80 FR 79483 - Payment of Emergency Medication by VA

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 80, Issue 245 (December 22, 2015)

Page Range		79483-79484
FR Document		2015-32098

The Department of Veterans Affairs (VA) is amending its medical regulations that govern reimbursement of emergency treatment provided by non-VA medical care providers. VA is clarifying its regulations insofar as it involves the reimbursement of medications prescribed or provided to the veteran during the episode of non-VA emergency treatment.

Federal Register, Volume 80 Issue 245 (Tuesday, December 22, 2015)

[Federal Register Volume 80, Number 245 (Tuesday, December 22, 2015)]
[Rules and Regulations]
[Pages 79483-79484]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-32098]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP34


Payment of Emergency Medication by VA

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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

SUMMARY: The Department of Veterans Affairs (VA) is amending its 
medical regulations that govern reimbursement of emergency treatment 
provided by non-VA medical care providers. VA is clarifying its 
regulations insofar as it involves the reimbursement of medications 
prescribed or provided to the veteran during the episode of non-VA 
emergency treatment.

DATES: This regulation is effective January 21, 2016.

FOR FURTHER INFORMATION CONTACT: Kristin J. Cunningham, Director, 
Business Policy, Chief Business Office (10NB6), Veterans Health 
Administration, Department of Veterans Affairs, 810 Vermont Ave. NW., 
Washington, DC 20420; (202) 382-2508. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: VA is authorized under 38 U.S.C. 1725 to 
reimburse an eligible veteran (or the provider of the emergency 
treatment or another person or entity who paid such expenses on the 
veteran's behalf) for the reasonable value of emergency treatment 
furnished to the Veteran at a non-VA medical facility. Under 38 U.S.C. 
1728, VA is authorized to reimburse eligible veterans (or the provider 
of the emergency treatment or another person or entity who paid such 
expenses on the veteran's behalf) for the customary and usual charges 
of non-VA emergency treatment furnished to the veteran.
    Current VA regulations implementing 38 U.S.C. 1725 and 1728 each 
state that covered emergency treatment includes ``medication, including 
a short course of medication related to and necessary for the treatment 
of the emergency condition that is provided directly to the patient for 
use after the emergency condition is stabilized and the patient is 
discharged.'' See 38 CFR 17.120(b) and 17.1002. It is undisputed that 
medications directly provided to the veteran or administered to the 
veteran as part of the emergency treatment are covered. VA has 
determined that the language ``provided directly to the patient'' is 
vague inasmuch as it does not clearly indicate that it also extends to 
a short course of necessary medication provided to the veteran by way 
of a prescription that is written or called in to an outpatient or 
commercial pharmacy by the emergency non-VA provider with instructions 
to the veteran-patient to obtain and use the medication post-discharge, 
as directed.
    On July 27, 2015, we proposed to amend Sec. Sec.  17.120(b) and 
17.1002 to address this issue. See 80 FR 44318. We proposed amending 
Sec.  17.120(b) to clarify that VA reimburses the cost of a short 
course of medication prescribed for the veteran at the time that the 
veteran was receiving emergency treatment, by stating that emergency 
treatment includes ``a short course of medication related to and 
necessary for the treatment of the emergency condition that is provided 
directly to or prescribed for the patient for use after the emergency 
condition is stabilized and the patient is discharged.'' We proposed 
making a similar amendment to the introductory paragraph of Sec.  
17.1002. The proposed amendments in this rulemaking are consistent with 
current VA policy and help ensure our regulations are not interpreted 
more narrowly than VA intends.
    We provided a 60-day comment period, which ended on September 25, 
2015. We received 1 comment in support of the proposed rule. Based on 
the rationale set forth in the Supplementary Information to the 
proposed rule and in this final rule, 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 final rule directly affects only individuals and will not 
directly affect 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,'' which requires 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 regulatory action 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

[[Page 79484]]

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 Fiscal Year to Date.

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 numbers and titles for 
the programs affected by this document are 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; 64.014, Veterans 
State Domiciliary Care; 64.015, Veterans State Nursing Home 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 Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. Robert L. 
Nabors II, Chief of Staff, Department of Veterans Affairs, approved 
this document on December 16, 2015, for publication.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
Government contracts, Grant programs--health, Grant programs--veterans, 
Health care, Health facilities, Health professions, Health records, 
Homeless, Incorporation by reference, Medical and dental schools, 
Medical devices, Medical research, Mental health programs, Nursing 
homes, Philippines, Reporting and recordkeeping requirements, 
Scholarships and fellowships, Travel and transportation expenses, 
Veterans.

    Dated: December 17, 2015.
William F. Russo
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 17 
as follows:

PART 17--MEDICAL

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


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


Sec.  17.120  [Amended]

0
2. Amend the first sentence of Sec.  17.120(b) by adding ``or 
prescribed for'' immediately after ``provided directly to''.


Sec.  17.1002  [Amended]

0
3. Amend the introductory text of Sec.  17.1002 by adding ``or 
prescribed for'' immediately after ``provided directly to''.

[FR Doc. 2015-32098 Filed 12-21-15; 8:45 am]
 BILLING CODE 8320-01-P

Federal Register / Vol. 80, No. 245 / Tuesday, December 22, 2015 / Rules and Regulations 79483

Dated: December 10, 2015. medications directly provided to the Regulatory Flexibility Act
E.J. Cubanski, III, veteran or administered to the veteran The Secretary hereby certifies that
Captain, U.S. Coast Guard, Captain of the as part of the emergency treatment are this final rule will not have a significant
Port Sector Long Island Sound. covered. VA has determined that the economic impact on a substantial
[FR Doc. 2015–32133 Filed 12–21–15; 8:45 am] language ‘‘provided directly to the number of small entities as they are
BILLING CODE 9110–04–P patient’’ is vague inasmuch as it does defined in the Regulatory Flexibility
not clearly indicate that it also extends Act, 5 U.S.C. 601–612. This final rule
to a short course of necessary directly affects only individuals and
DEPARTMENT OF VETERANS medication provided to the veteran by will not directly affect small entities.
AFFAIRS way of a prescription that is written or Therefore, pursuant to 5 U.S.C. 605(b),
called in to an outpatient or commercial this rulemaking is exempt from the
38 CFR Part 17 pharmacy by the emergency non-VA initial and final regulatory flexibility
provider with instructions to the analysis requirements of 5 U.S.C. 603
RIN 2900–AP34
veteran-patient to obtain and use the and 604.
Payment of Emergency Medication by medication post-discharge, as directed.
On July 27, 2015, we proposed to Executive Orders 12866 and 13563
VA
amend §§ 17.120(b) and 17.1002 to Executive Orders 12866 and 13563
AGENCY: Department of Veterans Affairs. address this issue. See 80 FR 44318. We direct agencies to assess the costs and
ACTION: Final rule. proposed amending § 17.120(b) to benefits of available regulatory
clarify that VA reimburses the cost of a alternatives and, when regulation is
SUMMARY: The Department of Veterans short course of medication prescribed necessary, to select regulatory
Affairs (VA) is amending its medical for the veteran at the time that the approaches that maximize net benefits
regulations that govern reimbursement veteran was receiving emergency (including potential economic,
of emergency treatment provided by treatment, by stating that emergency environmental, public health and safety
non-VA medical care providers. VA is treatment includes ‘‘a short course of effects, and other advantages;
clarifying its regulations insofar as it medication related to and necessary for distributive impacts; and equity).
involves the reimbursement of the treatment of the emergency Executive Order 13563 (Improving
medications prescribed or provided to condition that is provided directly to or Regulation and Regulatory Review)
the veteran during the episode of non- prescribed for the patient for use after emphasizes the importance of
VA emergency treatment. the emergency condition is stabilized quantifying both costs and benefits,
DATES: This regulation is effective and the patient is discharged.’’ We reducing costs, harmonizing rules, and
January 21, 2016. proposed making a similar amendment promoting flexibility. Executive Order
FOR FURTHER INFORMATION CONTACT: to the introductory paragraph of 12866 (Regulatory Planning and
Kristin J. Cunningham, Director, § 17.1002. The proposed amendments in Review) defines a ‘‘significant
Business Policy, Chief Business Office this rulemaking are consistent with regulatory action,’’ which requires
(10NB6), Veterans Health current VA policy and help ensure our review by the Office of Management and
Administration, Department of Veterans regulations are not interpreted more Budget (OMB) unless OMB waives such
Affairs, 810 Vermont Ave. NW., narrowly than VA intends. review, as ‘‘any regulatory action that is
Washington, DC 20420; (202) 382–2508. We provided a 60-day comment likely to result in a rule that may: (1)
(This is not a toll-free number.) period, which ended on September 25, Have an annual effect on the economy
SUPPLEMENTARY INFORMATION: VA is 2015. We received 1 comment in of $100 million or more or adversely
authorized under 38 U.S.C. 1725 to support of the proposed rule. Based on affect in a material way the economy, a
reimburse an eligible veteran (or the the rationale set forth in the sector of the economy, productivity,
provider of the emergency treatment or Supplementary Information to the competition, jobs, the environment,
another person or entity who paid such proposed rule and in this final rule, VA public health or safety, or State, local,
expenses on the veteran’s behalf) for the is adopting the proposed rule as a final or tribal governments or communities;
reasonable value of emergency rule with no changes. (2) Create a serious inconsistency or
treatment furnished to the Veteran at a otherwise interfere with an action taken
Effect of Rulemaking
non-VA medical facility. Under 38 or planned by another agency; (3)
U.S.C. 1728, VA is authorized to Title 38 of the Code of Federal Materially alter the budgetary impact of
reimburse eligible veterans (or the Regulations, as revised by this final entitlements, grants, user fees, or loan
provider of the emergency treatment or rulemaking, represents VA’s programs or the rights and obligations of
another person or entity who paid such implementation of its legal authority on recipients thereof; or (4) Raise novel
expenses on the veteran’s behalf) for the this subject. Other than future legal or policy issues arising out of legal
customary and usual charges of non-VA amendments to this regulation or mandates, the President’s priorities, or
emergency treatment furnished to the governing statutes, no contrary guidance the principles set forth in this Executive
veteran. or procedures are authorized. All Order.’’
Current VA regulations implementing existing or subsequent VA guidance The economic, interagency,
38 U.S.C. 1725 and 1728 each state that must be read to conform with this budgetary, legal, and policy
covered emergency treatment includes rulemaking if possible or, if not implications of this regulatory action
‘‘medication, including a short course of possible, such guidance is superseded have been examined, and it has been
medication related to and necessary for by this rulemaking. determined not to be a significant
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the treatment of the emergency regulatory action under Executive Order
Paperwork Reduction Act
condition that is provided directly to 12866. VA’s impact analysis can be
the patient for use after the emergency This final rule contains no provisions found as a supporting document at
condition is stabilized and the patient is constituting a collection of information http://www.regulations.gov, usually
discharged.’’ See 38 CFR 17.120(b) and under the Paperwork Reduction Act of within 48 hours after the rulemaking
17.1002. It is undisputed that 1995 (44 U.S.C. 3501–3521). document is published. Additionally, a

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79484 Federal Register / Vol. 80, No. 245 / Tuesday, December 22, 2015 / Rules and Regulations

copy of the rulemaking and its impact Scholarships and fellowships, Travel SUPPLEMENTARY INFORMATION: This
analysis are available on VA’s Web site and transportation expenses, Veterans. document announces that, on December
at http://www.va.gov/orpm/, by Dated: December 17, 2015. 4, 2015, OMB approved, for a period of
following the link for VA Regulations William F. Russo three years, the information collection
Published From FY 2004 Through Fiscal Director, Office of Regulation Policy &
requirements relating to the access
Year to Date. Management, Office of the General Counsel, stimulation rules contained in the
Department of Veterans Affairs. Commission’s EAS Sixth Report and
Unfunded Mandates
Order, FCC 15–60, published at 80 FR
For the reasons set forth in the
The Unfunded Mandates Reform Act 37167, June 30, 2015.
preamble, VA amends 38 CFR part 17 as The OMB Control Number is 3060–
of 1995 requires, at 2 U.S.C. 1532, that
follows: 0207. The Commission publishes this
agencies prepare an assessment of
anticipated costs and benefits before PART 17—MEDICAL notice as an announcement of the
issuing any rule that may result in the effective date of the rules. If you have
expenditure by State, local, and tribal ■ 1. The authority citation for part 17 any comments on the burden estimates
governments, in the aggregate, or by the continues to read as follows: listed below, or how the Commission
private sector, of $100 million or more can improve the collections and reduce
(adjusted annually for inflation) in any Authority: 38 U.S.C. 501, and as noted in any burdens caused thereby, please
specific sections. contact Nicole Ongele, Federal
one year. This final rule will have no
such effect on State, local, and tribal § 17.120 [Amended] Communications Commission, Room A–
governments, or on the private sector. C620, 445 12th Street SW., Washington,
■ 2. Amend the first sentence of
DC 20554. Please include the OMB
Catalog of Federal Domestic Assistance § 17.120(b) by adding ‘‘or prescribed
Control Number, 3060–0207, in your
for’’ immediately after ‘‘provided
The Catalog of Federal Domestic correspondence. The Commission will
directly to’’.
Assistance numbers and titles for the also accept your comments via email at
programs affected by this document are § 17.1002 [Amended] PRA@fcc.gov.
64.007, Blind Rehabilitation Centers; To request materials in accessible
■ 3. Amend the introductory text of
64.008, Veterans Domiciliary Care; formats for people with disabilities
§ 17.1002 by adding ‘‘or prescribed for’’
64.009, Veterans Medical Care Benefits; (Braille, large print, electronic files,
immediately after ‘‘provided directly
64.010, Veterans Nursing Home Care; audio format), send an email to fcc504@
to’’.
64.011, Veterans Dental Care; 64.012, fcc.gov or call the Consumer and
[FR Doc. 2015–32098 Filed 12–21–15; 8:45 am] Governmental Affairs Bureau at (202)
Veterans Prescription Service; 64.014,
Veterans State Domiciliary Care; 64.015,
BILLING CODE 8320–01–P 418–0530 (voice), (202) 418–0432
Veterans State Nursing Home Care; (TTY).
64.018, Sharing Specialized Medical Synopsis
Resources; 64.019, Veterans FEDERAL COMMUNICATIONS
Rehabilitation Alcohol and Drug COMMISSION As required by the Paperwork
Dependence; 64.022, Veterans Home Reduction Act of 1995 (44 U.S.C. 3507),
47 CFR Part 11 the FCC is notifying the public that it
Based Primary Care; and 64.024, VA
Homeless Providers Grant and Per Diem [EB Docket No. 04–296; FCC 15–60] received final OMB approval on
Program. December 4, 2015, for the information
Review of the Emergency Alert System collection requirements contained in the
Signing Authority modifications to the Commission’s rules
AGENCY: Federal Communications
in 47 CFR part 11. Under 5 CFR 1320,
The Secretary of Veterans Affairs, or Commission.
an agency may not conduct or sponsor
designee, approved this document and ACTION: Final rule; announcement of a collection of information unless it
authorized the undersigned to sign and effective date. displays a current, valid OMB Control
submit the document to the Office of the
SUMMARY: In this document, the Number.
Federal Register for publication
Commission announces that the Office No person shall be subject to any
electronically as an official document of
of Management and Budget (OMB) has penalty for failing to comply with a
the Department of Veterans Affairs.
approved, for a period of three years, the collection of information subject to the
Robert L. Nabors II, Chief of Staff,
information collection associated with Paperwork Reduction Act that does not
Department of Veterans Affairs,
the Commission’s EAS Test Reporting display a current, valid OMB Control
approved this document on December
System (ETRS). This notice is consistent Number. The OMB Control Number is
16, 2015, for publication.
with the Emergency Alert System (EAS) 3060–0207.
List of Subjects in 38 CFR Part 17 Sixth Report and Order, FCC 15–60, The foregoing notice is required by
which stated that the Commission the Paperwork Reduction Act of 1995,
Administrative practice and Pub. L. 104–13, October 1, 1995, and 44
procedure, Alcohol abuse, Alcoholism, would publish a document in the
Federal Register announcing the U.S.C. 3507.
Claims, Day care, Dental health, Drug The total annual reporting burdens
abuse, Foreign relations, Government effective date of those rules.
and costs for the respondents are as
contracts, Grant programs—health, DATES: The amendments to 47 CFR
follows:
Grant programs—veterans, Health care, 11.21(a) and 11.61(a)(3)(iv) published at OMB Control Number: 3060–0207.
Health facilities, Health professions, 80 FR 37167, June 30, 2015, are effective
rmajette on DSK2TPTVN1PROD with RULES

OMB Approval Date: December 4,
Health records, Homeless, Incorporation on December 31, 2015. 2015.
by reference, Medical and dental FOR FURTHER INFORMATION CONTACT: Lisa OMB Expiration Date: December 31,
schools, Medical devices, Medical Fowlkes, Deputy Bureau Chief, Public 2018.
research, Mental health programs, Safety and Homeland Security Bureau, Title: Part 11, Emergency Alert
Nursing homes, Philippines, Reporting at (202) 418–7452, or by email at System (EAS), Sixth Report and Order.
and recordkeeping requirements, Lisa.Fowlkes@fcc.gov. Form Number: N/A.

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Document Created: 2015-12-22 02:31:27
Document Modified: 2015-12-22 02:31:27

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Rules and Regulations
Action		Final rule.
Dates		This regulation is effective January 21, 2016.
Contact		Kristin J. Cunningham, Director, Business Policy, Chief Business Office (10NB6), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Ave. NW., Washington, DC 20420; (202) 382-2508. (This is not a toll-free number.)
FR Citation		80 FR 79483
RIN Number		2900-AP34
CFR Associated		Administrative Practice and Procedure; Alcohol Abuse; Alcoholism; Claims; Day Care; Dental Health; Drug Abuse; Foreign Relations; Government Contracts; Grant Programs-Health; Grant Programs-Veterans; Health Care; Health Facilities; Health Professions; Health Records; Homeless; Incorporation by Reference; Medical and Dental Schools; Medical Devices; Medical Research; Mental Health Programs; Nursing Homes; Philippines; Reporting and Recordkeeping Requirements; Scholarships and Fellowships; Travel and Transportation Expenses and Veterans