80 FR 24819 - Health Care for Homeless Veterans Program

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 80, Issue 84 (May 1, 2015)

The Department of Veterans Affairs (VA) amends its medical regulations concerning eligibility for the Health Care for Homeless Veterans (HCHV) program. The HCHV program provides per diem payments to non-VA community-based facilities that provide housing, outreach services, case management services, and rehabilitative services, and may provide care and/or treatment to homeless veterans who are enrolled in or eligible for VA health care. The rule modifies VA's HCHV regulations to conform to changes enacted in the Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012. Specifically, the rule removes the requirement that homeless veterans be diagnosed with a serious mental illness or substance use disorder to qualify for the HCHV program. This change makes the program available to all homeless veterans who are enrolled in or eligible for VA health care. The rule also updates the definition of homeless to match in part the one used by the Department of Housing and Urban Development (HUD). The rule further clarifies that the services provided by the HCHV program through non-VA community-based providers must include case management services, including non-clinical case management, as appropriate.

[Federal Register Volume 80, Number 84 (Friday, May 1, 2015)]
[Rules and Regulations]
[Pages 24819-24821]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-10150]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 63

RIN 2900-AO71


Health Care for Homeless Veterans Program

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) amends its medical 
regulations concerning eligibility for the Health Care for Homeless 
Veterans (HCHV) program. The HCHV program provides per diem payments to 
non-VA community-based facilities that provide housing, outreach 
services, case management services, and rehabilitative services, and 
may provide care and/or treatment to homeless veterans who are enrolled 
in or eligible for VA health care. The rule modifies VA's HCHV 
regulations to conform to changes enacted in the Honoring America's 
Veterans and Caring for Camp Lejeune Families Act of 2012. 
Specifically, the rule removes the requirement that homeless veterans 
be diagnosed with a serious mental illness or substance use disorder to 
qualify for the HCHV program. This change makes the program available 
to all homeless veterans who are enrolled in or eligible for VA health 
care. The rule also updates the definition of homeless to match in part 
the one used by the Department of Housing and Urban Development (HUD). 
The rule further clarifies that the services provided by the HCHV 
program through non-VA community-based providers must include case 
management services, including non-clinical case management, as 
appropriate.

DATES: This final rule is effective June 1, 2015.

FOR FURTHER INFORMATION CONTACT: Robert Hallett, Health Care for 
Homeless Veterans Manager, c/o Bedford VA Medical Center, Veterans 
Health Administration, 200 Springs Road, Bldg. 17, Bedford, MA 01730; 
(781) 687-3187. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: The HCHV program is authorized by section 
2031 of title 38, United States Code (U.S.C.), under which VA may 
provide to eligible veterans outreach; care, treatment, and 
rehabilitative services (directly or by contract in community-based 
treatment facilities, including halfway houses); and therapeutic 
transitional housing assistance, under 38 U.S.C. 2032, in conjunction 
with work therapy under 38 U.S.C. 1718(a)-(b). Under current 
regulations, only veterans who are homeless, enrolled in the VA health 
care system or eligible for VA health care under title 38, Code of 
Federal Regulations (CFR), Sec.  17.36 or 17.37, and have a serious 
mental illness and/or substance use disorder are eligible for the 
program. 38 CFR 63.3(a).
    In a document published in the Federal Register on May 15, 2014 (79 
FR 27826), VA proposed to amend part 63 of 38 CFR to remove the 
requirement that homeless veterans must suffer from a serious mental 
illness or substance use disorder to be eligible for HCHV, to modify 
the definition of the term ``homeless'' to match in part the definition 
used by HUD, and to require HCHV providers to offer case management 
services to homeless veterans, as appropriate. We provided a 60-day 
comment period, which ended on July 14, 2014. We received seven 
comments, all of which supported the proposed changes to part 63.
    One commenter stated that it is shameful that homeless veterans 
have to be diagnosed with an illness before they can receive the 
benefits they have earned through military service. Before the 
enactment of Public Law 112-154, Sec.  302, 126 Stat. 1164, 1184 (Aug. 
6, 2012), VA only had authority to provide HCHV services to veterans 
with serious mental illness, including veterans who are homeless. As 
amended, the law authorizes VA to make services under the HCHV program 
available to all homeless veterans VA provides care and services to, 
regardless of whether they have a serious mental illness. VA fully 
supports the change in law, and agrees with the commenter that benefits 
for homeless veterans provided through the HCHV program should not be 
predicated on a diagnosis of serious mental illness. This regulation 
will remove that requirement, thereby allowing all eligible homeless 
veterans to receive services. VA is not making a change based on this 
comment.
    Another commenter asked VA to make the changes in the proposed 
rule, stating that homeless veterans should be provided resources 
through the HCHV program regardless of whether or not they have a 
mental illness. Another commenter stated her wholehearted support for 
the proposed amendment. Another commenter stated the proposed changes 
need to be passed. We appreciate the commenters taking the time to 
review this rulemaking.
    Another commenter expressed support for the rule and noted that the 
proposed change could reduce the social stigma many homeless veterans 
who do not suffer from a serious mental illness feel about seeking 
assistance to address their homelessness. Another commenter noted that 
removing the requirement of a diagnosis for mental illness would also 
help homeless veterans with serious mental illness access the program, 
as they may not have been willing to acknowledge their disability 
before. We agree and believe that these changes will help more homeless 
veterans, both those with and without a serious mental illness, access 
the health care services they need through the HCHV program.
    One commenter expressed support for the proposed changes, but 
identified two concerns. First, the commenter urged VA to request 
increased funding and resources to accommodate the number of new 
enrollees that would be eligible as a result of the proposed rule. 
Second, the commenter stated their concern that the proposed rule could 
have the unintended effect of disadvantaging homeless veterans with a 
serious mental illness if HCHV providers find that veterans without a 
mental illness are easier to place or receive the bulk of the services 
available. While the first comment is somewhat outside the scope of 
this rule, VA will take into account the changes made as a result of 
this rule when

[[Page 24820]]

determining the resources it will allocate for the HCHV program. 
However, VA notes that the rule should not result in any increased 
expense to the Department, as it only modifies the pool of eligible 
persons, rather than the number of persons served. As explained in the 
proposed rule, the principal driver of costs is bed availability, which 
would not change as a result of this rule. Similarly, and also in 
response to the second comment, VA has found that the supply of HCHV 
services generally exceeds demand, so we do not believe there will be a 
shift in emphasis or a reduction in services from homeless veterans 
with a serious mental illness. Further, the HCHV provider would be 
prohibited from engaging in discrimination by virtue of entering into a 
contract with VA as a recipient of Federal financial assistance. 
Pursuant to 38 CFR 63.10(a)-(b), HCHV providers must enter into a 
contract with VA in order to be granted financial assistance. VA is 
authorized by section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 
706, 794) and VA's implementing regulations in subpart D, part 18, 38 
CFR to prohibit discrimination against persons on the basis of handicap 
by any party that receives Federal financial assistance. Under these 
authorities, any HCHV provider is prohibited from discriminating 
against beneficiaries on the basis of a disability, including a serious 
mental illness.
    Based on the rationale set forth in the proposed rule and in this 
document, VA is adopting the proposed rule as a final rule with no 
changes.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as revised by this 
final rulemaking, represents VA's implementation of its legal authority 
on this subject. Other than future amendments to this regulation or 
governing statutes, no contrary guidance or procedures are authorized. 
All existing or subsequent VA guidance must be read to conform with 
this rulemaking if possible or, if not possible, such guidance is 
superseded by this rulemaking.

Paperwork Reduction Act

    This final rule contains no provisions constituting a collection of 
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).

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, 5 U.S.C. 601-
612. This rule removes the requirement that veterans have a serious 
mental illness to participate in the HCHV program and clarifies that 
the HCHV program includes case management services. This rule only 
impacts those entities that choose to participate in the HCHV program. 
As of June 2014, approximately 300 non-profit entities participate in 
the HCHV program. We do not expect this rule to result in any 
additional costs or economic impacts on these entities, as the rule 
modestly expands the population of veterans eligible to receive care 
and requires case management services consistent with current practice. 
Small entity applicants will not be affected to a greater extent than 
large entity applicants. Small entities must elect to participate, and 
this clarification simply reinforces the services these entities are 
already providing. The expanded population of eligible veterans will 
not result in any additional costs because the principal driver of cost 
is bed availability, which will not change as a result of this rule. To 
the extent this rule will have any impact on small entities, it will 
not have an impact on a substantial number of small entities. 
Therefore, pursuant to 5 U.S.C. 605(b), this rulemaking is exempt from 
the initial and final regulatory flexibility analysis requirements of 5 
U.S.C. 603 and 604.

Executive Orders 12866 and 13563

    Executive Orders 12866 and 13563 direct agencies to assess the 
costs and benefits of available regulatory alternatives and, when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, and other advantages; distributive impacts; 
and equity). Executive Order 13563 (Improving Regulation and Regulatory 
Review) emphasizes the importance of quantifying both costs and 
benefits, reducing costs, harmonizing rules, and promoting flexibility. 
Executive Order 12866 (Regulatory Planning and Review) defines a 
``significant regulatory action,'' requiring review by the Office of 
Management and Budget (OMB), unless OMB waives such review, as ``any 
regulatory action that is likely to result in a rule that may: (1) Have 
an annual effect on the economy of $100 million or more or adversely 
affect in a material way the economy, a sector of the economy, 
productivity, competition, jobs, the environment, public health or 
safety, or State, local, or tribal governments or communities; (2) 
Create a serious inconsistency or otherwise interfere with an action 
taken or planned by another agency; (3) Materially alter the budgetary 
impact of entitlements, grants, user fees, or loan programs or the 
rights and obligations of recipients thereof; or (4) Raise novel legal 
or policy issues arising out of legal mandates, the President's 
priorities, or the principles set forth in this Executive Order.''
    The economic, interagency, budgetary, legal, and policy 
implications of this final rule have been examined, and it has been 
determined not to be a significant regulatory action under Executive 
Order 12866. VA's impact analysis can be found as a supporting document 
at http://www.regulations.gov, usually within 48 hours after the 
rulemaking document is published. Additionally, a copy of the 
rulemaking and its impact analysis are available on VA's Web site at 
http://www.va.gov/orpm, by following the link for VA Regulations 
Published from FY 2004 through FYTD.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before issuing any rule that may result in the expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any one year. This final rule will have no such effect on 
State, local, and tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance program numbers and 
titles for this rule are as follows: 64.005, Grants to States for 
Construction of State Home Facilities; 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; 64.022, Veterans Home Based 
Primary Care; and 64.024, VA Homeless Providers Grant and Per Diem 
Program.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the

[[Page 24821]]

Federal Register for publication electronically as an official document 
of the Department of Veterans Affairs. Jose D. Riojas, Chief of Staff, 
Department of Veterans Affairs, approved this document on April 24, 
2015, for publication.

List of Subjects in 38 CFR Part 63

    Administrative practice and procedure, Day care, Disability 
benefits, Government contracts, Health care, Homeless, Housing, 
Individuals with disabilities, Low and moderate income housing, Public 
assistance programs, Public housing, Relocation assistance, Reporting 
and recordkeeping requirements, Veterans.

    Dated: April 27, 2015.
William F. Russo,
Acting Director, Office of Regulation Policy & Management, Office of 
the General Counsel, Department of Veterans Affairs.

    For the reasons set forth in the preamble, VA amends 38 CFR part 63 
as follows:

PART 63--HEALTH CARE FOR HOMELESS VETERANS (HCHV) PROGRAM

0
1. The authority citation for part 63 continues to read as follows:

    Authority:  38 U.S.C. 501, 2031, and as noted in specific 
sections.


0
2. Revise Sec.  63.1 to read as follows:


Sec.  63.1  Purpose and scope.

    This part implements the Health Care for Homeless Veterans (HCHV) 
program. This program provides per diem payments to non-VA community-
based facilities that provide housing, outreach services, case 
management services, and rehabilitative services, and may provide care 
and/or treatment to all eligible homeless veterans.

(Authority: 38 U.S.C. 501, 2031(a)(2))


0
3. Amend Sec.  63.2 by:
0
a. Adding the definition ``Case management'' in alphabetical order.
0
b. Revising the definitions of ``Homeless'' and ``Non-VA community-
based provider''.
0
c. Removing the definitions of ``Serious mental illness'' and 
``Substance use disorder''.
0
d. Revising the authority citation at the end of the section.
    The addition and revisions read as follows:


Sec.  63.2  Definitions.

* * * * *
    Case management means arranging, coordinating, or providing direct 
clinical services and support; referring and providing linkage to VA 
and non-VA resources, providing crisis management services and 
monitoring; and intervening and advocating on behalf of veterans to 
support transportation, credit, legal, and other needs.
* * * * *
    Homeless has the meaning given that term in paragraphs (1) through 
(3) of the definition of homeless in 24 CFR 576.2.
    Non-VA community-based provider means a facility in a community 
that provides temporary, short-term housing (generally up to 6 months) 
for the homeless, as well as community outreach, case management, and 
rehabilitative services, and, as needed, basic mental health services.
* * * * *

(Authority: 38 U.S.C. 501, 2002, 2031)


0
4. Amend Sec.  63.3 by revising paragraph (a) to read as follows:


Sec.  63.3  Eligible Veterans.

    (a) Eligibility. In order to serve as the basis for a per diem 
payment through the HCHV program, a veteran served by the non-VA 
community-based provider must be:
    (1) Enrolled in the VA health care system, or eligible for VA 
health care under 38 CFR 17.36 or 17.37; and
    (2) Homeless.
* * * * *


Sec.  63.10  [Amended]

0
5. Amend Sec.  63.10 by revising paragraph (a) to read as follows:
    (a) Who can apply. VA may award per diem contracts to non-VA 
community-based providers who provide temporary residential assistance 
homeless persons, including but not limited to persons with serious 
mental illness, and who can provide the specific services and meet the 
standards identified in Sec.  63.15 and elsewhere in this part.
* * * * *

0
6. Amend Sec.  63.15 by revising paragraph (b) to read as follows:


Sec.  63.15  Duties of, and standards applicable to, non-VA community-
based providers.

* * * * *
    (b) Treatment plans, therapeutic/rehabilitative services, and case 
management. Individualized treatment plans are to be developed through 
a joint effort of the veteran, non-VA community-based provider staff, 
and VA clinical staff. Therapeutic and rehabilitative services, as well 
as case management and outreach services, must be provided by the non-
VA community-based provider as described in the treatment plan. In some 
cases, VA may complement the non-VA community-based provider's program 
with added treatment or other services, such as participation in VA 
outpatient programs or counseling. In addition to case management 
services, for example, to coordinate or address relevant issues related 
to a veteran's homelessness and health as identified in the individual 
treatment plan, services provided by the non-VA community-based 
provider should generally include, as appropriate:
    (1) Structured group activities such as group therapy, social 
skills training, self-help group meetings, or peer counseling.
    (2) Professional counseling, including counseling on self-care 
skills, adaptive coping skills, and, as appropriate, vocational 
rehabilitation counseling, in collaboration with VA programs and 
community resources.
* * * * *
[FR Doc. 2015-10150 Filed 4-30-15; 8:45 am]
 BILLING CODE 8320-01-P