Telehealth Grant Program, 89519-89543 [2024-25892]

Agencies

• DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 89, Number 219 (Wednesday, November 13, 2024)]
[Proposed Rules]
[Pages 89519-89543]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-25892]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Parts 17 and 84

RIN 2900-AS20


Telehealth Grant Program

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its 
regulation to implement a new authority to establish a telehealth grant 
program. This new authority requires VA to enter into agreements, and 
expand existing agreements, for the expansion of VA telehealth 
capabilities and provision of telehealth services by establishing 
telehealth access stations in rural, highly rural, or medically 
underserved areas, to the extent practicable. We also propose to amend 
the copayment regulation by exempting all telehealth services from the 
copayment requirement.

DATES: Comments must be received on or before January 13, 2025.

ADDRESSES: Comments may be submitted through www.regulations.gov. 
Except as provided below, comments received before the close of the 
comment period will be available at www.regulations.gov for public 
viewing, inspection, or copying, including any personally identifiable 
or confidential business information that is included in a comment. We 
post the comments received before the close of the comment period on 
the following website as soon as possible after they have been 
received: https://www.regulations.gov. VA will not post on 
Regulations.gov public comments that make threats to individuals or 
institutions or suggest that the commenter will take actions to harm an 
individual. VA encourages individuals not to submit duplicative 
comments; however, we will post comments from multiple unique 
commenters even if the content is identical or nearly identical to 
other comments. Any public comment received after the comment period's 
closing date is considered late and will not be considered in the final 
rulemaking. In accordance with the Providing Accountability Through 
Transparency Act of 2023, a 100 word Plain-Language Summary of this 
proposed rule is available at Regulations.gov, under RIN 2900-AS20.

FOR FURTHER INFORMATION CONTACT: Leonie Heyworth, MD, MPH, Deputy 
Director for Clinical Services, Telehealth Services, Office of 
Connected Care, 810 Vermont Ave. NW, Washington, DC 20420, 202-461-
6525. (This is not a toll-free telephone number.)

SUPPLEMENTARY INFORMATION: On October 17, 2020, the Commander John 
Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (the 
Act), Public Law 116-171, was enacted into law. Section 701 of the Act, 
codified as a note to section 1701 of title 38, United States Code 
(U.S.C.), mandated that VA enter into agreements, and expand existing 
agreements, with organizations that represent or serve veterans, 
nonprofit organizations, private businesses, and other interested 
parties for the expansion of telehealth capabilities and the provision 
of telehealth services to veterans through the award of grants.
    VA understands that veterans who live in rural and highly rural 
areas may not have reliable internet access. Also, veterans who live in 
medically underserved areas may not have accessible health care 
facilities within their communities. Thus, VA has developed a 
telehealth program as a modern, veteran-, beneficiary- and family-
centered health care delivery model that leverages information and 
telecommunication technologies to connect patients with health care 
providers, irrespective of the State or location within a State where 
the health care professional or the patient is physically located at 
the time the health care is provided. The telehealth access points use 
a secure video application to bridge the digital divide by providing 
veterans health care service via telehealth in a fixed, secure 
environment with a reliable internet connection. These telehealth 
access points allow veterans to receive telehealth services closer to 
their residence without the inconvenience of having long travel times 
to their nearest VA medical facility to receive health care, 
particularly when veterans may lack appropriate internet access in 
their home. The convenience of the telehealth access point also allows 
veterans to be more engaged in their health care, which results in a 
more positive health outcome.
    Section 701(b)(1) of the Act requires VA to award grants to 
entities in carrying out agreements entered into or expanded under this 
section with eligible entities. Section 701(b)(2) of the

[[Page 89520]]

Act provides that, to the extent practicable, the Secretary shall 
ensure that grants are awarded to entities that serve veterans in rural 
and highly rural areas (as determined through the use of the Rural-
Urban Commuting Areas coding system of the Department of Agriculture) 
or areas determined to be medically underserved. Section 701(b)(3) of 
the Act states that grants awarded to an entity pursuant to section 
701(b) may be used for one or more of the following: purchasing, 
replacing, or upgrading hardware or software necessary for the 
provision of secure and private telehealth services; upgrading security 
protocols for consistency with VA security requirement; training of 
site attendants, including payment of those attendants for completing 
that training, with respect to military and veteran cultural competence 
(if the entity is not an organization that represents veterans), 
equipment required to provide telehealth services, privacy (including 
the Health Insurance Portability and Accountability Act of 1996, HIPAA, 
privacy rule as it relates to health care for veterans), scheduling for 
telehealth services for veterans, or any other unique training needs 
for the provision of telehealth services to veterans; upgrading 
existing infrastructure owned or leased by the entity to make rooms 
more conducive to telehealth (including soundproofing of an existing 
room, new electrical, telephone, or internet outlets in an existing 
room, aesthetic enhancements to make a more suitable therapeutic 
environment, and additions or modifications to windows or walls in an 
existing room, or other alterations needed to create a new, private 
room, including permits or inspections associated with space 
modifications); upgrading existing infrastructure to comply with the 
Americans with Disabilities Act (the ADA, 42 U.S.C. 12101 et seq.); 
upgrading internet infrastructure and sustainment of internet services, 
and the sustainment of telephone services.
    The grants awarded under section 701 of the Act are to support the 
establishment or expansion of telehealth access points that would allow 
veterans to receive telehealth services from VA professionals. VA 
serves beneficiaries beyond veterans under title 38, U.S.C. and other 
laws. The Act, however, only uses the term veteran, so for purposes of 
this rulemaking, VA is only proposing that grant funds may be used to 
support the provision of telehealth services to veterans. We 
understand, however, that investment in technology and facilities at 
these access points could also be used to support other VA 
beneficiaries.
    While grant funds could not be used to establish or expand 
telehealth access points for non-veteran beneficiaries, such 
beneficiaries could access telehealth services through telehealth 
access points established using grant funds in either of two ways.
    First, they may be able to use these telehealth access points to 
serve non-veterans incidentally. If a grantee used grant funds to 
purchase technology and renovate space to conform with security and 
privacy requirements for the purpose of delivering telehealth services 
to veterans, those costs have been incurred, and the use of those 
facilities for others does not result in any additional expense or 
cost. VA awards grants and financial support through other programs 
whose primary purpose is to support veterans, but which can also 
benefit non-veterans as well. For example, 38 U.S.C. 2011 authorizes VA 
to award grants for new construction of facilities, expansion, 
remodeling, or alteration of existing facilities, or acquisition of 
facilities, for use as service centers, transitional housing, or other 
facilities to serve homeless veterans. Section 2011(e)(4) specifically 
notes that applicants must provide reasonable assurances that the 
facilities will be used principally to provide veterans the services 
for which the project was designed, and that not more than 25 percent 
of the services provided under the project will be provided to 
individuals who are not veterans. Although section 701 of the Act does 
not include similar language, we do not believe it was the intent of 
Congress to prohibit the use of telehealth access points by non-
veterans. This is particularly true given that these spaces may have 
been developed to provide access to telehealth services for the general 
public; placing restrictions on their use to only veterans would serve 
as a disincentive for potential applicants, who might lose a large 
portion of their beneficiary population. Particularly given that 
section 701(b)(3)(B) prohibits the use of grant funds to purchase new 
property or for major construction projects, applicants would have to 
have pre-existing space, and they may have been using this space to 
serve non-veteran patients. We do not believe Congress would have 
intended to create such barriers to potential applicants; section 
701(d) of the Act, for example, requires VA to complete an assessment 
of barriers faced by veterans in accessing telehealth services and how 
VA plans to address those barriers. Under this proposed rule, so long 
as the provision of telehealth services to non-veteran beneficiaries at 
telehealth access points supported using grant funds does not interfere 
with the provision of telehealth services to veterans, VA sees no issue 
with using these points to support other VA beneficiaries.
    Second, grantees may form separate agreements with the Department 
under a different authority to furnish telehealth services specifically 
to non-veteran beneficiaries at telehealth access points that were 
established or expanded using grant funds. No provision of law, section 
701 of the Act included, restricts VA's ability to form agreements with 
other eligible parties to create new access points, including 
telehealth access points, for non-veteran beneficiaries. While Congress 
did not use the term ``beneficiary'' in section 701 of the Act, we do 
not interpret this as evidence of an intent to exclude non-veteran 
beneficiaries from accessing telehealth services under any of the 
scenarios outlined above, again so long as that the provision of 
services to such individuals does not interfere with the provision of 
telehealth services to veterans and that the provision of such services 
to veterans was the primary objective of the grant award. VA would only 
award grant funds for services allowed under section 701.
    Some telehealth access points may also furnish in-person services 
to veterans and other beneficiaries. We do not interpret anything in 
section 701 to preclude the use of such access points to provide in-
person services to veterans. Modifications or enhancements to the 
telehealth access point made through the use of grant funds, such as 
training site attendants on military and veteran cultural competency, 
purchasing or upgrading hardware or software necessary for telehealth, 
upgrading existing infrastructure owned or leased by the entity, 
upgrading existing infrastructure to comply with the ADA, upgrading 
internet infrastructure and sustainment of internet services, and 
sustainment of telephone services, could also enhance the delivery of 
in-person care. Such investments, once made, do not result in 
additional incremental costs if they support the delivery of in-person 
care to veterans (or other beneficiaries). As noted above, so long as 
the principal purpose of the grant is to expand telehealth capabilities 
and support the provision of telehealth services, the improved delivery 
of in-person care is incidental and not prohibited. We welcome public 
comment on these interpretations.
    We propose to add part 84 to 38 CFR to establish the telehealth 
grant program

[[Page 89521]]

as mandated by the Act. We also propose to amend 38 CFR 17.108(e), as 
described further below.

Part 17 of 38 CFR

    Section 1710(g)(1) of 38 U.S.C. states that VA may not furnish 
medical services (except if such care constitutes hospice care) under 
section 1710(a) (including home health services under section 1717 of 
the title) to a veteran who is eligible for hospital care under the 
chapter by reason of section 1710(a)(3) unless the veteran agrees to 
pay to the United States in the case of each outpatient visit the 
applicable amount or amounts established by the Secretary by 
regulation. There are exceptions to this requirement; paragraph (3) of 
section 1710(g) establishes two situations in which copayments are not 
required, and sections 1722B and 1730A of 38 U.S.C. do as well. 
Specifically, section 1722B allows VA to waive the imposition or 
collection of copayments for telehealth and telemedicine visits of 
veterans under laws administered by VA. VA has implemented through 
regulation the copayments required by section 1710(g) at 38 CFR 17.108, 
which sets forth requirements regarding copayments for inpatient 
hospital care and outpatient medical care provided to veterans by VA. 
On March 6, 2012, prior to enactment of section 1722B, in a document 
published in the Federal Register at 77 FR 13195, VA determined that 
in-home video telehealth care should be exempt from copayments because 
it is not used to provide complex care and its use significantly 
reduces impact on VA resources compared to an in-person, outpatient 
visit. It also reduces any potential negative impact on the veteran's 
health that might be incurred if the veteran were required to travel to 
a VA hospital or medical center to obtain the care provided via in-home 
video telehealth. Paragraph (e) of 38 CFR 17.108 provides for the 
services not subject to copayment requirements for inpatient hospital 
care, outpatient medical care, or urgent care. Paragraph (e)(16), as 
added by the 2012 rulemaking, exempts in-home video telehealth care 
from the copayment requirement.
    Given advances in technology, VA understands that veterans may use 
telehealth services in other locations than the veteran's home. These 
other locations may be more convenient for veterans and do not 
represent any additional burden on VA, so VA also proposes to exempt 
these encounters from copayments under the authority of section 1722B. 
Similarly, VA has not imposed copayments on telephone visits or 
discussions with VA providers (as these are not considered 
``encounters'' for VA's purposes), but VA's regulations have not 
reflected this reality. Through this rulemaking, VA is exercising its 
authority under section 1722B by proposing to exempt all telehealth 
services from copayment requirements. These services would include 
telehealth services provided in VA medical facilities, in-home 
telehealth visits, telephone visits, telehealth services provided in 
telehealth access points, and telehealth services received at any non-
VA location, including homeless shelters and public libraries. 
Similarly, telehealth provided to eligible veterans by non-VA providers 
under the Veterans Community Care Program would be exempt from 
copayments, regardless of where the veteran is during the telehealth 
encounter. Exempting copayments for telehealth services would provide 
an incentive for veterans to utilize these services and be more engaged 
in their health care. It also would treat all telehealth services the 
same for purposes of applying copayments. Consequently, we propose to 
amend paragraph (e)(16) by exempting telehealth visits from a copayment 
requirement.

Part 84 of 38 CFR

    Establishment of part 84 ensures organization and clarity for 
implementation of this new grant program. This proposed rule would 
establish regulations authorizing VA to award telehealth grants to 
eligible entities who would establish telehealth access points for 
veterans.
    Consistent with section 701 of the Act, part 84 would be titled 
``Telehealth Grant Program.''

Section 84.0 Purpose

    Proposed Sec.  84.0 would state the purpose of part 84. We would 
state that Sec. Sec.  84.0 through 84.110 would establish the 
telehealth grant program. We would add that VA will enter into 
agreements, and expand existing agreements, with eligible entities 
(which would be defined below in Sec.  84.5) for the expansion of 
telehealth capabilities and the provision of telehealth services to 
veterans through the award of grants. This language is very similar to 
section 701(a) of the Act. In addition, we would state that, through 
the award of these grants, grantees will offer veterans a convenient 
space to connect with a VA health care professional through video 
telehealth in comfortable, private locations in communities where 
veterans may otherwise have long travel times to VA medical facilities, 
may have poor internet connectivity in their homes, or may face other 
barriers to accessing health care. This statement reflects several of 
the defined used of grants under 701(b)(3)(A), specifically: creating a 
comfortable space (see clauses (iv) and (v), regarding upgrading 
infrastructure to make rooms more conductive to telehealth and to 
comply with the ADA) and creating private locations (see clauses (i), 
(ii), (iii)(III), and (iv)(I), regarding purchasing, replacing, or 
upgrading hardware or software, upgrading security protocols, training 
with respect to privacy, and modifications to create a new, private 
room). We would clarify that the telehealth access point is not 
intended to be used for veterans who are in need of emergency health 
care services.
    Section 701(c) of the Act provides that an eligible entity that 
seeks to establish a telehealth access point for veterans, but does not 
require grant funding under this section, may enter into an agreement, 
under certain conditions, with VA for the establishment of such an 
access point. We do not need to establish regulations concerning 
section 701(c) of the Act because the substance of the agreements will 
make clear to the affected parties their responsibilities. We would, 
therefore, add that part 84 would only apply to telehealth grant 
agreements; however, VA may enter into an agreement for the 
establishment of a telehealth access point for veterans with an entity 
that seeks to establish such an access point but does not require grant 
funding under part 84. We would also make such statement in the Notice 
of Funding Opportunity.

Section 84.5 Definitions

    Proposed Sec.  84.5 would contain the definitions for key terms 
that would be applicable to part 84 and to any Notice of Funding 
Opportunity (NOFO) for the telehealth grant. We would list these 
definitions in alphabetical order.
    We propose to define the term applicant to mean an eligible entity 
that submits an application for a telehealth grant announced in a 
Notice of Funding Opportunity under part 84. VA would define the term 
applicant in this manner because only an eligible entity that submits 
an application for a telehealth grant under part 84 would be subject to 
any requirements of applicants. We would define this term similarly to 
other VA grant programs, such as the Supportive Services for Veteran 
Families (SSVF) program and the Staff Sergeant Parker Gordon Fox 
Suicide Prevention Grant Program (SPGP). See 38 CFR 62.2 and 78.5.
    We would define the term date of completion to mean the earliest of 
either

[[Page 89522]]

the date specified in the telehealth grant agreement, or any supplement 
or amendment thereto, or the effective date of a telehealth grant 
termination under Sec.  84.110. This definition would be similar to the 
use of this term in other VA grant programs. See 38 CFR 62.2.
    We propose to define the term eligible entity to mean an entity 
that meets the requirements of Sec.  84.10. We would define this term 
similarly to other VA grant programs, such as the Legal Services for 
Homeless Veterans and Veterans At-Risk for Homelessness grant program. 
See 38 CFR 79.5.
    We propose to define the term grantee to mean an eligible entity 
that is awarded a telehealth grant under part 84. This definition is 
similar to other VA grant programs. See 38 CFR 62.2.
    We propose to define the term medically underserved to mean an area 
as designated under 42 U.S.C. 254b(b)(3). This term would be used to 
implement section 701(b)(2) of the Act, which states in part that, to 
the extent practicable, the Secretary shall ensure that grants are 
awarded to entities that serve veterans in areas determined to be 
medically underserved. While section 254b(b)(3)(A) defines the term 
medically underserved population, section 254b(b)(3) generally 
establishes a process for identifying medically underserved areas that 
are designated by the Health Resources and Services Administration 
(HRSA), the U.S. Department of Health and Human Services 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 and populations at 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.  84.05. Rather, VA is proposing to define medically 
underserved to mean an area that is designated under 42 U.S.C. 
254b(b)(3). This term is defined consistently with its use in section 
246(d)(2)(A) of Division J of Public Law 115-141 (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.
    We would define Notice of Funding Opportunity (NOFO) to have the 
same meaning as given to this term in 2 CFR 200.1. Section 200.1 
defines NOFO to mean a formal announcement of the availability of 
Federal funding through a financial assistance program from a Federal 
awarding agency. The NOFO provides information on the award, who is 
eligible to apply, the evaluation criteria for selection of an awardee, 
required components of an application, and how to submit the 
application. The NOFO is any paper or electronic issuance that an 
agency uses to announce a funding opportunity, whether it is called a 
program announcement, notice of funding availability, broad agency 
announcement, research announcement, solicitation, or some other term. 
The telehealth grant program would be subject to the requirements of 2 
CFR part 200, which establishes the uniform administrative 
requirements, cost principles, and audit requirements for Federal 
awards to non-Federal entities. Citing to this definition ensures 
consistency and accuracy.
    Section 200.1 of 2 CFR defines nonprofit organization to mean any 
corporation, trust, association, cooperative, or other organization, 
not including Institutes of Higher Education, that: (1) is operated 
primarily for scientific, educational, service, charitable, or similar 
purposes in the public interest; (2) is not organized primarily for 
profit; and (3) uses net proceeds to maintain, improve, or expand the 
operations of the organization. Although VA defines nonprofit 
organization differently in other grant programs (see Sec.  62.2), we 
propose to use this general definition of nonprofit organization in 
Sec.  84.05 to be in alignment with all other Federal grant programs. 
We would not repeat the definition, but rather add a cross reference in 
the event that this definition would change in the future. We would 
therefore define nonprofit organization as having the meaning given to 
that term in 2 CFR 200.1.
    We propose to define the term subcontractor to mean any entity or 
organization that has a contract agreement to furnish services at the 
telehealth access point. Subcontractors do not include individuals who 
build the access point (e.g., entities who are hired to paint or 
construct walls or partitions) or provide technical services (e.g., 
commercial internet providers or electric services). This definition 
would clarify who VA would recognize as a subcontractor, which would be 
relevant for various requirements in the proposed rule.
    We propose to define the term rural and highly rural areas to mean 
an area or community that is designated as such by the Rural-Urban 
Commuting Areas coding system of the U.S. Department of Agriculture. We 
would define this term to implement section 701(b)(2) of the Act, which 
states in part that, to the extent practicable, the Secretary shall 
ensure that grants are awarded to entities that serve veterans in rural 
and highly rural areas (as determined through the use of the Rural-
Urban Commuting Areas coding system of the Department of Agriculture). 
The rural-urban commuting area (RUCA) codes are a Census tract-based 
classification that uses standard Census measures of population 
density, levels of urbanization, and journey-to-work commuting to 
characterize all U.S. Census tracts with respect to their rural/urban 
status and commuting relationships to other tracts. RUCA codes define 
county-level metropolitan and micropolitan areas. The RUCA codes are 
published on the Department of Agriculture's website. See https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx.
    We propose to define the term telehealth access point to mean a 
non-VA site supported by a telehealth grant where a veteran can 
participate in a telehealth visit with a VA health care professional. 
As previously stated in this rulemaking, the telehealth grant would be 
used to establish or expand telehealth access points in locations that 
are not owned by VA. This definition would make clear that telehealth 
access points are distinct from VA health care facilities that provide 
telehealth services. We note that this definition would not prohibit VA 
from offering other VA services (e.g., hearings with the Board of 
Veterans Appeals or Veterans Benefits Administration consultations) 
through video conferencing at the telehealth access point. We clarify, 
though, that the provision of any such ancillary services beyond 
telehealth would be agreed to under separate authorities for VA to 
enter into agreements and establish such locations in the first place. 
Grant funds under section 701 could only be used for the purpose of 
furnishing telehealth services, but as noted previously, certain 
investments for the expansion or provision of telehealth services could 
also facilitate the delivery of other services at no additional 
incremental cost. Separate agreements could include the transfer of 
funds to grantees under separate authority if additional resources were 
needed to support these functions.
    We propose to define the term telehealth grant to mean a grant 
awarded under part 84. This definition would be similar to how this 
term is defined in other VA grant programs. See, e.g., 38 CFR 78.5 and 
79.5.

[[Page 89523]]

Section 84.10 Eligible Entities

    In proposed Sec.  84.10, we would list the types of entities that 
could be an eligible entity for this grant program. To be eligible to 
receive a telehealth grant, the entity must be: (1) an organization 
that represents or serves veterans; (2) a nonprofit organization; (3) a 
private business; (4) State or local government; or (5) another 
interested party. This would be consistent with sections 701(a) and 
(b)(1) of the Act, which state VA shall award grants in carrying out 
agreements with organizations that represent or serve veterans, 
nonprofit organizations, private businesses, and other interested 
parties for the expansion of telehealth capabilities and the provision 
of telehealth services to veterans. We note that VA considers a private 
company as one that is not owned or operated by a State, local, or 
Federal Government. We anticipate that veterans service organizations 
and community establishments (such as a community center or faith-based 
organization) may apply for these grants and would be considered either 
organizations that represent or serve veterans or at least nonprofit 
organizations. Private businesses could apply as well, and VA would 
specify any requirements applicable to such businesses in the NOFO. 
Other interested parties are included in the text of section 701(a) but 
is not further defined. VA does not propose a more specific definition 
here in the interest of ensuring that a wide variety of possible 
organizations can apply and, if approved, receive a grant under this 
program. Examples of other interested parties might include Federally 
Qualified Health Centers, or associations, partnerships, or other 
collaborations of different organizations. VA solicits comment on 
whether further specificity should be included and whether certain 
organizations or other parties should be excluded under this 
definition.

Section 84.15 Application

    Proposed Sec.  84.15 would establish the application procedures for 
the telehealth grant. Section 701 of the Act does not provide extensive 
requirements associated with the requirements for applicants, as is 
found in other statutes. We infer from this gap that Congress delegated 
authority to VA to implement the necessary requirements to ensure that 
it could award grants consistent with Federal requirements regarding 
grant making and with the principles of sound fiscal policy.
    We would state in proposed paragraph (a) that an applicant must 
submit to VA a complete grant application package, as described in the 
NOFO. The NOFO would alert potential applicants of the availability of 
funds for the telehealth grant. The NOFO may include different 
application requirements based on a range of funding thresholds. For 
example, grant applications for technology and equipment, 
infrastructure upgrades, and sustainment may follow different 
application requirements. This variability would be included based on 
the potentially different uses of grant funds the applicant proposes. 
Some applicants may only need one-time, minimal support, such as new 
hardware or software or staff training. Other applicants may require 
long-term but still relatively minimal support (such as funds to 
sustain internet or telephone services that recur on a monthly basis). 
Other applicants may require long-term and significantly more 
assistance if they are undertaking infrastructure renovations that 
require permits or other substantial investments in time and resources. 
We note for general awareness that infrastructure projects using 
Federal funds are subject to additional requirements, such as the Build 
America, Buy America Act (Pub. L. 117-58). Grantees will be required to 
comply with the provisions of these separate authorities to the extent 
applicable. VA's interest in ensuring appropriate financial 
accountability varies based on the amount of support it is providing, 
and in the interest of ensuring that applicants seeking only a small 
amount of grant funds are not dissuaded from applying based on the 
compliance costs that may accompany a larger grant amount, VA proposes 
allowing the NOFO to further specify different requirements based on 
the amount of funds sought by the applicant. The requirements stated in 
this section reflect the most extensive requirements that applicants 
would need to meet, but depending upon the terms of the NOFO and ranges 
of support applicants seek, certain elements of these requirements 
could be less stringent. This paragraph would be similar to other grant 
programs, such as the SSVF program and the SPGP. See, e.g., Sec. Sec.  
62.20(a) and 78.15.
    Proposed paragraph (b)(1) through (6) would state what is required 
for a telehealth grant application to be complete. Proposed paragraph 
(b)(1) would provide that the applicant must provide a plan to 
establish, if needed, the telehealth access point and a description of 
how the size, scope, and grant management plan are feasible. We 
recognize that some applicants may have already established a 
telehealth access point, so for such applicants, a plan to establish a 
point is not necessary. Such applicants must, though, provide evidence 
that a telehealth access point has already been established. Such 
evidence could include site address, implementation date, VA medical 
facility letter of support, etc.
    Proposed paragraph (b)(2) would provide that the applicant must 
submit supporting documentation consisting of: the type of entity that 
is applying for the telehealth grant pursuant to Sec.  84.10; a 
proposed operating budget; supportive resources committed to the 
project; the applicant's ability to control the telehealth access point 
and meet appropriate zoning, preservation, accessibility, safety, and 
environmental laws (including any laws or requirements that apply based 
upon the receipt of grant funds under part 84); and a description of 
the geographic area that the telehealth access point will serve 
(including the name(s) of the municipalities, counties (or parishes), 
or Tribal lands). In addition, the applicant would have to attest that 
the facilities will be used principally to provide to veterans the 
services for which the project was designed. Documentation regarding 
the type of entity could consist of a letter on State or local 
government letterhead verifying the entity is a State or local 
government, or in the case of a non-profit, documentation establishing 
the entity's status. Private businesses could provide their business 
license or incorporation documents. Other interested parties should 
provide appropriate documentation clarifying what type of entity they 
are. The types of supportive resources committed to the project would 
include, but are not limited to, space, staffing, equipment, internet 
services, phone services, and furniture.
    Proposed paragraph (b)(3) would provide that the application must 
include documentation evidencing the experience of the applicant and 
any identified subcontractors, as defined in Sec.  84.5, relevant to 
creating an environment to provide telehealth services or 
organizational experience working with veterans.
    Proposed paragraph (b)(4) would provide that the applicant must 
include a statement containing several affirmations of fact. Section 
701(b)(3) of the Act establishes certain authorized uses of grant 
funds; these were described in detail earlier in this rulemaking. We 
infer that Congress authorized the use of Federal funds for certain 
activities or improvements with the expectation that the telehealth

[[Page 89524]]

access points would meet these requirements. In addition to granting 
funds, the Act provides in section 701(c)(2) that entities that do not 
require grant funding but that enter into an agreement to serve as a 
telehealth access point must ensure the access points are private, 
secure, clean, and accessible.
    In this context, proposed paragraph (b)(4) would require applicants 
to assert that all of the following are true: the project will furnish 
veterans a telehealth access point that is secure, private, clean, 
accessible, and meets the requirements of this grant. This is 
consistent with the authorized uses described in section 
701(b)(3)(A)(ii), (iv)(I), and (v) of the Act. We note that if Congress 
wanted to ensure, pursuant to section 701(c)(2), that entities that do 
not require Federal funds provide access points that are private, 
secure, clean, and accessible, it surely intended that eligible 
entities receiving Federal funds provide access points meeting the same 
requirements. Proposed paragraph (b)(4) also requires the applicant to 
certify that it will continue to maintain and operate the telehealth 
access point supported by this grant until the expiration of the period 
during which VA could seek full recovery under Sec.  84.100. This is 
supported by section 701(a) of the Act, which requires eligible 
entities to enter into agreements for the expansion of telehealth 
capabilities and the provision of telehealth services to veterans. If 
grantees could accept Federal funds but cease providing telehealth 
services, this would be contrary to the purpose articulated by 
Congress. Applicants also must attest that the title or lease to the 
telehealth access point will lie with the applicant and the applicant 
will, at a minimum, provide the equivalent insurance coverage for real 
property and equipment acquired or improved with Federal funds as 
provided to property owned by the applicant. Similar to the explanation 
provided earlier regarding the requirement to certify the applicant 
will continue to maintain and operate the telehealth access point, an 
attestation that the applicant will continue to retain possession of 
the property, even subject to a lease, will ensure that the purposes of 
this program defined by law are capable of being met. The insurance 
requirement also preserves the Government's interest in the items or 
improvements made using grant funds. However, the proposed rule would 
state that telehealth access points that are located on federally owned 
property (e.g., Department of Defense, Indian Health Service) need not 
be insured unless required by the terms and conditions of the Federal 
property award. Other federally owned property is already subject to a 
sufficient surety, and any loss or damage to such property would 
already be incurred by the Government. The statement would also need to 
include an attestation that adequate financial support will be 
available for the duration of the grant agreement; this would have to 
be supported by a demonstration of financial stability and a detailed 
project budget, which includes, but is not limited to, all existing and 
anticipated sources of funds for the project. This is also necessary to 
ensure the continued operation of the telehealth access point and to 
ensure that Federal funds are not wasted. Finally, the applicant would 
have to attest that it will keep records and submit reports as VA may 
reasonably require, within the timeframes required, and, upon demand, 
allow VA access to the records upon which such information is based. As 
explained later in this discussion, proposed Sec. Sec.  84.85 and 84.90 
further describe the reporting and recordkeeping requirements for this 
grant program. These requirements are necessary to ensure that grant 
funds are being used for authorized purposes and the proper accounting 
of Federal funds.
    Proposed Sec.  84.15(b)(5) would be similar to other VA grant 
programs (see Sec. Sec.  61.11 and 62.20) and would require that the 
application also include documentation of the managerial capacity of 
the applicant to: maintain and operate a telehealth access point where 
veterans who use the telehealth access point can receive high quality 
telehealth care from VA health care professionals; continuously assess 
the needs of the telehealth access point and the feedback from veterans 
who use the telehealth access point for quality improvement in areas 
such as accessibility, satisfaction, and experience; customize the 
telehealth access point to meet the needs of veterans who use the 
telehealth access point; and comply with and implement the requirements 
of the telehealth grant. These requirements would ensure that the 
access point is meeting and maintaining all requirements of the 
telehealth grant and is being operated consistent with the purposes set 
forth in section 701(a) of the Act.
    Proposed paragraph (b)(6) would be similar to Sec.  62.20(c) and 
would state that VA may request any additional information in writing 
relevant to the telehealth grant application. This is necessary to 
ensure that VA can verify or clarify information that is relevant to 
determining whether or not to award Federal funds to the applicant 
under section 701(a)-(b) of the Act.
    These application requirements in general are similar to other VA 
grant programs, such as the Grant and Per Diem program and SSVF 
program. See Sec. Sec.  61.11 and 62.20, respectively.
    Proposed paragraph (c) would state that subject to funding 
availability, grantees may apply for one renewal grant per fiscal year, 
after receiving an initial grant. The grantee must submit to VA a 
complete renewal grant application as described in the NOFO. This 
requirement is similar to other VA grant programs, such as the SSVF 
program. See Sec.  62.20. Additionally, under section 701(b)(3)(A)(vi) 
and (vii), sustainment of internet and telephone services are 
permissible uses of grants. Other grants, such as those involving 
renovations or other modifications to the physical infrastructure of a 
telehealth access point, may require additional funding to complete the 
project. While these are clear examples of grants that may make sense 
to be renewed from one fiscal year to another, other grants may not 
require further support, such as when a grant is needed only to 
purchase, replace, or upgrade hardware or software. The NOFO will 
describe any authorized uses of a renewal grant.

Section 84.20 Threshold Requirements Prior To Scoring Telehealth Grant 
Applicants

    Proposed Sec.  84.20 would set forth threshold requirements that 
applicants must meet before their applications can be scored pursuant 
to Sec.  84.25 and would be similar to other VA grant programs such as 
SSVF. See Sec.  62.21. In authorizing VA to award grants under section 
701(a) and (b) of the Act, Congress implicitly delegated to VA the 
authority to determine the terms and conditions for receipt of an 
award. Proposed Sec.  84.20 would provide for the threshold 
requirements and be similar to other existing VA grant programs, such 
as the SSVF program (see Sec.  62.21). These requirements would be 
minimum requirements that would have to be met before VA could score 
applications, and eligible entities could use these to know whether 
they meet these threshold requirements in advance of submitting an 
application. The threshold requirements are intended to be an 
administrative checklist with which eligible entities would confirm 
compliance prior to submitting a telehealth grant application. VA 
anticipates this would reduce the amount of time and resources that VA 
will dedicate to evaluating and scoring applicants while also providing 
clear notice to eligible entities about their obligations and necessary 
qualifications

[[Page 89525]]

This would facilitate the award of grants under section 701(a) and 
(b)(1) by ensuring applicants provide necessary information to allow VA 
to consider and score their application.
    We would state that VA would only score applicants that meet the 
following threshold requirements listed in paragraphs (a) through (h). 
Applicants would have to: (1) file the application within the time 
period established in the NOFO, and any additional information or 
documentation requested by VA under Sec.  84.15(b)(6) would have to be 
provided within the time frame established by VA; (2) complete the 
application in all parts; (3) meet the eligibility criteria in Sec.  
84.10; (4) request a telehealth grant only for uses authorized under 
Sec.  84.45; (5) ensure the veterans the applicant proposes to serve 
are eligible to receive telehealth services under title 38 of the 
United States Code; (6) agree to comply with the requirements of the 
telehealth grant; (7) not have an outstanding obligation to the Federal 
Government that is in arrears and not have an overdue or unsatisfactory 
response to an audit; and (8) not be in default by being in non-
compliance with the terms and conditions of the agreement of any 
previous Federal assistance. These requirements, again, would ensure 
that grants awarded under part 84 would be a responsible use of Federal 
funds and would be for the purposes outlined in section 701(a) and (b) 
of the Act.

Section 84.25 Scoring Criteria for the Telehealth Grant Applicants

    In proposed Sec.  84.25, VA would establish the criteria to be used 
to score applicants who are applying for a telehealth grant. VA would 
need to establish these criteria because 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 
would allow VA to award grants to those applicants who are most 
qualified and would ensure that VA administers grants in a manner 
consistent with section 701 of the Act. Section 701 of the Act did not 
provide criteria for scoring applicants for the telehealth grant. As 
such, we propose to utilize the scoring criteria of similar VA grant 
programs and tailor such criteria to the telehealth grant. See, e.g., 
the SSVF program's scoring criteria at 38 CFR 62.22. In requiring VA to 
award grants, Congress understood that VA would need to establish 
standards to determine which applicants should receive grant awards. 
Congress also specifically recognized that VA would need to prioritize 
applicants when it required in section 701(b)(2) of the Act that VA, to 
the extent practicable, ensure grants are awarded to entities that 
serve veterans in rural and highly rural areas or areas determined to 
be medically underserved.
    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. This is similar to other 
VA grant programs. See, e.g., the SPGP regulations at 38 CFR 78.25.
    Proposed Sec.  84.25(a) would state that VA will award points based 
on the background, qualifications, experience, and past performance of 
the applicant and any subcontractors identified by the applicant, if 
relevant, as demonstrated by the criteria listed in paragraphs (a)(1) 
through (3). These criteria would demonstrate the applicant's knowledge 
and experience in working with veterans and their ability to implement 
the telehealth grant. These attributes would be demonstrative of the 
applicant's ability to manage the telehealth access point consistent 
with authorized purposes.
    Proposed Sec.  84.25(a)(1) would address the applicant's background 
and organizational history by requiring that the applicant include (1) 
the applicant's and any identified subcontractors' background and 
organizational history that would help them maintain and operate a 
telehealth access point for veterans; (2) evidence that the applicant, 
and any identified subcontractors, maintain organizational structures 
with clear lines of reporting and defined responsibilities; and (3) the 
applicant's, and any identified subcontractors', history of complying 
with agreements and not defaulting on financial obligations. These 
criteria are needed to ensure funds are being applied appropriately 
toward the telehealth grant and are similar to other grant programs. 
See Sec.  78.25.
    Proposed Sec.  84.25(a)(2) would set forth what VA would consider 
in scoring the applicant's staff qualifications. This would include 
that evidence the applicant's staff, and any identified subcontractors' 
staff, have experience working with veterans or individuals receiving 
health care, as well as organizational experience in establishing an 
environment suitable for providing health care services.
    Proposed Sec.  84.25(a)(3) would set forth what VA would consider 
in scoring the organizational qualifications and past performance of 
the applicant. This would include that the applicant, and any 
identified subcontractors, have organizational experience partnering 
with health care organizations to create an environment to provide 
telehealth services; the applicant, and any identified subcontractors, 
have organizational experience coordinating or administering telehealth 
services; and the applicant, and any identified subcontractors, have 
organizational experience working with veterans. These criteria would 
demonstrate the applicant's knowledge and experience in working with 
veterans and their ability to implement the telehealth grant. These 
criteria would be similar to Sec.  62.22(a)(3).
    Proposed Sec.  84.25(b) would explain that VA would award points 
based on the applicant's plan to establish, maintain and operate the 
telehealth access point, as demonstrated by the criteria listed in 
paragraphs (b)(1) through (7).
    Proposed Sec.  84.25(b)(1) would explain how VA would score the 
need for the program. Applicants could demonstrate this by showing the 
need for a telehealth access point in a rural, highly rural, or 
medically underserved area. If the applicant is not proposing to 
provide telehealth services in a rural or highly rural area, or an area 
determined to be medically underserved, the applicant instead could 
demonstrate an understanding of the area and provide evidence that a 
telehealth access point is needed to meet the unique needs of veterans 
and the community to be served. As previously stated in this 
rulemaking, the purpose of the telehealth grant is to establish, 
maintain and operate a telehealth access point in locations that are 
rural, highly rural, or medically underserved, to the extent 
practicable. The applicant must demonstrate that telehealth access 
points would be in locations that are in accordance with the purpose of 
the telehealth grant and meet the needs of the community they serve. 
Applicants that can show they would provide telehealth services in 
rural, highly rural, or medically underserved areas would be 
prioritized, to the extent practicable and consistent with the terms of 
the NOFO.
    Proposed Sec.  84.25(b)(2) would explain that VA would score the 
applicant's outreach plan based on whether the applicant has a feasible 
communications plan to inform veterans about the telehealth access 
point and the services provided. This outreach is necessary to ensure 
that the telehealth access point can provide telehealth services to 
veterans, consistent with section 701(a) of the Act.

[[Page 89526]]

    Proposed Sec.  84.25(b)(3) would state that VA would score the 
applicant's plan to establish, maintain, and operate the telehealth 
access point based on whether the size, scope, and grant management 
plan are feasible and whether the applicant's plan is designed and 
scoped to meet the needs of veterans in their community through the 
provision of telehealth services. We would consider whether telehealth 
access point provides flexible hours of operation to maximize the 
telehealth access point's utilization. We would require this 
information because VA would want veterans to make the most use of the 
telehealth access point, which would require the applicant to be 
knowledgeable of the needs of veterans that would be using the 
telehealth access point. For example, some veterans may request use of 
the telehealth access point in the morning while others would prefer 
late afternoons. Applicants who could demonstrate they have a plan to 
accommodate scheduling flexibility would be scored more favorably than 
those who could not.
    Proposed Sec.  84.25(b)(4) would explain what VA would consider in 
scoring the applicant's plan to establish, maintain and operate a 
telehealth access point and use grant funding within the timeline 
specified in their application. We also would consider whether the 
applicant has a hiring plan in place to meet the applicant's 
implementation timeline or has existing staff to meet such timeline, if 
necessary.
    Proposed Sec.  84.25(b)(5) would state that the applicant must 
submit a letter of support from a local VA medical facility or 
facilities confirming the need for the telehealth access point and the 
intent of such VA facilities to work with the grantee. This letter, 
prepared either by a single facility or in combination by several 
facilities, would acknowledge the need for the telehealth access point 
and the intent of such facility or facilities to work with the 
applicant if the applicant is awarded a grant. This is essential 
because telehealth services necessarily involve the delivery of health 
care from one location to another. This letter ensures that VA 
facilities that would be furnishing telehealth services to the access 
point agree that there is a need for an access point in that area and 
that these facilities will work with the applicant, if awarded a grant, 
to provide telehealth services to the veteran in cooperation with the 
entity.
    Proposed Sec.  84.25(b)(6) would state that VA will score 
applicants based on their capacity to safely maintain and operate a 
telehealth access point. This would include staff resources. Similar to 
Sec.  78.25(b)(6), this would ensure that funds are awarded to entities 
that can provide telehealth services to veterans through a grant.
    Lastly, proposed Sec.  84.25(b)(7) would state that VA will score 
applicants based on their feasibility to sustain telehealth access 
point operations. Similar to Sec.  78.25(b)(7), this would ensure that 
funds are awarded to entities that can provide telehealth services to 
veterans through a grant.
    Proposed Sec.  84.25(c) would state that VA will award points based 
on the applicant's quality assurance and evaluation plan, as 
demonstrated by the criteria in paragraphs (c)(1) through (4). We would 
require that these measures be in place to continuously assess and 
improve, as necessary, services provided to veterans and to make 
certain that the applicants address any issues that may arise at the 
telehealth access point.
    Proposed Sec.  84.25(c)(1) would explain that VA would score the 
applicant's ability to evaluate the services provided at the telehealth 
access point. This would be based on whether the applicant provided 
clear, realistic, and measurable goals that reflect the grant's aim of 
providing a telehealth access point to veterans against which the 
applicant's program performance can be evaluated, as well as the 
applicant's plans to continually assess the telehealth access point to 
identify opportunities for quality improvement in areas such as 
accessibility, satisfaction, and experience.
    Proposed Sec.  84.25(c)(2) would explain how VA would score the 
applicant's ability to monitor key elements of the grant award and the 
telehealth access point. Proposed Sec.  84.25(c)(2)(i) would state that 
VA would score whether the applicant has adequate controls in place to 
regularly monitor all aspects of the execution of the grant (including 
any subcontractors) for compliance with all applicable laws, 
regulations, and guidelines. This will help ensure that grant funds are 
used appropriately and responsibly.
    Proposed Sec.  84.25(c)(2)(ii) would state that VA would score the 
applicant's plan to provide an environment that is private, secure, 
clean and complies with the ADA where veterans can participate in their 
telehealth appointments. As noted previously, VA interprets section 701 
of the Act to require these conditions for all participating telehealth 
access points.
    Proposed Sec.  84.25(c)(2)(iii) would provide that the applicant 
must also have financial and operational controls in place to ensure 
the proper use of telehealth grant funding. This information would be 
required to ensure that the grantee is meeting the terms of the 
agreement and maintaining operations of the telehealth access point.
    Lastly, proposed Sec.  84.25(c)(2)(iv) would provide that the 
applicant must have a plan for ensuring that their staff and any 
subcontractors are appropriately trained on, and the telehealth access 
point maintains compliance with, all fire and safety requirements as 
specified by State and local laws and regulations. We would not state 
the specific fire and safety requirements because telehealth access 
points may be placed in a variety of locations, which may not require 
the same standards. This is similar to other grant programs. See Sec.  
61.15.
    We would state in Sec.  84.25(c)(3) that VA would score the 
application based on whether the applicant has a plan to establish a 
system to remediate aspects of the grant program that are non-compliant 
with the terms of the telehealth grant agreement when they are 
identified. Once an issue has been spotted, the applicant must have a 
plan in place to fix it to continue to be compliant with the terms of 
the agreement. This is necessary to ensure that grant funds are used 
appropriately and responsibly.
    Lastly, Sec.  84.25(c)(4) would state that the applicant's program 
management team must have the capability and a system in place to 
provide to VA timely and accurate reports at the frequency set by VA. 
This is necessary to ensure that grant funds are used appropriately and 
responsibly.
    Proposed Sec.  84.25(d) would state that VA will award points based 
on the applicant's financial capability and plan, as demonstrated by 
the criteria listed in paragraphs (d)(1) and (2). Proposed Sec.  
84.25(d)(1) would require that the applicant, and any identified 
subcontractors, are financially stable. This criterion would ensure 
that the funds for the telehealth grant are properly administered.
    We would state in proposed Sec.  84.25(d)(2) that the applicant 
must have a realistic budget for utilizing grant funding and would 
require applicants to submit their implementation timeframe to operate 
the telehealth access point. In addition, the applicant's program would 
have to be cost-effective and could be effectively and fully 
implemented on-budget. VA would award a telehealth grant based in part 
on the projected budget of the applicant. Failure to maintain the 
proposed budget could result in breach of the grant agreement. This is 
necessary to ensure that grant

[[Page 89527]]

funds are used appropriately and responsibly.
    Proposed Sec.  84.25(e) would state that VA will award points based 
on the applicant's area or community associations and relations, as 
demonstrated by the criteria in paragraphs (e)(1) through (4). Proposed 
Sec.  84.25(e)(1) would require that the applicant have a plan for 
developing associations or have existing experience with Federal 
(including VA), State, local, and Tribal government agencies, as well 
as private entities, for the purposes of providing a telehealth access 
point to veterans, as applicable. This information would demonstrate 
associations or plans to develop relationships with the community that 
the applicant plans to serve, including any type of outreach activities 
to engage veterans in their community.
    Proposed Sec.  84.25(e)(2) would require that the applicant (or 
applicant's staff), and any identified subcontractors (or 
subcontractors' staff), as relevant, have fostered successful working 
relationships and experience with public and private organizations 
providing services to veterans. This experience would ensure the 
applicant has a network of resources to help it establish, maintain and 
operate a telehealth access point for veterans now and in the future.
    Proposed Sec.  84.25(e)(3) would require that the applicant have a 
presence in the area or community they intend to serve, and that the 
applicant understands the dynamics of the area or community they intend 
to serve. These criteria would ensure that the applicant understands 
the veterans whom they propose to serve and would facilitate engagement 
with these veterans to deliver telehealth services to them.
    Lastly, proposed Sec.  84.25(e)(4) would require applicants to 
demonstrate that their experience in the area or community they intend 
to serve will enhance the effectiveness of the applicant's program. 
This, again, is necessary to ensure that grant funds are awarded to 
entities that can furnish telehealth services to veterans.

Section 84.30 Selection of Applicants To Receive a Telehealth Grant

    Proposed Sec.  84.30 would state the selection process VA would use 
to identify applicants who would be offered a telehealth grant under 
part 84. Section 701 of the Act does not establish specific provisions 
for the selection of applicants, but Congress clearly intended VA to 
evaluate and select candidates, so we infer that section 701(a) and (b) 
implicitly delegated this authority to VA. VA is proposing to follow a 
selection process that is similar to the selection process used in the 
SSVF program (described in Sec.  62.25) and other grant programs, as 
that process has proven to be an effective and equitable means for 
choosing applicants. We are, therefore, basing the proposed Sec.  84.30 
on current Sec.  62.25, but we have adapted the language for the 
telehealth grant. In proposed Sec.  84.30, we would state that VA will 
use the process in this section to select applicants to receive 
telehealth grants. The process would then be set forth in proposed 
paragraphs (a) through (e).
    Proposed paragraph (a) would explain that VA will score all 
applicants that meet the threshold requirements set forth in Sec.  
84.20 using the scoring criteria set forth in Sec.  84.25. This is 
similar to other grant programs. See Sec.  78.30(a). This ensures that 
applicants will only be scored if they meet the basic requirements 
already discussed.
    Proposed paragraph (b) would state that VA will group applicants 
within the applicable funding priorities if funding priorities are set 
forth in the NOFO. This is similar to other grant programs. See Sec.  
78.30(b). This ensures that applications are evaluated relative to 
other, similar applications.
    Pursuant to proposed paragraph (c), VA would rank those applicants 
who 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 would be ranked in order from 
highest to lowest scores, within their respective funding priority 
group, if any. This is similar to other grant programs. See Sec.  
78.30(c). This ensures that applicants who are selected meet certain 
minimum requirements.
    Pursuant to proposed paragraph (d), VA would use the applicant's 
ranking as the primary basis for selection for funding. However, VA 
will prioritize entities that serve veterans in rural and highly rural 
areas or areas determined to be medically underserved, as practicable. 
This clarification is in alignment with section 701(b)(2) of the Act, 
which provides that, to the extent practicable, the Secretary shall 
ensure that grants are awarded to entities that serve veterans in rural 
and highly rural areas (as determined through the use of the Rural-
Urban Commuting Areas coding system of the Department of Agriculture) 
or areas determined to be medically underserved.
    Lastly, we would state in paragraph (e) that, subject to paragraph 
(d), VA would fund the highest-ranked applicants for which funding is 
available, within the highest funding priority group, if any. If 
multiple applications are received from the same geographic area, the 
applicant's rankings would be the primary basis for selection. If 
funding priorities have been established, to the extent funding is 
available, and still subject to paragraph (d), VA would select 
applicants in the next highest funding priority group based on their 
rank within that group. This would ensure that, consistent with the 
requirement in section 701(b)(2) of the Act and paragraph (d), VA 
selects those applicants that have provided the strongest applications, 
within funding priorities, which should help ensure that Federal funds 
are put to the best use.
    In proposed paragraph (f), we would explain that if an applicant 
would have been selected but for a procedural error committed by VA, VA 
could select that applicant for funding in the next applicable funding 
round or when sufficient funds otherwise become available (provided the 
applicant still wants to participate in the program). If there is no 
material change in the information, a new application would not be 
required. This would ease any administrative burden on applicants when 
VA committed a procedural error 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 part 84.

Section 84.35 Scoring Criteria for Grantees Applying for Renewal of 
Telehealth Grants

    Proposed Sec.  84.35 would state the scoring criteria for grantees 
applying for renewal of telehealth grants. VA would award renewal 
grants in situations where there is a continued need of a grant to 
maintain and operate a telehealth access point based on the veteran 
population that accesses these points. Such situations could include 
continued renovations or sustainment of internet or telephone services. 
VA would evaluate the grantee's prior year's use of the grant to 
maintain and operate a telehealth access point to determine the need 
for a renewal grant. Renewal grants may be awarded even if the number 
of veterans accessing the telehealth access point is small but the 
continued use of the telehealth access point has been beneficial to 
veterans' health care needs. Section 701 of the Act did not have 
provisions for the scoring of telehealth grants renewals, and we would, 
therefore, use the provisions of similar VA grant programs such as the 
SSVF program because these provisions are essential to the effective 
and efficient administration of a grant program and because we infer 
that

[[Page 89528]]

Congress implicitly delegated this authority, as discussed above. See 
Sec.  62.24.
    While this section would not include specific point values for the 
criteria, such point values will be set forth in the NOFO. This would 
allow VA to retain flexibility in determining those point values each 
year of this grant program and would be consistent with the process for 
an initial award under part 84.
    Proposed Sec.  84.35(a) would state that VA will assess the success 
of the grantee's program, as measured by veteran satisfaction with the 
services provided by the grantee and how the grantee met the telehealth 
grant goals and requirements for VA to deliver telehealth services to 
veterans at that telehealth access point in accordance with the 
agreement. These measures should provide a clear basis to determine the 
success of the program based on veteran feedback and VA's experience 
with the grantee in terms of delivering telehealth care through the 
access point.
    Proposed paragraph (b) would state that VA will assess the cost-
effectiveness of the grantee's telehealth access point, as demonstrated 
by how the hours for the point attendant (the grantee staff assisting 
veterans in using the telehealth access point) correlate with the 
veterans' telehealth appointments and how the telehealth access point 
was implemented effectively using the available funding in the 
designated timeframe.
    Proposed paragraph (c) would state that VA will assess the extent 
to which the grantee complies with all applicable laws, regulations, 
and guidelines for the administration of the telehealth access point. 
This is necessary to ensure that grant funds are supporting efforts 
consistent with all legal requirements.

Section 84.40 Selecting Grantees for Renewal of Telehealth Grants

    Proposed Sec.  84.40 would establish the selection criteria for 
renewal of telehealth grants. Section 701 of the Act did not have 
provisions for the selection of telehealth grants renewals, but we 
infer this was an implicit delegation of authority by Congress because 
this would be needed for the administration of the grant program 
required by section 701(a) of the Act. We would, therefore, base the 
requirements in this proposed section on the provisions of similar VA 
grant programs, such as the SSVF program (see Sec.  62.25). These 
provisions are essential to the effective and efficient administration 
of a grant program.
    Proposed paragraph (a) would state that, provided the grantee 
continues to meet the threshold requirements (in proposed Sec.  84.20), 
VA would use the scoring criteria (in proposed Sec.  84.35) to evaluate 
the renewal grant application. This is similar to other grant programs, 
such as the SSVF program. See Sec.  62.25(a).
    Proposed paragraph (b) would explain that VA will rank those 
grantees who receive at least the minimum amounts of total points and 
points per category set forth in the NOFO. The grantees will be ranked 
in order from highest to lowest scores within their respective funding 
priority group, if applicable. This is similar to other grant programs, 
such as the SSVF program. See Sec.  62.25(b). This would also be 
similar to how new applicants would be evaluated under part 84.
    Proposed paragraph (c) would state that VA will use the grantee's 
ranking as the primary basis for the selection for funding. Similar to 
new applicants, though, VA would prioritize entities that serve 
veterans in rural and highly rural areas or areas determined to be 
medically underserved, to the extent practicable. VA would fund the 
highest-ranked grantees for which funding is available within their 
respective funding priority group, if applicable. This also would be 
similar to other grant programs and how new applicants would be 
evaluated under part 84.
    Pursuant to proposed paragraph (d), VA would retain the discretion 
to award any deobligated funds to an applicant or existing grantee. 
This is similar to other grant programs, such as the SSVF program. See 
Sec.  62.25(d). We would further explain in proposed paragraph (d)(1) 
that if VA chose to award deobligated funds to an applicant or existing 
grantee, VA could first award the deobligated 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 community as, 
or a proximate community to, the affected community. Such applicant or 
grantee would need to have the capacity and agree to provide prompt 
services to the affected community. Under this section, the relevant 
NOFO would be the most recently published NOFO which covers the 
geographic area that includes the affected community. In proposed 
paragraph (d)(2), we would explain that if the first such applicant or 
grantee offered the deobligated funds refuses the funds, VA would offer 
to award the funds to the next highest-ranked such applicant or 
grantee, per the criteria in paragraph (d)(1), and continue on in rank 
order until the deobligated funds are awarded. Under proposed paragraph 
(d)(3), VA could offer to award funds under other conditions, or could 
choose to not award the deobligated funds at all, when VA determines 
appropriate based on other relevant factors. For example, if a grantee 
had been maintaining and operating a telehealth access point in a 
community and VA opened a new clinic in that community, the continued 
need for a telehealth access point there may be limited. It may be more 
appropriate for another location to receive those funds to provide 
telehealth services to other veterans with limited access to care. We 
believe this is the most likely reason to shift funds from one 
community to another, but it is not necessarily the only reason, so we 
leave open the possibility that we may need to reallocate deobligated 
funds to other communities. There may also be situations where it would 
not make sense to award deobligated funds, such as near the end of a 
fiscal year when only limited funds would remain. VA would consider 
other relevant factors in making these decisions and act accordingly.
    Paragraph (e) would authorize VA to select an existing grantee for 
available funding, in the next applicable funding round or when 
sufficient funds otherwise become available, based on the grantee's 
previously submitted renewal application, if that grantee is not 
initially selected for renewal because of a procedural error by VA (and 
provided the applicant is still interested in participating in the 
program). If there is no material change in the information, a new 
application would not be required. This would ease any administrative 
burden on grantees and could be used in situations where there is no 
material change in the renewal grant application that would have 
resulted in the grantee's selection for renewal of a grant under part 
84. This is similar to other grant programs, such as the SSVF program. 
See Sec.  62.61. It is also similar to the provisions regarding new 
applicants described above.

Section 84.45 Awards for the Telehealth Grant

    Proposed Sec.  84.45 would establish how awards for telehealth 
grants could be used, related exclusions, and VA's ability to enter 
into agreements with organizations for the establishment of telehealth 
access points.
    Proposed paragraph (a) would list the permissible uses of grant 
funds awarded under part 84. This would be consistent with section 
701(b)(3) of the Act, which provides for the general use of grant

[[Page 89529]]

funds. Paragraphs (a)(1) through (7) are consistent with clauses (i) 
through (vii) in section 701(b)(3)(A) of the Act.
    Proposed paragraph (a)(1) would reflect the criterion from section 
701(b)(3)(A)(i), which states that telehealth grant funds may be used 
for purchasing, replacing, or upgrading hardware or software necessary 
for the provision of secure and private telehealth services. Proposed 
paragraph (a)(1) would clarify that the equipment and software must be 
compatible with telehealth requirements as described in the NOFO and be 
purchased under warranty. We would not place these requirements in 
regulation as technological advances would require VA to constantly 
update its regulations to reflect the new hardware and software 
requirements. Grantees may contact VA with any questions they may have 
regarding the correct hardware or software needed in the telehealth 
access point prior to their purchase. In addition, purchasing the 
equipment and software under warranty safeguards the grantee against 
any manufacturer's defect that might render the equipment or software 
faulty. We also encourage grantees to purchase an extended warranty for 
the hardware and software to safeguard against any costs beyond the 
manufacturer's warranty. VA is aware that some grantees may not have 
the technological expertise to set up the hardware and software in the 
telehealth access points and as such, we would also clarify that the 
telehealth grant funds may be used to purchase services to configure 
and set up grantee-purchased equipment. This would be needed to ensure 
installation and functionality of the equipment. In addition, VA would 
provide direct technical support for the initial connection to a VA-
secure application, and continued VA technical support for issues that 
may arise with the connection to the VA-secure application during the 
term of the grant. We emphasize, though, that this technical support 
would only extend to issues regarding VA's platform or its network and 
would not extend to any technical issues the grantee is experiencing on 
its side of the connection.
    We understand that some organizations expressed interest in VA 
providing equipment and software directly to applicants, but we have 
not proposed to do so here. VA's other grant programs involve the 
distribution of financial resources to grantees so they can obtain 
goods and services as needed to perform the functions of the grant 
program. Adhering to this model for this grant program is appropriate 
for several reasons. First, disbursing funds is a more well-established 
and well-known process that would avoid potential delays or issues with 
implementation. Second, VA would have no way of knowing in advance the 
quantity of hardware and software reasonably expected to be required by 
the grantees that would request VA-purchased hardware and software. If 
not all of the VA-purchased hardware and software were awarded to 
grantees, VA would be left with excess equipment that would be rendered 
outdated after a few years due to changes in technology. Not only would 
this mean a loss of revenue for VA, but, more importantly, it would 
decrease the amount of grant funds available for grantees. This would 
leave communities that are in need of a telehealth access point without 
the ability to provide health care services to veterans. Third, and as 
noted previously, VA encourages grantees to use awards to purchase 
warranties and service plans to ensure that technological support and 
services are available when needed. This preserves a cleaner 
distinction between VA involvement and the grantee's operations. As 
such, we will not be awarding VA-purchased hardware or software as part 
of the grant agreement with the grantee. If grantees identify 
significant issues with this approach, VA can consider whether another 
approach would be legally permissible and more appropriate.
    Proposed paragraph (a)(2) would be consistent with section 
701(b)(3)(A)(ii), which states that the telehealth grant may be used 
for upgrading security protocols for consistency with the security 
requirements of the Department of Veterans Affairs. We would state that 
telehealth grants may be used for upgrading security protocols for 
consistency with VA security requirements and digital applications. We 
would further state that these security requirements would be described 
in the NOFO. Telehealth access point services would be delivered 
through the VA Video Connect secure application or other programs. We 
would not use the term VA Video Connect in this rule in the event the 
platform name changes in the future to avoid amending the regulation. 
Security protocols may include antivirus or information security 
programs, encryption, or other programs or requirements.
    Proposed paragraph (a)(3) would be consistent with section 
701(b)(3)(A)(iii) of the Act, which states that telehealth grants may 
be used for the training of site attendants, including payment of those 
attendants for completing that training. We would state that telehealth 
grant funds may be used for the payment for the training of telehealth 
access point attendants, including payment of those attendants for 
completing that training, with respect to: (1) military and veteran 
cultural competence, if the entity is not an organization that 
represents veterans; (2) equipment required to provide telehealth 
services; (3) privacy, including the Health Insurance Portability and 
Accountability Act (HIPAA) of 1996 privacy rule under 45 CFR part 160 
and part 164, subparts A and E, as it relates to health care for 
veterans; (4) scheduling for telehealth services for veterans; or (5) 
any other unique training needs for the provision of services to 
veterans in a telehealth access point.
    We note that section 701(b)(3)(A)(iii) only authorizes the use of 
grants to pay for wages or salaries of site attendants when they are 
engaged in training described in that clause. We interpret this to mean 
that grant funds may not be used otherwise to pay for salary or wages 
for site attendants when they are not engaged in training. We 
understand this limitation could prove an obstacle for some potential 
applicants for grants under part 84, so we are taking this opportunity 
to clarify that while grant funds cannot be used to pay salaries or 
wages for site attendants, VA could enter into separate agreements 
under separate authorities for these services. VA has general authority 
to appoint staff to provide support to veterans receiving health care 
through telehealth. VA similarly can contract for others to provide 
telehealth services, or to support the delivery of telehealth services, 
to veterans. While grant funds under part 84 are not authorized to pay 
salaries and wages, VA could enter into separate agreements, such as 
contracts, with grantees to cover these costs. These separate 
agreements would not be grant agreements under part 84 and would not be 
governed by the terms and conditions of part 84 or the grant agreement 
themselves. These separate agreements would be authorized by provisions 
of law other than section 701 of the Act and would be governed by those 
laws, any applicable regulations, and the terms of these separate 
agreements. As such, we are not including the payment of salaries or 
wages for site attendants in this rulemaking, but we do provide this 
clarification so that eligible entities who are interested in applying 
for a telehealth grant but who also need financial assistance to pay 
staff to administer the telehealth access points understand the limits 
of the grant program and the alternative

[[Page 89530]]

arrangements VA is considering to try to address this potential issue.
    Proposed paragraph (a)(4) would be consistent with section 
701(b)(3)(A)(iv) of the Act, which provides that the telehealth grant 
may be used for upgrading existing infrastructure owned or leased by 
the entity to make rooms more conducive to telehealth care, including: 
(1) additions or modifications to windows or walls in an existing room, 
or other alterations as needed to create a new, private room, including 
permits or inspections required in association with space 
modifications; (2) soundproofing of an existing room; (3) new 
electrical, telephone, or internet outlets in an existing room; or (4) 
aesthetic enhancements to establish a more suitable therapeutic 
environment. We would state that telehealth grant funds may be used for 
these purposes generally, and regarding aesthetic enhancements, we 
would specifically include, but not limit to, enhancements such as 
seating for both the veteran and caregiver, bariatric seating, and 
adequate lighting. These are examples of enhancements that would make 
the environment more suitable for therapeutic purposes by supporting 
the needs of the veteran (and by extension, a caregiver of a veteran). 
We note that a caregiver, as used in this context, is not limited to a 
caregiver recognized by or participating in a program of caregiver 
assistance administered by VA.
    Proposed paragraphs (a)(5) through (7) would be consistent with 
section 701(b)(3)(A)(v) through (vii) of the Act, which state that 
telehealth grants may be used for upgrading existing infrastructure to 
comply with the ADA; upgrading internet infrastructure and sustainment 
of internet services; and sustainment of telephone services.
    Proposed paragraph (b) would address other exclusions to the use of 
grant funds. Section 701(b)(3)(B) of the Act states that telehealth 
grant funds may not be used for the purchase of new property or for 
major construction projects, as determined by the Secretary. We would 
mirror this exclusion in proposed paragraph (b) by stating that 
telehealth grant funds may not be used for the purchase of new property 
or for major construction projects, or for the acquisition of new space 
through other arrangements (such as a lease agreement), as determined 
by VA. Funds could not be used to acquire new space through other 
arrangements, such as a lease agreement. We would add that major 
construction would consist of new construction, or activities that 
would increase the square footage of an existing facility (e.g., 
relocation of existing exterior walls, roofs, or floors). We would not 
further define major construction in the regulation, but we could 
provide clarification in the NOFO. We would retain flexibility to 
provide further clarity through the NOFO to allow for adjustment to 
changing conditions or situations, both generally and specifically 
based on the needs of veterans, applicants, and grantees.

Section 84.50 General Operation Requirements

    Proposed Sec. Sec.  84.50 through 84.110 provide general parameters 
for this grant program that are similar to requirements established in 
other VA grant programs. These are administrative provisions regarding 
grant administration. As noted previously, there is little in section 
701 of the Act that addresses the issues that would be covered by these 
provisions directly, but we interpret that as an implicit delegation by 
Congress to VA, as these requirements are necessary for the consistent 
and appropriate administration of this grant program. Sound 
administration is necessary to ensure VA and grantees are financially 
responsible in the use of Federal funds.
    Proposed Sec.  84.50 would establish general operation requirements 
for telehealth access points and grantees. These requirements would 
make certain that all grantees adhere to the same standards for 
maintaining the telehealth access points and administering the grants. 
This section would be similar to other VA grant programs such as the 
SSVF program. See Sec.  62.36.
    We would state in proposed paragraph (a) that grantees must 
maintain the confidentiality of veterans utilizing the telehealth 
access point. Maintaining the confidentiality of veterans is paramount 
in keeping with VA's standards of provision of services to veterans. We 
would add that the grantees could not keep any records on the veterans 
who use the telehealth access point. These records are maintained 
exclusively by VA. As previously stated in this rule, VA will provide 
services at the telehealth access points through a secure internet 
application. The grantees will not have access to the veteran's 
information. We would state, however, that this prohibition only 
applies to veteran records, however, grantees must maintain a record of 
the hours the point attendant provides services to veterans. These 
records would be used by VA to make certain that the grantee is 
utilizing telehealth grant funds appropriately and the point attendant 
is only performing duties related to the telehealth access point.
    Proposed paragraph (b) would establish the grantees' responsibility 
to operate and maintain the telehealth access point. This requirement 
would be needed to make certain that the grantee is providing the 
required services in the telehealth access point.
    We would state in proposed paragraph (c)(1) that the grantee must 
notify each veteran that the telehealth services are being provided by 
VA. We would require grantees to notify veterans that telehealth 
services are being provided by VA because under section 701(a) of the 
Act, grantees are required to support VA's provision of telehealth 
services to veterans.
    We would also state in proposed paragraph (c)(2) that the grantee 
must notify the veteran of any conditions or restrictions on the 
receipt of telehealth services by the veteran. We would allow grantees 
to create such rules and standards as are necessary for the safe and 
effective operation of the telehealth access point. We would add that 
the grantee has the right to prohibit services to veterans who have 
demonstrated disruptive behavior within their facility. This would 
ensure the safety of the telehealth access point attendants, other 
veterans utilizing the point, and caregivers of such veterans.
    We would state in proposed paragraph (d) that the grantee must 
participate in telehealth program evaluation interviews and surveys. 
This participation will help to improve services and enhance veterans' 
experience.
    We would state in proposed paragraph (e) that grantees must 
regularly assess that the grant funds are utilized according to the 
agreement. This is necessary to ensure proper accounting for and use of 
Federal funds. Failure to utilize grant funds according to the 
agreement would be a breach of the agreement.
    We would state in proposed paragraph (f) that grantees must ensure 
that telehealth grants are administered in accordance with the 
requirements of part 84, the telehealth grant agreement, and other 
applicable laws and regulations. Further, grantees would be responsible 
for ensuring that any subcontractors, carry out activities in 
compliance with this telehealth grant program agreement, laws, and 
regulations.
    Proposed paragraph (g) would state that the grantees must follow, 
implement, and adhere to all requirements in the grant agreement and in 
2 CFR part 200 on the use and disposition of property improved and/or 
equipment acquired under the telehealth grant program. Regulations at

[[Page 89531]]

2 CFR part 200 generally provide for the use and disposition of 
property once the grantee is no longer participating in the telehealth 
grant program. If potential applicants are interested in which 
regulations may be potentially relevant, VA would direct such 
individuals to review 2 CFR 200.311(c), 200.312, 200.313, and 200.439. 
VA's draft grant agreements will include specific terms setting forth 
disposition requirements for grantees and will be consistent with these 
regulations.
    The disposition of property includes any additions or modifications 
to windows or walls in an existing room, or other alterations as needed 
to create a new, private room for the telehealth access point. 
Disposition would also include any federally owned telehealth equipment 
or equipment acquired with telehealth grant funds. The recoupment of 
funds used for property improvements made or equipment acquired under 
the telehealth grant would also be stated in the NOFO. VA would provide 
for the specifics regarding the improvement, maintenance, and 
disposition of upgraded infrastructure or purchased equipment in the 
telehealth grant agreement.

Section 84.55 Fee Prohibition

    Proposed Sec.  84.55 would state that grantees must not charge a 
fee to veterans for providing VA services in telehealth access points 
that are funded with amounts from the telehealth grant. Under section 
701(a) of the Act, grantees are required to support VA's provision of 
telehealth services to veterans. As proposed elsewhere in this rule, VA 
would eliminate copayment liability on the part of veterans who use 
telehealth services for VA care; prohibiting grantees from charging 
veterans for these services would ensure parity and support the 
ultimate goal of this program; to increase veterans' access to care. We 
also believe this would be consistent with current practice. We do not 
believe Congress intended to allow grantees to charge veterans for the 
use of telehealth access points; this type of decision would be a 
significant departure from other VA care and would deter utilization of 
these locations, which would be contrary to the goal of increased 
access. Further, section 701 of the Act does not authorize the 
collection of fees by grantees, and we do not believe Congress would 
have been silent on such a major issue if it had intended for grantees 
to receive such payments. This is consistent with the intent of the Act 
and similar to other VA grant programs, such as the SSVF program. See 
38 CFR 62.37.

Section 84.60 Notice of Funding Opportunity (NOFO)

    As previously stated in this rulemaking, a NOFO would alert 
eligible entities that there are funds available for the telehealth 
grant. Proposed Sec.  84.60 would explain what would be included in a 
NOFO. This would align with other VA grant programs, such as the SSVF 
program (see Sec.  62.40). This would also be consistent with the 
requirements and recommendations within 2 CFR part 200 regarding 
notices of funding opportunity (see 2 CFR 200.204).
    In proposed Sec.  84.60, we would state that when funds are 
available for the telehealth grant, VA will publish a NOFO. We would 
also state that VA has the authority to modify the duration, amount, or 
both of an existing telehealth grant agreement, subject to availability 
of funding and grantee performance, as set forth in Sec.  84.65. We 
would make this statement to allow VA to modify an existing telehealth 
grant depending on the performance of the grantee to provide services 
at the telehealth access point. The NOFO would identify: (1) the 
location for obtaining the applications for the telehealth grant; (2) 
the date, time, and place for submitting completed telehealth grant 
applications; (3) the estimated amount and type of grant funding 
available; (4) any priorities for or exclusions from funding to meet 
the requirements of the telehealth grant and VA goals for providing 
telehealth services to veterans; (5) the length of term for the 
telehealth grant award; (6) specific point values to be awarded for 
each criterion listed in Sec. Sec.  84.25 and 84.35; (7) the minimum 
number of total points and points per category that an applicant or 
grantee, as applicable, must receive for a telehealth grant to be 
funded; (8) any maximum award amounts for the telehealth grant; (9) the 
timeframes and manner for payments under the telehealth grant; and (10) 
other information necessary for the telehealth grant application 
process as determined by VA. These provisions would ensure that 
eligible entities have all necessary information to submit a complete 
and timely application for a telehealth grant under part 84.

Section 84.65 Telehealth Grant Agreements

    As previously explained in this rulemaking, section 701(a) of the 
Act provides that VA shall enter into agreements, and expand existing 
agreements, with organizations that represent or serve veterans, 
nonprofit organizations, private businesses, and other interested 
parties for the expansion of telehealth capabilities and the provision 
of telehealth services to veterans through the award of grants for 
telehealth. Proposed Sec.  84.65 would provide what the telehealth 
grant agreement entails and would align with 2 CFR 200.201 and other VA 
grant programs, such as the SSVF program. See Sec.  62.50.
    Proposed paragraph (a) would apply to grant agreements for the 
initial telehealth grant. We would state that after an applicant is 
selected for a telehealth grant in accordance with Sec.  84.30, VA will 
draft a telehealth grant agreement to be executed by VA and the 
applicant. Upon execution of the telehealth grant agreement, VA would 
obligate grant funds to cover the amount of the approved grant, subject 
to the availability of funding. We would also state that the telehealth 
grant agreement would provide that the grantee agrees, and will ensure 
that each subcontractor, as relevant, agrees, to: (1) operate the 
telehealth access point in accordance with the provisions of part 84 
and the applicant's telehealth 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 providing services in a telehealth access point in an 
effective and efficient manner; and (3) provide such additional 
information as deemed appropriate by VA. These requirements would 
ensure compliance with legal requirements associated with the grant and 
with proper and effective administration of a telehealth access point.
    Proposed paragraph (b) would apply to instances where the grantee 
has already received an initial grant for telehealth and is applying 
for renewal of a telehealth grant. We would state that after a grantee 
is selected for renewal of a telehealth grant in accordance with Sec.  
84.40, VA would draft a telehealth grant agreement to be executed by VA 
and the grantee. Upon execution of the telehealth grant agreement, VA 
would obligate grant funds to cover the amount of the approved 
telehealth grant, subject to the availability of funding. To avoid 
redundancy in regulations, we would state that the agreement for the 
renewal of the telehealth grant will contain the same provisions 
described in paragraph (a). As with paragraph (a), these requirements 
would ensure compliance with legal requirements associated with the 
grant and with proper and effective administration of a telehealth 
access point.

[[Page 89532]]

    We would provide in paragraph (c) that grantees may not use funds 
provided under part 84 to replace Federal, State, Tribal, or local 
funds previously used, or designated for use, to establish a telehealth 
access point. Grantees must only use funds for the purposes stated in 
part 84. This is necessary to ensure that grant funds are not used as a 
substitute for other available resources.
    Lastly, we would provide in proposed paragraph (d) that subject to 
Sec. Sec.  84.60 and 84.100, the availability of funding, and grantee 
performance, VA may modify an existing telehealth grant agreement by 
one or both of the following: (1) extending or reducing the period for 
which the telehealth grant was established; and (2) increasing or 
decreasing the amount of funds awarded. These modifications would be 
contingent upon the grantee's provision of services at the telehealth 
access point. Also, any extension of funds would be provided based on 
the availability of funds. VA would provide in the NOFO the terms under 
which extensions would be granted. Any reduction in funds or period of 
the telehealth grant agreement would be subject to the provisions in 
Sec.  84.100.

Section 84.70 Program or Budget Change and Corrective Action Plans

    Proposed Sec.  84.70 sets forth the requirements for changes to the 
telehealth grant agreement that propose significant changes that would 
alter the terms of the agreement. These requirements would be similar 
to how VA manages program and budget changes and corrective action 
plans in other VA grant programs, such as the SSVF program. See Sec.  
62.60. The requirements would also allow VA to ensure that grant funds 
are used appropriately and maintain control over the quality of the 
services provided by the grantee. This section is also consistent with 
2 CFR 200.308, which establishes policy and processes for revision of 
budget and program plans for Federal awards. VA does not intend to 
waive any modifications that would require prior written VA approval as 
authorized by 2 CFR 200.308(e).
    Proposed paragraph (a) would cover instances in which a grantee 
requests a modification to their telehealth grant agreement. We would 
state that a grantee must submit to VA a written request to modify a 
telehealth grant agreement for any proposed significant change that 
will alter the agreement. We would also state that if VA approves such 
change, VA will issue a written amendment to the telehealth grant 
agreement. In addition, grantees would have to receive VA's approval 
prior to implementing a significant change. This would ensure that the 
grant agreement is current and accurate.
    We would state in proposed paragraph (a)(1) what would constitute a 
significant change to the telehealth grant agreement. A significant 
change would include, but not be limited to, a change in the grantee or 
any subcontractors, identified in the telehealth grant agreement; a 
change in the area or community served by the grantee; or addition or 
removal of equipment, connectivity, or other services provided by the 
grantee; and a change in budget line items that are more than 10 
percent of the total telehealth grant award. These are common examples 
of possible changes, but they are not an exhaustive list; VA proposes 
to retain flexibility to address novel circumstances as they arise. If 
applicants or grantees have questions about whether a change would 
constitute a significant change, they may contact VA for assistance.
    Proposed paragraph (a)(2) would state that VA's approval of changes 
would be contingent upon the grantee's amended application retaining a 
high enough rank to have been competitively selected for funding in the 
year that the application was granted. This would ensure that grant 
funds are used for purposes that would have received an award if the 
modified terms had been the initially proposed terms.
    We would state in proposed paragraph (a)(3) that each telehealth 
grant modification request must contain a description of the revised 
proposed use of telehealth grant funds. This, again, would ensure that 
the grant agreement accurately reflects the intended use of funds and 
operation of the telehealth access point.
    Proposed paragraph (b) would provide for corrective action plans 
that a grantee must submit to VA if the grantee's expenditures vary 
from the expenditures listed in the agreement. We would state that VA 
may require that the grantee initiate, develop, and submit to VA for 
approval a Corrective Action Plan (CAP) if actual telehealth grant 
expenditures vary from the amount disbursed to a grantee or actual 
telehealth grant activities vary from the telehealth grant agreement. 
Reporting frequency may be on a bi-monthly, monthly, or quarterly 
basis. We would add in proposed paragraph (b)(1) 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(s). We would also state in 
proposed paragraph (b)(2) that, after receipt of the CAP, VA would send 
a letter to the grantee indicating that the CAP is approved or 
disapproved. If disapproved, VA would make beneficial suggestions to 
improve the proposed CAP and request resubmission or take other actions 
in accordance with this program. This would ensure that grant funds are 
used for appropriate and authorized purposes, and that such funds are 
used responsibly.
    Proposed paragraph (c) would provide that grantees must inform VA 
in writing of any key personnel changes, local or national, (e.g., new 
executive director, telehealth grant program director, or chief 
financial officer) and grantee address changes within 30 days of the 
change. This would ensure that critical changes that might affect the 
maintenance and operation of the telehealth access point are 
communicated to VA in a timely manner.

Section 84.75 Faith-Based Organizations

    Proposed Sec.  84.75 would state that organizations that are faith-
based are eligible, on the same basis as any other organization, to 
participate in the telehealth grant under part 84 in accordance with 38 
CFR part 50. Part 50 explains that faith-based organizations are 
eligible to participate in VA's grant-making programs on the same basis 
as any other organizations, that VA will not discriminate against 
faith-based organizations in the selection of service providers, and 
that faith-based and other organizations may request accommodations 
from program requirements and may be afforded such accommodations in 
accordance with Federal law.
    VA would apply the provisions of 38 CFR part 50 to the telehealth 
grant. However, we would not restate the provisions of part 50 in 
proposed part 84 but would merely cite to it. VA recently amended part 
50 on March 4, 2024 (89 FR 15671), and in the event that part 50 is 
further amended in the future, VA would not need to amend part 84.

Section 84.80 Financial Management

    Proposed Sec.  84.80 would provide for the grantee's financial 
management of the telehealth grant and would be similar to other VA 
grant programs, such as the SSVF program. See Sec.  62.70. These 
provisions are necessary to ensure that grantees comply with applicable 
Federal law, regulations, and policy and that grant funds are used 
appropriately.

[[Page 89533]]

    Proposed paragraph (a) would state that grantees must comply with 
applicable requirements of the Uniform Administrative Requirements, 
Cost Principles, and Audit Requirements for Federal Awards under 2 CFR 
part 200. As noted previously, 2 CFR part 200 establishes the uniform 
administrative requirements, cost principles, and audit requirements 
for Federal awards to non-Federal entities.
    Proposed paragraph (b) would state that 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.
    Proposed paragraph (c) would state payment up to the amount 
specified in the telehealth grant must be made only for allowable, 
allocable, and reasonable costs in establishing, maintaining, and 
operating the telehealth access point. We would add that the 
determination of allowable costs must be made in accordance with the 
applicable Federal Cost Principles set forth in 2 CFR part 200.
    Proposed paragraph (d) would state that, in accordance with 2 CFR 
200.414, applicants that do not have a negotiated indirect cost rate 
(NICRA) may (1) request a de minimis rate, which is in accordance with 
the amounts set forth in 2 CFR 200.414(f). In the alternative, 
applicants may (2) apply the NICRA established with their cognizant 
agency for indirect costs (as defined in 2 CFR 200.1) or may (3) 
request to negotiate an indirect cost rate with VA.

Section 84.85 Telehealth Grant Reports

    Proposed paragraph Sec.  84.85 would establish the reporting 
requirements for the telehealth grant. Such reporting requirements 
would ensure that grant funds are being used consistent with the Act 
and with part 84. In addition, the reports would allow VA to be 
transparent and show that it is being a good fiscal steward of the 
taxpayer dollar. Additionally, this is similar to how VA administers 
other grant programs such as the SSVF program. See Sec.  62.71. 
Reporting requirements tasked to grantees will be in accordance with 
their risk level associated with their risk assessment and set forth in 
the NOFO. Examples may include bi-monthly, monthly, or quarterly 
reports of grant funding awarded.
    Proposed paragraph (a) would state that 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 the telehealth grant.
    Proposed paragraph (b) would state, grantees must report on the 
deviations to grant expenditures to VA on a basis determined by VA 
(e.g., bi-monthly, monthly, or quarterly) in accordance with the 
results of their risk assessment; this would be set forth in the NOFO. 
We would add a note to proposed paragraph (b) to direct the reader to 
information on corrective action plans, which may be required in this 
circumstance, and to see Sec.  84.70.
    Proposed paragraph (c) would require grantees, at least once per 
year, to submit to VA a report that describes grant agreement 
compliance, legal and regulatory compliance, the activities for which 
the telehealth grant funds were used, including but not limited to, the 
equipment costs, renovation expenses, attendant expenses, any other 
types of ongoing expenses for services provided during the year covered 
by the report, and any other information that VA may request.
    To be fully informed on how the grantee utilizes the telehealth 
grant funds, we would state in proposed paragraph (d) that VA may 
request additional reports to allow VA to fully assess the provision or 
coordination of the provision of services under part 84.
    Proposed paragraph (e) would state that all pages of the reports 
must cite the assigned telehealth grant number and be submitted in a 
timely manner as set forth in the grant agreement.
    Proposed paragraph (f) would state that grantees agree to allow VA 
to post information from reports on the internet or use such 
information in other ways deemed appropriate by VA (including, but not 
limited to, activities regarding litigation). Grantees should clearly 
mark confidential information to assist VA in redacting such 
information when appropriate. We would expressly call out litigation 
activities as one use for which grantees would have to consent to VA's 
use of information, but we emphasize this is not the only potentially 
permissible use. We would add that grantees must clearly mark 
information that is confidential to individual veterans so VA could 
exclude such information from any public use. We do not anticipate that 
any such information would be included given the prohibition on the 
retention of records on the veterans who use the telehealth access 
point under proposed Sec.  84.50(a), but we propose including this 
language out of an abundance of caution.

Section 84.90 Recordkeeping

    Proposed Sec.  84.90 would provide recordkeeping requirements for 
the telehealth grant. This provision would be similar to other VA grant 
programs such as the SSVF program (see Sec.  62.72) and 2 CFR 200.334, 
requiring Federal award recipients to keep financial records, 
supporting documents, statistical records, and all other non-Federal 
entity records pertinent to a Federal award for a three-year retention 
period. We would state that grantees must ensure that records are 
maintained for at least a three-year period (unless a longer period is 
otherwise required) to document compliance with the telehealth grant. 
We would add that grantees must produce such records at VA's request.

Section 84.95 Technical and Technological Assistance

    VA understands that eligible entities may need technical assistance 
in complying with requirements of part 84. VA currently provides 
technical assistance to other grantees through other programs. See, 
e.g., Sec.  62.73. Proposed paragraph (a) would state that VA will 
provide technical assistance, as necessary, to eligible entities to 
meet the requirements of part 84. This assistance is available to 
eligible entities, not just grantees, and can include assistance with 
applying for a grant under part 84 or administering a grant awarded 
under part 84.
    In addition, we recognize that grantees may sometimes experience 
technological issues or challenges when connecting to VA's secure 
application and may need technological assistance throughout the length 
of the telehealth grant agreement. We would state proposed paragraph 
(b), that VA will provide technological assistance, as necessary, to 
grantees to ensure that the grantee's equipment is able to connect to 
the VA system and network as necessary to support the delivery of 
telehealth services. As noted above, proposed Sec.  84.45(a)(1) would 
require that all equipment must be compatible with telehealth 
requirements as described in the NOFO and be purchased under warranty. 
The provision of technological assistance to grantees is implicitly 
authorized by section 701 of the Act, as it would frustrate the purpose 
of this program if grantees were experiencing technological issues 
unique to accessing VA's system and VA was unable to assist in 
resolving these issues. This assistance is also no different than what 
VA provides for other members of the public attempting to use VA 
platforms or networks; if there are service outages or disruptions, 
these issues are reported to VA, and VA works to address them to 
restore operability. We emphasize, though, as noted above, that this

[[Page 89534]]

assistance would be limited to VA's secure platform and its network; 
any issues regarding the grantee's equipment or network would not be 
addressed through VA's technological assistance described here. VA 
encourages grantees to purchase warranties and service plans, as 
appropriate, to resolve technological issues with their networks or 
equipment.
    Proposed paragraph (c) would state that the technical and 
technological assistance will be provided either directly by VA or 
through grants or contracts with appropriate public or nonprofit 
private entities. Like paragraph (b), this assistance would be limited 
to issues with VA's platform or network. This proposed section would 
align with other VA grant programs, at least in relation to the 
provision of technical assistance, while also addressing unique issues 
raised by this program. It would also be consistent with how VA 
provides similar support to the public with other platforms to ensure 
operability.

Section 84.100 Withholding, Suspension, Deobligation, Termination, and 
Recovery of Funds by VA

    If a grantee fails to comply with the terms of the telehealth 
agreement, VA could withhold, suspend, deobligate, terminate, or 
recover grant funds. Section 84.100(a) would explain that VA would 
enforce part 84 through such actions as may be appropriate. Appropriate 
actions would include withholding, suspension, deobligation, 
termination, recovery of funds by VA, and actions in accordance with 2 
CFR part 200.
    Part 200 of 2 CFR describes such actions. See 2 CFR 200.208, 
200.305, 200.339 through 200.343, and 200.346. As telehealth grants are 
subject to the requirements of 2 CFR part 200, VA explicitly references 
2 CFR part 200 in proposed Sec.  84.100 to ensure that grantees 
understand and know where to locate these requirements related to 
withholding, suspension, deobligation, termination, and recovery of 
funds. 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 veterans may occur. We would 
state in proposed Sec.  84.100(b)(1) that upon taking a remedy for 
noncompliance under paragraph (a), grantees have 30 days to object and 
provide information and documentation challenging the action, subject 
to three conditions: (1) objections must be provided to VA in writing; 
(2) VA's decision stands while an objection is under consideration; and 
(3) other VA decisions (such as competing award decisions, continuation 
award decisions, decisions made with the consent of the recipient) are 
not subject to this opportunity to object. Specifically regarding this 
third condition, VA could begin making other decisions, such as 
reallocating funds under an existing or future NOFO.
    We would add in proposed Sec.  84.100(b)(2) that the grant 
agreement will provide additional requirements and responsibilities for 
grantees in the event of noncompliance under paragraph (a). This will 
ensure that the disruption and impact upon veterans is minimized as 
much as possible.

Section 84.105 Oversight

    To verify that the telehealth grant is utilized in accordance with 
the agreement, VA may inspect the telehealth access points and records 
of any entity that has received a telehealth grant when VA deems 
necessary to determine compliance with Sec. Sec.  84.0 through 84.110. 
We would state such requirement in this section, which would align with 
other VA grant programs, such as the SSVF program (see Sec.  62.63). We 
would add that the authority to inspect does not authorize VA to manage 
or control the organization. We would also state that monitoring and 
oversight requirements for each grantee would be determined by a pre-
award risk assessment under 2 CFR 200.206. This would reduce the burden 
for complying with oversight requests for those grantees whose awards 
are below certain thresholds established in the NOFO.

Section 84.110 Telehealth Grant Closeout Procedures

    Proposed Sec.  84.110 would describe the telehealth grant closeout 
procedures. Section 84.110 explains that telehealth grants would 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 telehealth grants are subject to the requirements of 2 CFR part 200, 
VA explicitly references 2 CFR part 200 in Sec.  84.110 to ensure that 
grantees understand and know where to locate these requirements. VA 
refers to 2 CFR part 200 rather than include the current citations to 
those requirements or outline the actual closeout requirements in this 
section because 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.

Executive Orders 12866, 13563 and 14094

    Executive Order 12866 (Regulatory Planning and Review) directs 
agencies to assess the costs and benefits of available regulatory 
alternatives and, when regulation is necessary, to select regulatory 
approaches that maximize net benefits (including potential economic, 
environmental, public health and safety effects, and other advantages; 
distributive impacts; and equity). Executive Order 13563 (Improving 
Regulation and Regulatory Review) emphasizes the importance of 
quantifying both costs and benefits, reducing costs, harmonizing rules, 
and promoting flexibility. Executive Order 14094 (Executive Order on 
Modernizing Regulatory Review) supplements and reaffirms the 
principles, structures, and definitions governing contemporary 
regulatory review established in Executive Order 12866 of September 30, 
1993 (Regulatory Planning and Review), and Executive Order 13563 of 
January 18, 2011 (Improving Regulation and Regulatory Review). The 
Office of Information and Regulatory Affairs has determined that this 
rulemaking is not a significant regulatory action under Executive Order 
12866, as amended by Executive Order 14094. The Regulatory Impact 
Analysis associated with this rulemaking can be found as a supporting 
document at www.regulations.gov.

Regulatory Flexibility Act

    The Secretary hereby certifies that this proposed rule will not 
have a significant economic impact on participating eligible entities 
who are awarded grants by VA or small businesses. To the extent there 
is any such impact, it will result in financial assistance and revenue 
for them as they purchase, upgrade, or install new technologies or 
infrastructure. Therefore, pursuant to 5 U.S.C. 605(b), the initial and 
final regulatory flexibility analysis requirements of 5 U.S.C. 603 and 
604 do not apply.

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

[[Page 89535]]

one year. This proposed rule would have no such effect on State, local, 
and Tribal governments, or on the private sector.

Paperwork Reduction Act

    This proposed rule includes provisions constituting a new 
collection 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 and approval.
    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. If OMB does not approve the 
collection of information as requested, VA will immediately remove the 
provisions containing the 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-AS20; 
Telehealth Grant Program'' and should be sent within 60 days of 
publication of this rulemaking. The collection of information 
associated with this rulemaking can be viewed at: www.reginfo.gov/public/do/PRAMain.
    OMB is required to make a decision concerning the collection of 
information contained in this rulemaking between 30 and 60 days after 
publication of this rulemaking in the Federal Register (FR). Therefore, 
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 provisions of this 
rulemaking.
    The Department considers comments by the public on new collections 
of information in:
     Evaluating whether the new 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 new collection 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 collection 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 associated with this rulemaking 
contained in 38 CFR 84.15, 84.50, 84.75, and 84.85 are described 
immediately following this paragraph, under its respective title.

    Title: Telehealth Grant Program Grant Application.
    OMB Control No.: 2900-TBD (New).
    CFR Provision: 38 CFR 84.15.
     Summary of collection of information: The new collection 
of information in 38 CFR 84.15 requires that applications be submitted 
to be evaluated and considered for a grant under new part 84. 
Applications require specific information so that VA can properly 
evaluate such applications for telehealth grants. We note that the 
average burden per response is the highest threshold requirement, but 
this estimate would be a lower time burden for lower threshold 
applicants.
     Description of need for information and proposed use of 
information: This collection of information is necessary to award 
telehealth grants to eligible entities.
     Description of likely respondents: Organizations that 
represent or serve veterans, nonprofit organizations, private 
businesses, and other interested parties for the expansion of 
telehealth capabilities and the provision of telehealth services to 
veterans through the award of telehealth grants.
     Estimated number of respondents: 65.
     Estimated frequency of responses: Once annually.
     Estimated average burden per response: 1500 minutes.
     Estimated total annual reporting and recordkeeping burden: 
1625 hours.
     * Estimated annual cost to respondents: $51,155.00.

    Title: Telehealth Grant Program Grant Renewal Application.
    OMB Control No.: 2900-TBD (New).
    CFR Provision: 38 CFR 84.15.
     Summary of collection of information: The new collection 
of information in 38 CFR 84.15 requires that renewal applications be 
submitted to be evaluated and considered for a renewal of a grant under 
new part 84. Applications require specific information so that VA can 
properly evaluate such applications for renewal of telehealth grants. 
We note that the average burden per response is the highest threshold 
requirement, but this estimate would be a lower time burden for lower 
threshold applicants.
     Description of need for information and proposed use of 
information: This collection of information is necessary to award 
renewal telehealth grants to grantees.
     Description of likely respondents: Grantees that seek 
renewal of their telehealth grant.
     Estimated number of respondents: 50.
     Estimated frequency of responses: Once annually.
     Estimated average burden per response: 600 minutes.
     Estimated total annual reporting and recordkeeping burden: 
500 hours.
     *Estimated annual cost to respondents: $15,740.00.

    Title: Telehealth Grant Program Veterans Satisfaction Survey.
    OMB Control No.: 2900-TBD (New).
    CFR Provision: 38 CFR 84.50.
     Summary of collection of information: The new collection 
of information in 38 CFR 84.50 requires grantees to conduct 
satisfaction surveys from veterans.
     Description of need for information and proposed use of 
information: The collection of information by VA is necessary to 
evaluate whether veterans are satisfied with the services provided by 
the grantee and the effectiveness of such services.
     Description of likely respondents: Veterans who receive 
telehealth services at telehealth access points.
     Estimated number of respondents: 500.
     Estimated frequency of responses: Once annually.
     Estimated average burden per response: 5 minutes.
     Estimated total annual reporting and recordkeeping burden: 
42 hours.
     * Estimated annual cost to respondents: $1,322.16.

    Title: Telehealth Grant Program Grantee Satisfaction Survey.
    OMB Control No.: 2900-XXXX (New/TBD).
    CFR Provision: 38 CFR 84.85.
    Summary of collection of information: The new collection of 
information in 38 CFR 84.85 has been developed to capture telehealth 
grantee reports. As stated, VA may require grantees to provide, in any 
form as may be prescribed, reports or answers in writing to specific 
questions, surveys, or questionnaires as VA determines necessary to 
carry out the telehealth grant program and agreement.

[[Page 89536]]

     Description of need for information and proposed use of 
information: This collection of information is necessary to provide 
more effective customer service and identify areas of improvement.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 50.
     Estimated frequency of responses: Once annually.
     Estimated average burden per response: 20 minutes.
     Estimated total annual reporting and recordkeeping burden: 
17 hours.
     * Estimated annual cost to respondents: $535.16.

    Title: Telehealth Grant Program Annual Performance Report.
    OMB Control No.: 2900-XXXX (New/TBD).
    CFR Provision: 38 CFR 84.85.
     Summary of collection of information: The new collection 
of information in 38 CFR 84.85 requires grantees to provide reports, as 
VA requests, 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 the telehealth grant program and 
agreement and to assess the provision of services under this grant 
program and the grant agreement.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 50.
     Estimated frequency of responses: Once annually.
     Estimated average burden per response: 45 minutes.
     Estimated total annual reporting and recordkeeping burden: 
38 hours.
     * Estimated annual cost to respondents: $1,196.24.

    Title: Telehealth Grant Program Other Performance Report.
    OMB Control No.: 2900-XXXX (New/TBD).
    CFR Provision: 38 CFR 84.85.
     Summary of collection of information: The new collection 
of information in 38 CFR 84.85 requires grantees to provide reports, as 
VA requests, 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 determine 
compliance with the requirements for the telehealth grant and to assess 
the provision of services under this grant program and the grant 
agreement.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 50.
     Estimated frequency of responses: 2 times annually.
     Estimated average burden per response: 30 minutes.
     Estimated total annual reporting and recordkeeping burden: 
50 hours.
     * Estimated annual cost to respondents: $1,574.00.

    Title: Telehealth Grant Program Annual Financial Expenditure 
Report.
    OMB Control No.: 2900-XXXX (New/TBD).
    CFR Provision: 38 CFR 84.85.
    Summary of collection of information: The new collection of 
information in 38 CFR 84.85 requires grantees to provide reports, as VA 
requests, to assess the provision of services under this grant program. 
At least once per year, each grantee must submit to VA a report that 
describes grant agreement compliance, legal and regulatory compliance, 
the activities for which the telehealth grant funds were used 
including, but not limited to, the equipment costs, renovation 
expenses, attendant expenses, any other types of ongoing expenses for 
services provided during the year covered by the report, and any other 
information that VA may request.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determine 
compliance with the requirements for the telehealth grant and to assess 
the ongoing expenditures under this grant program and the grant 
agreement.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 50.
     Estimated frequency of responses: Once annually.
     Estimated average burden per response: 45 minutes.
     Estimated total annual reporting and recordkeeping burden: 
38 hours.
     * Estimated annual cost to respondents: $1,196.24.

    Title: Telehealth Grant Program Other Financial Expenditure Report.
    OMB Control No.: 2900-XXXX (New/TBD).
    CFR Provision: 38 CFR 84.85.
     Summary of collection of information: The new collection 
of information in 38 CFR 84.85 requires grantees to provide reports, as 
VA requests, to assess the provision of services under this grant 
program. If actual telehealth grant expenditures vary from the amount 
disbursed to a grantee or actual telehealth grant activities vary from 
the grantee's program description provided in the telehealth grant 
agreement, grantees must report the deviation to VA. Reporting 
frequency may be on a bi-monthly, monthly, or quarterly basis. For the 
frequency of responses, we estimate that this reporting would be on a 
quarterly basis. We note that the average burden per response is the 
highest threshold requirement, but this estimate would be a lower time 
burden for lower threshold applicants.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determining 
compliance with the requirements for the telehealth grant and to assess 
the provision of services and the ongoing expenditures under this grant 
program and the grant agreement.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 50.
     Estimated frequency of responses: Quarterly = 4 times 
annually.
     Estimated average burden per response: 30 minutes.
     Estimated total annual reporting and recordkeeping burden: 
100 hours.
     * Estimated annual cost to respondents: $3148.00.

    Title: Compliance--Program & Budget Changes.
    OMB Control No.: 2900-XXXX (New/TBD).
    CFR Provision: 38 CFR 84.70 and 84.85.
     Summary of collection of information: The new collection 
of information in 38 CFR 84.85 requires grantees to provide reports, as 
VA requests, to assess the provision of services under this grant 
program. These compliance reports also include program changes and 
corrective action plans under 38 CFR 84.70.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determine 
compliance with the requirements for the telehealth grant and to assess 
the provision of services under this grant program and the grant 
agreement.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 10.
     Estimated frequency of responses: 2 times annually.
     Estimated average burden per response: 15 minutes.
     Estimated total annual reporting and recordkeeping burden: 
5 hours.
     * Estimated annual cost to respondents: $157.40.

    Title: Compliance--Corrective Action Plan.

[[Page 89537]]

    OMB Control No.: 2900-XXXX (New/TBD).
    CFR Provision: 38 CFR 84.70 and 84.85.
     Summary of collection of information: The new collection 
of information in 38 CFR 84.85 requires grantees to provide reports, as 
VA requests, to assess the provision of services under this grant 
program. These compliance reports also include program changes and 
corrective action plans under 38 CFR 84.70.
     Description of need for information and proposed use of 
information: The collection of information is necessary to determine 
compliance with the requirements for the telehealth grant and to assess 
the provision of services under this grant program and the grant 
agreement.
     Description of likely respondents: Grantees.
     Estimated number of respondents: 5.
     Estimated frequency of responses: Once annually.
     Estimated average burden per response: 30 minutes.
     Estimated total annual reporting and recordkeeping burden: 
3 hours.
     * Estimated annual cost to respondents: $94.44.
     * The total respondent information collection burden cost 
associated with this regulation is estimated to be $76,118.64 (2,418 
burden hours x $31.48 per hour). To estimate the total information 
collection burden cost, VA used the 2023 Bureau of Labor Statistics 
(BLS) mean hourly wage for hourly wage for ``all occupations'' of 
$31.48 per hour. This information is available at https://www.bls.gov/oes/current/oes_nat.htm.

Assistance Listing

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

List of Subjects

38 CFR Part 17

    Administrative practice and procedure, Health care, Health 
facilities, Mental health programs, Veterans.

38 CFR Part 84

    Administrative practice and procedure, Government contracts, Grant 
programs--health, Grant programs--veterans, Health care, Health 
facilities, Health professions, Health records, Veterans.

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved and signed 
this document on October 31, 2024, and authorized the undersigned to 
sign and submit the document to the Office of the Federal Register for 
publication electronically as an official document of the Department of 
Veterans Affairs.

Luvenia Potts,
Regulation Development Coordinator, 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 proposes to amend 38 CFR chapter I as follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 continues to read, in part, as 
follows:

    Authority:  38 U.S.C. 501, and as noted in specific sections.
* * * * *
0
2. Amend Sec.  17.108 by revising paragraph (e)(16) to read as follows:


Sec.  17.108   Copayments for inpatient hospital care and outpatient 
medical care.

* * * * *
    (e) * * *
    (16) Telehealth visits;
* * * * *
0
3. Add part 84 to read as follows:

PART 84--TELEHEALTH GRANT PROGRAM

Sec.
84.0 Purpose.
84.5 Definitions.
84.10 Eligible entity.
84.15 Application.
84.20 Threshold requirements prior to scoring telehealth grant 
applicants.
84.25 Scoring criteria for the telehealth grant applicants.
84.30 Selection of applicants to receive a telehealth grant.
84.35 Scoring criteria for grantees applying for renewal of 
telehealth grants.
84.40 Selecting grantees for renewal of telehealth grants.
84.45 Awards for telehealth grants.
84.50 General operation requirements.
84.55 Fee prohibition.
84.60 Notice of Funding Opportunity.
84.65 Telehealth grant agreements.
84.70 Program or budget changes and Corrective Action Plans.
84.75 Faith-based organizations.
84.80 Financial management.
84.85 Telehealth grant reports.
84.90 Recordkeeping.
84.95 Technical and technological assistance.
84.100 Withholding, suspension, deobligation, termination, recovery 
of funds by VA, and disposition of property or equipment.
84.105 Oversight.
84.110 Telehealth grant closeout procedures.

    Authority:  38 U.S.C. 501 and sec. 701, Pub. L. 116-171, 134 
Stat. 778 (38 U.S.C. 1701 (note)).


Sec.  84.0   Purpose.

    The purpose of this part is to establish the telehealth grant 
program. The Department of Veterans Affairs (VA) will enter into 
agreements, and expand existing agreements, with eligible entities for 
the expansion of telehealth capabilities and the provision of 
telehealth services to veterans through the award of grants. Through 
the award of these grants, grantees will offer veterans a convenient 
space to connect with a VA health care professional through video 
telehealth in comfortable private locations in communities where 
veterans may otherwise have long travel times to VA medical facilities, 
may have poor internet connectivity in their homes, or may face other 
barriers to accessing health care. The telehealth access point is not 
intended to be used by veterans who are in need of emergency health 
care services. This part only applies to telehealth grant agreements; 
however, VA may enter into an agreement for the establishment of a 
telehealth access point for veterans with an eligible entity that seeks 
to establish such an access point but does not require grant funding 
under this part.


Sec.  84.5   Definitions.

    The following definitions apply to this part and any Notice of 
Funding Opportunity (NOFO) issued under this part:
    Applicant means an eligible entity that submits an application for 
a grant announced in a NOFO under this part.
    Date of completion means the earliest of the following dates:
    (1) The date specified in the telehealth grant agreement, or any 
supplement or amendment thereto; or
    (2) The effective date of a telehealth grant termination under 
Sec.  84.110.
    Eligible entity means an entity that meets the requirements under 
Sec.  84.10.
    Grantee means an eligible entity that is awarded a telehealth grant 
under this part.
    Medically underserved means an area that is designated under 42 
U.S.C. 254b(b)(3).
    Nonprofit organization has the meaning as given to this term in 2 
CFR 200.1.
    Notice of Funding Opportunity (NOFO) has the meaning as given to 
this term in 2 CFR 200.1.
    Rural and highly rural area means an area or community that is 
designated as such by the Rural-Urban Commuting Areas coding system of 
the U.S. Department of Agriculture.

[[Page 89538]]

    Subcontractor means any entity or organization that has a contract 
agreement to furnish services at the telehealth access point. 
Subcontractors do not include individuals who build the access point 
(e.g., entities who are hired to paint or put up walls or partitions) 
or provide technical services (e.g., commercial internet providers or 
electric services).
    Telehealth access point means a non-VA site supported by a 
telehealth grant where a veteran can participate in a telehealth visit 
with a VA health care professional.
    Telehealth grant means a grant awarded under this part.


Sec.  84.10   Eligible entity.

    To be eligible to receive a telehealth grant, an entity must be:
    (a) An organization that represents or serves veterans;
    (b) A nonprofit organization;
    (c) A private business;
    (d) A State or local government; or
    (e) Other interested party.


Sec.  84.15   Application.

    (a) General. An applicant must submit to VA a complete grant 
application package, as described in the NOFO. The NOFO may include 
different application requirements based on a range of funding 
thresholds. For example, grant applications for technology and 
equipment, infrastructure upgrades, and sustainment may follow 
different application requirements. The requirements in this section 
represent the most extensive requirements that applicants would need to 
meet.
    (b) Content of application. The telehealth grant application 
package will require the following:
    (1) A plan to establish, if needed, the telehealth access point (or 
evidence that a telehealth access point has already been established) 
and a description of how the size, scope, and grant management plan are 
feasible;
    (2) Supporting documentation consisting of the following:
    (i) The type of entity that is applying for the telehealth grant 
pursuant to Sec.  84.10;
    (ii) A proposed operating budget;
    (iii) Supportive resources committed to the project, which 
includes, but is not limited to, space, staffing, equipment, internet 
services, phone services, and furniture;
    (iv) The applicant's ability to control the telehealth access point 
and meet appropriate zoning, preservation, accessibility, safety, and 
environmental laws;
    (v) A description of the geographic area that the telehealth access 
point will serve (include the name(s) of the municipalities, counties 
(or parishes), or Tribal lands); and
    (vi) An attestation that the facilities will be used principally to 
provide to veterans the services for which the project was designed;
    (3) Documentation evidencing the experience of the applicant and 
any identified subcontractors relevant to creating an environment to 
provide telehealth services or organizational experience working with 
veterans;
    (4) A statement from the applicant asserting that all of the 
following are true:
    (i) The project will furnish veterans a telehealth access point 
that is private, secure, clean, accessible, and meets the requirements 
of this grant;
    (ii) The applicant will continue to maintain and operate the 
telehealth access point supported by this grant until the expiration of 
the period during which VA could seek full recovery under Sec.  84.100;
    (iii) The title or lease to the point will lie with the applicant 
and the applicant will, at a minimum, provide the equivalent insurance 
coverage for real property and equipment acquired or improved with 
Federal funds as provided to property owned by the applicant. 
Telehealth access points that are located in federally owned property 
(e.g., Federally Qualified Health Centers, Department of Defense, and 
Indian Health Services) need not be insured unless required by the 
terms and conditions of the Federal property award;
    (iv) Adequate financial support will be available for the duration 
of the grant agreement that must be supported by a demonstration of 
financial stability and a detailed project budget, which includes, but 
is not limited to, all existing and anticipated sources of funds for 
the project; and
    (v) The applicant will keep records and submit reports as VA may 
reasonably require, within the timeframes required, and, upon demand, 
allow VA access to the records upon which such information is based;
    (5) Documentation of the managerial capacity of the applicant to:
    (i) Maintain and operate a telehealth access point where veterans 
who use the telehealth access point can receive high quality telehealth 
care from VA health care professionals;
    (ii) Continuously assess the needs of the telehealth access point 
and the veterans who use the telehealth access point for quality 
improvement in areas such as accessibility, satisfaction, and 
experience;
    (iii) Customize the telehealth access point to meet the needs of 
veterans who use the telehealth access point; and
    (iv) Comply with and implement the requirements of the telehealth 
grant; and
    (6) Any additional information in writing relevant to the 
telehealth grant application as requested by VA.
    (c) Renewal application. Subject to funding availability, grantees 
may apply for one renewal grant per fiscal year, after receiving an 
initial grant. The grantee must submit to VA a complete renewal 
application as described in the NOFO.
    (The Office of Management and Budget has approved the information 
collection provisions in this section under control number 2900-TBD.)


Sec.  84.20   Threshold requirements prior to scoring for the 
telehealth grant applicants.

    VA will only score applicants that 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.  84.15(b)(6) is provided within the time frame 
established by VA;
    (b) The application is completed in all parts;
    (c) The applicant meets the eligibility criteria in Sec.  84.10;
    (d) The activities for which the telehealth grant is requested are 
eligible for funding under this grant under Sec.  84.45;
    (e) The veterans the applicant proposes to serve are eligible to 
receive telehealth services under title 38 of the United States Code;
    (f) The applicant agrees to comply with the requirements of the 
telehealth grant;
    (g) 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
    (h) The applicant is not in default by being in non-compliance with 
the terms and conditions of the agreement of any previous Federal 
assistance.


Sec.  84.25   Scoring criteria for the telehealth grant applicants.

    VA will score applicants who are applying for a telehealth 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 
applicants who are applying for a telehealth grant:
    (a) VA will award points based on the background, qualifications, 
experience, and past performance of the applicant and any 
subcontractors identified by the

[[Page 89539]]

applicant, if relevant, as demonstrated by the following:
    (1) Background and organizational history. (i) Applicant's and any 
identified subcontractors' background and organizational history that 
would help them maintain and operate a telehealth access point for 
veterans.
    (ii) Evidence that the applicant, and any identified 
subcontractors, maintain organizational structures with clear lines of 
reporting and defined responsibilities.
    (iii) Applicant's, and any identified subcontractors', history of 
complying with agreements and not defaulting on financial obligations.
    (2) Staff qualifications. (i) Applicant's staff, and any identified 
subcontractors' staff, have experience working with veterans or health 
care recipients.
    (ii) Applicant's staff, and any identified subcontractors' staff, 
have organizational experience in establishing an environment suitable 
for providing health care services.
    (3) Organizational qualifications and past performance. (i) 
Applicant, and any identified subcontractors, have experience 
partnering with health care organizations to create an environment to 
provide telehealth services.
    (ii) Applicant, and any identified subcontractors, have 
organizational experience coordinating or administering telehealth 
services.
    (iii) Applicant, and any identified subcontractors, have 
organizational experience working with veterans.
    (b) VA will award points based on the applicant's plan to 
establish, maintain, and operate the telehealth access point, as 
demonstrated by the following:
    (1) Need for program. (i) Applicant demonstrates a need for the 
telehealth access point in a rural, highly rural, or medically 
underserved area, to the extent practicable, where the telehealth 
access point will be located.
    (ii) Applicant demonstrates an understanding of the area and 
provides evidence that a telehealth access point is needed to meet the 
unique needs of veterans and the community to be served.
    (2) Outreach plan. Applicant has a feasible communications plan to 
inform veterans about the telehealth access point and the services 
provided.
    (3) Plan to establish the telehealth access point. (i) Applicant's 
plan to establish, maintain, and operate the telehealth access point 
and a description of how the size, scope, and grant management plan are 
feasible.
    (ii) Applicant's program is designed and scoped to meet the needs 
of veterans in their community through the provision of telehealth 
services. We would consider whether the telehealth access point 
availability provides flexible hours of operation to maximize the 
telehealth access point's utilization.
    (4) Implementation timeline. (i) Applicant's plan to establish, 
maintain, and operate a telehealth access point and use grant funding 
within the timeline specified in their application.
    (ii) Applicant has a hiring plan in place to meet the applicant's 
implementation timeline or has existing staff to meet such timeline, if 
necessary.
    (5) Collaboration and communication with VA. The applicant must 
submit a letter of support from a local VA medical facility or 
facilities confirming the need for the telehealth access point and the 
intent of such facility or facilities to work with the applicant if the 
applicant is awarded a grant.
    (6) Capacity to maintain and operate a telehealth access point. 
Applicant has sufficient capacity, including staff resources, to safely 
maintain and operate a telehealth access point.
    (7) Sustainment plan. The applicant has a feasible plan to sustain 
telehealth access point operations.
    (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 the grant's aim of providing a 
telehealth access point to veterans against which the applicant's 
program performance can be evaluated.
    (ii) Applicant plans to continually assess the telehealth access 
point to identify opportunities for quality improvement in areas such 
as accessibility, satisfaction, and experience.
    (2) Monitoring. (i) Applicant has adequate controls in place to 
regularly monitor all aspects of the execution of the grant, including 
any subcontractors, for compliance with all applicable laws, 
regulations, and guidelines.
    (ii) Applicant has a plan to provide an environment that is 
private, secure, clean, and complies with the Americans with 
Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) where veterans can 
participate in their telehealth appointments.
    (iii) Applicant has adequate financial and operational controls in 
place to ensure the proper use of telehealth grant funding.
    (iv) Applicant has a plan for ensuring that their staff and any 
subcontractors are appropriately trained on, and the telehealth access 
point maintains compliance with, all fire and safety requirements as 
specified by State and local laws and regulations.
    (3) Remediation. Applicant has a plan to establish a system to 
remediate aspects of the grant program that are non-compliant with the 
terms of telehealth grant agreement when they are identified.
    (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 
subcontractors, are financially stable.
    (2) Financial feasibility of utilizing telehealth grant funds. (i) 
Applicant has a realistic budget for utilizing grant funding and will 
submit their implementation timeframe to operate the telehealth access 
point.
    (ii) Applicant's program is cost-effective and can be effectively 
and fully implemented on-budget.
    (e) VA will award points based on the applicant's area or community 
associations and relations, as demonstrated by the following:
    (1) Area or community associations. Applicant has a plan for 
developing associations or has existing experience with Federal 
(including VA), State, local, and Tribal government agencies, and 
private entities for the purposes of providing a telehealth access 
point to veterans, as applicable.
    (2) Past working relationships. Applicant (or applicant's staff), 
and any identified subcontractors (or subcontractors' staff), as 
relevant, have fostered successful working relationships and experience 
with public and private organizations providing services to veterans.
    (3) Local presence and knowledge. (i) Applicant has a presence in 
the area or community they intend to serve; and
    (ii) Applicant understands the dynamics of the area or community 
they intend to serve.
    (4) Integration of experience and plan to establish the telehealth 
access point. Applicant's experience in the area or community they 
intend to serve will enhance the effectiveness of the applicant's 
program.


Sec.  84.30   Selection of applicants to receive a telehealth grant.

    VA will use the following process to select applicants to receive 
telehealth grants:
    (a) VA will score all applicants that meet the threshold 
requirements set forth in Sec.  84.20 using the scoring criteria set 
forth in Sec.  84.25.

[[Page 89540]]

    (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 who 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 prioritize entities that serve 
veterans in rural and highly rural areas or areas determined to be 
medically underserved, to the extent practicable.
    (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 multiple applications are 
received from the same geographic area, the applicants' rankings will 
be the primary basis for selection. If funding priorities have been 
established, to the extent funding is available, and still subject to 
paragraph (d), 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 in the 
next applicable funding round or when sufficient funds otherwise become 
available (provided the applicant still wants to participate in the 
program). If there is no material change in the information, a new 
application would not be required.


Sec.  84.35   Scoring criteria for grantees applying for renewal of 
telehealth grants.

    VA will score applicants who are applying for a renewal of a 
telehealth 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 telehealth grant:
    (a) VA will award points based on the success of the grantee's 
program, as determined by VA. Success would be measured by:
    (1) Veteran satisfaction with the services provided by the grantee; 
and
    (2) How the grantee met the telehealth grant goals and requirements 
for VA to deliver telehealth services to veterans at that telehealth 
access point in accordance with the agreement.
    (b) VA will award points based on the cost-effectiveness of the 
grantee's program, as demonstrated by how:
    (1) The hours for the point attendant correlate with the veterans' 
telehealth appointments; and
    (2) The telehealth access point was implemented effectively using 
the available funding in the designated timeframe.
    (c) VA will award points based on the extent to which the grantee 
complies with applicable laws, regulations, and guidelines for the 
administration of the telehealth access point.


Sec.  84.40   Selecting grantees for renewal of telehealth grants.

    VA will use the following process to select grantees applying for 
renewal of telehealth grants:
    (a) Provided the grantee continues to meet the threshold 
requirements set forth in Sec.  84.20, VA will score the grantee using 
the scoring criteria set forth in Sec.  84.35.
    (b) VA will rank those grantees who receive at least the minimum 
amounts of total points and points per category set forth in the NOFO. 
The grantees will be ranked in order from highest to lowest scores 
within their respective funding priority group, if applicable.
    (c) VA will use the grantee's ranking as the primary basis for 
selection for funding. However, VA will prioritize entities that serve 
veterans in rural and highly rural areas or areas determined to be 
medically underserved, to the extent practicable. VA will fund the 
highest-ranked grantees for which funding is available within their 
respective funding priority group, if applicable.
    (d) At its discretion, VA may award any deobligated funds to an 
applicant or existing grantee. If VA chooses to award deobligated funds 
to an applicant or existing grantee, funds will be awarded as follows:
    (1) VA may offer to award the deobligated 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 community as, 
or a proximate community to, the affected community. Such applicant or 
grantee must have the capacity and agree to provide prompt services to 
the affected community. Under this section, the relevant NOFO is the 
most recently published NOFO which covers the geographic area that 
includes the affected community.
    (2) If the first such applicant or grantee offered the deobligated 
funds refuses the funds, VA may 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 
deobligated funds are awarded.
    (3) VA, at its discretion, may choose to award the deobligated 
funds under other conditions, or may choose to not award the 
deobligated funds at all, when VA determines appropriate based on 
consideration of other relevant factors.
    (e) If a grantee would have been selected but for a procedural 
error committed by VA, VA may select that grantee for funding in the 
next applicable funding round or when sufficient funds otherwise become 
available (provided the applicant still wants to participate in the 
program). If there is no material change in the information, a new 
application would not be required.


Sec.  84.45   Awards for telehealth grants.

    (a) Use of funds. Telehealth grants may be used for one or more of 
the following:
    (1) Purchasing, replacing, or upgrading hardware or software solely 
dedicated to the telehealth grant program necessary for the provision 
of secure and private telehealth services. Equipment and software must 
be compatible with telehealth requirements as described in the NOFO and 
must be purchased under warranty. Funds may be used to purchase 
services to configure and set up grantee-purchased equipment. VA will 
provide direct technical support for initial connection to a VA-secure 
application, and continued VA technical support for issues that may 
arise with the connection to the VA-secure application during the term 
of the grant.
    (2) Upgrading security protocols for consistency with VA security 
requirements and digital applications, as described in the NOFO.
    (3) Payment for the training of telehealth access point attendants, 
including payment of those attendants for completing that training, 
with respect to:
    (i) Military and veteran cultural competence, if the entity is not 
an organization that represents veterans;
    (ii) Equipment required to provide telehealth services;
    (iii) Privacy, including the Health Insurance Portability and 
Accountability Act of 1996 privacy rule under 45 CFR part 160 and part 
164, subparts A and E, as it relates to health care for veterans;
    (iv) Scheduling for telehealth services for veterans; or
    (v) Any other unique training needs for the provision of services 
to veterans in a telehealth access point.

[[Page 89541]]

    (4) Upgrading existing infrastructure owned or leased by the entity 
to make rooms more conducive to telehealth care, including:
    (i) Additions or modifications to windows or walls in an existing 
room, or other alterations as needed to create a new, private room, 
including permits or inspections required in association with space 
modifications;
    (ii) Soundproofing of an existing room;
    (iii) New electrical, telephone, or internet outlets in an existing 
room; or
    (iv) Aesthetic enhancements to establish a more suitable 
therapeutic environment, including, but not limited to, seating for 
both the veteran and caregiver, bariatric seating, and adequate 
lighting.
    (5) Upgrading existing infrastructure to comply with the Americans 
with Disabilities Act (42 U.S.C. 12101 et seq.).
    (6) Upgrading internet infrastructure and sustainment of internet 
services.
    (7) Sustainment of telephone services.
    (b) Exclusions. Telehealth grants may not be used for the purchase 
of new property or for major construction projects, or for the 
acquisition of new space through other arrangements (such as a lease 
agreement), as determined by VA. Major construction may consist of new 
construction, or activities that would increase the square footage of 
an existing facility (e.g., relocation of existing exterior walls, 
roofs, or floors). VA may further define major construction in the 
NOFO.


Sec.  84.50   General operation requirements.

    (a) Confidentiality. Grantees must maintain the confidentiality of 
veterans utilizing the telehealth access point. The grantees will not 
keep any records on the veterans who use the telehealth access point. 
This prohibition only applies to veteran records, however, grantees 
must maintain a record of the hours the point attendant provides 
services to veterans.
    (b) Grantee's responsibilities. Grantee is responsible for the 
operation and maintenance of the telehealth access point.
    (c) Notification to veterans. The grantee must notify each veteran 
of the following:
    (1) The telehealth services are being provided by VA and the 
grantee may not charge the veteran for use of their space.
    (2) Any conditions or restrictions on the receipt of telehealth 
services by the veteran. The grantee has the right to prohibit services 
to veterans who have demonstrated disruptive behavior within their 
facility.
    (d) Evaluation interviews and surveys. The grantee must participate 
in telehealth program evaluation interviews and surveys.
    (e) Assessment of funds. Grantees must regularly assess that the 
grant funds are utilized according to the agreement.
    (f) Administration of telehealth grants. Grantees must ensure that 
telehealth grants are administered in accordance with the requirements 
of this part, the telehealth grant agreement, and other applicable laws 
and regulations. Grantees are responsible for ensuring that any 
subcontractors carry out activities in compliance with this program.
    (g) Use and disposition of property and/or equipment. The grantees 
must follow, implement, and adhere to all requirements in the grant 
agreement and in 2 CFR part 200 on the use and disposition of property 
improved and/or equipment acquired under the telehealth grant program.
    (The Office of Management and Budget has approved the information 
collection provisions in this section under control number 2900-TBD.)


Sec.  84.55   Fee prohibition.

    Grantees must not charge a fee to veterans for providing VA 
services in telehealth access points that are funded with amounts from 
the telehealth grant.


Sec.  84.60   Notice of Funding Opportunity.

    When funds are available for the telehealth grant, VA will publish 
a NOFO. VA has the authority to modify the duration, amount, or both of 
an existing telehealth grant agreement, subject to availability of 
funding and grantee performance, as set forth in Sec.  84.65. The NOFO 
will identify:
    (a) The location for obtaining the applications for the telehealth 
grant;
    (b) The date, time, and place for submitting completed telehealth 
grant applications;
    (c) The estimated amount and type of grant funding available;
    (d) Any priorities for or exclusions from funding to meet the 
requirements of the telehealth grant and VA goals for providing 
telehealth services to veterans;
    (e) The length of term for the telehealth grant award;
    (f) Specific point values to be awarded for each criterion listed 
in Sec. Sec.  84.25 and 84.35;
    (g) The minimum number of total points and points per category that 
an applicant or grantee, as applicable, must receive for a telehealth 
grant to be funded;
    (h) Any maximum award amounts for the telehealth grant;
    (i) The timeframes and manner for payments under the telehealth 
grant; and
    (j) Other information necessary for the telehealth grant 
application process as determined by VA.


Sec.  84.65   Telehealth grant agreements.

    (a) After an applicant is selected for a telehealth grant in 
accordance with Sec.  84.30, VA will draft a telehealth grant agreement 
to be executed by VA and the applicant. Upon execution of the 
telehealth grant agreement, VA will obligate grant funds to cover the 
amount of the approved grant, subject to the availability of funding. 
The telehealth grant agreement will provide that the grantee agrees, 
and will ensure that each subcontractor, as relevant, agrees, to:
    (1) Operate the telehealth access point in accordance with the 
provisions of this part and the applicant's telehealth 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 providing services in a 
telehealth access point 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 telehealth grant 
in accordance with Sec.  84.40 VA will draft a telehealth grant 
agreement to be executed by VA and the grantee. Upon execution of the 
telehealth grant agreement, VA will obligate grant funds to cover the 
amount of the approved telehealth grant, subject to the availability of 
funding. The agreement for the renewal of the telehealth grant 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 establish a telehealth access point.
    (d) Subject to Sec. Sec.  84.60 and 84.100, the availability of 
funding, and grantee performance, VA may modify an existing telehealth 
grant agreement by one or both of the following:
    (1) Extending or reducing the period for which the telehealth grant 
was established; and
    (2) Increasing or decreasing the amount of funds awarded.


Sec.  84.70   Program or budget changes and Corrective Action Plans.

    (a) Change in telehealth grant agreement. A grantee must submit to 
VA a written request to modify a telehealth

[[Page 89542]]

grant agreement for any proposed significant change that will alter the 
agreement. If VA approves such change, VA will issue a written 
amendment to the telehealth grant agreement. A grantee must receive 
VA's approval prior to implementing a significant change.
    (1) Significant changes include, but are not limited to:
    (i) A change in the grantee or any subcontractors, identified in 
the telehealth grant agreement;
    (ii) A change in the area or community served by the grantee; or
    (iii) Additions or removal of equipment, connectivity, or other 
services provided by the grantee; and
    (iv) A change in budget line items that are more than 10 percent of 
the total telehealth grant award.
    (2) VA's approval of changes is contingent upon the grantee's 
amended application retaining a high enough rank to have been 
competitively selected for funding in the year that the application was 
granted.
    (3) Each telehealth grant modification request must contain a 
description of the revised proposed use of telehealth grant funds.
    (b) Corrective Action Plan. VA may require that the grantee 
initiate, develop, and submit to VA for approval a Corrective Action 
Plan (CAP) if actual telehealth grant expenditures vary from the amount 
disbursed to a grantee or actual telehealth grant activities vary from 
the telehealth grant agreement. Reporting frequency may be on a bi-
monthly, monthly, or quarterly basis.
    (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(s).
    (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 
program.
    (c) Key personnel change. Grantees must inform VA in writing of any 
key personnel changes, local or national, (e.g., new executive 
director, telehealth 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.  84.75   Faith-based organizations.

    Organizations that are faith-based are eligible, on the same basis 
as any other organization, to participate in the telehealth grant under 
this part in accordance with 38 CFR part 50.


Sec.  84.80   Financial management.

    (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 telehealth grant must 
be made only for allowable, allocable, and reasonable costs in 
establishing, maintaining, and operating the telehealth access point. 
The determination of allowable costs must be made in accordance with 
the applicable Federal Cost Principles set forth in 2 CFR part 200.
    (d) In accordance with 2 CFR 200.414, applicants that do not have a 
negotiated indirect cost rate (NICRA) may:
    (1) Request a de minimis rate, which is in accordance with the 
amounts set forth in 2 CFR 200.414(f);
    (2) Apply the NICRA established with their cognizant agency; or
    (3) Request to negotiate an indirect cost rate with VA.


Sec.  84.85   Telehealth grant reports.

    (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 the 
telehealth grant.
    (b) If actual telehealth grant expenditures vary from the amount 
disbursed to a grantee or actual telehealth grant activities vary from 
the grantee's program description provided in the telehealth grant 
agreement, grantees must report the deviation to VA. Reporting 
frequency may be on a bi-monthly, monthly, or quarterly basis.

    Note 1 to paragraph (b):  For information on Corrective Action 
Plans, which may be required by this paragraph (b), see Sec.  84.70.

    (c) At least once per year, each grantee must submit to VA a report 
that describes grant agreement compliance, legal and regulatory 
compliance, the activities for which the telehealth grant funds were 
used including but not limited to, the equipment costs, renovation 
expenses, attendant expenses, any other types of ongoing expenses for 
services provided during the year covered by the report, and any other 
information that VA may request.
    (d) VA may request additional reports to allow VA to fully assess 
the provision or coordination of the provision of services under this 
part.
    (e) All pages of the reports must cite the assigned telehealth 
grant number and be submitted in a timely manner as set forth in the 
grant agreement.
    (f) Grantees agree to allow VA to post information from reports on 
the internet or use such information in other ways deemed appropriate 
by VA (including, but not limited to, activities regarding litigation). 
Grantees must clearly mark information that is confidential to 
individual veterans so that VA could exclude such information from any 
public use.
    (The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-TBD.)


Sec.  84.90   Recordkeeping.

    Grantees must ensure that records are maintained for at least a 3-
year period (unless a longer period is otherwise required) to document 
compliance with the telehealth grant. Grantees must produce such 
records at VA's request.


Sec.  84.95   Technical and technological assistance.

    (a) VA will provide technical assistance, as necessary, to eligible 
entities to meet the requirements of this part.
    (b) VA will provide technological assistance, as necessary, to 
ensure that the grantee's equipment is able to connect to the VA system 
and network as necessary to support the delivery of telehealth 
services.
    (c) Such technical and technological assistance will be provided 
either directly by VA or through grants or contracts with appropriate 
public or nonprofit private entities.


Sec.  84.100   Withholding, suspension, deobligation, termination, 
recovery of funds by VA, and disposition of property or equipment.

    (a) General. 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.
    (b) Opportunities to object. (1) Upon VA taking a remedy for 
noncompliance under paragraph (a) of this section, grantees have 30 
days to object and provide information and documentation challenging 
the action, subject to the following conditions:

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    (i) Objections must be provided to VA in writing.
    (ii) VA's decision stands while an objection is under 
consideration.
    (iii) Other VA decisions (such as competing award decisions, 
continuation award decisions, decisions made with the consent of the 
grantee) are not subject to this opportunity to object.
    (2) The grant agreement will provide additional requirements and 
responsibilities for grantees in the event of noncompliance under 
paragraph (a) of this section.


Sec.  84.105   Oversight.

    VA may inspect the telehealth access points and records of any 
entity that has received a telehealth grant when VA deems necessary to 
determine compliance with this part. The authority to inspect does not 
authorize VA to manage or control the organization. Monitoring and 
oversight requirements for each grantee will be determined by a pre-
award risk assessment in alignment with 2 CFR 200.206.


Sec.  84.110   Telehealth grant closeout procedures.

    Telehealth grants will be closed out in accordance with 2 CFR part 
200.

[FR Doc. 2024-25892 Filed 11-12-24; 8:45 am]
BILLING CODE 8320-01-P