82_FR_21205 82 FR 21119 - Payment or Reimbursement for Certain Medical Expenses for Camp Lejeune Family Members

82 FR 21119 - Payment or Reimbursement for Certain Medical Expenses for Camp Lejeune Family Members

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 82, Issue 86 (May 5, 2017)

Page Range21119-21123
FR Document2017-09163

The Department of Veterans Affairs (VA) adopts as final an interim final rule addressing payment or reimbursement of certain medical expenses for family members of Camp Lejeune veterans. Under this rule, VA reimburses family members, or pays providers, for medical expenses incurred as a result of certain illnesses and conditions that may be associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune (Camp Lejeune), North Carolina, from August 1, 1953, to December 31, 1987. Payment or reimbursement is made within the limitations set forth in statute and Camp Lejeune family members receive hospital care and medical services that are consistent with the manner in which we provide hospital care and medical services to Camp Lejeune veterans. The statutory authority has since been amended to also include certain veterans' family members who resided at Camp Lejeune, North Carolina, for no less than 30 days (consecutive or nonconsecutive) between August 1, 1953, and December 31, 1987. This final rule will reflect that statutory change and will address public comments received in response to the interim final rule.

Federal Register, Volume 82 Issue 86 (Friday, May 5, 2017) 
[Federal Register Volume 82, Number 86 (Friday, May 5, 2017)]
[Rules and Regulations]
[Pages 21119-21123]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-09163]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AO79


Payment or Reimbursement for Certain Medical Expenses for Camp 
Lejeune Family Members

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) adopts as final an 
interim final rule addressing payment or reimbursement of certain 
medical expenses for family members of Camp Lejeune veterans. Under 
this rule, VA reimburses family members, or pays providers, for medical 
expenses incurred as a result of certain illnesses and conditions that 
may be associated with contaminants present in the base water supply at 
U.S. Marine Corps Base Camp Lejeune (Camp Lejeune), North Carolina, 
from August 1, 1953, to December 31, 1987. Payment or reimbursement is 
made within the limitations set forth in statute and Camp Lejeune 
family members receive hospital care and medical services that are 
consistent with the manner in which we provide hospital care and 
medical services to Camp Lejeune veterans. The statutory authority has 
since been amended to also include certain veterans' family members who 
resided at Camp Lejeune, North Carolina, for no less than 30 days 
(consecutive or nonconsecutive) between August 1, 1953, and December 
31, 1987. This final rule will reflect that statutory change and will 
address public comments received in response to the interim final rule.

DATES: Effective Date: This final rule is effective May 5, 2017.

FOR FURTHER INFORMATION CONTACT: Karyn Barrett, Director, Program 
Administration Directorate, Chief Business Office Purchased Care 
(10NB3), Veterans Health Administration, Department of Veterans 
Affairs, 810 Vermont Ave. NW., Washington, DC 20420, (303) 331-7500. 
(This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: On September 24, 2014, VA published an 
interim final rule to implement 38 U.S.C. 1787, which was created by 
section 102 of the Honoring America's Veterans and Caring for Camp 
Lejeune Families Act of 2012, Public Law 112-154 (the Act). 79 FR 
57415-57421, Sept. 24, 2014. The Act requires VA to reimburse family 
members of Camp Lejeune veterans, or pay providers, when they have 
exhausted all claims and remedies against a third party for payment of 
medical care for any of the 15 specified illnesses and conditions. We 
received a total of 14 comments. One commenter fully supported the 
interim final rule and did not suggest any changes to it. Several 
comments related to provisions of 38 CFR 17.400, the regulation 
governing hospital care and medical services for Camp Lejeune veterans 
and coverage for certain illnesses or conditions. That regulation was 
the subject of a separate rulemaking. See 81 FR 46603-46606 (July 18, 
2016). Three comments expressed general dissatisfaction with the 
interim final rule but neither opposed a specific provision of the 
regulation nor suggested how the regulation should be changed. As a 
result, these comments do not address any matter to which VA can 
respond and so will not be addressed here.
    All of the issues raised by other commenters that criticized at 
least one portion of the rule can be grouped together by similar topic, 
and we have organized our discussion of the comments accordingly.

Concerns Over Covered Illnesses or Conditions

    Several commenters referenced medical conditions that are not 
listed in the definition of covered illness or condition in 38 CFR 
17.400(b). One commenter suggested that the reimbursement provisions of 
Sec.  17.410 should apply to all illnesses or defects that science has 
shown were caused by exposure to the chemicals in the Camp Lejeune 
water supply. However, 38 U.S.C. 1787 limits payment or reimbursement 
for hospital care and medical services for Camp Lejeune family members 
to the 15 covered illnesses and conditions specified in 38 U.S.C. 
1710(e)(1)(F). VA does not have the authority to expand the payment or 
reimbursement provisions of 38 U.S.C. 1787 beyond those specified in 
the statute. We therefore make no changes in the final rule.
    One commenter expressed concern that the regulation identified the 
15 statutory covered illnesses and conditions but also noted the 
reference, found in the preamble to the interim final rule, 79 FR at 
57417, to VA's intent to consider any newly available science. The 
comment suggests that newly available science might identify other 
illnesses or conditions caused by exposure to the contaminated water at 
Camp Lejeune and thus expand the list of covered illnesses and 
conditions. However, as stated in the interim final rule, 79 FR at 
57417, any such science

[[Page 21120]]

is intended only to refine VA's clinical guidelines with respect to 
determining the cause or causes of a Camp Lejeune family member's 
illness. The enumerated list of covered illnesses and conditions 
referenced in 38 U.S.C. 1787 cannot be expanded by regulation.

Timeliness of Claims

    One commenter suggested that the two-year filing requirement of 
Sec.  17.410(d)(1)(i) was too short. This commenter noted the 
possibility that family members may not have had access to medical care 
to determine whether an illness was related to Camp Lejeune residency. 
This comment suggests the existence of a requirement to demonstrate a 
causal relationship between an illness or condition and residence at 
Camp Lejeune. However, under Sec.  17.410(d)(3), a family member will 
be eligible for payment or reimbursement for certain hospital care and 
medical services for a covered illness or condition unless VA makes a 
clinical finding, in accordance with VA clinical guidelines, that the 
illness or condition resulted from a cause other than the family 
member's residence at Camp Lejeune. The commenter also stated that a 
``large segment'' of family members might not know of the contamination 
today. The United States Marine Corps has taken steps over the past few 
years to publicize the issue of contaminants in the water at Camp 
Lejeune, and is making a continuing effort to contact individuals who 
were stationed there during the relevant time period and provide 
pertinent information. VA believes the two-year time frame provides an 
adequate period for affected family members to obtain and submit 
supporting evidence. Moreover, the two-year limit in paragraph 
(d)(1)(i) is consistent with VA's review of applications for 
retroactive copayment exemptions made by Camp Lejeune veterans under 
Sec.  17.400(d).
    Another commenter criticized the limitation of claims to expenses 
incurred after March 26, 2013. However, 38 U.S.C. 1787(b)(1) covers 
family members' claims only to the extent and in the amount provided in 
advance in appropriations for such purpose. Because March 26, 2013, is 
the date on which VA received appropriations to pay family members' 
claims, VA does not have the authority to pay claims for hospital care 
and medical services received before that date.

Medical Evaluations by Non-VA Physicians

    One commenter found ``unacceptable'' the information required of 
family members' treating physicians under Sec.  17.410(d)(2). This 
commenter suggested that VA needs to locate qualified occupational 
physicians and pay for expert opinions as part of the family members' 
treatment ``rather than strictly as part of a VA claim denial 
process.'' The commenter also criticized the application of VA clinical 
guidelines by VA physicians as applied to the opinions of family 
members' personal physicians regarding their patients' illnesses or 
conditions on the basis that VA clinicians were ``people who have never 
examined the patient.'' This comment misinterprets the intent of Sec.  
17.410(d)(2) and (d)(3), which do not establish a means for VA to rebut 
the diagnosis of a family member's physician. This is not an 
adversarial process in which VA requires the family member to undergo 
an independent medical examination, followed by an administrative 
weighing of the evidence to establish causation. The process is more 
analogous to submitting a claim for reimbursement to a health insurer. 
Because VA is not going to be conducting clinical examinations, 
paragraphs (d)(2) and (d)(3) establish a process whereby we rely on the 
clinical determinations made by family members' treating physicians who 
have conducted such examinations. VA will use this information to reach 
the clinical determinations described in Sec.  17.410(d)(3). The rule 
provides that a family member will be eligible for payment or 
reimbursement for certain hospital care and medical services for a 
covered illness or condition unless VA makes a clinical finding, in 
accordance with VA clinical guidelines, that the illness or condition 
resulted from a cause other than the family member's residence at Camp 
Lejeune. This is consistent with the statute at 38 U.S.C. 1787(a). The 
statute requires VA to apply clinical guidelines to determine, per 38 
U.S.C. 1787(b)(2), whether the illness or condition resulted from a 
cause other than the residence of the family member at Camp Lejeune 
during a covered period.
    The commenter also stated that VA would always be liable for full 
payment or reimbursement because most health care insurance policies 
contain exclusions and exceptions for poisonings, chemical or 
occupational exposure. The statute at 38 U.S.C. 1787(b)(3) authorizes 
VA to provide payment or reimbursement for hospital care or medical 
services provided to a family member only after the family member or 
the health care provider has exhausted without success all claims and 
remedies reasonably available to the family member or provider against 
a third party for payment of such care or services, including with 
respect to health-plan contracts. The regulation at Sec.  17.410(d)(5) 
is consistent with the statute, providing that VA is the payer of last 
resort after all other claims and remedies have been exhausted. The 
purpose of 38 U.S.C. 1787 is to ensure that the family member receives 
reimbursement for monies spent on, or the provider receives payment 
for, treatment of illnesses or conditions that are now covered, and 
that the family member has no residual financial liability for that 
treatment. We make no change based on this comment.

Amendment of 38 U.S.C. 1787

    After passage of the Act (Pub.L. 112-154), Congress subsequently 
passed Public Law 113-235, the Consolidated and Further Continuing 
Appropriations Act, 2015 (``the Consolidated Act''), which President 
Obama signed into law on December 16, 2014. Division I, Title II, sec. 
243 of the law amended 38 U.S.C. 1710(e)(1)(F) by striking ``January 1, 
1957,'' and inserting ``August 1, 1953.'' This added a new cohort of 
veterans to the group who are eligible for care pursuant to 38 U.S.C. 
1710(e)(1)(F), namely, veterans who served on active duty in the Armed 
Forces at Camp Lejeune, North Carolina, for not fewer than 30 days 
during the period from August 1, 1953, to December 31, 1956 (the ``1953 
cohort''). Consequently, this amendment expanded eligibility for 
payment and reimbursement for certain health care to qualifying family 
members of Camp Lejeune veterans in the 1953 cohort.
    Pursuant to the Consolidated Act, VA amends Sec.  17.410 in this 
final rule to account for the change in the date that begins the period 
of eligibility for Camp Lejeune veterans to receive VA hospital care 
and medical services. First, we amend the definition of ``Camp Lejeune 
family member'' in Sec.  17.410(b) by deleting ``January 1, 1957'' and 
adding in its place ``August 1, 1953.'' In addition, because the 
amendment is not retroactive, we amend Sec.  17.410(d)(1) to clarify 
that the family members of the 1953 cohort are not eligible for payment 
or reimbursement for hospital care and medical services received before 
December 16, 2014, the effective date of the Consolidated Act. More 
specifically, we amend Sec.  17.410(d)(1) by making a clarifying change 
to paragraph (d)(1)(i), adding a new paragraph (d)(1)(ii), and re-
designating existing paragraph (d)(1)(ii) as paragraph (d)(1)(iii). 
Section 17.410(d)(1)(i) addresses retroactive payment or reimbursement 
for hospital and medical services to the Camp

[[Page 21121]]

Lejeune family member of a Camp Lejeune veteran who served on active 
duty at Camp Lejeune between January 1, 1957, and December 31, 1987 
(``the 1957 cohort''). We amend Sec.  17.410(d)(1)(i) to specifically 
address retroactive reimbursement for hospital care and medical 
services provided before the date of application of a family member of 
a Camp Lejeune veteran in the 1957 cohort, and add a new paragraph 
(d)(1)(ii) to address separately retroactive reimbursement for hospital 
care and medical services provided before the date of application of a 
Camp Lejeune family member of a Camp Lejeune veteran in the 1953 
cohort. Paragraph (d)(1)(ii), addressing payment or reimbursement for 
hospital care and medical services provided on or after the date an 
application is filed, is re-designated as paragraph (d)(1)(iii) and 
remains otherwise unchanged. We make no other changes to Sec.  17.410 
based on the Consolidated Act.
    We also make a technical amendment to Sec.  17.410(d)(2), which 
required a Camp Lejeune family member's physician to certify that the 
claimed hospital care or medical services were provided for an illness 
or condition ``listed in Sec.  17.400(d)(1).'' Section 17.400 has since 
been amended to remove the list of covered illnesses and conditions 
from paragraph (d)(1) of that section and add the list as the 
definition of ``covered illness or condition'' in paragraph (b) of that 
section. 81 FR at 46603. Accordingly, we revise Sec.  17.410(d)(2) to 
reference the definition of ``covered illness or condition'' in Sec.  
17.400(b).

Miscellaneous

    One commenter stated that the comment period provided was too short 
and should be extended. The Administrative Procedures Act requires 
federal agencies to provide the public with adequate notice of a 
proposed rule followed by a meaningful opportunity to comment on the 
rule's content. 5 U.S.C. 553. The requirement to provide the public 
with adequate notice of a proposed rule is generally achieved through 
the publication of a notice of proposed rulemaking in the Federal 
Register. Once adequate notice is provided, the agency must provide 
interested persons with a meaningful opportunity to comment on the 
proposed rule through the submission of written data, views, or 
arguments. Executive Order 12866 directs that in most cases the public 
comment period on a proposed rule should be not less than 60 days. The 
same principles apply to comment periods for interim final rules. 
Comment periods may be extended where there is a showing of inadequate 
notice, the proposed rulemaking presents novel or complex issues, or a 
responsive public comment prompts the agency to consider a different 
approach to the issues addressed in the proposed rulemaking. Here, the 
rulemaking is consistent with a statutory mandate for VA to reimburse 
family members, or pay providers, for medical expenses incurred as a 
result of certain illnesses and conditions that may be attributed to 
exposure to contaminants in the drinking water at Camp Lejeune during a 
specified time period. The rulemaking does not deviate from the 
statutory parameters, and does not present any novel or complex issues. 
VA believes that it provided sufficient notice and opportunity for the 
public to comment.
    Based on the rationale set forth in the interim final rule and in 
this document, VA is adopting the provisions of the interim final rule 
as a final rule with changes as noted above.

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.

Administrative Procedure Act

    The Secretary of Veterans Affairs finds under 38 U.S.C. 553(b)(B) 
that there is good cause to publish a portion of this final rule 
without prior opportunity for public comment, and under 5 U.S.C. 
553(d)(3) that there is good cause to publish this portion of the rule 
with an immediate effective date. This rulemaking amends Sec.  17.410 
to incorporate a provision mandated by Congress. See Public Law 113-
235. Notice and public comment is unnecessary because it could not 
result in any change to this provision. Further, since the public law 
became effective on its date of enactment, VA believes it is 
impracticable and contrary to law and the public interest to delay this 
rule for the purpose of soliciting advance public comment or to have a 
delayed effective date. In addition, through this rulemaking VA adopts 
as final an interim final rule for which we provided notice and 
opportunity for the public to comment. Substantive comments received in 
the interim final rule have been addressed in this rulemaking.

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.

Paperwork Reduction Act

    The Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3507) requires 
that VA consider the impact of paperwork and other information 
collection burdens imposed on the public. Under 44 U.S.C. 3507(a), an 
agency may not collect or sponsor the collection of information, nor 
may it impose an information collection requirement unless it displays 
a currently valid Office of Management and Budget (OMB) control number. 
See also 5 CFR 1320.8(b)(3)(vi).
    This final rule will impose the following amended information 
collection requirements. Section 17.410(c) of title 38, CFR, requires 
an individual applying for benefits associated with hospital care and 
medical services for Camp Lejeune family members to submit an 
application to VA. VA Form 10068, ``Camp Lejeune Family Member Program 
Application'' is used for that purpose. Section 17.410(d)(1) requires a 
Camp Lejeune family member or provider of care or services to submit a 
timely claim for payment or reimbursement. Section 17.410(d)(2) 
requires the provider of a Camp Lejeune family member to certify that a 
Camp Lejeune family member has been diagnosed with one of the 15 
required illnesses or conditions. Section 17.410 requires VA to 
maintain timely information about the Camp Lejeune family member in 
order to correctly identify the individual in VA's system, and to 
submit any information or reimbursements. OMB approved these new 
information collection requirements associated with the interim final 
rule on an emergency basis and assigned OMB control number 2900-0822. 
Pursuant to the Consolidated Act, VA amends these forms to require 
applicants to certify that they resided at Camp Lejeune between 1953 
and 1987. The information collection is pending OMB approval. Notice of 
OMB approval for this information collection will be

[[Page 21122]]

published in a future Federal Register document.

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. 601-12. 
This final rule will directly affect only individuals and will not 
affect any small entities. Therefore, pursuant to 5 U.S.C. 605(b), this 
rulemaking is exempt from the initial and final flexibility analysis 
requirements of 5 U.S.C. 603 and 604.

Executive Order 12866 and Executive Order 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 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 Fiscal Year to Date.''

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance numbers and titles for 
the program affected by this rule are 64.007, Blind Rehabilitation 
Centers; 64.008, Veterans Domiciliary Care; 64.009, 64.009, Veterans 
Medical Care Benefits, Veterans Medical Care Benefits; 64.010, Veterans 
Nursing Home Care; 64.012, Veterans Prescription Service; 64.013, 
Veterans Prosthetic Appliances; 64.014, Veterans State Domiciliary 
Care; 64.015, Veterans State Nursing Home Care; 64.022, Veterans Home 
Based Primary Care.

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. Gina S. 
Farrisee, Deputy Chief of Staff, Department of Veterans Affairs, 
approved this document on April 24, 2017, 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: May 2, 2017.
Janet Coleman,
Chief, Office of Regulation Policy & Management, Office of the 
Secretary, Department of Veterans Affairs.
    Accordingly, the interim rule amending 38 CFR part 17 which was 
published at 79 FR 57415 on September 24, 2014, is adopted as final 
with the following change:

PART 17--MEDICAL

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

    Authority: 38 U.S.C. 501, and as noted in specific sections.
    Section 17.38 also issued under 38 U.S.C. 101, 501, 1701, 1705, 
1710, 1710A, 1721, 1722, 1782, and 1786.
    Section 17.169 also issued under 38 U.S.C. 1712C.
    Sections 17.380 and 17.412 are also issued under sec. 260, 
Public Law 114-223, 130 Stat. 857.
    Section 17.410 is also issued under 38 U.S.C. 1787.
    Section 17.415 is also issued under 38 U.S.C. 7301, 7304, 7402, 
and 7403.
    Sections 17.640 and 17.647 are also issued under sec. 4, Public 
Law 114-2, 129 Stat. 30.
    Sections 17.641 through 17.646 are also issued under 38 U.S.C. 
501(a) and sec. 4, Public Law 114-2, 129 Stat. 30.


0
2. Revise Sec.  17.410 to read as follows:


Sec.  17.410  Hospital care and medical services for Camp Lejeune 
family members.

    (a) General. In accordance with this section and subject to the 
availability of funds appropriated for such purpose, VA will provide 
payment or reimbursement for certain hospital care and medical services 
furnished to Camp Lejeune family members by non-VA health care 
providers.
    (b) Definitions. For the purposes of this section:
    Camp Lejeune has the meaning set forth in Sec.  17.400(b).
    Camp Lejeune family member means an individual who:
    (i) Resided at Camp Lejeune (or was in utero while his or her 
mother either resided at Camp Lejeune or served at Camp Lejeune under 
Sec.  17.400(b)) for at least 30 (consecutive or nonconsecutive) days 
during the period beginning on August 1, 1953, and ending on December 
31, 1987; and
    (ii) Meets one of the following criteria:
    (A) Is related to a Camp Lejeune veteran by birth;
    (B) Was married to a Camp Lejeune veteran; or
    (C) Was a legal dependent of a Camp Lejeune veteran.
    Camp Lejeune veteran has the meaning set forth in Sec.  17.400(b).
    Health-plan contract has the meaning set forth in Sec.  17.1001(a).
    Third party has the meaning set forth in Sec.  17.1001(b).
    (c) Application. An individual may apply for benefits under this 
section by completing and submitting an application form.
    (d) Payment or reimbursement of certain medical care and hospital 
services. VA will provide payment or reimbursement for hospital care 
and medical services provided to a Camp Lejeune family member by a non-
VA provider if all of the following are true:
    (1) The Camp Lejeune family member or provider of care or services 
has submitted a timely claim for payment or reimbursement, which means:

[[Page 21123]]

    (i) In the case of a Camp Lejeune family member who resided at Camp 
Lejeune between January 1, 1957, and December 31, 1987, for hospital 
care and medical services received prior to the date an application for 
benefits is filed per paragraph (c) of this section, the hospital care 
and medical services must have been provided on or after March 26, 
2013, but no more than 2 years prior to the date that VA receives the 
application. The claim for payment or reimbursement must be received by 
VA no more than 60 days after VA approves the application;
    (ii) In the case of a Camp Lejeune family member who resided at 
Camp Lejeune between August 1, 1953, and December 31, 1956, for 
hospital care and medical services received prior to the date an 
application for benefits is filed per paragraph (c) of this section, 
the hospital care and medical services must have been provided on or 
after December 16, 2014, but no more than 2 years prior to the date 
that VA receives the application. The claim for payment or 
reimbursement must be received by VA no more than 60 days after VA 
approves the application;
    (iii) For hospital care and medical services provided on or after 
the date an application for benefits is filed per paragraph (c) of this 
section, the claim for payment or reimbursement must be received by VA 
no more than 2 years after the later of either the date of discharge 
from a hospital or the date that medical services were rendered;
    (2) The Camp Lejeune family member's treating physician certifies 
that the claimed hospital care or medical services were provided for a 
covered illness or condition as defined in Sec.  17.400(b), and 
provides information about any co-morbidities, risk factors, or other 
exposures that may have contributed to the illness or condition;
    (3) VA makes the clinical finding, under VA clinical practice 
guidelines, that the illness or condition did not result from a cause 
other than the residence of the family member at Camp Lejeune;
    (4) VA would be authorized to provide the claimed hospital care or 
medical services to a veteran under VA's medical benefits package in 
Sec.  17.38;
    (5) The Camp Lejeune family member or hospital care or medical 
service provider has exhausted without success all claims and remedies 
reasonably available to the family member or provider against a third 
party, including health-plan contracts; and
    (6) Funds were appropriated to implement 38 U.S.C. 1787 in a 
sufficient amount to permit payment or reimbursement.
    (e) Payment or reimbursement amounts. Payments or reimbursements 
under this section will be in amounts determined in accordance with 
this paragraph (e).
    (1) If a third party is partially liable for the claimed hospital 
care or medical services, then VA will pay or reimburse the lesser of 
the amount for which the Camp Lejeune family member remains personally 
liable or the amount for which VA would pay for such care under 
Sec. Sec.  17.55 and 17.56.
    (2) If VA is the sole payer for hospital care and medical services, 
then VA will pay or reimburse in accordance with Sec. Sec.  17.55 and 
17.56, as applicable.
    (The information collection requirements have been submitted to OMB 
and are pending OMB approval.)
[FR Doc. 2017-09163 Filed 5-4-17; 8:45 am]
 BILLING CODE 8320-01-P

Federal Register / Vol. 82, No. 86 / Friday, May 5, 2017 / Rules and Regulations 21119 medication copayment system, effective DEPARTMENT OF VETERANS when they have exhausted all claims February 27, 2017. Under AP35, the AFFAIRS and remedies against a third party for new regulatory formula, focuses on the payment of medical care for any of the type of medication being prescribed and 38 CFR Part 17 15 specified illnesses and conditions. removes the automatic escalator RIN 2900–AO79 We received a total of 14 comments. provision, meaning that changes in One commenter fully supported the copayments would only occur through Payment or Reimbursement for Certain interim final rule and did not suggest subsequent rulemakings. Veterans Medical Expenses for Camp Lejeune any changes to it. Several comments exempt by law from copayments under Family Members related to provisions of 38 CFR 17.400, the regulation governing hospital care 38 U.S.C. 1722A(a)(3) continue to be AGENCY: Department of Veterans Affairs. and medical services for Camp Lejeune exempt. Three classes of medications ACTION: Final rule. veterans and coverage for certain were established for copayment illnesses or conditions. That regulation purposes: Tier 1 medications, Tier 2 SUMMARY: The Department of Veterans was the subject of a separate medications, and Tier 3 medications. Affairs (VA) adopts as final an interim rulemaking. See 81 FR 46603–46606 Tiers 1 and 2 includes multi-source final rule addressing payment or (July 18, 2016). Three comments medications, a term that is defined in reimbursement of certain medical expressed general dissatisfaction with § 17.110(b)(1)(iv). Tier 3 includes expenses for family members of Camp the interim final rule but neither medications that retain patent Lejeune veterans. Under this rule, VA opposed a specific provision of the protection and exclusivity and are not reimburses family members, or pays regulation nor suggested how the multi-source medications. Copayment providers, for medical expenses regulation should be changed. As a amounts vary depending upon the Tier incurred as a result of certain illnesses result, these comments do not address in which the medication is classified. A and conditions that may be associated any matter to which VA can respond 30-day or less supply of Tier 1 with contaminants present in the base and so will not be addressed here. medications has a copayment of $5. For water supply at U.S. Marine Corps Base All of the issues raised by other Tier 2 medications, the copayment is $8, Camp Lejeune (Camp Lejeune), North commenters that criticized at least one and for Tier 3 medications, the Carolina, from August 1, 1953, to portion of the rule can be grouped copayment is $11. The rule also December 31, 1987. Payment or together by similar topic, and we have reimbursement is made within the organized our discussion of the changed the annual cap for medication limitations set forth in statute and Camp comments accordingly. copayments, lowering the cap to $700 Lejeune family members receive for all veterans who are required to pay Concerns Over Covered Illnesses or hospital care and medical services that medication copayments. Conditions are consistent with the manner in which Paperwork Reduction Act we provide hospital care and medical Several commenters referenced services to Camp Lejeune veterans. The medical conditions that are not listed in This resolution contains no statutory authority has since been the definition of covered illness or provisions constituting a collection of amended to also include certain condition in 38 CFR 17.400(b). One information under the Paperwork veterans’ family members who resided commenter suggested that the Reduction Act of 1995 (44 U.S.C. 3501– at Camp Lejeune, North Carolina, for no reimbursement provisions of § 17.410 3521). less than 30 days (consecutive or should apply to all illnesses or defects nonconsecutive) between August 1, that science has shown were caused by Signing Authority 1953, and December 31, 1987. This final exposure to the chemicals in the Camp rule will reflect that statutory change Lejeune water supply. However, 38 The Secretary of Veterans Affairs, or U.S.C. 1787 limits payment or designee, approved this document and and will address public comments received in response to the interim final reimbursement for hospital care and authorized the undersigned to sign and medical services for Camp Lejeune rule. submit the document to the Office of the family members to the 15 covered Federal Register for publication DATES: Effective Date: This final rule is illnesses and conditions specified in 38 electronically as an official document of effective May 5, 2017. U.S.C. 1710(e)(1)(F). VA does not have the Department of Veterans Affairs. Gina FOR FURTHER INFORMATION CONTACT: the authority to expand the payment or S. Farrisee, Deputy Chief of Staff, Karyn Barrett, Director, Program reimbursement provisions of 38 U.S.C. Department of Veterans Affairs, Administration Directorate, Chief 1787 beyond those specified in the approved this document on April 28, Business Office Purchased Care statute. We therefore make no changes 2017, for publication. (10NB3), Veterans Health in the final rule. Administration, Department of Veterans One commenter expressed concern Dated: May 2, 2017. Affairs, 810 Vermont Ave. NW., that the regulation identified the 15 Janet Coleman, Washington, DC 20420, (303) 331–7500. statutory covered illnesses and Chief, Office of Regulation Policy & (This is not a toll-free number.) conditions but also noted the reference, Management, Office of the Secretary, SUPPLEMENTARY INFORMATION: On found in the preamble to the interim Department of Veterans Affairs. September 24, 2014, VA published an final rule, 79 FR at 57417, to VA’s intent [FR Doc. 2017–09081 Filed 5–4–17; 8:45 am] interim final rule to implement 38 to consider any newly available science. BILLING CODE 8320–01–P U.S.C. 1787, which was created by The comment suggests that newly jstallworth on DSK7TPTVN1PROD with RULES section 102 of the Honoring America’s available science might identify other Veterans and Caring for Camp Lejeune illnesses or conditions caused by Families Act of 2012, Public Law 112– exposure to the contaminated water at 154 (the Act). 79 FR 57415–57421, Sept. Camp Lejeune and thus expand the list 24, 2014. The Act requires VA to of covered illnesses and conditions. reimburse family members of Camp However, as stated in the interim final Lejeune veterans, or pay providers, rule, 79 FR at 57417, any such science VerDate Sep<11>2014 17:48 May 04, 2017 Jkt 241001 PO 00000 Frm 00013 Fmt 4700 Sfmt 4700 E:\FR\FM\05MYR1.SGM 05MYR1

21120 Federal Register / Vol. 82, No. 86 / Friday, May 5, 2017 / Rules and Regulations is intended only to refine VA’s clinical required of family members’ treating family member or provider against a guidelines with respect to determining physicians under § 17.410(d)(2). This third party for payment of such care or the cause or causes of a Camp Lejeune commenter suggested that VA needs to services, including with respect to family member’s illness. The locate qualified occupational physicians health-plan contracts. The regulation at enumerated list of covered illnesses and and pay for expert opinions as part of § 17.410(d)(5) is consistent with the conditions referenced in 38 U.S.C. 1787 the family members’ treatment ‘‘rather statute, providing that VA is the payer cannot be expanded by regulation. than strictly as part of a VA claim denial of last resort after all other claims and process.’’ The commenter also criticized remedies have been exhausted. The Timeliness of Claims the application of VA clinical guidelines purpose of 38 U.S.C. 1787 is to ensure One commenter suggested that the by VA physicians as applied to the that the family member receives two-year filing requirement of opinions of family members’ personal reimbursement for monies spent on, or § 17.410(d)(1)(i) was too short. This physicians regarding their patients’ the provider receives payment for, commenter noted the possibility that illnesses or conditions on the basis that treatment of illnesses or conditions that family members may not have had VA clinicians were ‘‘people who have are now covered, and that the family access to medical care to determine never examined the patient.’’ This member has no residual financial whether an illness was related to Camp comment misinterprets the intent of liability for that treatment. We make no Lejeune residency. This comment § 17.410(d)(2) and (d)(3), which do not change based on this comment. suggests the existence of a requirement establish a means for VA to rebut the to demonstrate a causal relationship Amendment of 38 U.S.C. 1787 diagnosis of a family member’s between an illness or condition and physician. This is not an adversarial After passage of the Act (Pub.L. 112– residence at Camp Lejeune. However, process in which VA requires the family 154), Congress subsequently passed under § 17.410(d)(3), a family member member to undergo an independent Public Law 113–235, the Consolidated will be eligible for payment or medical examination, followed by an and Further Continuing Appropriations reimbursement for certain hospital care administrative weighing of the evidence Act, 2015 (‘‘the Consolidated Act’’), and medical services for a covered to establish causation. The process is which President Obama signed into law illness or condition unless VA makes a more analogous to submitting a claim on December 16, 2014. Division I, Title clinical finding, in accordance with VA for reimbursement to a health insurer. II, sec. 243 of the law amended 38 clinical guidelines, that the illness or Because VA is not going to be U.S.C. 1710(e)(1)(F) by striking ‘‘January condition resulted from a cause other 1, 1957,’’ and inserting ‘‘August 1, conducting clinical examinations, than the family member’s residence at 1953.’’ This added a new cohort of paragraphs (d)(2) and (d)(3) establish a Camp Lejeune. The commenter also veterans to the group who are eligible process whereby we rely on the clinical stated that a ‘‘large segment’’ of family for care pursuant to 38 U.S.C. determinations made by family members might not know of the 1710(e)(1)(F), namely, veterans who members’ treating physicians who have contamination today. The United States served on active duty in the Armed conducted such examinations. VA will Marine Corps has taken steps over the Forces at Camp Lejeune, North Carolina, use this information to reach the clinical past few years to publicize the issue of for not fewer than 30 days during the determinations described in contaminants in the water at Camp period from August 1, 1953, to § 17.410(d)(3). The rule provides that a Lejeune, and is making a continuing December 31, 1956 (the ‘‘1953 cohort’’). family member will be eligible for Consequently, this amendment effort to contact individuals who were payment or reimbursement for certain expanded eligibility for payment and stationed there during the relevant time hospital care and medical services for a reimbursement for certain health care to period and provide pertinent covered illness or condition unless VA qualifying family members of Camp information. VA believes the two-year makes a clinical finding, in accordance Lejeune veterans in the 1953 cohort. time frame provides an adequate period with VA clinical guidelines, that the Pursuant to the Consolidated Act, VA for affected family members to obtain illness or condition resulted from a amends § 17.410 in this final rule to and submit supporting evidence. cause other than the family member’s account for the change in the date that Moreover, the two-year limit in residence at Camp Lejeune. This is begins the period of eligibility for Camp paragraph (d)(1)(i) is consistent with consistent with the statute at 38 U.S.C. Lejeune veterans to receive VA hospital VA’s review of applications for 1787(a). The statute requires VA to care and medical services. First, we retroactive copayment exemptions made apply clinical guidelines to determine, amend the definition of ‘‘Camp Lejeune by Camp Lejeune veterans under per 38 U.S.C. 1787(b)(2), whether the family member’’ in § 17.410(b) by § 17.400(d). Another commenter criticized the illness or condition resulted from a deleting ‘‘January 1, 1957’’ and adding limitation of claims to expenses cause other than the residence of the in its place ‘‘August 1, 1953.’’ In incurred after March 26, 2013. However, family member at Camp Lejeune during addition, because the amendment is not 38 U.S.C. 1787(b)(1) covers family a covered period. retroactive, we amend § 17.410(d)(1) to members’ claims only to the extent and The commenter also stated that VA clarify that the family members of the in the amount provided in advance in would always be liable for full payment 1953 cohort are not eligible for payment appropriations for such purpose. or reimbursement because most health or reimbursement for hospital care and Because March 26, 2013, is the date on care insurance policies contain medical services received before which VA received appropriations to exclusions and exceptions for December 16, 2014, the effective date of pay family members’ claims, VA does poisonings, chemical or occupational the Consolidated Act. More specifically, not have the authority to pay claims for exposure. The statute at 38 U.S.C. we amend § 17.410(d)(1) by making a jstallworth on DSK7TPTVN1PROD with RULES hospital care and medical services 1787(b)(3) authorizes VA to provide clarifying change to paragraph (d)(1)(i), received before that date. payment or reimbursement for hospital adding a new paragraph (d)(1)(ii), and care or medical services provided to a re-designating existing paragraph Medical Evaluations by Non-VA family member only after the family (d)(1)(ii) as paragraph (d)(1)(iii). Section Physicians member or the health care provider has 17.410(d)(1)(i) addresses retroactive One commenter found exhausted without success all claims payment or reimbursement for hospital ‘‘unacceptable’’ the information and remedies reasonably available to the and medical services to the Camp VerDate Sep<11>2014 14:00 May 04, 2017 Jkt 241001 PO 00000 Frm 00014 Fmt 4700 Sfmt 4700 E:\FR\FM\05MYR1.SGM 05MYR1

Federal Register / Vol. 82, No. 86 / Friday, May 5, 2017 / Rules and Regulations 21121 Lejeune family member of a Camp extended where there is a showing of received in the interim final rule have Lejeune veteran who served on active inadequate notice, the proposed been addressed in this rulemaking. duty at Camp Lejeune between January rulemaking presents novel or complex Unfunded Mandates 1, 1957, and December 31, 1987 (‘‘the issues, or a responsive public comment 1957 cohort’’). We amend prompts the agency to consider a The Unfunded Mandates Reform Act § 17.410(d)(1)(i) to specifically address different approach to the issues of 1995 requires, at 2 U.S.C. 1532, that retroactive reimbursement for hospital addressed in the proposed rulemaking. agencies prepare an assessment of care and medical services provided Here, the rulemaking is consistent with anticipated costs and benefits before before the date of application of a family a statutory mandate for VA to reimburse issuing any rule that may result in the member of a Camp Lejeune veteran in family members, or pay providers, for expenditure by State, local, and tribal the 1957 cohort, and add a new medical expenses incurred as a result of governments, in the aggregate, or by the paragraph (d)(1)(ii) to address separately certain illnesses and conditions that private sector, of $100 million or more retroactive reimbursement for hospital may be attributed to exposure to (adjusted annually for inflation) in any care and medical services provided contaminants in the drinking water at one year. This final rule will have no before the date of application of a Camp Camp Lejeune during a specified time such effect on State, local, and tribal Lejeune family member of a Camp period. The rulemaking does not deviate governments, or on the private sector. Lejeune veteran in the 1953 cohort. from the statutory parameters, and does Paperwork Reduction Act Paragraph (d)(1)(ii), addressing payment not present any novel or complex or reimbursement for hospital care and The Paperwork Reduction Act of 1995 issues. VA believes that it provided medical services provided on or after (44 U.S.C. 3501–3507) requires that VA sufficient notice and opportunity for the the date an application is filed, is re- consider the impact of paperwork and public to comment. other information collection burdens designated as paragraph (d)(1)(iii) and Based on the rationale set forth in the remains otherwise unchanged. We make imposed on the public. Under 44 U.S.C. interim final rule and in this document, 3507(a), an agency may not collect or no other changes to § 17.410 based on VA is adopting the provisions of the the Consolidated Act. sponsor the collection of information, interim final rule as a final rule with nor may it impose an information We also make a technical amendment changes as noted above. collection requirement unless it to § 17.410(d)(2), which required a Camp Lejeune family member’s Effect of Rulemaking displays a currently valid Office of physician to certify that the claimed Management and Budget (OMB) control Title 38 of the Code of Federal number. See also 5 CFR 1320.8(b)(3)(vi). hospital care or medical services were Regulations, as revised by this final This final rule will impose the provided for an illness or condition rulemaking, represents VA’s following amended information ‘‘listed in § 17.400(d)(1).’’ Section 17.400 has since been amended to implementation of its legal authority on collection requirements. Section remove the list of covered illnesses and this subject. Other than future 17.410(c) of title 38, CFR, requires an conditions from paragraph (d)(1) of that amendments to this regulation or individual applying for benefits section and add the list as the definition governing statutes, no contrary guidance associated with hospital care and of ‘‘covered illness or condition’’ in or procedures are authorized. All medical services for Camp Lejeune paragraph (b) of that section. 81 FR at existing or subsequent VA guidance family members to submit an 46603. Accordingly, we revise must be read to conform with this application to VA. VA Form 10068, § 17.410(d)(2) to reference the definition rulemaking if possible or, if not ‘‘Camp Lejeune Family Member of ‘‘covered illness or condition’’ in possible, such guidance is superseded Program Application’’ is used for that § 17.400(b). by this rulemaking. purpose. Section 17.410(d)(1) requires a Camp Lejeune family member or Miscellaneous Administrative Procedure Act provider of care or services to submit a One commenter stated that the The Secretary of Veterans Affairs timely claim for payment or comment period provided was too short finds under 38 U.S.C. 553(b)(B) that reimbursement. Section 17.410(d)(2) and should be extended. The there is good cause to publish a portion requires the provider of a Camp Lejeune Administrative Procedures Act requires of this final rule without prior family member to certify that a Camp federal agencies to provide the public opportunity for public comment, and Lejeune family member has been with adequate notice of a proposed rule under 5 U.S.C. 553(d)(3) that there is diagnosed with one of the 15 required followed by a meaningful opportunity to good cause to publish this portion of the illnesses or conditions. Section 17.410 comment on the rule’s content. 5 U.S.C. rule with an immediate effective date. requires VA to maintain timely 553. The requirement to provide the This rulemaking amends § 17.410 to information about the Camp Lejeune public with adequate notice of a incorporate a provision mandated by family member in order to correctly proposed rule is generally achieved Congress. See Public Law 113–235. identify the individual in VA’s system, through the publication of a notice of Notice and public comment is and to submit any information or proposed rulemaking in the Federal unnecessary because it could not result reimbursements. OMB approved these Register. Once adequate notice is in any change to this provision. Further, new information collection provided, the agency must provide since the public law became effective on requirements associated with the interested persons with a meaningful its date of enactment, VA believes it is interim final rule on an emergency basis opportunity to comment on the impracticable and contrary to law and and assigned OMB control number proposed rule through the submission of the public interest to delay this rule for 2900–0822. Pursuant to the jstallworth on DSK7TPTVN1PROD with RULES written data, views, or arguments. the purpose of soliciting advance public Consolidated Act, VA amends these Executive Order 12866 directs that in comment or to have a delayed effective forms to require applicants to certify most cases the public comment period date. In addition, through this that they resided at Camp Lejeune on a proposed rule should be not less rulemaking VA adopts as final an between 1953 and 1987. The than 60 days. The same principles apply interim final rule for which we provided information collection is pending OMB to comment periods for interim final notice and opportunity for the public to approval. Notice of OMB approval for rules. Comment periods may be comment. Substantive comments this information collection will be VerDate Sep<11>2014 14:00 May 04, 2017 Jkt 241001 PO 00000 Frm 00015 Fmt 4700 Sfmt 4700 E:\FR\FM\05MYR1.SGM 05MYR1

21122 Federal Register / Vol. 82, No. 86 / Friday, May 5, 2017 / Rules and Regulations published in a future Federal Register rulemaking and its impact analysis are Section 17.38 also issued under 38 U.S.C. document. available on VA’s Web site at http:// 101, 501, 1701, 1705, 1710, 1710A, 1721, www.va.gov/orpm/, by following the 1722, 1782, and 1786. Regulatory Flexibility Act Section 17.169 also issued under 38 U.S.C. link for ‘‘VA Regulations Published The Secretary hereby certifies that 1712C. From FY 2004 Through Fiscal Year to Sections 17.380 and 17.412 are also issued this final rule will not have a significant Date.’’ under sec. 260, Public Law 114–223, 130 economic impact on a substantial Stat. 857. number of small entities as they are Catalog of Federal Domestic Assistance Section 17.410 is also issued under 38 defined in the Regulatory Flexibility The Catalog of Federal Domestic U.S.C. 1787. Act, 5 U.S.C. 601–12. This final rule Assistance numbers and titles for the Section 17.415 is also issued under 38 will directly affect only individuals and program affected by this rule are 64.007, U.S.C. 7301, 7304, 7402, and 7403. will not affect any small entities. Blind Rehabilitation Centers; 64.008, Sections 17.640 and 17.647 are also issued Therefore, pursuant to 5 U.S.C. 605(b), under sec. 4, Public Law 114–2, 129 Stat. 30. Veterans Domiciliary Care; 64.009, Sections 17.641 through 17.646 are also this rulemaking is exempt from the 64.009, Veterans Medical Care Benefits, issued under 38 U.S.C. 501(a) and sec. 4, initial and final flexibility analysis Veterans Medical Care Benefits; 64.010, Public Law 114–2, 129 Stat. 30. requirements of 5 U.S.C. 603 and 604. Veterans Nursing Home Care; 64.012, ■ 2. Revise § 17.410 to read as follows: Executive Order 12866 and Executive Veterans Prescription Service; 64.013, Order 13563 Veterans Prosthetic Appliances; 64.014, § 17.410 Hospital care and medical Executive Orders 12866 and 13563 Veterans State Domiciliary Care; 64.015, services for Camp Lejeune family members. direct agencies to assess the costs and Veterans State Nursing Home Care; (a) General. In accordance with this benefits of available regulatory 64.022, Veterans Home Based Primary section and subject to the availability of alternatives and, when regulation is Care. funds appropriated for such purpose, necessary, to select regulatory Signing Authority VA will provide payment or approaches that maximize net benefits reimbursement for certain hospital care (including potential economic, The Secretary of Veterans Affairs, or and medical services furnished to Camp environmental, public health, and safety designee, approved this document and Lejeune family members by non-VA effects, and other advantages; authorized the undersigned to sign and health care providers. distributive impacts; and equity). submit the document to the Office of the (b) Definitions. For the purposes of Executive Order 13563 (Improving Federal Register for publication this section: Regulation and Regulatory Review) electronically as an official document of Camp Lejeune has the meaning set emphasizes the importance of the Department of Veterans Affairs. Gina forth in § 17.400(b). quantifying both costs and benefits, S. Farrisee, Deputy Chief of Staff, Camp Lejeune family member means reducing costs, harmonizing rules, and Department of Veterans Affairs, an individual who: promoting flexibility. Executive Order approved this document on April 24, (i) Resided at Camp Lejeune (or was 12866 (Regulatory Planning and 2017, for publication. in utero while his or her mother either Review) defines a ‘‘significant resided at Camp Lejeune or served at List of Subjects in 38 CFR Part 17 Camp Lejeune under § 17.400(b)) for at regulatory action,’’ requiring review by OMB as any regulatory action that is least 30 (consecutive or nonconsecutive) Administrative practice and days during the period beginning on likely to result in a rule that may: (1) procedure, Alcohol abuse, Alcoholism, Have an annual effect on the economy August 1, 1953, and ending on Claims, Day care, Dental health, Drug December 31, 1987; and of $100 million or more or adversely abuse, Government contracts, Grant affect in a material way the economy, a (ii) Meets one of the following criteria: programs—health, Grant programs— (A) Is related to a Camp Lejeune sector of the economy, productivity, veterans, Health care, Health facilities, veteran by birth; competition, jobs, the environment, Health professions, Health records, (B) Was married to a Camp Lejeune public health or safety, or State, local, Homeless, Medical and Dental schools, veteran; or or tribal governments or communities; Medical devices, Medical research, (C) Was a legal dependent of a Camp (2) create a serious inconsistency or Mental health programs, Nursing Lejeune veteran. otherwise interfere with an action taken homes, Reporting and recordkeeping Camp Lejeune veteran has the or planned by another agency; (3) requirements, Travel and transportation meaning set forth in § 17.400(b). materially alter the budgetary impact of expenses, Veterans. Health-plan contract has the meaning entitlements, grants, user fees, or loan set forth in § 17.1001(a). Dated: May 2, 2017. programs or the rights and obligations of Third party has the meaning set forth recipients thereof; or (4) raise novel Janet Coleman, in § 17.1001(b). legal or policy issues arising out of legal Chief, Office of Regulation Policy & (c) Application. An individual may mandates, the President’s priorities, or Management, Office of the Secretary, Department of Veterans Affairs. apply for benefits under this section by the principles set forth in this Executive completing and submitting an Order. Accordingly, the interim rule application form. The economic, interagency, amending 38 CFR part 17 which was (d) Payment or reimbursement of budgetary, legal, and policy published at 79 FR 57415 on September certain medical care and hospital implications of this final rule have been 24, 2014, is adopted as final with the services. VA will provide payment or examined, and it has been determined following change: reimbursement for hospital care and jstallworth on DSK7TPTVN1PROD with RULES not to be a significant regulatory action medical services provided to a Camp under Executive Order 12866. VA’s PART 17—MEDICAL Lejeune family member by a non-VA impact analysis can be found as a provider if all of the following are true: supporting document at http:// ■ 1. The authority citation for part 17 is (1) The Camp Lejeune family member www.regulations.gov, usually within 48 revised to read as follows: or provider of care or services has hours after the rulemaking document is Authority: 38 U.S.C. 501, and as noted in submitted a timely claim for payment or published. Additionally, a copy of the specific sections. reimbursement, which means: VerDate Sep<11>2014 14:00 May 04, 2017 Jkt 241001 PO 00000 Frm 00016 Fmt 4700 Sfmt 4700 E:\FR\FM\05MYR1.SGM 05MYR1

Federal Register / Vol. 82, No. 86 / Friday, May 5, 2017 / Rules and Regulations 21123 (i) In the case of a Camp Lejeune provider against a third party, including Office of Ecosystem Protection, U.S. family member who resided at Camp health-plan contracts; and Environmental Protection Agency, EPA Lejeune between January 1, 1957, and (6) Funds were appropriated to New England Regional Office, 5 Post December 31, 1987, for hospital care implement 38 U.S.C. 1787 in a sufficient Office Square, Suite 100, (OEP05–2), and medical services received prior to amount to permit payment or Boston, MA 02109–3912, phone number the date an application for benefits is reimbursement. (617) 918–1653, fax number (617) 918– filed per paragraph (c) of this section, (e) Payment or reimbursement 0653, email McDonnell.Ida@epa.gov. the hospital care and medical services amounts. Payments or reimbursements SUPPLEMENTARY INFORMATION: EPA must have been provided on or after under this section will be in amounts issued a final rule in the Federal March 26, 2013, but no more than 2 determined in accordance with this Register on July 8, 2016 (81 FR 44542). years prior to the date that VA receives paragraph (e). An error occurred in the amendatory the application. The claim for payment (1) If a third party is partially liable instructions to the table in 40 CFR or reimbursement must be received by for the claimed hospital care or medical 52.1520(e). The table entry for VA no more than 60 days after VA services, then VA will pay or reimburse ‘‘Infrastructure SIP for the 2010 NO2 approves the application; the lesser of the amount for which the Camp Lejeune family member remains NAAQS’’ was unintentionally removed (ii) In the case of a Camp Lejeune and later restored. This corrective action family member who resided at Camp personally liable or the amount for which VA would pay for such care adds an entry for ‘‘Infrastructure SIP for Lejeune between August 1, 1953, and the 2010 SO2 NAAQS’’ to the table in December 31, 1956, for hospital care under §§ 17.55 and 17.56. (2) If VA is the sole payer for hospital 40 CFR 52.1520(e), as was originally and medical services received prior to intended. the date an application for benefits is care and medical services, then VA will filed per paragraph (c) of this section, pay or reimburse in accordance with List of Subjects in 40 CFR Part 52 the hospital care and medical services §§ 17.55 and 17.56, as applicable. (The information collection Environmental protection, Air must have been provided on or after pollution control, Incorporation by requirements have been submitted to December 16, 2014, but no more than 2 reference, Intergovernmental relations, OMB and are pending OMB approval.) years prior to the date that VA receives [FR Doc. 2017–09163 Filed 5–4–17; 8:45 am] Reporting and recordkeeping the application. The claim for payment requirements, Sulfur oxides. BILLING CODE 8320–01–P or reimbursement must be received by Dated: March 16, 2017. VA no more than 60 days after VA approves the application; Deborah A. Szaro, ENVIRONMENTAL PROTECTION Acting Regional Administrator, EPA New (iii) For hospital care and medical AGENCY England. services provided on or after the date an application for benefits is filed per 40 CFR Part 52 Correction paragraph (c) of this section, the claim for payment or reimbursement must be [EPA–R01–OAR–2012–0950; FRL–9959–68– In final rule FR Doc. 2016–15623, received by VA no more than 2 years Region 1] published in the issue of Friday, July 8, after the later of either the date of 2016 (81 FR 44542), make the following Air Plan Approval; New Hampshire; correction: discharge from a hospital or the date Infrastructure Requirements for the that medical services were rendered; On page 44553, in the third column, 2010 Sulfur Dioxide National Ambient remove amendatory instruction 3. (2) The Camp Lejeune family Air Quality Standards; Correction member’s treating physician certifies Part 52 of chapter I, title 40 of the that the claimed hospital care or AGENCY: Environmental Protection Code of Federal Regulations is corrected medical services were provided for a Agency, (EPA). by making the following correcting covered illness or condition as defined ACTION: Final rule; correcting amendment: in § 17.400(b), and provides information amendment. PART 52—APPROVAL AND about any co-morbidities, risk factors, or SUMMARY: The Environmental Protection PROMULGATION OF other exposures that may have Agency (EPA) published a final rule IMPLEMENTATION PLANS contributed to the illness or condition; approving a New Hampshire’s State (3) VA makes the clinical finding, ■ 1. The authority citation for part 52 Implementation Plan (SIP) submissions under VA clinical practice guidelines, continues to read as follows: that addressed infrastructure that the illness or condition did not requirements of the Clean Air Act (CAA Authority: 42 U.S.C. 7401 et seq. result from a cause other than the or Act) for the 2010 sulfur dioxide (SO2) residence of the family member at Camp Subpart EE—New Hampshire National Ambient Air Quality Standards Lejeune; (NAAQS) in the Federal Register on (4) VA would be authorized to July 8, 2016. An error in the ■ 2. In § 52.1520, the table in paragraph provide the claimed hospital care or nonregulatory table in New Hampshire’s (e) is amended by adding the entry medical services to a veteran under SIP is identified and corrected in this ‘‘Infrastructure SIP for the 2010 SO2 VA’s medical benefits package in action. NAAQS’’ after the entry ‘‘Infrastructure § 17.38; SIP for the 2010 SO2 NAAQS’’ to read (5) The Camp Lejeune family member DATES: This rule is effective May 5, as follows: or hospital care or medical service 2017. jstallworth on DSK7TPTVN1PROD with RULES provider has exhausted without success FOR FURTHER INFORMATION CONTACT: Ida § 52.1520 Identification of plan. all claims and remedies reasonably E. McDonnell, Manager, Air Permits, * * * * * available to the family member or Toxics, and Indoor Programs Unit, (e) * * * VerDate Sep<11>2014 14:00 May 04, 2017 Jkt 241001 PO 00000 Frm 00017 Fmt 4700 Sfmt 4700 E:\FR\FM\05MYR1.SGM 05MYR1


Document Created: 2018-11-08 08:39:35
Document Modified: 2018-11-08 08:39:35
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionRules and Regulations
ActionFinal rule.
DatesEffective Date: This final rule is effective May 5, 2017.
ContactKaryn Barrett, Director, Program Administration Directorate, Chief Business Office Purchased Care (10NB3), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Ave. NW., Washington, DC 20420, (303) 331-7500. (This is not a toll-free number.)
FR Citation82 FR 21119 
RIN Number2900-AO79
CFR AssociatedAdministrative 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 and Veterans
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