Behavior, 40(5), 421-424. Thus, VA believes it is appropriate to allow 
payment for expenses associated with lethal means safety and secure 
storage, as these would also be services necessary for improving the 
wellbeing and reducing the suicide risk of eligible individuals and 
their families.
    Paragraph (b) explains that grantees providing or coordinating the 
provision of other suicide prevention services may provide or 
coordinate the provision of other services as set forth in the NOFO or 
as approved by VA that are consistent with SSG Fox SPGP. Applicants may 
propose additional services in their suicide prevention services grant 
application, and grantees may propose additional services by submitting 
a written request to modify the suicide prevention services grant 
program in accordance with Sec.  78.125. VA reserves the right to 
approve or disapprove other suicide prevention services to be provided 
or coordinated to be provided using funds authorized under SSG Fox 
SPGP. This is consistent with how VA authorizes additional services for 
the SSVF Program (see 38 CFR 62.34) and is authorized by the statute as 
noted above.
    Section 201(q)(11)(A)(xi) includes as examples of services the 
Secretary may include adaptive sports, equine assisted therapy, or in-
place or outdoor recreational therapy; substance use reduction 
programming; individual, group, or family counseling; and relationship 
coaching. VA is not identifying these services as expressly covered in 
its regulations, but applicants may propose these services in their 
grant application. VA believes Congress included these as examples of 
other services to ensure that applicants proposing to furnish these 
services would be able to do so if VA determines that such services are 
appropriate and likely for the purpose of reducing veteran suicide. VA 
believes the list in section 201(q)(11)(A)(xi) also is indicative of 
the types of other services that may be approved. VA believes the 
intent of this section of law is to provide flexibility for different 
approaches; thus, VA is not regulating these services further to 
preserve that flexibility. Paragraph (b) will control the disposition 
of any requests by applicants and grantees to offer these or other 
services.

78.95 General Operation Requirements

    In Sec.  78.95, VA establishes requirements for the general 
operation of suicide prevention services programs. Paragraph (a) 
explains that prior to providing suicide prevention services, grantees 
must verify, document, and classify each participant's eligibility for 
suicide prevention services and determine and document each 
participant's degree of risk of suicide using tools identified in the 
suicide prevention services grant agreement. Such documentation must be 
maintained consistent with Sec.  78.150. This ensures that grantees are 
providing services and using grant funds for those who are eligible for 
such services under this grant program and consistent with the Act.
    Paragraph (b) explains that prior to services ending, grantees must 
provide or coordinate the provision of a mental health screening to all 
participants they serve, when possible. This screening must be 
conducted with the same tool used to conduct the baseline mental health 
screening under Sec.  78.50. Having this screening occur at the 
beginning (pursuant to Sec.  78.50) and prior to services ending is 
important in evaluating the effectiveness of the

[[Page 13825]]

services provided, when possible. VA acknowledges that some 
participants may leave services early or opt out of screening so 
meeting this requirement may not always be possible. Thus, the language 
``when possible'' is included in paragraph (b).
    Under paragraph (c), for each participant who receives suicide 
prevention services from the grantee, the grantee must document the 
suicide prevention services provided or coordinated, how such services 
are provided or coordinated, the duration of the services provided or 
coordinated, and any goals for the provision or coordination of such 
services. Such documentation must be maintained consistent with Sec.  
78.150. This is information eligible entities typically maintain 
regarding the provision or coordination of these or similar services. 
Additionally, this information may be requested by VA for purposes of 
monitoring the grantee's operation and compliance with these 
regulations (under Sec. Sec.  78.135 and 78.145), will be collected as 
part of the grantee's reporting requirements in Sec.  78.145, and will 
be required to be maintained for at least three years (consistent with 
the recordkeeping requirements in Sec.  78.150), and may be requested 
by VA for auditing and evaluation purposes.
    Consistent with section 201(e) of the Act, in paragraph (d)(1), 
prior to initially providing or coordinating suicide prevention 
services to an eligible individual and their family, the grantee is 
required to notify each eligible individual and their family that the 
suicide prevention services are being paid for, in whole or in part, by 
VA; the suicide prevention services available to the eligible 
individual and their family through the grantee's program; any 
conditions or restrictions on the receipt of suicide prevention 
services by the eligible individual and their family; and in the 
instance of an eligible individual who receives assistance from the 
grantee under this program, that the eligible individual is able to 
apply for enrollment in VA health care pursuant to 38 CFR 17.36. If the 
eligible individual wishes to enroll in VA health care, the grantee 
must inform the eligible individual of a VA point of contact for 
assistance in enrollment. These requirements concerning information 
about enrollment are consistent with section 201(e)(3) of the Act. 
While not every eligible individual may be able to enroll in VA health 
care under Sec.  17.36, they can apply to determine their eligibility. 
It may not be possible to know at the time the eligible individual 
expresses an interest in enrolling in VA health care whether or not the 
person is a veteran under 38 U.S.C. 101(2), so VA is using the term 
eligible individual, as it is more inclusive and potentially a more 
accurate description of the person at the point of time this 
information is provided. Other than members of the Armed Forces who are 
included as an eligible individual through reference to 38 U.S.C. 
1712A(a)(1)(C)(i)-(iv), eligible individuals may be able to enroll in 
VA health care. Consequently, VA includes an exception in paragraph 
(d)(1)(iv) stating that the requirements in this clause do not apply to 
eligible individuals who are members of the Armed Forces described in 
section 1712A(a)(1)(C)(i)-(iv) of title 38, United States Code.
    In paragraph (d)(2), grantees must provide each participant with a 
satisfaction survey, which the participant can submit directly to VA, 
within 30 days of such participant's pending exit from the grantee's 
program. This is required to assist VA in evaluating grantees' 
performance and participants' satisfaction with the suicide prevention 
services they receive. This is consistent with the SSVF Program (see 38 
CFR 62.36(c)(2)).
    Paragraph (e) requires that grantees regularly assess how suicide 
prevention services grant funds can be used in conjunction with other 
available funds and services to assist participants. This is consistent 
with the SSVF Program (see Sec.  62.36(d)) and encourages grantees to 
leverage other financial resources to ensure continuity of program 
operations and assistance to participants.
    Paragraph (f) requires that for each participant, grantees must 
develop and document an individualized a plan with respect to the 
provision of suicide prevention services provided under this part. 
Consistent with section 201(e)(2) of the Act, this plan must be 
developed in consultation with the participant and must be maintained 
consistent with Sec.  78.150. This requirement would ensure that a plan 
is developed to address the needs of participants. Such plan would 
include, but not be limited to, the suicide prevention services needed, 
the goals and objectives of the plan, and the applicable services. This 
plan would allow grantees and VA to monitor the delivery of suicide 
prevention services to participants. VA would include information about 
the suicide prevention services plan in the program guide developed for 
grantees. This requirement for a suicide prevention services plan is 
also authorized under section 201(f)(1) of the Act, as VA has authority 
to include such commitments as it considers necessary to carry out this 
section.
    In paragraph (g), VA requires grantees to coordinate with VA with 
respect to the provision of health care and other services to eligible 
individuals under 38 U.S.C. Chapters 17 and 20. This is consistent with 
the requirements in section 201(e)(3)(A), (m), and (n) of the Act. VA 
expects that grantees will work with local VA facilities on a regular 
basis to coordinate care when needed for eligible individuals.
    Consistent with section 201(e)(4) of the Act, VA requires in 
paragraph (h) that the grantee submit to VA a description of the tools 
and assessments the grantee uses or will use to determine the 
effectiveness of the suicide prevention services furnished by the 
grantee. These include any measures and metrics developed and provided 
by VA for the purposes of measuring the effectiveness of the 
programming to be provided in improving mental health status and 
wellbeing, and reducing suicide risk and suicide deaths of eligible 
individuals. While the Act uses the phrase ``completed suicides'', VA 
uses the term ``suicide deaths'', as that is the terminology commonly 
used by VA. VA recognizes that messaging and language around suicide 
attempts and suicide death has an impact on beliefs and attitudes 
related to suicide. Thus, VA has developed a Safe Messaging Best 
Practices guide for public use regarding this topic. See https://www.mentalhealth.va.gov/suicide_prevention/docs/OMH-086-VA-OMHSP-Safe-Messaging-Factsheet-4-9-2019.pdf.
    Consistent with section 201(o) of the Act, under paragraph (i), 
only grantees that are a State or local government or an Indian tribe 
are able to use grant funds to enter into an agreement with a community 
partner under which the grantee may provide funds to the community 
partner for the provision of suicide prevention services to eligible 
individuals and their families.
    Paragraph (j) explains that grantees may enter into contracts for 
goods or services under this part. Section 201(o)(2) of the Act states 
that the ability of a grantee to provide grant funds to a community 
partner is limited to grantees that are a State or local government or 
an Indian tribe. VA does not interpret section 201(o)(2) of the Act to 
prohibit a grantee from using funds provided under this part to pay 
vendors or contractors for certain services, as VA does not interpret 
the term ``community partner'' to limit such arrangements. Indeed, VA 
believes that if the term ``community partner'' prohibited the use of 
grant funds to be used to pay vendors and other contractors, section 
201(o)(2) of the Act would effectively bar any entity that was not a 
State or local

[[Page 13826]]

government, or an Indian tribe, from participating in the grant 
program, or at least from providing many of the suicide prevention 
services defined in this rule. VA understands that the intent behind 
section 201(o)(2) of the Act was to clarify that only State or local 
governments and Indian tribes are able to provide sub-grants to 
community partners. VA's interpretation, which permits grantees to use 
grant funds to pay vendors and contractors for goods and services, is 
consistent with this intent and is necessary for effective operation of 
the program. No non-governmental entity, and likely no governmental 
entity, would be able to provide the full range of services identified 
as suicide prevention services in section 201(q)(11) of the Act absent 
the ability to pay vendors and contractors for goods and services. For 
example, assistance with emergent needs related to transportation 
services under section 201(q)(11)(A)(ix) often involves the provision 
of tokens or vouchers for use of transportation services such as buses 
or rail. However, no non-governmental entity, and few governmental 
entities, actually operate the transportation systems that would be 
needed to provide this assistance, so any effort to provide support 
with transportation services would require the use of grant funds to 
obtain goods or services from another party that is not a community 
partner. Similarly, Congress authorized up to $5,000 in assistance per 
family of an eligible individual per fiscal year for child care in 
section 201(q)(11)(A)(ix)(VIII) of the Act. Including a cap on the 
amount of funds that could be used for such services would not make 
sense unless Congress intended for grantees to be able to use grant 
funds to purchase goods and services like child care. Taken to its 
logical extreme, if section 201(o)(2) of the Act were to prohibit non-
governmental grantees from providing any grant funds to any other 
party, these grantees would be prohibited from using grant funds to pay 
their utility bills, purchase office supplies, or pay rent. VA does not 
believe that such a result could possibly have been intended by 
Congress.
    VA further believes that existing Federal regulations concerning 
the use of grants, set forth in 2 CFR part 200, support VA's 
interpretation. For example, 2 CFR 200.1 provides definitions 
applicable to the uniform administrative requirements, cost principles, 
and audit requirements for Federal awards. These regulations define the 
term ``contract'', for purposes of Federal financial assistance, as a 
legal instrument by which a recipient or subrecipient purchases 
property or services needed to carry out the project or program under a 
Federal award. This is clearly distinguished from a subaward, which is 
an award provided by a pass-through entity to a subrecipient for the 
subrecipient to carry out part of a Federal award received by the pass-
through entity; subawards do not include payments to a contractor or 
payments to an individual that is a beneficiary of a Federal program. 
In this context, VA interprets section 201(o)(2) of the Act as limiting 
the use of subawards but not contracts by grantees. Grantees may choose 
to enter into contracts because in some situations, resources may be 
more readily available at a lower cost, or they may only be available, 
from another party in the community.
    Lastly, in paragraph (k), VA requires grantees to ensure that 
suicide prevention services grants are administered in accordance with 
the requirements of part 78, the suicide prevention services grant 
agreement, and other applicable Federal, State, and local laws and 
regulations, including Federal civil rights laws. Grantees must ensure 
that any community partners carry out activities in compliance with 
this part. This is consistent with how VA administers the SSVF Program 
(see Sec.  62.36(e)).

78.100 Fee Prohibition

    In Sec.  78.100, VA prohibits grantees from charging a fee to 
participants for providing suicide prevention services that are funded 
with amounts from a suicide prevention services grant. VA believes this 
prohibition is appropriate because charging a fee could be a barrier to 
receiving care and services. There may be eligible individuals who may 
not be able to afford to pay any fees or those who do not otherwise 
seek care and services under this grant program because they do not 
want to pay a fee. Because of the importance of the services, including 
referrals to VA care as appropriate, provided under this grant program 
to eligible individuals at risk of suicide, VA does not want financial 
liability for fees to result in an eligible individual not receiving 
such critical services that may save such individual's life, as doing 
so would be inconsistent with the purpose of this grant program under 
section 201 of the Act to reduce suicide among veterans. This 
prohibition is authorized by section 201(f)(1) of the Act, which 
permits VA to include such commitments as the Secretary considers 
necessary to carry out this section. This is also similar to other 
prohibitions that have been implemented for other, similar grant 
programs, such as the SSVF Program (see 38 CFR 62.37). VA also notes 
that collecting and processing fees would increase administrative costs 
and time for the grantee, which would negatively affect the provision 
of services to eligible individuals.

78.105 Ineligible Activities

    Section 78.105 sets forth certain activities for which grantees 
will not be authorized to use suicide prevention services grant funds. 
Pursuant to section 201(q)(11)(B) of the Act, direct cash assistance to 
participants is prohibited, which is reflected in paragraph (a). Other 
prohibited activities are set forth in paragraphs (b) through (d) to 
include those legal services prohibited pursuant to Sec.  78.80(g); 
medical or dental care and medicines except for clinical services for 
emergency treatment authorized pursuant to Sec.  78.60; and any 
activities considered illegal under Federal law. Some of the items on 
this list of ineligible activities are consistent with those prohibited 
under the SSVF Program (see 38 CFR 62.38). However, VA does not feel it 
is necessary to include all of the activities that are ineligible under 
the SSVF program as these programs have distinct purposes, and many of 
those ineligible activities (for example, mortgage costs) are not 
necessarily applicable to the suicide prevention grant program. If VA 
wanted to include any of those activities under this grant program, 
such activities would be subject to Sec.  78.90. Similarly, VA does not 
think it is necessary to list every ineligible activity as all 
activities would be subject to the requirements in part 78. VA also 
notes that 2 CFR part 200 prohibits the use of grant awards for certain 
activities, such as entertainment. Such prohibitions are applicable to 
suicide prevention services grants awarded under part 78. However, it 
is unnecessary to include that language in Sec.  78.105 because 2 CFR 
part 200 controls the administration of these grants regardless of 
whether explicit language exists in part 78.

78.110 Notice of Funding Opportunity

    Consistent with existing processes for other VA grant programs, VA 
will notify the public, through a NOFO, when funds for this grant 
program are available. Section 78.110 explains that when funds are 
available for the grant program, VA will publish a NOFO on grants.gov. 
It also describes the information that will be included in such NOFO, 
including the location for obtaining suicide prevention services grant 
applications; the date, time, and place for submitting completed 
suicide

[[Page 13827]]

prevention services grant applications; the estimated amount and type 
of suicide prevention services grant funding available; any priorities 
for or exclusions from funding to meet the statutory mandates of 
section 201 of the Act and VA's goals for SSG Fox SPGP; the length of 
term for the suicide prevention services grant award; the minimum 
number of total points and points per category that an applicant or 
grantee, as applicable, must receive for a suicide prevention services 
grant to be funded; any maximum uses of suicide prevention services 
grant funds for specific suicide prevention services; the timeframes 
and manner for payments under the suicide prevention services grant; 
and other information necessary for the suicide prevention services 
grant application process as determined by VA.
    This is consistent with the requirements and recommendations within 
2 CFR part 200 regarding notices of funding opportunity (see 2 CFR 
200.204).

78.115 Suicide Prevention Services Grant Agreements

    Consistent with other the SSVF Program (see 38 CFR 62.50) and 2 CFR 
200.201, section 78.115 explains that VA and the selected applicant 
will enter into an agreement prior to obligating funds under part 78 
and sets forth requirements that will be included in such agreement. 
Section 200.201 requires that Federal awarding agencies must decide on 
the appropriate instrument for Federal awards. Such appropriate 
instruments include grant agreements, which VA uses for the SSVF 
Program (see 38 CFR 62.50). This is also authorized by section 
201(f)(1) of the Act, which permits VA to include such commitments as 
the Secretary considers necessary to carry out this section.
    This agreement will be enforceable against the grantee, providing 
VA assurance that the grantee will use the suicide prevention services 
grant funds in the manner described in the application and in 
accordance with the requirements of part 78.
    Paragraph (a) states that after an applicant is selected for a 
suicide prevention services grant in accordance with Sec.  78.30, VA 
will draft a suicide prevention services grant agreement to be executed 
by VA and the applicant. Upon execution of the suicide prevention 
services grant agreement, VA will obligate suicide prevention services 
grant funds to cover the amount of the approved suicide prevention 
services grant, subject to the availability of funding. Such agreement 
will provide that the grantee agrees, and will ensure that each 
community partner agrees, to operate the program in accordance with the 
provisions of part 78 and the applicant's suicide prevention services 
grant application; comply with such other terms and conditions, 
including recordkeeping and reports for program monitoring and 
evaluation purposes, as VA may establish for purposes of carrying out 
SSG Fox SPGP, in an effective and efficient manner; and provide such 
additional information as deemed appropriate by VA.
    Paragraph (b) explains that after a grantee is selected for renewal 
of a suicide prevention services grant in accordance with Sec.  78.40, 
VA will draft a suicide prevention services grant agreement to be 
executed by VA and the grantee. Upon execution of the suicide 
prevention services grant agreement, VA will obligate suicide 
prevention services grant funds to cover the amount of the approved 
suicide prevention services grant, subject to the availability of 
funding. Such grant agreement will contain the same provisions 
described in paragraph (a) of this section.
    Pursuant to paragraph (c), no funds provided under part 78 may be 
used to replace Federal, State, tribal, or local funds previously used, 
or designated for use, to assist eligible individuals and their 
families.

78.120 Amount and Payment of Grants

    Consistent with section 201(c)(2)(A) of the Act, Sec.  78.120(a) 
states that the maximum funding that a grantee may be awarded under 
part 78 is $750,000 per fiscal year. VA may provide less than $750,000 
per award per its discretion under section 201 of the Act. As explained 
in Sec.  78.110, the NOFO will identify the estimated amount of grant 
funding available. However, because of the statutory restriction, VA 
will not provide more than $750,000 per grantee per fiscal year.
    Section 78.120(b) explains that grantees are to be paid in 
accordance with the timeframes and manner set forth in the NOFO. 
Section 201(c)(2)(B) of the Act authorizes VA to establish intervals of 
payment for purposes of this grant program, and VA will do so in the 
NOFO, which is consistent with how VA establishes payment in other 
grant programs. See 38 CFR 62.51. Including such information in the 
NOFO provides VA with the flexibility to determine the time and manner 
of payment for suicide prevention services grants that is appropriate 
for each funding cycle.

78.125 Program or Budget Changes and Corrective Action Plans

    Section 78.125 sets forth the requirements if there are changes to 
the program or budget that alter the grantee's suicide prevention 
services grant program. This section is consistent with 2 CFR 200.308 
which establishes policy and processes for revision of budget and 
program plans for Federal awards. These requirements are authorized by 
section 201(f)(1) of the Act, which permits VA to include such 
commitments as the Secretary considers necessary to carry out this 
section. These requirements are also consistent with how VA handles 
program and budget changes and corrective action plans in the SSVF 
Program (see 62 CFR 62.60) and allow VA to ensure that grant funds are 
used appropriately and to maintain control over the quality of suicide 
prevention services provided by the grantee.
    Paragraph (a) states that a grantee must submit to VA a written 
request to modify a suicide prevention services grant for any proposed 
significant change that will alter the suicide prevention services 
grant program. It further explains that if VA approves such change, it 
will issue a written amendment to the suicide prevention services grant 
agreement. A grantee must receive VA's approval prior to implementing a 
significant change. Significant changes include, but are not limited 
to, a change in the grantee or any community partners identified in the 
suicide prevention services grant agreement; a change in the area 
served by the grantee; additions or deletions of suicide prevention 
services provided by the grantee; a change in category of participants 
to be served; and a change in budget line items that are more than 10 
percent of the total suicide prevention services grant award. VA's 
approval of changes will be contingent upon the grantee's amended 
application retaining a sufficient rank to have been competitively 
selected for funding in the year that the application was granted, and 
each suicide prevention services grant modification request will be 
required to contain a description of, and justification for, the 
revised proposed use of suicide prevention services grant funds.
    Under paragraph (b), VA may require that the grantee initiate, 
develop, and submit to VA for approval a Corrective Action Plan (CAP) 
if, on a quarterly basis, actual suicide prevention services grant 
expenditures vary from the amount disbursed to a grantee for that same 
quarter or actual suicide prevention services grant activities vary

[[Page 13828]]

from the grantee's program description provided in the suicide 
prevention services grant agreement. Paragraph (b) also sets forth 
specific requirements related to the CAP. These include that the CAP 
must identify the expenditure or activity source that has caused the 
deviation, describe the reason(s) for the variance, provide specific 
proposed corrective action(s), and provide a timetable for 
accomplishment of the corrective action. After receipt of the CAP, VA 
will send a letter to the grantee indicating that the CAP is approved 
or disapproved. If disapproved, VA will make beneficial suggestions to 
improve the proposed CAP and request resubmission or take other actions 
in accordance with this part.
    Paragraph (c) explains that grantees are required to inform VA in 
writing of any key personnel changes (e.g., new executive director, 
suicide prevention services grant program director, or chief financial 
officer) and grantee address changes within 30 days of the change.

78.130 Faith-Based Organizations

    As VA anticipates that religious or faith-based organizations may 
apply for grants under part 78, Sec.  78.130 explains that religious or 
faith-based organizations are eligible for suicide prevention services 
grants and describes the conditions for use of these grants as they 
relate to religious activities. This is similar to the language used in 
the Homeless Providers Grant and Per Diem Program (38 CFR 61.64) and 
the SSVF Program (38 CFR 61.62). However, VA has moved the definitions 
of indirect financial assistance and direct federal financial 
assistance to the definitions section of part 78.
    Under paragraph (a), organizations that are faith-based will be 
eligible, on the same basis as any other organization, to participate 
in SSG Fox SPGP under part 78. Decisions about awards of Federal 
financial assistance must be free from political interference or even 
the appearance of such interference and must be made on the basis of 
merit, not on the basis of religion or religious belief or lack 
thereof.
    Paragraph (b)(1) states that no organization may use direct 
financial assistance from VA under this part to pay for any of the 
following: (i) Explicitly religious activities such as, religious 
worship, instruction, or proselytization; or (ii) equipment or supplies 
to be used for any of those activities. Paragraph (b)(2) states that 
references to financial assistance are deemed to be references to 
direct Federal financial assistance, unless the referenced assistance 
meets the definition of indirect Federal financial assistance in part 
78.
    Under paragraph (c), organizations that engage in explicitly 
religious activities, such as worship, religious instruction, or 
proselytization, must offer those services separately in time or 
location from any programs or services funded with direct financial 
assistance from VA under this part, and participation in any of the 
organization's explicitly religious activities must be voluntary for 
the participants in a program or service funded by direct financial 
assistance from VA under part 78.
    Paragraph (d) states that a faith-based organization that 
participates in SSG Fox SPGP under part 78 will retain its independence 
from Federal, State, or local governments. It further states that such 
organizations may continue to carry out its mission, including the 
definition, practice and expression of its religious beliefs, so long 
as the organization does not use direct financial assistance from VA 
under part 78 to support any explicitly religious activities, such as 
worship, religious instruction, or proselytization. Faith-based 
organizations may use space in their facilities to provide VA-funded 
services under part 78, without concealing, removing, or altering 
religious art, icons, scripture, or other religious symbols. In 
addition, a VA-funded faith-based organization retains its authority 
over its internal governance, and it may retain religious terms in its 
organization's name, select its board members and otherwise govern 
itself on a religious basis, and include religious reference in its 
organization's mission statements and other governing documents.
    Under paragraph (e), an organization that participates in a VA 
program under this part must not, in providing direct program 
assistance, discriminate against a program participant or prospective 
program participant on the basis of religion or religious belief.
    Under paragraph (f), if a State or local government voluntarily 
contributes its own funds to supplement Federally funded activities, 
the State or local government has the option to segregate the Federal 
funds or commingle them. However, if the funds are commingled, this 
provision applies to all of the commingled funds.
    Under paragraph (g), to the extent otherwise permitted by Federal 
law, the restrictions on explicitly religious activities set forth in 
this section do not apply where VA funds are provided to faith-based 
organizations through indirect assistance as a result of a genuine and 
independent private choice of a participant, provided the faith-based 
organizations otherwise satisfy the requirements of this part. A faith-
based organization may receive such funds as the result of a 
participant's genuine and independent choice if, for example, a 
participant redeems a voucher, coupon, or certificate, allowing the 
participant to direct where funds are to be paid, or a similar funding 
mechanism provided to that participant and designed to give that 
participant a choice among providers.

78.135 Visits to Monitor Operation and Compliance

    Section 78.135(a) authorizes VA, at all reasonable times, to make 
visits to all grantee locations where a grantee is using suicide 
prevention services grant funds to review grantee accomplishments and 
management control systems and to provide such technical assistance as 
may be required. VA may also conduct inspections of all program 
locations and records of a grantee at such times as are deemed 
necessary to determine compliance with the provisions of this part. In 
the event that a grantee delivers services in a participant's home, or 
at a location away from the grantee's place of business, VA may 
accompany the grantee. If the grantee's visit is to the participant's 
home, VA will only accompany the grantee with the consent of the 
participant. If any visit is made by VA on the premises of the grantee 
or a community partner under the suicide prevention services grant, the 
grantee must provide, and must require its community partners to 
provide, all reasonable facilities and assistance for the safety and 
convenience of the VA representatives in the performance of their 
duties. All visits and evaluations will be performed in such a manner 
as will not unduly delay services.
    Paragraph (b) explains that the authority to inspect carries with 
it no authority over the management or control of any applicant or 
grantee under this part.
    These provisions are critical for VA oversight over suicide 
prevention services grants and are consistent with how VA administers 
other grant programs (see 38 CFR 61.65 and 62.63). These provisions are 
authorized by section 201(f)(1) and 201(g) of the Act, which authorize 
VA to require eligible entities seeking grants to provide such 
commitments and information as VA considers necessary and require VA to 
provide training and technical assistance to eligible entities in 
receipt of grants. These provisions are also consistent with 2 CFR 
200.329 regarding

[[Page 13829]]

monitoring and reporting program performance for Federal awards.

78.140 Financial Management and Administrative Costs

    Section 78.140 sets forth requirements with which grantees must 
comply and ensures that grantees are aware of these requirements. These 
requirements are consistent with other grant programs, such as the SSVF 
Program (see 38 CFR 62.70) and the Homeless Providers Grant and Per 
Diem Program (see 38 CFR 61.66).
    Paragraph (a) requires grantees to comply with applicable 
requirements of the Uniform Administrative Requirements, Cost 
Principles, and Audit Requirements for Federal Awards under 2 CFR part 
200. Part 200 of 2 CFR establishes the uniform administrative 
requirements, cost principles, and audit requirements for Federal 
awards to non-Federal entities.
    Paragraph (b) requires grantees use a financial management system 
that provides adequate fiscal control and accounting records and meets 
the requirements set forth in 2 CFR part 200.
    Under paragraph (c), payment up to the amount specified in the 
suicide prevention services grant must be made only for allowable, 
allocable, and reasonable costs in conducting the work under the 
suicide prevention services grant, and the determination of allowable 
costs must be made in accordance with the applicable Federal Cost 
Principles set forth in 2 CFR part 200.
    Paragraph (d) prohibits costs for administration by a grantee from 
exceeding 10 percent of the total amount of the suicide prevention 
services grant. Administrative costs include all costs associated with 
the management of the program and include the administrative costs of 
community partners.
    VA has determined this limitation on administrative costs to be 
reasonable and consistent with the purpose of SSG Fox SPGP, as VA 
believes it is important that almost all of funding provided by VA goes 
towards providing services for participants. This requirement ensures 
that the vast majority of suicide prevention services grant funds (at 
least 90 percent) are used to provide suicide prevention services to 
participants. These requirements are also consistent with the SSVF 
Program, which allows only 10 percent of the grant funds to be used for 
specified administrative costs. See 38 CFR 62.10. VA has not identified 
any issues with this limitation in the context of the SSVF program. VA 
believes that 10 percent is a reasonable maximum for administrative 
costs, and any additional funds needed by grantees to administer the 
suicide prevention services should be provided by non-VA funds.

78.145 Grantee Reporting Requirements

    Section 78.145 sets forth reporting requirements regarding the 
projects carried out using grant funds provided under part 78. Such 
reporting requirements ensure that grants funds are being properly used 
in accordance with the Act and with part 78, and that VA is being a 
good fiscal steward of the taxpayer dollar. These reporting 
requirements are consistent with subsections (e)(5) and (k) of section 
201 of the Act. Section 201(e)(5)(A) mandates that VA require each 
entity receiving a suicide prevention services grant to submit to VA an 
annual report that describes the projects carried out with such grant 
during the year covered by the report. Section 201(e)(5)(C) further 
authorizes VA to require each such entity to submit to VA such 
additional reports as VA considers appropriate. Section 201(k) of the 
Act requires VA to submit an interim report and final report on the 
provision of grants to eligible entities under part 78 to the 
appropriate committees of Congress. Subsection (k)(1)(C) further 
provides VA with the authority to require eligible entities to provide 
to Congress such information as VA determines necessary regarding 
certain information that must be included in such reports. These 
provisions of section 201 of the Act are implemented in paragraphs (b) 
and (c), as explained in more detail below. Additionally, these 
reporting requirements are consistent with how VA administers the SSVF 
Program. See 38 CFR 62.71.
    In paragraph (a), VA reserves the right to require grantees to 
provide, in any form as may be prescribed, such reports or answers in 
writing to specific questions, surveys, or questionnaires as VA 
determines necessary to carry out SSG Fox SPGP.
    Consistent with section 201(e)(5)(A) of the Act, paragraph (b) 
requires that at least once per year, each grantee must submit to VA a 
report that describes the projects carried out with such grant during 
the year covered by the report; and information relating to operational 
effectiveness, fiscal responsibility, suicide prevention services grant 
agreement compliance, and legal and regulatory compliance, including a 
description of the use of suicide prevention grant funds, the number of 
participants assisted, the types of suicide prevention services 
provided, and any other information that VA may request. The 
information gathered in this report should also support VA in carrying 
out its responsibilities under section 201(k) of the Act in providing 
necessary information to Congress to facilitate its oversight of this 
program.
    Under paragraph (c), VA retains the discretion to request 
additional reports or information to be able to fully assess the 
provision or coordination of the provision of suicide prevention 
services under part 78. This is a catch-all provision to allow VA to 
request additional reports or information that it may need to further 
assess the project and the pilot program. These will vary on a case-by-
case basis dependent on the project and its progression. Additionally, 
if VA is required to submit additional reports to Congress on this 
pilot program, VA reserves the right under this paragraph to request 
such information as needed to respond to Congress. This also provides a 
safeguard in instances where there may be confusing, misleading, 
inconsistent, or unclear statements in submitted reports. VA reserves 
the right to request additional reports to clarify any such information 
it receives in other reports that are submitted by a grantee. This 
requirement is authorized by section 201(f)(1) of the Act, which 
authorizes VA to require applicants to provide such commitments and 
information as VA considers necessary, and by section 201(e)(5)(C) of 
the Act, which authorizes VA to require eligible entities to submit to 
VA such additional reports as VA considers appropriate.
    Paragraph (d) requires that all pages of the reports must cite the 
assigned suicide prevention services grant number and be submitted in a 
timely manner as set forth in the grant agreement. Including the 
assigned grant number on each page of the report is important for 
tracking reports and to ensure that all pages of the relevant report 
are received by VA for each grant.
    Paragraph (e) further requires that grantees provide VA with 
consent to post information from reports on the internet and use such 
information in other ways deemed appropriate by VA. Grantees shall 
clearly mark information that is confidential to individual 
participants. This is consistent with the SSVF program (see 38 CFR 
62.71(f)).

78.150 Recordkeeping

    Section 78.150 requires grantees, consistent with 2 CFR 200.334, to 
keep records and maintain such records for at least a three-year 
period, to document compliance with SSG Fox SPGP requirements in part 
78. Grantees will need to produce these records at VA's

[[Page 13830]]

request. This will assist VA in providing oversight of grantees and is 
consistent with section 201(k)(1)(B)(i) of the Act, which requires VA 
to assess the effectiveness of this grant program, as well as the 
requirements for recordkeeping in 2 CFR 200.334.

78.155 Technical Assistance

    Consistent with section 201(g) of the Act, Sec.  78.155 explains 
that VA will provide technical assistance, as necessary, to applicants 
and grantees to meet the requirements of part 78. Section 201(g) of the 
Act specifically requires VA to provide training and technical 
assistance, in coordination with the Centers for Disease Control and 
Prevention (CDC), to grantees regarding (1) suicide risk identification 
and management, (2) the data required to be collected and shared with 
VA, (3) the means of data collection and sharing, (4) familiarization 
with and appropriate use of any tool to be used to measure the 
effectiveness of the use of grants, and (5) the requirements for 
reporting on services provided via such grants. Section 78.155 further 
explains that such technical assistance will be provided either 
directly by VA or through contracts with appropriate public or non-
profit private entities. Technical assistance may consist of activities 
related to the planning, development, and provision of suicide 
prevention services to participants.
    In addition to other forms of technical assistance that will be 
provided, such as training and assistance with the five categories 
described above, VA will develop a program guide to be used by 
applicants, grantees, VA staff members, and other interested third 
parties to assist with understanding and implementing SSG Fox SPGP. 
This technical assistance will be conducted in coordination with the 
CDC, as required by section 201(g)(1) of the Act. CDC will be available 
on technical assistance calls, including those relating to the 
availability of data on suicide in grantees' local areas. This is 
consistent with the technical assistance VA provides in the SSVF 
Program. See 38 CFR 62.73.

78.160 Withholding, Suspension, Deobligation, Termination, and Recovery 
of Funds by VA

    Section 78.160 explains that VA will enforce part 78 through such 
actions as may be appropriate. Appropriate actions include withholding, 
suspension, deobligation, termination, recovery of funds by VA, and 
actions in accordance with 2 CFR part 200.
    As suicide prevention services grants are subject to the 
requirements of 2 CFR part 200, VA explicitly references 2 CFR part 200 
in Sec.  78.160 to ensure that grantees understand and know where to 
locate these requirements related to withholding, suspension, 
deobligation, termination, and recovery of funds. The specific sections 
of 2 CFR part 200 on withholding, suspension, deobligation, 
termination, and recovery of funds are 2 CFR 200.208, 200.305, and 
200.339 through 200.343, and 200.346, respectively. VA refers to 2 CFR 
part 200 rather than include those requirements in this section as 
those requirements in 2 CFR part 200 may change. Referencing 2 CFR part 
200 provides VA the ability to implement those changes without having 
to conduct further rulemaking.
    VA acknowledges that when certain actions (such as suspension and 
termination) are taken against grantees pursuant to this section and 2 
CFR part 200, a disruption in services to participants may occur. While 
VA is not regulating responsibilities for grantees to continue to 
provide services or to coordinate the transfer of participants to other 
sources of support, VA will include such requirements and 
responsibilities in the grant agreement that VA and the grantee enter 
into pursuant to this part. This will ensure that the disruption and 
impact upon participants is minimized as much as possible.

78.165 Suicide Prevention Services Grant Closeout Procedures

    Section 78.165 explains that suicide prevention services grants 
will be closed out in accordance with 2 CFR part 200. Procedures for 
closing out Federal awards are currently located at 2 CFR 200.344 and 
200.345. As suicide prevention services grants are subject to the 
requirements of 2 CFR part 200, VA explicitly references 2 CFR part 200 
in Sec.  78.165 to ensure that grantees understand and know where to 
locate these requirements. VA refers to 2 CFR part 200 rather than 
include those requirements in this section as those requirements in 2 
CFR part 200 may change, and referencing 2 CFR part 200 provides VA 
ability to implement those changes without having to conduct further 
rulemaking.

Administrative Procedure Act

    The Administrative Procedure Act (APA), codified in part at 5 
U.S.C. 553, generally requires agencies publish substantive rules in 
the Federal Register for notice and comment. These notice and comment 
requirements generally do not apply to ``a matter relating to agency 
management or personnel or to public property, loans, grants, benefits 
or contracts.'' 5 U.S.C. 553(a)(2). However, 38 U.S.C. 501(d) requires 
VA comply with the notice and comment requirements in 5 U.S.C. 553 for 
matters relating to grants, notwithstanding section 553(a)(2). Thus, as 
this rulemaking relates to the grant program required by section 201 of 
the Act, VA is required to comply with the notice and comment 
requirements of 5 U.S.C. 553.
    However, pursuant to 5 U.S.C. 553(b)(B), general notice and the 
opportunity for public comment are not required with respect to a 
rulemaking when an ``agency for good cause finds (and incorporates the 
finding and a brief statement of reasons therefor in the rules issued) 
that notice and public procedure thereon are impracticable, 
unnecessary, or contrary to the public interest.''
    In accordance with 5 U.S.C. 553(b)(B), the Secretary has concluded 
that there is good cause to publish this rule without prior opportunity 
for public comment. This rule implements the mandates of section 201 of 
the Act to establish a new suicide prevention services grant program. 
This new grant program, SSG Fox SPGP, will provide eligible individuals 
and their families with suicide prevention services that will aim to 
reduce and prevent suicide by providing outreach, mental health 
screenings, education on suicide risk and prevention, clinical services 
for emergency treatment, case management services, peer support 
services, and assistance with obtaining VA and other government 
benefits, among other services.
    Suicide is a national public health concern, and it is preventable. 
The rate of veteran suicide in the United States remains high, despite 
great effort. It is critical that this rulemaking publish without 
delay, as these grants will result in increased engagement with a 
specific population at risk of suicide, which is especially needed 
during the Coronavirus Disease-2019 (COVID-19) pandemic and the 
immediate period following this pandemic. The COVID-19 pandemic has 
caused significant psychological distress related to economic 
hardships, physical safety concerns, illness, and death of family and 
friends, uncertainty about the future, and isolation from social 
supports. See Panchal, N., Kamal, R., Orgera, K., Cox, C., Garfield, 
R., Hamel, L., Mu[ntilde]ana, C. & Chidambaram, P. (2021). The 
implications of COVID-19 for mental health and substance use. Kaiser 
Family Foundation. https://www.kff.org/coronavirus-covid-19/issuebrief/the-implications-of-covid-19-for-mental-health-and-substance-use;

[[Page 13831]]

See also, Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., 
Wessely, S., Greenberg, N., & Rubin, G.J., (2020). The psychological 
impact of quarantine and how to reduce it: Rapid review of the 
evidence. Lancet, 395, 912-920. COVID-19 has had a detrimental effect 
on mental health in the United States. See id.; see also, Czeisler, 
M[Eacute], Lane, RI, Petroski, E, et al. Mental Health, Substance Use, 
and Suicidal Ideation During the COVID-19 Pandemic--United States, June 
24-30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049; See also, National 
Center for Health Statistics (2021). Anxiety and depression: Household 
Pulse Survey. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm (Last accessed May 17, 
2021).
    According to a recent CDC report, more Americans are reporting 
negative mental health impacts, including higher rates of suicidal 
thoughts, during the COVID-19 pandemic. Czeisler M[Eacute], Lane RI, 
Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation 
During the COVID-19 Pandemic--United States, June 24-30, 2020. MMWR 
Morb Mortal Wkly Rep 2020;69:1049-1057. DOI: https://dx.doi.org/10.15585/mmwr.mm6932a1. While this report examined the general 
population of America, there is also evidence of increased distress 
among the veteran population. For instance, there has been an increase 
in call volume to the Veterans Crisis Line (VCL). In fiscal year (FY) 
2019, VCL answered an average daily call volume of 1590.67 calls 
compared with 1765.02 FY 2020 and 1807.52 in FY 2021, with VCL call 
volume increasing over 22% in direct-date comparisons from FY 2019 to 
FY 2021.
    Veterans, in particular, may be uniquely vulnerable to negative 
mental health effects of the pandemic such as suicidality due to their 
older age, previous trauma exposures, and higher pre-pandemic 
prevalence of physical and psychiatric risk factors and conditions. Na, 
P.J., Tsai, J., Hill, M.L., Nichter, B., Norman, S.B., Southwick, S.M., 
& Pietrzak, R.H. (2021). Prevalence, risk and protective factors 
associated with suicidal ideation during the COVID-19 pandemic in U.S. 
military veterans with pre-existing psychiatric conditions. Journal of 
Psychiatric Research, 137, 351-359. In an analysis of data from the 
National Health and Resilience in Veterans Study, researchers found 
that 19.2% of veterans screened positive for suicidal ideation peri-
pandemic, and such veterans had lower income, were more likely to have 
been infected with COVID-19, reported greater COVID-19-related 
financial and social restriction stress, and increases in psychiatric 
symptoms and loneliness during the pandemic when compared to veterans 
without suicidal ideation. Id. Additionally, they found that among 
veterans who were infected with COVID-19, those aged 45 or older and 
who reported lower purpose in life were more likely to endorse suicidal 
ideation. Id. These researchers noted that monitoring for suicide risk 
and worsening psychiatric symptoms in older veterans who have been 
infected with COVID-19 may be important, and that interventions that 
enhance purpose in life may help protect against suicidal ideation in 
this population. Consistent with the recommendations of this research, 
SSG Fox SPGP will support monitoring for suicide risk and worsening 
psychiatric symptoms by providing support to more organizations who can 
reach veterans who do not seek or obtain care through VA. Through this 
grant program, organizations' efforts can also help protect this 
population against suicidal ideation by enhancing purpose in life.
    Furthermore, studies have shown increased suicide after pandemics 
such as the 1918 Influenza (H1N1) pandemic and the 2003 Severe Acute 
Respiratory Syndrome (SARS) outbreak, in which increased risk factors 
associated with negative impacts of epidemics were believed to 
contribute to suicide. See Wasserman IM. The impact of epidemic, war, 
prohibition and media on suicide: United States, 1910-1920. Suicide 
Life Threat Behav. 1992 Summer;22(2):240-54. PMID: 1626335.; See also, 
Cheung YT., Chau PH., and Yip PS. A revisit on older adults suicides 
and severe acute respiratory syndrome (SARS) epidemic in Hong Kong. Int 
J Geriatr Psychiatry. 2008; 23: 1231-1238. Thus, increased suicide 
death could occur after the COVID-19 pandemic unless action is taken. 
See Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., 
Kapur, N., Khan, M., O'Connor, R.C., & Pirkis, J. (2020). Suicide risk 
and prevention during the COVID-19 pandemic. The Lancet Psychiatry, 
7(6), 468-471.
    It is therefore critical that VA publish this rulemaking without 
delay to ensure the services provided through this grant program will 
assist the growing number of eligible individuals who are suffering 
from mental health concerns and may be at risk of suicide as a result 
of the COVID-19 pandemic, particularly as the period immediately 
following a pandemic can result in elevated risk of suicide. Publishing 
this rulemaking without delay will help ensure that services under this 
grant program can be provided to eligible individuals during the 
pandemic or in the immediate aftermath of it when they can have the 
most impact. As noted earlier in this section, efforts and actions 
supported through this grant program will be consistent with recent 
findings and recommendations on the impact of the COVID-19 pandemic on 
veterans and can help protect this population against suicidal 
ideation. See, Na, P.J., Tsai, J., Hill, M.L., Nichter, B., Norman, 
S.B., Southwick, S.M., & Pietrzak, R.H. (2021). Prevalence, risk and 
protective factors associated with suicidal ideation during the COVID-
19 pandemic in U.S. military veterans with pre-existing psychiatric 
conditions. Journal of Psychiatric Research, 137, 351-359.
    VA believes that increased engagement with veterans and their 
families from VA and community partners through this grant program will 
help prevent veteran suicide. As detailed in VA's 2021 National Veteran 
Suicide Prevention Annual Report, the average number of veteran suicide 
deaths per day in 2019 was 17.2. (Available online: https://www.mentalhealth.va.gov/docs/data-sheets/2021/2021-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-9-8-21.pdf). Of those, 6.8 were 
veterans who recently used VA health care (that is, these veterans had 
received VA health care services within the preceding two years) and 
10.4 were veterans who had not recently used VA health care. See id. 
Furthermore, from 2005 to 2018, suicide rates fell among veterans with 
depression, anxiety, and substance use disorders who were in VA care. 
See VA's 2020 National Veteran Suicide Prevention Annual Report. 
(Available online: https://www.mentalhealth.va.gov/docs/data-sheets/2020/2020-National-Veteran-Suicide-Prevention-Annual-Report-11-2020-508.pdf. In addition to VA engagement and services reducing suicide 
rates, studies have shown that community-based and public health 
suicide prevention have been effective in reducing suicide rates in 
diverse communities. See Hegerl, U., Althaus, D., Schmidtke, A., & 
Niklewski, G. (2006); The alliance against depression: 2-year 
evaluation of a community-based intervention to reduce suicidality. 
Psychological Medicine, 36(9), 1225-1233. These statistics and studies 
support VA's contention that increased engagement from VA and community 
partners through this grant program can help reduce suicide risk among 
eligible individuals by providing critical

[[Page 13832]]

services connecting veterans with VA care and services.
    Additionally, this rulemaking is not entirely without public input. 
VA reiterates that as described earlier in this document, VA published 
a request for information on this rulemaking and held multiple 
listening sessions to obtain input from the public as part of the 
consultation required by section 201 of the Act. Conducting 
consultation in this manner is consistent with VA's past practice and 
interpretation of consultation requirements under Federal law. VA 
received 124 comments in response to the request for information and 
had 32 speakers at the listening sessions. This public input has been 
reviewed and incorporated, as appropriate, into this rulemaking.
    For these reasons, the Secretary has concluded that ordinary notice 
and comment procedures would be impracticable and contrary to the 
public interest and is accordingly issuing this rule as an interim 
final rule. The Secretary will consider and address comments that are 
received within 60 days after the date that this interim final rule is 
published in the Federal Register and address them in a subsequent 
Federal Register document announcing a final rule incorporating any 
changes made in response to the public comments.

Executive Orders 12866 and 13563

    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. 
The Office of Information and Regulatory Affairs has determined that 
this rule is a significant regulatory action under Executive Order 
12866. The Regulatory Impact Analysis associated with this rulemaking 
can be found as a supporting document at www.regulations.gov.

Regulatory Flexibility Act

    The Regulatory Flexibility Act, 5 U.S.C. 601-612, is not applicable 
to this rulemaking because notice of proposed rulemaking is not 
required. 5 U.S.C. 601(2), 603(a), 604(a).

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 interim final rule will have no such 
effect on State, local, and tribal governments, or on the private 
sector.

Paperwork Reduction Act

    This interim final rule includes provisions constituting new 
collections of information under the Paperwork Reduction Act of 1995 
(44 U.S.C. 3501-3521) that require approval by the Office of Management 
and Budget (OMB). Accordingly, under 44 U.S.C. 3507(d), VA has 
submitted a copy of this rulemaking action to OMB for review.
    OMB assigns control numbers to collections of information it 
approves. VA 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. Sections 78.10, 78.15, 78.95, 
78.125, 78.145 contain new collections of information under the 
Paperwork Reduction Act of 1995. If OMB does not approve the 
collections of information as requested, VA will immediately remove the 
provisions containing a collection of information or take such other 
action as is directed by OMB.
    Comments on the new collection of information contained in this 
rulemaking should be submitted through www.regulations.gov. Comments 
should indicate that they are submitted in response to ``RIN 2900-
AR16--Staff Sergeant Parker Gordon Fox Suicide Prevention Grant 
Program'' and should be sent within 30 days of publication of this 
rulemaking. The collection of information associated with this 
rulemaking can be viewed at: www.reginfo.gov/public/do/PRAMain.
    A comment to OMB is best assured of having its full effect if OMB 
receives it within 30 days of publication. This does not affect the 
deadline for the public to comment on the interim final rule.
    The Department considers comments by the public on proposed 
collections of information in--
     Evaluating whether the proposed collections of information 
are necessary for the proper performance of the functions of the 
Department, including whether the information will have practical 
utility;
     Evaluating the accuracy of the Department's estimate of 
the burden of the proposed collections of information, including the 
validity of the methodology and assumptions used;
     Enhancing the quality, usefulness, and clarity of the 
information to be collected; and
     Minimizing the burden of the collections of information on 
those who are to respond, including through the use of appropriate 
automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology, e.g., permitting 
electronic submission of responses.
    The collections of information contained in 38 CFR 78.10, 78.15, 
78.95, 78.125, and 78.145 are described immediately following this 
paragraph, under their respective titles.
    Title: Eligibility Screening.
    OMB Control No: 2900-TBD (New).
    CFR Provision: 38 CFR 78.10.
     Summary of collection of information: This new collection 
of information in 38 CFR 78.10 requires grantees to determine 
eligibility for purposes of this grant program using screening tools.
     Description of need for information and proposed use of 
information: This collection of information is necessary to evaluate 
and determine eligibility for suicide prevention services and ensure 
that VA resources are directed at the intended population, in an 
efficient equitable method.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 90.
     Estimated frequency of responses: 67.
     Estimated average burden per response: 30 minutes.
     Estimated total annual reporting and recordkeeping burden: 
3,015 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $81,616.05.

    Title: Suicide Risk Screening.
    OMB Control No: 2900-TBD (New).
    CFR Provision: 38 CFR 78.10.
     Summary of collection of information: This new collection 
of information in 38 CFR 78.10 requires grantees to use screening tools 
to assess risk of suicide among program participants for purposes of 
implementing this grant program.
     Description of need for information and proposed use of 
information: This collection of information is necessary to assess risk 
of suicide and ensure that VA resources are directed at the intended 
population, in an efficient equitable method.
     Description of likely respondents: Grantees.

[[Page 13833]]

     Estimated number of respondents: 90.
     Estimated frequency of responses: 67.
     Estimated average burden per response: 15 minutes.
     Estimated total annual reporting and recordkeeping burden: 
1,507.5 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $40,808.03.

    Title: Application Provisions for the Staff Sergeant Gordon Parker 
Fox Suicide Prevention Grant Program.
    OMB Control No: 2900-TBD (New).
    CFR Provision: 38 CFR 78.15.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.15 requires applications be submitted to be 
evaluated and considered for a grant under this new part 78. 
Applications require specific information so that VA can properly 
evaluate such applications for grants.
     Description of need for information and proposed use of 
information: This collection of information is necessary to award 
suicide prevention services grants to eligible entities.
     Description of likely respondents: Eligible entities.
     Estimated number of respondents: 250.
     Estimated frequency of responses: 1.
     Estimated average burden per response: 2,100 minutes.
     Estimated total annual reporting and recordkeeping burden: 
8,750 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $236,862.50.

    Title: Suicide Prevention Services Grant Renewal Applications.
    OMB Control No: 2900-TBD (New).
    CFR Provision: 38 CFR 78.15.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.15 requires that renewal applications be 
submitted to be evaluated and receive a renewal of a grant under this 
new part 78. Applications require specific information so that VA can 
properly evaluate such applications for renewal of grants.
     Description of need for information and proposed use of 
information: This collection of information is necessary to award 
suicide prevention services grants to eligible entities.
     Description of likely respondents: Grantees that seek 
renewal of their grants.
     Estimated number of respondents: 90.
     Estimated frequency of responses: 1.
     Estimated average burden per response: 600 minutes.
     Estimated total annual reporting and recordkeeping burden: 
900 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $24,363.

    Title: Participant Satisfaction Surveys.
    OMB Control No: 2900-TBD (New).
    CFR Provision: 38 CFR 78.95.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.95 requires grantees to conduct 
satisfaction surveys from participants.
     Description of need for information and proposed use of 
information: The collection of information is necessary to evaluate 
whether participants are satisfied with the suicide prevention services 
provided by the grantee and the effectiveness of such services.
     Description of likely respondents: Eligible individuals 
and their families who receive suicide prevention services.
     Estimated number of respondents: 5,000.
     Estimated frequency of responses: 1.
     Estimated average burden per response: 15 minutes.
     Estimated total annual reporting and recordkeeping burden: 
1,250 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $33,837.50.

    Title: Intake Form.
    OMB Control No: 2900-TBD (New).
    CFR Provision: 38 CFR 78.95.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.95 requires grantees to use tools and 
assessments (that is, an intake form) to determine the effectiveness of 
the suicide prevention services furnished by the grantee.
     Description of need for information and proposed use of 
information: The collection of information is necessary to ensure that 
the appropriate services are offered to participants, and the data 
collected will be used by VA to determine the participant's baseline 
with regards to mood-related symptoms, overall wellbeing, and financial 
stressors and social supports. This will enable VA to measure the 
effectiveness of the programming provided in improving mental health 
status, wellbeing, and reducing suicide risk and suicide deaths of 
eligible individuals.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 90.
     Estimated frequency of responses: 67.
     Estimated average burden per response: 30 minutes.
     Estimated total annual reporting and recordkeeping burden: 
3,015 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $81,616.05.

    Title: Program Exit Checklist.
    OMB Control No: 2900-TBD (New).
    CFR Provision: 38 CFR 78.95.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.95 requires grantees to use tools and 
assessments (that is, a program exit checklist) to determine the 
effectiveness of the suicide prevention services furnished by the 
grantee.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determine 
whether there was a reduction of the participant's mood-related 
symptoms, an overall improved wellbeing, and mitigation of any 
financial and social support stressors. This will enable VA to measure 
the effectiveness of the programming provided in improving mental 
health status, wellbeing, and reducing suicide risk and suicide deaths 
of eligible individuals.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 90.
     Estimated frequency of responses: 67.
     Estimated average burden per response: 30 minutes.
     Estimated total annual reporting and recordkeeping burden: 
3,015 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $81,616.05.

    Title: Program and Budget Changes.
    OMB Control No: 2900-TBD (New).
    CFR Provision: 38 CFR 78.125.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.125 requires certain grantees to provide VA 
with program and/or budget changes.
     Description of need for information and proposed use of 
information: Reporting of program/budget changes is necessary for VA to 
approve and ensure that such changes are consistent with proposed 38 
CFR part 78 and the goals and intent of the Staff Sergeant Parker 
Gordon Fox Suicide Prevention Grant Program. These collections are not 
required of every grantee and are needed only in limited instances.
     Description of likely respondents: Grantees.

[[Page 13834]]

     Estimated number of respondents: 90.
     Estimated frequency of responses: 2.
     Estimated average burden per response: 15 minutes.
     Estimated total annual reporting and recordkeeping burden: 
45 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $1,218.15.

    Title: Annual Performance Compliance Reports for Suicide Prevention 
Services Program.
    OMB Control No: 2900-TBD (New).
    CFR Provision: 38 CFR 78.145.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.145 requires grantees to provide annual 
reports to assess the provision of services under this grant program.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determining 
compliance with the requirements for a suicide prevention services 
grant and to assess the provision of services under this grant program.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 90.
     Estimated frequency of responses: 1.
     Estimated average burden per response: 45 minutes.
     Estimated total annual reporting and recordkeeping burden: 
67.50 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $1,827.23.

    Title: Other Performance Compliance Reports for Suicide Prevention 
Services Program.
    OMB Control No.: 2900-TBD (New).
    CFR Provision: 38 CFR 78.145.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.145 requires grantees to provide two 
performance reports to assess the provision of services under this 
grant program.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determining 
compliance with the requirements for a suicide prevention services 
grant and to assess the provision of services under this grant program.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 90.
     Estimated frequency of responses: 2.
     Estimated average burden per response: 30 minutes.
     Estimated total annual reporting and recordkeeping burden: 
90 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $2,436.30.

    Title: Other Financial Compliance Reports for Suicide Prevention 
Services Program.
    OMB Control No.: 2900-TBD (New).
    CFR Provision: 38 CFR 78.145.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.145 requires grantees to provide two 
reports to assess financial compliance under this grant program.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determining 
compliance with the financial requirements for a suicide prevention 
services grant.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 90.
     Estimated frequency of responses: 2.
     Estimated average burden per response: 30 minutes.
     Estimated total annual reporting and recordkeeping burden: 
90 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $2,436.30.

    Title: Annual Financial Expenditure Reports for Suicide Prevention 
Services Program.
    OMB Control No.: 2900-TBD (New).
    CFR Provision: 38 CFR 78.145.
     Summary of collection of information: The new collection 
of information in 38 CFR 17.145 requires grantees to provide annual 
reports to assess financial expenditure compliance under this grant 
program.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determining 
compliance with the financial expenditure requirements for a suicide 
prevention services grant.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 90.
     Estimated frequency of responses: 1.
     Estimated average burden per response: 45 minutes.
     Estimated total annual reporting and recordkeeping burden: 
67.5 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $1,827.23.

    Title: Compliance--Corrective Action Plan.
    OMB Control No.: 2900-TBD (New).
    CFR Provision: 38 CFR 17.145.
     Summary of collection of information: The new collection 
of information in 38 CFR 78.145 requires grantees to provide ad hoc 
compliance corrective action plans under this grant program.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determining 
compliance with any necessary corrective action plans for a suicide 
prevention services grant.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 25.
     Estimated frequency of responses: 1.
     Estimated average burden per response: 30 minutes.
     Estimated total annual reporting and recordkeeping burden: 
12.5 hours.
     * Estimated annual cost to respondents for the hour 
burdens for collections of information: $338.38.

    * To estimate the total information collection burden cost, VA used 
the Bureau of Labor Statistics (BLS) median hourly wage for hourly wage 
for ``all occupations'' of $27.07 per hour. This information is 
available at https://www.bls.gov/oes/current/oes_nat.htm#13-0000.

Assistance Listing

    The Assistance Listing number and title for the program affected by 
this document is 64.009, Veterans Medical Care Benefits.

Congressional Review Act

    Pursuant to Subtitle E of the Small Business Regulatory Enforcement 
Fairness Act of 1996, also known as the Congressional Review Act (5 
U.S.C. 801 et seq.), the Office of Information and Regulatory Affairs 
designated this rule as not a major rule, as defined by 5 U.S.C. 
804(2).

List of Subjects in 38 CFR Part 78

    Administrative practice and procedure; Grant programs--health; 
Grant programs--veterans; Health care; Mental health programs; 
Reporting and recordkeeping requirements; Veterans.

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved this 
document on November 24, 2021, and authorized the undersigned to sign 
and submit the document to the Office of the Federal Register for 
publication

[[Page 13835]]

electronically as an official document of the Department of Veterans 
Affairs.

Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of 
General Counsel, Department of Veterans Affairs.


0
For the reasons stated in the preamble, the Department of Veterans 
Affairs amends 38 CFR chapter I by adding part 78 to read as follows:

PART 78--STAFF SERGEANT PARKER GORDON FOX SUICIDE PREVENTION GRANT 
PROGRAM

Sec.
78.0 Purpose and scope.
78.5 Definitions.
78.10 Eligible individuals.
78.15 Applications for suicide prevention services grants.
78.20 Threshold requirements prior to scoring suicide prevention 
services grant applicants.
78.25 Scoring criteria for awarding grants.
78.30 Selection of grantees.
78.35 Scoring criteria for grantees applying for renewal of suicide 
prevention services grants.
78.40 Selection of grantees for renewal of suicide prevention 
services grants.
78.45 Suicide prevention services: Outreach.
78.50 Suicide prevention services: Baseline mental health screening.
78.55 Suicide prevention services: Education.
78.60 Suicide prevention services: Clinical services for emergency 
treatment.
78.65 Suicide prevention services: Case management services.
78.70 Suicide prevention services: Peer support services.
78.75 Suicide prevention services: Assistance in obtaining VA 
benefits.
78.80 Suicide prevention services: Assistance in obtaining and 
coordinating other public benefits and assistance with emergent 
needs.
78.85 Suicide prevention services: Nontraditional and innovative 
approaches and treatment practices.
78.90 Suicide prevention services: Other services.
78.95 General operation requirements.
78.100 Fee prohibition.
78.105 Ineligible activities.
78.110 Notice of Funding Opportunity.
78.115 Suicide prevention services grant agreements.
78.120 Amount and payment of grants.
78.125 Program or budget changes and corrective action plans.
78.130 Faith-based organizations.
78.135 Visits to monitor operation and compliance.
78.140 Financial management and administrative costs.
78.145 Grantee reporting requirements.
78.150 Recordkeeping.
78.155 Technical assistance.
78.160 Withholding, suspension, deobligation, termination, and 
recovery of funds by VA.
78.165 Suicide prevention services grant closeout procedures.

    Authority:  38 U.S.C. 501, 38 U.S.C. 1720F (note), sec. 201, 
Pub. L. 116-171, and as noted in specific sections.


Sec.  78.0   Purpose and scope.

    (a) Purpose. This part implements the Staff Sergeant Parker Gordon 
Fox Suicide Prevention Grant Program (SSG Fox SPGP) with the purpose of 
reducing veteran suicide by expanding suicide prevention programs for 
veterans through the award of suicide prevention services grants to 
eligible entities to provide or coordinate the provision of suicide 
prevention services to eligible individuals and their families.
    (b) Scope. Suicide prevention services covered by this part are 
those services that address the needs of eligible individuals and their 
families and are necessary for improving the mental health status and 
wellbeing and reducing the suicide risk of eligible individuals and 
their families.


Sec.  78.5   Definitions.

    For purposes of this part and any Notice of Funding Opportunity 
(NOFO) issued under this part:
    Applicant means an eligible entity that submits an application for 
a suicide prevention services grant announced in a NOFO.
    Direct Federal financial assistance means Federal financial 
assistance received by an entity selected by the Government or a pass-
through entity as defined in 38 CFR 50.1(d) to provide or carry out a 
service (e.g., by contract, grant, or cooperative agreement).
    Eligible child care provider means a provider of child care 
services for compensation, including a provider of care for a school-
age child during non-school hours, that--
    (1) Is licensed, regulated, registered, or otherwise legally 
operating, under State and local law; and
    (2) Satisfies the State and local requirements, applicable to the 
child care services the provider providers.
    Eligible entity means an entity that meets the definition of an 
eligible entity in section 201(q) of Public Law 116-171.
    Eligible individual means an individual that meets the requirements 
of Sec.  78.10(a).
    Family means any of the following: A parent, spouse, child, 
sibling, step-family member, extended family member, and any other 
individual who lives with the eligible individual.
    Grantee means an eligible entity that is awarded a suicide 
prevention services grant under this part.
    Indian tribe means an Indian tribe as defined in 25 U.S.C. 4103.
    Indirect Federal financial assistance means Federal financial 
assistance in which a service provider receives program funds through a 
voucher, certificate, agreement or other form of disbursement, as a 
result of the genuine, independent choice of a participant.
    Medically underserved area means an area that is designated as a 
medically underserved population under 42 U.S.C. 254b(b)(3).
    Notice of Funding Opportunity (NOFO) means a Notice of Funding 
Opportunity published on grants.gov in accordance with Sec.  78.110.
    Participant means an eligible individual or their family who is 
receiving suicide prevention services for which they are eligible from 
a grantee.
    Rural communities means those communities considered rural 
according to the Rural-Urban Commuting Area (RUCA) system as determined 
by the United States Department of Agriculture.
    State means any of the several States of the United States, the 
District of Columbia, the Commonwealth of Puerto Rico, any territory or 
possession of the United States, or any agency or instrumentality of a 
State exclusive of local governments.
    Suicide prevention services includes the following services 
provided to address the needs of a participant:
    (1) Outreach as specified under Sec.  78.45.
    (2) Baseline mental health screening as specified under Sec.  
78.50.
    (3) Education as specified under Sec.  78.55.
    (4) Clinical services for emergency treatment as specified under 
Sec.  78.60.
    (5) Case management services as specified under Sec.  78.65.
    (6) Peer support services as specified under Sec.  78.70.
    (7) Assistance in obtaining VA benefits as specified under Sec.  
78.75.
    (8) Assistance in obtaining and coordinating other public benefits 
and assistance with emergent needs as specified under Sec.  78.80.
    (9) Nontraditional and innovative approaches and treatment 
practices as specified under Sec.  78.85.
    (10) Other services as specified under Sec.  78.90.
    Suicide prevention services grant means a grant awarded under this 
part.
    Suicide prevention services grant agreement means the agreement 
executed between VA and a grantee as specified under Sec.  78.115.
    Suspension means an action by VA that temporarily withdraws VA 
funding under a suicide prevention services grant, pending corrective 
action by the grantee or pending a decision to

[[Page 13836]]

terminate the suicide prevention services grant by VA. Suspension of a 
suicide prevention services grant is a separate action from suspension 
under VA regulations or guidance implementing Executive Orders 12549 
and 12689, ``Debarment and Suspension.''
    Territories means the territories of the United States, including 
Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the 
Northern Mariana Islands.
    Veterans means a veteran as defined under 38 U.S.C. 101(2).
    Veterans Crisis Line means the toll-free hotline for veterans in 
crisis and their families and friends established under 38 U.S.C. 
1720F(h).
    Withholding means that payment of a suicide prevention services 
grant will not be paid until such time as VA determines that the 
grantee provides sufficiently adequate documentation and/or actions to 
correct a deficiency for the suicide prevention services grant.


Sec.  78.10   Eligible individuals.

    (a) To be an eligible individual under this part, a person must be 
at risk of suicide and further meet the definition of eligible 
individual in section 201(q) of Public Law 116-171.
    (b) For purposes of paragraph (a) of this section, risk of suicide 
means exposure to, or the existence of, any of the following factors, 
to any degree, that increase the risk for suicidal ideation and/or 
behaviors:
    (1) Health risk factors, including mental health challenges, 
substance use disorder, serious or chronic health conditions or pain, 
and traumatic brain injury.
    (2) Environmental risk factors, including prolonged stress, 
stressful life events, unemployment, homelessness, recent loss, and 
legal or financial challenges.
    (3) Historical risk factors, including previous suicide attempts, 
family history of suicide, and history of abuse, neglect, or trauma, 
including military sexual trauma.

    Note 1 to paragraph (b): Grantees must use these risk factors 
and the impact thereof to determine the degree of risk of suicide 
for eligible individuals using a screening tool approved by the 
Department. The degree of risk depends on the presence of one or 
more suicide risk factors and the impact of those factors on an 
individual's mental health and wellbeing.


(The Office of Management and Budget has approved the information 
collection provisions in this section under control number 2900-TBD.)


Sec.  78.15   Applications for suicide prevention services grants.

    (a) To apply for a suicide prevention services grant, an applicant 
must submit to VA a complete suicide prevention services grant 
application package, as described in the NOFO. A complete suicide 
prevention services grant application package includes the following:
    (1) Documentation evidencing the experience of the applicant and 
any identified community partners in providing or coordinating the 
provision of suicide prevention services to eligible individuals and 
their families.
    (2) A description of the suicide prevention services proposed to be 
provided or coordinated by the applicant and the identified need for 
those services.
    (3) A detailed plan describing how the applicant proposes to 
coordinate or deliver suicide prevention services to eligible 
individuals, including:
    (i) If the applicant is a State or local government or an Indian 
tribe, an identification of the community partners, if any, with which 
the applicant proposes to work in delivering such services;
    (ii) A description of the arrangements currently in place between 
the applicant and such partners with regard to the provision or 
coordination the provision of suicide prevention services;
    (iii) An identification of how long such arrangements have been in 
place;
    (iv) A description of the suicide prevention services provided by 
such partners that the applicant must coordinate, if any; and
    (v) An identification of local VA suicide prevention coordinators 
and a description of how the applicant will communicate with local VA 
suicide prevention coordinators.
    (4) A description of the location and population of eligible 
individuals and their families proposed to be provided suicide 
prevention services.
    (5) An estimate of the number of eligible individuals at risk of 
suicide and their families proposed to be provided suicide prevention 
services, including the percentage of those eligible individuals who 
are not currently receiving care furnished by VA.
    (6) Evidence of measurable outcomes related to reductions in 
suicide risk and mood-related symptoms utilizing validated instruments 
by the applicant (and the proposed partners of the applicant, if any) 
in providing suicide prevention services to individuals at risk of 
suicide, particularly to eligible individuals and their families.
    (7) A description of the managerial and technological capacity of 
the applicant to:
    (i) Coordinate the provision of suicide prevention services with 
the provision of other services;
    (ii) Assess on an ongoing basis the needs of eligible individuals 
and their families for suicide prevention services;
    (iii) Coordinate the provision of suicide prevention services with 
VA services for which eligible individuals are also eligible;
    (iv) Tailor (i.e., provide individualized) suicide prevention 
services to the needs of eligible individuals and their families;
    (v) Seek continuously new sources of assistance to ensure the 
continuity of suicide prevention services for eligible individuals and 
their families as long as the eligible individuals are determined to be 
at risk of suicide; and
    (vi) Measure the effects of suicide prevention services provided by 
applicant or partner organization on the lives of eligible individuals 
and their families who receive such services provided by the 
organization using pre- and post-evaluations on validated measures of 
suicide risk and mood-related symptoms.
    (8) Clearly defined objectives for the provision of suicide 
prevention services.
    (9) A description and physical address of the primary location of 
the applicant.
    (10) A description of the geographic area the applicant plans to 
serve during the grant award period for which the application applies.
    (11) If the applicant is a State or local government or an Indian 
tribe, the amount of grant funds proposed to be made available to 
community partners, if any, through agreements.
    (12) A description of how the applicant will assess the 
effectiveness of the provision of grants under this part.
    (13) An agreement to use the measures and metrics provided by VA 
for the purposes of measuring the effectiveness of the programming to 
be provided in improving mental health status, wellbeing, and reducing 
suicide risk and suicide deaths of eligible individuals and their 
families.
    (14) An agreement to comply with and implement the requirements of 
this part throughout the term of the suicide prevention services grant.
    (15) Any additional information as deemed appropriate by VA.
    (b) Subject to funding availability, grantees may submit an 
application for renewal of a suicide prevention services grant if the 
grantee's program will remain substantially the same. To apply for 
renewal of a suicide prevention

[[Page 13837]]

services grant, a grantee must submit to VA a complete suicide 
prevention services grant renewal application package, as described in 
the NOFO.
    (c) VA may request in writing that an applicant or grantee, as 
applicable, submit other information or documentation relevant to the 
suicide prevention services grant application.


(The Office of Management and Budget has approved the information 
collection provisions in this section under control number 2900-TBD.)


Sec.  78.20   Threshold requirements prior to scoring suicide 
prevention services grant applicants.

    VA will only score applicants who meet the following threshold 
requirements:
    (a) The application is filed within the time period established in 
the NOFO, and any additional information or documentation requested by 
VA under Sec.  78.15(c) is provided within the time frame established 
by VA;
    (b) The application is completed in all parts;
    (c) The activities for which the suicide prevention services grant 
is requested are eligible for funding under this part;
    (d) The applicant's proposed participants are eligible to receive 
suicide prevention services under this part;
    (e) The applicant agrees to comply with the requirements of this 
part;
    (f) The applicant does not have an outstanding obligation to the 
Federal government that is in arrears and does not have an overdue or 
unsatisfactory response to an audit; and
    (g) The applicant is not in default by failing to meet the 
requirements for any previous Federal assistance.


Sec.  78.25   Scoring criteria for awarding grants.

    VA will score applicants who are applying for a suicide prevention 
services grant. VA will set forth specific point values to be awarded 
for each criterion in the NOFO. VA will use the following criteria to 
score these applicants:
    (a) VA will award points based on the background, qualifications, 
experience, and past performance of the applicant, and any community 
partners identified by the applicant in the suicide prevention services 
grant application, as demonstrated by the following:
    (1) Background and organizational history. (i) Applicant's, and any 
identified community partners', background and organizational history 
are relevant to the program.
    (ii) Applicant, and any identified community partners, maintain 
organizational structures with clear lines of reporting and defined 
responsibilities.
    (iii) Applicant, and any identified community partners, have a 
history of complying with agreements and not defaulting on financial 
obligations.
    (2) Staff qualifications. (i) Applicant's staff, and any identified 
community partners' staff, have experience providing services to, or 
coordinating services for, eligible individuals and their families.
    (ii) Applicant's staff, and any identified community partners' 
staff, have experience administering programs similar to SSG Fox SPGP.
    (3) Organizational qualifications and past performance, including 
experience with veterans services. (i) Applicant, and any identified 
community partners, have organizational experience providing suicide 
prevention services to, or coordinating suicide prevention services 
for, eligible individuals and their families.
    (ii) Applicant, and any identified community partners, have 
organizational experience coordinating services for eligible 
individuals and their families among multiple organizations, and 
Federal, State, local and tribal governmental entities.
    (iii) Applicant, and any identified community partners, have 
organizational experience administering a program similar in type and 
scale to SSG Fox SPGP to eligible individuals and their families.
    (iv) Applicant, and any identified community partners, have 
organizational experience working with veterans and their families.
    (b) VA will award points based on the applicant's program concept 
and suicide prevention services plan, as demonstrated by the following:
    (1) Need for program. (i) Applicant has shown a need amongst 
eligible individuals and their families in the area where the program 
will be based.
    (ii) Applicant demonstrates an understanding of the unique needs 
for suicide prevention services of eligible individuals and their 
families.
    (2) Outreach and screening plan. (i) Applicant has a feasible plan 
for outreach, consistent with Sec.  78.45, and referral to identify and 
assist individuals and their families that may be eligible for suicide 
prevention services and are most in need of suicide prevention 
services.
    (ii) Applicant has a feasible plan to process and receive 
participant referrals.
    (iii) Applicant has a feasible plan to assess and accommodate the 
needs of incoming participants, including language assistance needs of 
limited English proficient individuals.
    (3) Program concept. (i) Applicant's program concept, size, scope, 
and staffing plan are feasible.
    (ii) Applicant's program is designed to meet the needs of eligible 
individuals and their families.
    (4) Program implementation timeline. (i) Applicant's program will 
be implemented in a timely manner and suicide prevention services will 
be delivered to participants as quickly as possible and within a 
specified timeline.
    (ii) Applicant has a feasible staffing plan in place to meet the 
applicant's program timeline or has existing staff to meet such 
timeline.
    (5) Coordination with VA. Applicant has a feasible plan to 
coordinate outreach and services with local VA facilities.
    (6) Ability to meet VA's requirements, goals, and objectives for 
SSG Fox SPGP. Applicant demonstrates commitment to ensuring that its 
program meets VA's requirements, goals, and objectives for SSG Fox SPGP 
as identified in this part and the NOFO.
    (7) Capacity to undertake program. Applicant has sufficient 
capacity, including staff resources, to undertake the program.
    (c) VA will award points based on the applicant's quality assurance 
and evaluation plan, as demonstrated by the following:
    (1) Program evaluation. (i) Applicant has created clear, realistic, 
and measurable goals that reflect SSG Fox SPGP's aim of reducing and 
preventing suicide among veterans against which the applicant's program 
performance can be evaluated.
    (ii) Applicant has a clear plan to continually assess the program.
    (2) Monitoring. (i) Applicant has adequate controls in place to 
regularly monitor the program, including any community partners, for 
compliance with all applicable laws, regulations, and guidelines.
    (ii) Applicant has adequate financial and operational controls in 
place to ensure the proper use of suicide prevention services grant 
funds.
    (iii) Applicant has a feasible plan for ensuring that the 
applicant's staff and any community partners are appropriately trained 
and stay informed of SSG Fox SPGP policy, evidence-informed suicide 
prevention practices, and the requirements of this part.
    (3) Remediation. Applicant has an appropriate plan to establish a 
system to remediate non-compliant aspects of the program if and when 
they are identified.

[[Page 13838]]

    (4) Management and reporting. Applicant's program management team 
has the capability and a system in place to provide to VA timely and 
accurate reports at the frequency set by VA.
    (d) VA will award points based on the applicant's financial 
capability and plan, as demonstrated by the following:
    (1) Organizational finances. Applicant, and any identified 
community partners, are financially stable.
    (2) Financial feasibility of program. (i) Applicant has a realistic 
plan for obtaining all funding required to operate the program for the 
time period of the suicide prevention services grant.
    (ii) Applicant's program is cost-effective and can be effectively 
implemented on-budget.
    (e) VA will award points based on the applicant's area linkages and 
relations, as demonstrated by the following:
    (1) Area linkages. Applicant has a feasible plan for developing or 
relying on existing linkages with Federal (including VA), State, local, 
and tribal government agencies, and private entities for the purposes 
of providing additional services to participants within a given 
geographic area.
    (2) Past working relationships. Applicant (or applicant's staff), 
and any identified community partners (or community partners' staff), 
have fostered similar and successful working relationships and linkages 
with public and private organizations providing services to veterans or 
their families in need of services.
    (3) Local presence and knowledge. (i) Applicant has a presence in 
the area to be served by the applicant.
    (ii) Applicant understands the dynamics of the area to be served by 
the applicant.
    (4) Integration of linkages and program concept. Applicant's 
linkages to the area to be served by the applicant enhance the 
effectiveness of the applicant's program.


Sec.  78.30   Selection of grantees.

    VA will use the following process to select applicants to receive 
suicide prevention services grants:
    (a) VA will score all applicants that meet the threshold 
requirements set forth in Sec.  78.20 using the scoring criteria set 
forth in Sec.  78.25.
    (b) VA will group applicants within the applicable funding 
priorities if funding priorities are set forth in the NOFO.
    (c) VA will rank those applicants that receive at least the minimum 
amount of total points and points per category set forth in the NOFO, 
within their respective funding priority group, if any. The applicants 
will be ranked in order from highest to lowest scores, within their 
respective funding priority group, if any.
    (d) VA will use the applicant's ranking as the primary basis for 
selection for funding. However, VA will also use the following 
considerations to select applicants for funding:
    (1) VA will give preference to applicants that have demonstrated 
the ability to provide or coordinate suicide prevention services;
    (2) VA may prioritize the distribution of suicide prevention 
services grants to:
    (i) Rural communities;
    (ii) Tribal lands;
    (iii) Territories of the United States;
    (iv) Medically underserved areas;
    (v) Areas with a high number or percentage of minority veterans or 
women veterans; and
    (vi) Areas with a high number or percentage of calls to the 
Veterans Crisis Line.
    (3) To the extent practicable, VA will ensure that suicide 
prevention services grants are distributed to:
    (i) Provide services in areas of the United States that have 
experienced high rates of suicide by eligible individuals, including 
suicide attempts; and
    (ii) Applicants that can assist eligible individuals at risk of 
suicide who are not currently receiving health care furnished by VA.
    (iii) Ensure services are provided in as many areas as possible.
    (e) Subject to paragraph (d) of this section, VA will fund the 
highest-ranked applicants for which funding is available, within the 
highest funding priority group, if any. If funding priorities have been 
established, to the extent funding is available and subject to 
paragraph (d) of this section, VA will select applicants in the next 
highest funding priority group based on their rank within that group.
    (f) If an applicant would have been selected but for a procedural 
error committed by VA, VA may select that applicant for funding when 
sufficient funds become available if there is no material change in the 
information that would have resulted in the applicant's selection. A 
new application will not be required for this purpose.


Sec.  78.35   Scoring criteria for grantees applying for renewal of 
suicide prevention service grants.

    VA will score grantees who are applying for a renewal of suicide 
prevention services grant. VA will set forth specific point values to 
be awarded for each criterion in the NOFO. VA will use the following 
criteria to score grantees applying for renewal of a suicide prevention 
services grant:
    (a) VA will award points based on the success of the grantee's 
program, as demonstrated by the following:
    (1) The grantee made progress in reducing veteran suicide deaths 
and attempts, reducing all-cause mortality, reducing suicidal ideation, 
increasing financial stability; improving mental health status, well-
being, and social supports; and engaging in best practices for suicide 
prevention services.
    (2) Participants were satisfied with the suicide prevention 
services provided or coordinated by the grantee, as reflected by the 
satisfaction survey conducted under Sec.  78.95(d).
    (3) The grantee implemented the program by delivering or 
coordinating suicide prevention services to participants in a timely 
manner consistent with SSG Fox SPGP policy, the NOFO, and the grant 
agreement.
    (4) The grantee was effective in conducting outreach to eligible 
individuals and their families and increasing engagement of eligible 
individuals and their families in suicide prevention services, as 
assessed through SSG Fox SPGP grant evaluation.
    (b) VA will award points based on the cost-effectiveness of the 
grantee's program, as demonstrated by the following:
    (1) The cost per participant was reasonable.
    (2) The grantee's program was effectively implemented on-budget.
    (c) VA will award points based on the extent to which the grantee's 
program complies with SSG Fox SPGP goals and requirements, as 
demonstrated by the following:
    (1) The grantee's program was administered in accordance with VA's 
goals for SSG Fox SPGP as noted in the NOFO.
    (2) The grantee's program was administered in accordance with all 
applicable laws, regulations, and guidelines.
    (3) The grantee's program was administered in accordance with the 
grantee's suicide prevention services grant agreement.


Sec.  78.40   Selection of grantees for renewal of suicide prevention 
services grants.

    VA will use the following process to select grantees applying for 
renewal of suicide prevention services grants:
    (a) So long as the grantee continues to meet the threshold 
requirements set forth in Sec.  78.20, VA will score the grantee using 
the scoring criteria set forth in Sec.  78.35.
    (b) VA will rank those grantees who receive at least the minimum 
amount of

[[Page 13839]]

total points and points per category set forth in the NOFO. The 
grantees will be ranked in order from highest to lowest scores.
    (c) VA will use the grantee's ranking as the basis for selection 
for funding. VA will fund the highest-ranked grantees for which funding 
is available.
    (d) At its discretion, VA may award any non-renewed funds to an 
applicant or existing grantee. If VA chooses to award non-renewed funds 
to an applicant or existing grantee, funds will be awarded as follows:
    (1) VA will first offer to award the non-renewed funds to the 
applicant or grantee with the highest grant score under the relevant 
NOFO that applies for, or is awarded a renewal grant in, the same area 
as, or a proximate area to, the affected area if available. Such 
applicant or grantee must have the capacity and agree to provide prompt 
services to the affected area. Under this section, the relevant NOFO is 
the most recently published NOFO which covers the affected area, or for 
multi-year grant awards, the NOFO for which the grantee, who is offered 
the additional funds, received the multi-year award.
    (2) If the first such applicant or grantee offered the non-renewed 
funds refuses the funds, VA will offer to award the funds to the next 
highest-ranked such applicant or grantee, per the criteria in paragraph 
(d)(1) of this section, and continue on in rank order until the non-
renewed funds are awarded.
    (e) If an applicant would have been selected but for a procedural 
error committed by VA, VA may select that applicant for funding when 
sufficient funds become available if there is no material change in the 
information that would have resulted in the applicant's selection. A 
new application will not be required for this purpose.


Sec.  78.45   Suicide prevention services: Outreach.

    (a) Grantees providing or coordinating the provision of outreach 
must use their best efforts to ensure that eligible individuals, 
including those who are at highest risk of suicide or who are not 
receiving health care or other services furnished by VA, and their 
families are identified, engaged, and provided suicide prevention 
services.
    (b) Outreach must include active liaison with local VA facilities; 
State, local, or tribal government (if any); and private agencies and 
organizations providing suicide prevention services to eligible 
individuals and their families in the area to be served by the grantee.


Sec.  78.50   Suicide prevention services: Baseline mental health 
screening.

    (a) Grantees must provide or coordinate the provision of a baseline 
mental health screening to all participants they serve at the time 
those services begin. This mental health screening must be provided 
using a validated screening tool that assesses suicide risk and mental 
and behavioral health conditions. Information on the specific tool or 
tools to be used will be included in the NOFO.
    (b) If an eligible individual is at risk of suicide or other mental 
or behavioral health condition pursuant to the baseline mental health 
screening conducted under paragraph (a) of this section, the grantee 
must refer such individual to VA for care. If the eligible individual 
refuses the grantee's referral to VA, any ongoing clinical services 
provided to the eligible individual by the grantee is at the expense of 
the grantee.
    (c) If a participant other than an eligible individual is at risk 
of suicide or other mental or behavioral health condition pursuant to 
the baseline mental health screening conducted under paragraph (a) of 
this section, the grantee must refer such participant to appropriate 
health care services in the area unless the grantee is capable of 
furnishing such care. Any ongoing clinical services provided to the 
participant by the grantee is at the expense of the grantee.
    (d) Except as provided for under Sec.  78.60(a), funds provided 
under this grant program may not be used to provide clinical services 
to participants, and any ongoing clinical services provided to such 
individuals by the grantee is at the expense of the grantee. The 
grantee may not charge, bill, or otherwise hold liable participants for 
the receipt of such care or services.


Sec.  78.55   Suicide prevention services: Education.

    Grantees providing or coordinating the provision of education must 
provide or coordinate the provision of suicide prevention education 
programs to educate communities, veterans, and families on how to 
identify those at risk of suicide, how and when to make referrals for 
care, and the types of suicide prevention resources available within 
the area. Education can include gatekeeper training, lethal means 
safety training, or specific educations programs that assist with 
identification, assessment, or prevention of suicide.


Sec.  78.60   Suicide prevention services: Clinical services for 
emergency treatment.

    (a) Grantees providing or coordinating the provision of clinical 
services for emergency treatment must provide or coordinate the 
provision of clinical services for emergency treatment of a 
participant.
    (b) If an eligible individual is furnished clinical services for 
emergency treatment under paragraph (a) of this section and the grantee 
determines that the eligible individual requires ongoing services, the 
grantee must refer the eligible individual to VA for additional care. 
If the eligible individual refuses the grantee's referral to VA, any 
ongoing clinical services provided to the eligible individual by the 
grantee is at the expense of the grantee. The grantee may not charge, 
bill, or otherwise hold liable eligible individuals for the receipt of 
such care or services.
    (c) If a participant other than an eligible individual is furnished 
clinical services for emergency treatment under paragraph (a) of this 
section and the grantee determines that the participant requires 
ongoing services, the grantee must refer the participant to appropriate 
health care services in the area for additional care. Except as 
provided for under paragraph (a) of this section, funds provided under 
this grant program may not be used to provide ongoing clinical services 
to such participants, and any ongoing clinical services provided to the 
participant by the grantee is at the expense of the grantee. The 
grantee may not charge, bill, or otherwise hold liable such 
participants for the receipt of such care or services.
    (d) For purposes of this section, emergency treatment means medical 
services, professional services, ambulance services, ancillary care and 
medication (including a short course of medication related to and 
necessary for the treatment of the emergency condition that is provided 
directly to or prescribed for the patient for use after the emergency 
condition is stabilized and the patient is discharged) was rendered in 
a medical emergency of such nature that a prudent layperson would have 
reasonably expected that delay in seeking immediate medical attention 
would have been hazardous to life or health. This standard is met by an 
emergency medical condition manifesting itself by acute symptoms of 
sufficient severity (including severe pain) that a prudent layperson 
who possesses an average knowledge of health and medicine could 
reasonably expect the absence of immediate medical attention to result 
in placing

[[Page 13840]]

the health of the individual in serious jeopardy, serious impairment to 
bodily functions, or serious dysfunction of any bodily organ or part.
    (e) The direct provision of clinical services for emergency 
treatment by grantees under this section is not prohibited by Sec.  
78.80(a).


Sec.  78.65   Suicide prevention services: Case management services.

    Grantees providing or coordinating the provision of case management 
services must provide or coordinate the provision of case management 
services that include, at a minimum:
    (a) Performing a careful assessment of participants, and developing 
and monitoring case plans in coordination with a formal assessment of 
suicide prevention services needed, including necessary follow-up 
activities, to ensure that the participant's needs are adequately 
addressed;
    (b) Establishing linkages with appropriate agencies and service 
providers in the area to help participants obtain needed suicide 
prevention services;
    (c) Providing referrals to participants and related activities 
(such as scheduling appointments for participants) to help participants 
obtain needed suicide prevention services, such as medical, social, and 
educational assistance or other suicide prevention services to address 
participants' identified needs and goals;
    (d) Deciding how resources and services are allocated to 
participants on the basis of need;
    (e) Educating participants on issues, including, but not limited 
to, suicide prevention services availability and participant rights; 
and
    (f) Other activities, as approved by VA, to serve the comprehensive 
needs of participants for the purpose of reducing suicide risk.


Sec.  78.70   Suicide prevention services: Peer support services.

    (a) Grantees providing or coordinating the provision of peer 
support services must provide or coordinate the provision of peer 
support services to help participants understand what resources and 
supports are available in their area for suicide prevention. Peer 
support services must be provided by veterans trained in peer support 
with similar lived experiences related to suicide or mental health. 
Peer support specialists serve as role models and a resource to assist 
participants with their mental health recovery.
    (b) Each grantee providing or coordinating the provision of peer 
support services must ensure that veterans providing such services to 
participants meet the requirements of 38 U.S.C. 7402(b)(13) and meet 
qualification standards for appointment; or have completed peer support 
training, are pursuing credentials to meet the minimum qualification 
standards for appointment, and are under the supervision of an 
individual who meets the requirements of 38 U.S.C. 7402(b)(13). Grant 
funds may be used to provide education and training for employees of 
the grantee or the community partner who provide peer support services 
consistent with the terms set forth in the grant agreement.


Sec.  78.75   Suicide prevention services: Assistance in obtaining VA 
benefits.

    (a) Grantees assisting participants in obtaining VA benefits must 
assist participants in obtaining any benefits from VA for which the 
participants are eligible. Such benefits include but are not limited 
to:
    (1) Vocational and rehabilitation counseling;
    (2) Supportive services for homeless veterans;
    (3) Employment and training services;
    (4) Educational assistance; and
    (5) Health care services.
    (b) Grantees are not permitted to represent participants before VA 
with respect to a claim for VA benefits unless they are recognized for 
that purpose pursuant to 38 U.S.C. 5902. Employees and members of 
grantees are not permitted to provide such representation unless the 
individual providing representation is accredited pursuant to 38 U.S.C. 
chapter 59.


Sec.  78.80   Suicide prevention services: Assistance in obtaining and 
coordinating other public benefits and assistance with emergent needs.

    Grantees assisting in obtaining and coordinating other public 
benefits or assisting with emergent needs must assist participants with 
obtaining and coordinating the provision of other public benefits, 
including at a minimum those listed in paragraphs (a) through (h) of 
this section, that are being provided by Federal, State, local, or 
tribal agencies, or any other grantee in the area served by the grantee 
by referring the participant to and coordinating with such entity. If a 
public benefit is not being provided by Federal, State, local, or 
tribal agencies, or any other grantee in the area, the grantee is not 
required to obtain, coordinate, or provide such public benefit. 
Grantees may elect to provide directly to participants the public 
benefits identified in paragraphs (c) through (h) of this section.
    (a) Health care services, which include:
    (1) Health insurance; and
    (2) Referral to a governmental entity or grantee that provides any 
of the following services:
    (i) Hospital care, nursing home care, outpatient care, mental 
health care, preventive care, habilitative and rehabilitative care, 
case management, respite care, and home care;
    (ii) The training of any eligible individual's family in the care 
of any eligible individual; and
    (iii) The provision of pharmaceuticals, supplies, equipment, 
devices, appliances, and assistive technology.
    (b) Referral of a participant, as appropriate, to an entity that 
provides daily living services relating to the functions or tasks for 
self-care usually performed in the normal course of a day, including, 
but not limited to, eating, bathing, grooming, dressing, and home 
management activities.
    (c) Personal financial planning services, which include, at a 
minimum, providing recommendations regarding day-to-day finances and 
achieving long-term budgeting and financial goals. Grant funds may pay 
for credit counseling and other services necessary to assist 
participants with critical skills related to household budgeting, 
managing money, accessing a free personal credit report, and resolving 
credit problems.
    (d) Transportation services:
    (1) The grantee may provide temporary transportation services 
directly to participants if the grantee determines such assistance is 
necessary; however, the preferred method of direct provision of 
transportation services is the provision of tokens, vouchers, or other 
appropriate instruments so that participants may use available public 
transportation options.
    (2) If public transportation options are not sufficient within an 
area, costs related to the lease of vehicle(s) may be included in a 
suicide prevention services grant application if the applicant or 
grantee, as applicable, agrees that:
    (i) The vehicle(s) will be safe, accessible, and equipped to meet 
the needs of the participants;
    (ii) The vehicle(s) will be maintained in accordance with the 
manufacturer's recommendations; and
    (iii) All transportation personnel (employees and community 
partners) will be licensed, insured, and trained in managing any 
special needs of participants and handling emergency situations.
    (3) Transportation services furnished under this paragraph may 
include

[[Page 13841]]

reimbursement for transportation furnished through ride sharing 
services, taxi services, or similar sources, but only if:
    (i) The participant lacks any other means of transportation, 
including transportation or reimbursement for transportation from the 
Department under part 70 of this title; and
    (ii) The grantee documents the participant's lack of other means.
    (e) Temporary income support services, which may consist of 
providing assistance in obtaining other Federal, State, tribal and 
local assistance, in the form of, but not limited to, mental health 
benefits, food assistance, housing assistance, employment counseling, 
medical assistance, veterans' benefits, and income support assistance.
    (f) Fiduciary and representative payee services, which may consist 
of acting on behalf of a participant by receiving the participant's 
paychecks, benefits or other income, and using those funds for the 
current and foreseeable needs of the participant and saving any 
remaining funds for the participant's future use in an interest bearing 
account or saving bonds.
    (g) Legal services to assist eligible individuals with issues that 
may contribute to the risk of suicide. This may include issues that 
interfere with the eligible individual's ability to obtain or retain 
permanent housing, cover basic needs such as food, transportation, 
medical care, and issues that affect the eligible individual's 
employability and financial security (such as debt, credit problems, 
and lacking a driver's license).
    (1) Except for legal assistance with resolving outstanding 
warrants, fines, expungements, and drivers' license revocations 
symptomatic of reentry obstacles in employment or housing, legal 
services do not include legal assistance with criminal matters nor 
matters in which the eligible individual is taking or has taken any 
adversarial legal action against the United States.
    (2) Legal services do not include matters in which the United 
States is prosecuting an eligible individual.
    (h) Child care for children under the age of 13, unless the child 
is disabled. Disabled children must be under the age of 18 to receive 
assistance under this paragraph. Child care includes the:
    (1) Referral of a participant, as appropriate, to an eligible child 
care provider that provides child care with sufficient hours of 
operation and serves appropriate ages, as needed by the participant; 
and
    (2) Payment by a grantee on behalf of a participant for child care 
by an eligible child care provider. Payment may not exceed $5,000 per 
family of an eligible individual per Federal fiscal year.
    (i) Payments for child care services must be paid by the grantee 
directly to an eligible child care provider.
    (ii) Payments for child care services cannot be provided on behalf 
of participants for the same period of time and for the same cost types 
that are being provided through another Federal (including VA), State 
or local subsidy program.
    (iii) As a condition of providing payments for child care services, 
the grantee must help the participant develop a reasonable plan to 
address the participant's future ability to pay for child care 
services. Grantees must assist the participant to implement such plan 
by providing any necessary assistance or helping the participant to 
obtain any necessary public or private benefits or services.


Sec.  78.85   Suicide prevention services: Nontraditional and 
innovative approaches and treatment practices.

    Grantees providing or coordinating the provision of nontraditional 
and innovative approaches and treatment practices may provide or 
coordinate the provision of nontraditional and innovative approaches 
and treatment, including but not limited to complementary or 
alternative interventions with some evidence for effectiveness of 
improving mental health or mitigating a risk factor for suicidal 
thoughts and behaviors, as set forth in the NOFO or as approved by VA 
that are consistent with SSG Fox SPGP. Applicants may propose 
nontraditional and innovative approaches and treatment practices in 
their suicide prevention services grant application, and grantees may 
propose these additional approaches and treatment practices by 
submitting a written request to modify the suicide prevention services 
grant in accordance with Sec.  78.125. VA reserves the right to approve 
or disapprove nontraditional and innovative approaches and treatment 
practices to be provided or coordinate to be provided using funds 
authorized under SSG Fox SPGP. VA will only approve approaches and 
treatment practices consistent with applicable Federal law.


Sec.  78.90   Suicide prevention services: Other services.

    (a) General suicide prevention assistance. A grantee may pay 
directly to a third party (and not to a participant), in an amount not 
to exceed $750 per participant during any 1-year period, beginning on 
the date that the grantee first submits a payment to a third party, the 
following types of expenses:
    (i) Expenses associated with gaining or keeping employment, such as 
uniforms, tools, certificates, and licenses.
    (ii) Expenses associated with lethal means safety and secure 
storage, such as gun locks and locked medication storage.
    (b) Other. Grantees providing or coordinating the provision of 
other suicide prevention services may provide or coordinate the 
provision of the other services as set forth in the NOFO or as approved 
by VA that are consistent with SSG Fox SPGP. Applicants may propose 
additional services in their suicide prevention services grant 
application, and grantees may propose additional services by submitting 
a written request to modify the suicide prevention services grant 
program in accordance with Sec.  78.125. VA reserves the right to 
approve or disapprove other suicide prevention services to be provided 
or coordinate to be provided using funds authorized under SSG Fox SPGP.


Sec.  78.95   General operation requirements.

    (a) Eligibility documentation. Prior to providing suicide 
prevention services, grantees must verify, document, and classify each 
participant's eligibility for suicide prevention services, and 
determine and document each participant's degree of risk of suicide 
using tools identified in the suicide prevention services grant 
agreement. Documentation must be maintained consistent with Sec.  
78.150.
    (b) Required screening prior to services ending. Prior to services 
ending, grantees must provide or coordinate the provision of a mental 
health screening using the screening tool described in Sec.  78.50(a) 
to all participants they serve, when possible.
    (c) Suicide prevention services documentation. For each participant 
who receives suicide prevention services from the grantee, the grantee 
must document the suicide prevention services provided or coordinated, 
how such services are provided or coordinated, the duration of the 
services provided or coordinated, and any goals for the provision or 
coordination of such services. Such documentation must be maintained 
consistent with Sec.  78.150.
    (d) Notifications to participants. (1) Prior to initially providing 
or coordinating suicide prevention services to an eligible individual 
and their family, the grantee must notify each eligible individual and 
their family of the following:

[[Page 13842]]

    (i) The suicide prevention services are being paid for, in whole or 
in part, by VA;
    (ii) The suicide prevention services available to the eligible 
individual and their family through the grantee's program;
    (iii) Any conditions or restrictions on the receipt of suicide 
prevention services by the eligible individual and their family; and
    (iv) In the instance of an eligible individual who receives 
assistance from the grantee under this program, that the eligible 
individual is able to apply for enrollment in VA health care pursuant 
to 38 CFR 17.36. If the eligible individual wishes to enroll in VA 
health care, the grantee must inform the eligible individual of a VA 
point of contact for assistance with enrollment. The requirements in 
this clause do not apply to eligible individuals who are members of the 
Armed Forces described in 38 U.S.C. 1712A(a)(1)(C)(i)-(iv).
    (2) The grantee must provide each participant with a satisfaction 
survey, which the participant can submit directly to VA, within 30 days 
of such participant's pending exit from the grantee's program.
    (e) Assessment of funds. Grantees must regularly assess how suicide 
prevention services grant funds can be used in conjunction with other 
available funds and services to assist participants.
    (f) Development of a suicide prevention services plan. For each 
participant, grantees must develop and document an individualized plan 
with respect to the provision of suicide prevention services provided 
under this part. This plan must be developed in consultation with the 
participant and must be maintained consistent with Sec.  78.150.
    (g) Coordination with VA. The grantee will coordinate with VA with 
respect to the provision of health care and other services to eligible 
individuals pursuant to 38 U.S.C. chapters 17 and 20.
    (h) Measurement and monitoring. The grantee will submit to VA a 
description of the tools and assessments the grantee uses or will use 
to determine the effectiveness of the suicide prevention services 
furnished by the grantee. These will include any measures and metrics 
developed and provided by VA for the purposes of measuring the 
effectiveness of the programming to be provided in improving mental 
health status, wellbeing, and reducing suicide risk and suicide deaths 
of eligible individuals.
    (i) Agreements with community partners. Only grantees that are a 
State or local government or an Indian tribe may use grant funds to 
enter into an agreement with a community partner under which the 
grantee may provide funds to the community partner for the provision of 
suicide prevention services to eligible individuals and their families.
    (j) Contracts for goods and services under this part. Grantees may 
enter into contracts for good or services under this part.
    (k) Administration of suicide prevention services grants. Grantees 
must ensure that suicide prevention services grants are administered in 
accordance with the requirements of this part, the suicide prevention 
services grant agreement, and other applicable Federal, State, and 
local laws and regulations, including Federal civil rights laws. 
Grantees are responsible for ensuring that any community partners carry 
out activities in compliance with this part.


(The Office of Management and Budget has approved the information 
collection provisions in this section under control number 2900-TBD.)


Sec.  78.100   Fee prohibition.

    Grantees must not charge a fee to participants for providing 
suicide prevention services that are funded with amounts from a suicide 
prevention services grant.


Sec.  78.105   Ineligible activities.

    Notwithstanding any other section in this part, grantees are not 
authorized to use suicide prevention services grant funds to pay for 
the following:
    (a) Direct cash assistance to participants.
    (b) Those legal services prohibited pursuant to Sec.  78.80(g).
    (c) Medical or dental care and medicines except for clinical 
services authorized pursuant to Sec.  78.60.
    (d) Any activities considered illegal under Federal law.


Sec.  78.110   Notice of Funding Opportunity.

    When funds are available for suicide prevention services grants, VA 
will publish a NOFO on grants.gov. The NOFO will identify:
    (a) The location for obtaining suicide prevention services grant 
applications;
    (b) The date, time, and place for submitting completed suicide 
prevention services grant applications;
    (c) The estimated amount and type of suicide prevention services 
grant funding available;
    (d) Any priorities for or exclusions from funding to meet the 
statutory mandates of section 201 of Public Law 116-171 and VA's goals 
for SSG Fox SPGP;
    (e) The length of term for the suicide prevention services grant 
award;
    (f) The minimum number of total points and points per category that 
an applicant or grantee, as applicable, must receive for a suicide 
prevention services grant to be funded;
    (g) Any maximum uses of suicide prevention services grant funds for 
specific suicide prevention services;
    (h) The timeframes and manner for payments under the suicide 
prevention services grant; and
    (i) Other information necessary for the suicide prevention services 
grant application process as determined by VA.


Sec.  78.115   Suicide prevention services grant agreements.

    (a) After an applicant is selected for a suicide prevention 
services grant in accordance with Sec.  78.30, VA will draft a suicide 
prevention services grant agreement to be executed by VA and the 
applicant. Upon execution of the suicide prevention services grant 
agreement, VA will obligate suicide prevention services grant funds to 
cover the amount of the approved suicide prevention services grant, 
subject to the availability of funding. The suicide prevention services 
grant agreement will provide that the grantee agrees, and will ensure 
that each community partner agrees, to:
    (1) Operate the program in accordance with the provisions of this 
part and the applicant's suicide prevention services grant application;
    (2) Comply with such other terms and conditions, including 
recordkeeping and reports for program monitoring and evaluation 
purposes, as VA may establish for purposes of carrying out SSG Fox 
SPGP, in an effective and efficient manner; and
    (3) Provide such additional information as deemed appropriate by 
VA.
    (b) After a grantee is selected for renewal of a suicide prevention 
services grant in accordance with Sec.  78.40, VA will draft a suicide 
prevention services grant agreement to be executed by VA and the 
grantee. Upon execution of the suicide prevention services grant 
agreement, VA will obligate suicide prevention services grant funds to 
cover the amount of the approved suicide prevention services grant, 
subject to the availability of funding. The suicide prevention services 
grant agreement will contain the same provisions described in paragraph 
(a) of this section.
    (c) No funds provided under this part may be used to replace 
Federal, State, tribal, or local funds previously used, or designated 
for use, to assist eligible individuals and their families.

[[Page 13843]]

Sec.  78.120   Amount and payment of grants.

    (a) Amount of grants. The maximum funding that a grantee may be 
awarded under this part is $750,000 per fiscal year.
    (b) Payment of grants. Grantees are to be paid in accordance with 
the timeframes and manner set forth in the NOFO.


Sec.  78.125   Program or budget changes and corrective action plans.

    (a) A grantee must submit to VA a written request to modify a 
suicide prevention services grant for any proposed significant change 
that will alter the suicide prevention services grant program. If VA 
approves such change, VA will issue a written amendment to the suicide 
prevention services grant agreement. A grantee must receive VA's 
approval prior to implementing a significant change. Significant 
changes include, but are not limited to, a change in the grantee or any 
community partners identified in the suicide prevention services grant 
agreement; a change in the area served by the grantee; additions or 
deletions of suicide prevention services provided by the grantee; a 
change in category of participants to be served; and a change in budget 
line items that are more than 10 percent of the total suicide 
prevention services grant award.
    (1) VA's approval of changes is contingent upon the grantee's 
amended application retaining a sufficient rank to have been 
competitively selected for funding in the year that the application was 
granted.
    (2) Each suicide prevention services grant modification request 
must contain a description of, and justification for, the revised 
proposed use of suicide prevention services grant funds.
    (b) VA may require that the grantee initiate, develop, and submit 
to VA for approval a Corrective Action Plan (CAP) if, on a quarterly 
basis, actual suicide prevention services grant expenditures vary from 
the amount disbursed to a grantee for that same quarter or actual 
suicide prevention services grant activities vary from the grantee's 
program description provided in the suicide prevention services grant 
agreement.
    (1) The CAP must identify the expenditure or activity source that 
has caused the deviation, describe the reason(s) for the variance, 
provide specific proposed corrective action(s), and provide a timetable 
for accomplishment of the corrective action.
    (2) After receipt of the CAP, VA will send a letter to the grantee 
indicating that the CAP is approved or disapproved. If disapproved, VA 
will make beneficial suggestions to improve the proposed CAP and 
request resubmission or take other actions in accordance with this 
part.
    (c) Grantees must inform VA in writing of any key personnel changes 
(e.g., new executive director, the suicide prevention services grant 
program director, or chief financial officer) and grantee address 
changes within 30 days of the change.


(The Office of Management and Budget has approved the information 
collection provisions in this section under control number 2900-TBD.)


Sec.  78.130   Faith-based organizations.

    (a) Organizations that are faith-based are eligible, on the same 
basis as any other organization, to participate in SSG Fox SPGP under 
this part. Decisions about awards of Federal financial assistance must 
be free from political interference or even the appearance of such 
interference and must be made on the basis of merit, not on the basis 
of religion or religious belief or lack thereof.
    (b)(1) No organization may use direct financial assistance from VA 
under this part to pay for any of the following:
    (i) Explicitly religious activities such as, religious worship, 
instruction, or proselytization; or
    (ii) Equipment or supplies to be used for any of those activities.
    (2) References to ``financial assistance'' will be deemed to be 
references to direct Federal financial assistance, unless the 
referenced assistance meets the definition of ``indirect Federal 
financial assistance'' in this part.
    (c) Organizations that engage in explicitly religious activities, 
such as worship, religious instruction, or proselytization, must offer 
those services separately in time or location from any programs or 
services funded with direct financial assistance from VA under this 
part, and participation in any of the organization's explicitly 
religious activities must be voluntary for the participants of a 
program or service funded by direct financial assistance from VA under 
this part.
    (d) A faith-based organization that participates in SSG Fox SPGP 
under this part will retain its independence from Federal, State, or 
local governments and may continue to carry out its mission, including 
the definition, practice and expression of its religious beliefs, 
provided that it does not use direct financial assistance from VA under 
this part to support any explicitly religious activities, such as 
worship, religious instruction, or proselytization. Among other things, 
faith-based organizations may use space in their facilities to provide 
VA-funded services under this part, without concealing, removing, or 
altering religious art, icons, scripture, or other religious symbols. 
In addition, a VA-funded faith-based organization retains its authority 
over its internal governance, and it may retain religious terms in its 
organization's name, select its board members and otherwise govern 
itself on a religious basis, and include religious reference in its 
organization's mission statements and other governing documents.
    (e) An organization that participates in a VA program under this 
part must not, in providing direct program assistance, discriminate 
against a program participant or prospective program participant on the 
basis of religion or religious belief.
    (f) If a State or local government voluntarily contributes its own 
funds to supplement Federally funded activities, the State or local 
government has the option to segregate the Federal funds or commingle 
them. However, if the funds are commingled, this provision applies to 
all of the commingled funds.
    (g) To the extent otherwise permitted by Federal law, the 
restrictions on explicitly religious activities set forth in this 
section do not apply where VA funds are provided to faith-based 
organizations through indirect assistance as a result of a genuine and 
independent private choice of a participant, provided the faith-based 
organizations otherwise satisfy the requirements of this part. A faith-
based organization may receive such funds as the result of a 
participant's genuine and independent choice if, for example, a 
participant redeems a voucher, coupon, or certificate, allowing the 
participant to direct where funds are to be paid, or a similar funding 
mechanism provided to that participant and designed to give that 
participant a choice among providers.


Sec.  78.135   Visits to monitor operation and compliance.

    (a) VA has the right, at all reasonable times, to make visits to 
all grantee locations where a grantee is using suicide prevention 
services grant funds to review grantee accomplishments and management 
control systems and to provide such technical assistance as may be 
required. VA may conduct inspections of all program locations and 
records of a grantee at such times as are deemed necessary to determine 
compliance with the provisions of this part. In the event that a 
grantee delivers services in a participant's home, or at a

[[Page 13844]]

location away from the grantee's place of business, VA may accompany 
the grantee. If the grantee's visit is to the participant's home, VA 
will only accompany the grantee with the consent of the participant. If 
any visit is made by VA on the premises of the grantee or a community 
partner under the suicide prevention services grant, the grantee must 
provide, and must require its community partners to provide, all 
reasonable facilities and assistance for the safety and convenience of 
the VA representatives in the performance of their duties. All visits 
and evaluations will be performed in such a manner as will not unduly 
delay services.
    (b) The authority to inspect carries with it no authority over the 
management or control of any applicant or grantee under this part.


Sec.  78.140   Financial management and administrative costs.

    (a) Grantees must comply with applicable requirements of the 
Uniform Administrative Requirements, Cost Principles, and Audit 
Requirements for Federal Awards under 2 CFR part 200.
    (b) Grantees must use a financial management system that provides 
adequate fiscal control and accounting records and meets the 
requirements set forth in 2 CFR part 200.
    (c) Payment up to the amount specified in the suicide prevention 
services grant must be made only for allowable, allocable, and 
reasonable costs in conducting the work under the suicide prevention 
services grant. The determination of allowable costs must be made in 
accordance with the applicable Federal Cost Principles set forth in 2 
CFR part 200.
    (d) Costs for administration by a grantee must not exceed 10 
percent of the total amount of the suicide prevention services grant. 
Administrative costs will consist of all costs associated with the 
management of the program. These costs will include the administrative 
costs of community partners.


Sec.  78.145   Grantee reporting requirements.

    (a) VA may require grantees to provide, in any form as may be 
prescribed, such reports or answers in writing to specific questions, 
surveys, or questionnaires as VA determines necessary to carry out SSG 
Fox SPGP.
    (b) At least once per year, each grantee must submit to VA a report 
that describes the projects carried out with such grant during the year 
covered by the report; and information relating to operational 
effectiveness, fiscal responsibility, suicide prevention services grant 
agreement compliance, and legal and regulatory compliance, including a 
description of the use of suicide prevention grant funds, the number of 
participants assisted, the types of suicide prevention services 
provided, and any other information that VA may request.
    (c) VA may request additional reports or information to allow VA to 
fully assess the provision or coordination of the provision of suicide 
prevention services under this part.
    (d) All pages of the reports must cite the assigned suicide 
prevention services grant number and be submitted in a timely manner as 
set forth in the grant agreement.
    (e) Grantees must provide VA with consent to post information from 
reports on the internet and use such information in other ways deemed 
appropriate by VA. Grantees shall clearly mark information that is 
confidential to individual participants.


(The Office of Management and Budget has approved the information 
collection provisions in this section under control number 2900-TBD.)


Sec.  78.150   Recordkeeping.

    Grantees must ensure that records are maintained for at least a 3-
year period to document compliance with this part. Grantees must 
produce such records at VA's request.


Sec.  78.155   Technical assistance.

    VA will provide technical assistance, as necessary, to applicants 
and grantees to meet the requirements of this part. Such technical 
assistance will be provided either directly by VA or through contracts 
with appropriate public or non-profit private entities.


Sec.  78.160   Withholding, suspension, deobligation, termination, and 
recovery of funds by VA.

    VA will enforce this part through such actions as may be 
appropriate. Appropriate actions include withholding, suspension, 
deobligation, termination, recovery of funds by VA, and actions in 
accordance with 2 CFR part 200.


Sec.  78.165   Suicide prevention services grant closeout procedures.

    Suicide prevention services grants will be closed out in accordance 
with 2 CFR part 200.

[FR Doc. 2022-04477 Filed 3-9-22; 8:45 am]
BILLING CODE 8320-01-P