Department of Veterans Affairs.
The Department of Veterans Affairs (VA) hereby establishes regulations regarding the provision of hospital care and medical services under the VA Emergency Preparedness Act of 2002, to individuals responding to, involved in, or otherwise affected by certain disasters or emergencies (including individuals who otherwise do not have VA eligibility for such care and services).
Effective Date: This final rule is effective May 12, 2008.Start Further Info
FOR FURTHER INFORMATION CONTACT:
Tony A. Guagliardo, Director, Business Policy, Chief Business Office (163), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 (202) 254-0406. (This is not a toll-free number.)End Further Info End Preamble Start Supplemental Information
This document amends VA medical regulations to implement provisions of Public Law 107-287, the VA Emergency Preparedness Act of 2002, regarding hospital care and medical services provided to individuals responding to, involved in, or otherwise affected by certain disasters or emergencies (including individuals who otherwise do not have VA eligibility for such care and services).
This final rule adopts, without change, the provisions of the corresponding proposed rule published in the Federal Register on July 12, 2007 (72 FR 38042), based on the rationale set forth in the proposed rule and this document. The proposed rule provided for a 60-day comment period which ended September 10, 2007. We received comments from three individuals. The comments are discussed below.
One commenter merely expressed agreement with the provisions of the proposed rule.
A second commenter asserted that free care should be provided by the Federal government to anyone who needs it when a disaster occurs. We made no changes based on this comment. As proposed and under this final rule at § 17.86(e), individuals who receive hospital care or medical services under the emergency provisions are responsible for the cost of the hospital care or medical services when charges are mandated by Federal law (including applicable appropriation acts) or when the cost of care or services is not reimbursed by other-than-VA Federal departments or agencies. This is intended to help ensure that funding will be available to VA for hospital care and medical services for veterans eligible for such care and services and in some instances is required by Federal law.
A third commenter expressed support for the proposed rule changes. The commenter also expressed views concerning how VA should prepare for and act in response to disasters. Those statements concern matters not within the scope of this rulemaking. Accordingly, we made no changes based on this comment.
Administrative Procedure Act
Pursuant to 5 U.S.C. 553(d), we find that there is good cause to dispense with a 30-day delay in the effective date of this rule. We find that delay in its effective date would be contrary to the public interest. A disaster or emergency requiring the use of this rule could occur at any time and it is in the public interest that we have in place regulations to implement the emergency program under 38 U.S.C. 1785, in compliance with the provisions of section 205 of division I of Public Law 110-161, the Consolidated Appropriations Act, 2008, if and when the need arises. Further, we find that this rule's provisions are not ones for which members of the public would need a delay in effective date to prepare for the changes made by the rule.
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 given year. This rule will have no such effect on State, local, and tribal governments, or the private sector.
Paperwork Reduction Act of 1995
This document contains no provisions constituting a collection of information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521).
Executive Order 12866
Executive Order 12866 directs agencies to assess all costs and benefits Start Printed Page 26946of available regulatory alternatives and, when regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety, and other advantages; distributive impacts; and equity). The Executive Order classifies a “significant regulatory action,” requiring review by the Office of Management and Budget (OMB) unless OMB waives such review, as any regulatory action that is likely to result in a rule that may: (1) Have an annual effect on the economy of $100 million or more or adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, or tribal governments or communities; (2) create a serious inconsistency or otherwise interfere with an action taken or planned by another agency; (3) materially alter the budgetary impact of entitlements, grants, user fees, or loan programs or the rights and obligations of recipients thereof; or (4) raise novel legal or policy issues arising out of legal mandates, the President's priorities, or the principles set forth in the Executive Order.
The economic, interagency, budgetary, legal, and policy implications of this final rule have been examined and it has been determined to be a significant regulatory action under the Executive Order because it is likely to result in a rule that may raise novel legal or policy issues arising out of legal mandates, the President's priorities, or the principles set forth in the Executive Order.
Regulatory Flexibility Act
The Secretary hereby certifies that this final rule will not have a significant economic impact on a substantial number of small entities as they are defined in the Regulatory Flexibility Act. In addition to affecting individuals, this document will affect mainly large insurance companies. Further, where small entities are involved, they will not be impacted significantly since an inconsequential portion of their business will be with VA. Accordingly, pursuant to 5 U.S.C. 605(b), this final rule is exempt from the initial and final regulatory flexibility analysis requirements of sections 603 and 604.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic Assistance numbers and titles for the programs affected by this document are 64.005, Grants to States for the Construction of State Homes; 64.007, Blind Rehabilitation Centers; 64.008, Veterans Domiciliary Care; 64.009, Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.011, Veterans Dental Care; 64.012, Veterans Prescription Service; 64.013, Veterans Prosthetic Appliances; 64.014, Veterans State Domiciliary Care; 64.015, Veterans State Nursing Home Care; 64.016, Veterans State Hospital Care; 64.018, Sharing Specialized Medical Resources; 64.019, Veterans Rehabilitation Alcohol and Drug Dependence; and 64.022, Veterans Home Based Primary Care.Start List of Subjects
List of Subjects in 38 CFR Part 17
- Administrative practice and procedure
- Alcohol abuse
- Day care
- Dental health
- Drug abuse
- Foreign relations
- Government contracts
- Grant programs-health
- Grant programs-veterans
- Health care
- Health facilities
- Health professions
- Health records
- Medical and dental schools
- Medical devices
- Medical research
- Mental health programs; Nursing homes
- Reporting and recordkeeping requirements
- Scholarships and fellowships
- Travel and transportation expenses
Approved: February 5, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
For the reasons set forth in the preamble, the Department of Veterans Affairs amendsEnd Amendment Part Start Part
PART 17—MEDICALEnd Part Start Amendment Part
1. The authority citation for part 17 continues to read as follows:End Amendment Part Start Amendment Part
2. Add an undesignated center heading and § 17.86 to read as follows:End Amendment Part
Care During Certain Disasters and Emergencies
(a) This section sets forth regulations regarding the provision of hospital care and medical services under 38 U.S.C. 1785.
(b) During and immediately following a disaster or emergency referred to in paragraph (c) of this section, VA under 38 U.S.C. 1785 may furnish hospital care and medical services to individuals (including those who otherwise do not have VA eligibility for such care and services) responding to, involved in, or otherwise affected by that disaster or emergency.
(c) For purposes of this section, a disaster or emergency means:
(1) A major disaster or emergency declared by the President under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5121 et seq.) (Stafford Act); or
(2) A disaster or emergency in which the National Disaster Medical System established pursuant to section 2811(b) of the Public Health Service Act (42 U.S.C. 300hh-11(b)) is activated either by the Secretary of Health and Human Services under paragraph (3)(A) of that section or as otherwise authorized by law.
(d) For purposes of paragraph (b) of this section, the terms hospital care and medical services have the meanings given such terms by 38 U.S.C. 1701(5) and 1701(6).
(e) Unless the cost of care is charged at rates agreed upon in a sharing agreement as described in § 17.102(e), the cost of hospital care and medical services provided under this section to an officer or employee of a department or agency of the United States (other than VA) or to a member of the Armed Forces shall be calculated in accordance with the provisions of § 17.102(c) and (h). Other individuals who receive hospital care or medical services under this section are responsible for the cost of the hospital care or medical services when charges are mandated by Federal law (including applicable appropriation acts) or when the cost of care or services is not reimbursed by other-than-VA Federal departments or agencies. When individuals are responsible under this section for the cost of hospital care or medical services, VA will bill in the amounts calculated in accordance with the provisions of § 17.102(h), without applying the exception provided in the first paragraph of § 17.102.
(f) VA may furnish care and services under this section to a veteran without regard to whether that individual is enrolled in the VA healthcare system under 38 U.S.C. 1705 and § 17.36 of this part.
(Authority: 38 U.S.C. 501, 1785)
3. Amend § 17.102 by:End Amendment Part Start Amendment Part
a. In paragraph (b)(1), removing “§ 17.43(c)(1)” and adding, in its place, “§ 17.43(b)(1)”.End Amendment Part Start Amendment Part
b. In the first sentence of paragraph (h), adding “§ 17.86 and under” after “charges under”; removing “Cost Distribution Report” and adding, in its place, “Monthly Program Cost Report (MPCR)”; and removing “and outpatient visit” and adding, in its place, “, and actual basic costs and rates for outpatient care visits or prescriptions filled”.End Amendment Part Start Amendment Part
c. In the fifth sentence of paragraph (h), removing “Cost DistributionEnd Amendment Part End Supplemental Information
[FR Doc. E8-10488 Filed 5-9-08; 8:45 am]
BILLING CODE 8320-01-P