81 FR 13994 - Telephone Enrollment in the VA Healthcare System

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 81, Issue 51 (March 16, 2016)

This rulemaking amends VA's medical regulations to allow veterans to complete applications for health care enrollment by telephone by providing application information to a VA employee, agreeing to VA's provisions regarding copayment liability and assignment of third-party insurance benefits, and attesting to the accuracy and authenticity of the information provided over the phone. This action will make it easier for veterans to apply to enroll and will speed VA processing of applications.

[Federal Register Volume 81, Number 51 (Wednesday, March 16, 2016)]
[Rules and Regulations]
[Pages 13994-13997]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-05680]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP68


Telephone Enrollment in the VA Healthcare System

AGENCY: Department of Veterans Affairs.

ACTION: Interim final rule.

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SUMMARY: This rulemaking amends VA's medical regulations to allow 
veterans to complete applications for health care enrollment by 
telephone by providing application information to a VA employee, 
agreeing to VA's provisions regarding copayment liability and 
assignment of third-party insurance benefits, and attesting to the 
accuracy and authenticity of the information provided over the phone. 
This action will make it easier for veterans to apply to enroll and 
will speed VA processing of applications.

[[Page 13995]]


DATES: Effective Date: This rule is effective on March 16, 2016. 
Applicability dates: This rule applies on March 15, 2016, to veterans 
who served in a theater of combat operations after November 11, 1998, 
and were discharged or released from active service on or after January 
28, 2003. This rule applies to all other veterans on and after July 5, 
2016.
    Comment Date: Comments must be received on or before May 16, 2016.

ADDRESSES: Written comments may be submitted through 
www.Regulations.gov; by mail or hand-delivery to Director, Regulation 
Policy and Management (02REG), Department of Veterans Affairs, 810 
Vermont Avenue NW., Room 1066, Washington, DC 20420; or by fax to (202) 
273-9026. Comments should indicate that they are submitted in response 
to [``RIN 2900-AP68--Telephone enrollment in the VA healthcare 
system.''] Copies of comments received will be available for public 
inspection in the Office of Regulation Policy and Management, Room 
1066, between the hours of 8:00 a.m. and 4:30 p.m., Monday through 
Friday (except holidays). Please call (202) 461-4902 for an 
appointment. (This is not a toll-free number.) In addition, during the 
comment period, comments may be viewed online through the Federal 
Docket Management System (FDMS) at www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Mathew J. Eitutis, Acting Director, 
Member Services 3401 SW 21st St. Building 9 Topeka, KS 66604; 785-925-
0605. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: Section 1710 of title 38, United States Code 
(U.S.C.), authorizes VA to provide health care to veterans, and section 
1705 requires VA to enroll most veterans in the VA healthcare system 
before providing health care. This rulemaking amends VA's enrollment 
regulations, Sec.  17.36(d)(1) of title 38, Code of Federal Regulations 
(CFR), to allow veterans to apply for enrollment in the VA healthcare 
system by telephone, in addition to submitting an application on paper 
or online. Submitting an application does not guarantee enrollment in 
the VA health care system.
    VA's regulation at 38 CFR 17.36(d)(1) has allowed veterans to apply 
for enrollment in VA health care in two ways, by submitting a signed 
paper application on the VA Form 10-10EZ or by completing that 
application online. The current regulation provides for submission of 
the form to a VA medical facility, which any veteran may. The mailing 
address on the form, however, is to a VA office not in a VA medical 
facility. We propose to revise the regulation to explicitly include 
that the veteran may also submit the form to the address on the form, 
consistent with actual practice. This change also makes the rule more 
transparent, showing how veterans actually access VA health care.
    The current paper application and its online counterpart include 
the veteran's consent to pay any copayments the law requires the 
veteran pay for treatment or services, 38 U.S.C. 1710 and 1722A, and to 
assign insurance benefits to VA. 38 U.S.C. 1729; 42 U.S.C. 2651. The 
application also includes a notification of the consequences of making 
a materially false statement in an application for enrollment.
    Under the existing regulations, it is VA's practice to assist 
veterans in filling out the VA Form 10-10EZ, which often occurs when 
veterans call a designated telephone number; however, in order to 
complete the application process, VA currently requires the veteran's 
signature. In these cases, a VA employee enters into the VA application 
form the information the veteran provides over the telephone, then VA 
mails the form to the veteran to sign and return to VA. With this 
rulemaking, VA is now able to complete the entire enrollment 
application for the veteran based on information given and attestations 
made by the veteran over the telephone that are legally equivalent to 
those in VA Form 10-10EZ. Analysis of our current application process 
persuades us we can potentially enroll veterans more quickly using this 
method, particularly those who are transitioning from active duty to 
veteran status. We also believe the new process will be less burdensome 
on veterans.
    To accomplish a telephone application for enrollment under revised 
Sec.  17.36(d)(1), a VA employee will verify the veteran's identify 
based on information already in VA's records or records VA can access, 
and obtain the information necessary to complete the veteran's 
application. The VA employee will also inform the veteran of the 
consequences of making a materially false statement and explain the VA 
copayment obligation and the assignment of benefits provision.
    With respect to the copayment obligation, VA is required by law to 
charge some veterans a copayment for treatment or services. 38 U.S.C. 
1710 and 1722A. As part of the telephone application, the VA employee 
will provide notice to the veteran that he or she is agreeing to make 
applicable copayments and that by accepting care or services from VA, 
he or she may be subject to copayment obligations. In addition, 
pursuant to 38 U.S.C. 1729 and 42 U.S.C. 2651, VA is authorized to 
recover or collect from a veteran's health plan or other legally 
responsible third party for the reasonable charges of nonservice-
connected VA care or services. As part of the telephone application, 
the VA employee will obtain the veteran's verbal consent to assign his 
or her third-party insurance benefits to VA and inform the veteran that 
in order to pursue third-party collections, VA may disclose certain 
information about the veteran and his or her treatment.
    The VA employee will obtain the veteran's verbal assurance of his 
or her understanding of these potential consequences and obligations 
and continued intent to apply for enrollment in the VA healthcare 
system. After those steps are complete, the veteran will attest to the 
accuracy and authenticity of the information provided in the 
application and must provide verbal confirmation that he or she 
consents to VA copayment obligations and third-party billing 
procedures. These steps will be considered to complete the application 
process in the same manner as submitting the online application or 
signed paper form under current regulations.
    By adding the telephone application to VA's regulations with this 
amendment, VA will now offer three ways to enroll under 38 CFR 
17.36(d)(1). For clarity, we are reorganizing paragraph (d)(1) to show 
the three alternatives as (d)(1)(i), (ii), or (iii). Paragraphs 
(d)(1)(i) and (ii) restate the existing means to apply, by paper 
submission in person or by mail, (d)(1)(i); or online, (d)(1)(ii). We 
are removing the Web address from the regulation at new paragraph 
(d)(1)(iii) because VA may change the location of its Web application 
in the future. Veterans are informed of the Web address in a number of 
other media. New paragraph (d)(1)(iii) authorizes applications to be 
completed over the telephone by calling a designated phone number, 
submitting application information verbally, attesting to the accuracy 
and authenticity of the verbal application for enrollment and 
consenting to VA's copayment obligations and third-party billing 
procedures.
    We will begin telephone applications in two phases. Veterans in the 
first applicability date group (first group) are eligible to receive 
cost-free VA health care for combat-related conditions and enrollment 
in Priority Group 6 for 5 years after their separation from active 
duty. 38 U.S.C. 1710(e). Because these veterans are eligible for a 
benefit

[[Page 13996]]

Congress created with a limited duration, their opportunity to enroll 
in VA health care with enhanced Priority Group assignment is passing 
quickly. For this reason, VA will take telephone applications from them 
first. Beginning March 15, 2016, VA will telephone veterans in the 
first group with pending applications for enrollment in VA health care 
to offer them an opportunity to complete their applications by 
telephone. Veterans in the first group without pending applications may 
begin calling VA on March 15, 2016, to apply by telephone to enroll in 
VA health care. All veterans who are not in the first group may begin 
calling VA on July 5, 2016, to apply by telephone to enroll in VA 
health care.
    The phased initiation of telephone applications permits VA to best 
marshal limited resources as we perfect the program, which we can only 
do by processing real applications this new way, while preparing to 
marshal the additional resources necessary to serve all applicants for 
enrollment in VA health care who wish to apply by telephone. Although 
we could wait until we develop the capacity to serve all potential 
applicants from the first day of this program, that would delay 
initiating telephone application, and there is no good reason for that 
delay.

Administrative Procedure Act

    The Secretary of Veterans Affairs finds that there is good cause 
under the provisions of 5 U.S.C. 553(b)(B) to publish this rule without 
prior opportunity for public comment. Failure to authorize verbal 
applications as soon as possible is contrary to the public interest 
because it prolongs current delays in processing applications for 
enrollment in the VA healthcare system. Recently separated combat 
veterans comprise a large portion of new applicants for VA health care, 
with an especially great need for immediate access to care. Prompt 
processing of applications for enrollment in the VA health care system 
will ease their transition to civilian life. Any delay in initiating an 
available, viable means of enrolling this group would be detrimental to 
their well-being and consequently contrary to the public interest.
    We are dispensing with the 30-day delay requirement for the 
effective date of a rule for good cause under 5 U.S.C. 553(d)(3). The 
object of this rulemaking is to expedite the healthcare application and 
enrollment process. We anticipate that this regulation will be 
uncontroversial and believe that any further delay in allowing VA to 
complete applications by telephone would be contrary to the public 
interest, for the same reasons described above.

Effect of Rulemaking

    The Code of Federal Regulations, as revised by this interim final 
rulemaking, will represent the exclusive legal authority on this 
subject. No contrary rules or procedures are authorized. All VA 
guidance must be read to conform with this interim final rulemaking if 
possible or, if not possible, such guidance is superseded by this 
rulemaking.

Paperwork Reduction Act

    Although this action contains provisions constituting collections 
of information, at 38 CFR 17.36(d)(1), under the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501-3521), no new or proposed revised 
collections of information are associated with this interim final rule. 
It will amend an approved collection by allowing a new method for 
veterans to submit the requested information, but this change will not 
affect the burden on the public under the approved collection. The 
information collection requirements for 38 CFR 17.36(d)(1) are 
currently approved by the Office of Management and Budget (OMB) and 
have been assigned OMB control numbers 2900-0091.

Regulatory Flexibility Act

    The Secretary hereby certifies that this interim 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 interim final rule will directly affect 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 Order 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 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 interim 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 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 interim 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; 64.013, Veterans 
Prosthetic Appliances; 64.014, Veterans State Domiciliary Care; 64.015, 
Veterans State Nursing Home Care;

[[Page 13997]]

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 D. 
Snyder, Interim Chief of Staff, Department of Veterans Affairs, 
approved this document on February 9, 2016, for publication.

List of Subjects in 38 CFR Part 17

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

    Dated: March 9, 2016.
Michael P. Shores,
Chief Impact Analyst, Office of Regulation Policy & Management, Office 
of the General Counsel, Department of Veterans Affairs.

    For the reasons stated in the preamble, Department of Veterans 
Affairs proposes to amend 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.


0
2. Amend Sec.  17.36 to revise paragraph (d)(1) to read as follows:


Sec.  17.36  Enrollment--provision of hospital and outpatient care to 
veterans.

* * * * *
    (d) * * *
    (1) Application for enrollment. A veteran who wishes to be enrolled 
must apply by submitting a VA Form 10-10EZ:
    (i) To a VA medical facility or by mail it to the U.S. Postal 
address on the form; or
    (ii) Online at the designated World Wide Web internet address; or
    (iii) By calling a designated telephone number and submitting 
application information verbally. To complete a telephone application, 
the veteran seeking enrollment must attest to the accuracy and 
authenticity of their verbal application for enrollment and consent to 
VA's copayment requirements and third-party billing procedures.
* * * * *

[FR Doc. 2016-05680 Filed 3-15-16; 8:45 am]
BILLING CODE 8320-01-P