82_FR_6285 82 FR 6273 - Fertility Counseling and Treatment for Certain Veterans and Spouses

82 FR 6273 - Fertility Counseling and Treatment for Certain Veterans and Spouses

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 82, Issue 12 (January 19, 2017)

Page Range6273-6276
FR Document2017-00280

The Department of Veterans Affairs (VA) amends its regulation regarding fertility counseling and treatment available to certain veterans and spouses. VA currently provides certain infertility services other than in vitro fertilization (IVF) to veterans as part of the medical benefits package. IVF is the process of fertilization by manually fertilizing an egg, and then transferring the embryo to the uterus. This interim final rulemaking adds a new section authorizing IVF for a veteran with a service-connected disability that results in the inability of the veteran to procreate without the use of fertility treatment. In addition, we add a new section stating that VA may provide fertility counseling and treatment using assisted reproductive technologies (ART), including IVF, to a spouse of a veteran with a service-connected disability that results in the inability of the veteran to procreate without the use of fertility treatment. VA will provide ART treatment, including IVF, to these veterans and spouses as specified in the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act to the extent such services are consistent with the services available to enrolled veterans under the medical benefits package.

Federal Register, Volume 82 Issue 12 (Thursday, January 19, 2017)
[Federal Register Volume 82, Number 12 (Thursday, January 19, 2017)]
[Rules and Regulations]
[Pages 6273-6276]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-00280]



[[Page 6273]]

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

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP94


Fertility Counseling and Treatment for Certain Veterans and 
Spouses

AGENCY: Department of Veterans Affairs.

ACTION: Interim final rule.

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

SUMMARY: The Department of Veterans Affairs (VA) amends its regulation 
regarding fertility counseling and treatment available to certain 
veterans and spouses. VA currently provides certain infertility 
services other than in vitro fertilization (IVF) to veterans as part of 
the medical benefits package. IVF is the process of fertilization by 
manually fertilizing an egg, and then transferring the embryo to the 
uterus. This interim final rulemaking adds a new section authorizing 
IVF for a veteran with a service-connected disability that results in 
the inability of the veteran to procreate without the use of fertility 
treatment. In addition, we add a new section stating that VA may 
provide fertility counseling and treatment using assisted reproductive 
technologies (ART), including IVF, to a spouse of a veteran with a 
service-connected disability that results in the inability of the 
veteran to procreate without the use of fertility treatment. VA will 
provide ART treatment, including IVF, to these veterans and spouses as 
specified in the Continuing Appropriations and Military Construction, 
Veterans Affairs, and Related Agencies Appropriations Act, 2017, and 
Zika Response and Preparedness Act to the extent such services are 
consistent with the services available to enrolled veterans under the 
medical benefits package.

DATES: Effective Date: This rule is effective on January 19, 2017.
    Comment date: Comments must be received on or before March 20, 
2017.

ADDRESSES: Written comments may be submitted by email through http://www.regulations.gov; by mail or hand-delivery to Director, Regulation 
Policy and Management (00REG), Department of Veterans Affairs, 810 
Vermont Avenue NW., Room 1068, Washington, DC 20420; or by fax to (202) 
273-9026. (This is not a toll-free number.) Comments should indicate 
that they are submitted in response to ``RIN 2900AP94--Fertility 
Counseling and Treatment for Certain Veterans and Spouses.'' Copies of 
comments received will be available for public inspection in the Office 
of Regulation Policy and Management, Room 1068, 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 http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Patricia M. Hayes, Ph.D., Chief 
Consultant, Women's Health Services, Patient Care Services, Veterans 
Health Administration, Department of Veterans Affairs, 810 Vermont Ave. 
NW., Washington, DC 20420. (202) 461-0373. (This is not a toll-free 
number.)

SUPPLEMENTARY INFORMATION: Section 260 of the Continuing Appropriations 
and Military Construction, Veterans Affairs, and Related Agencies 
Appropriations Act, 2017, and Zika Response and Preparedness Act 
(Public Law 114-223) states that VA may use appropriated funds 
available to VA for the Medical Services account to provide fertility 
counseling and treatment using assisted reproductive technology (ART) 
to a covered veteran or the spouse of a covered veteran, or adoption 
reimbursement to a covered veteran. This rulemaking expands the types 
of ART treatment available to certain veterans and makes fertility 
counseling and treatment including ART treatment available to spouses 
of those veterans, consistent with this statutory authority. 
Reimbursement of adoption expenses will be the subject of a separate 
rulemaking.
    According to this law, Veterans who will receive this benefit are 
those with a service-connected disability that results in the inability 
of the veteran to procreate without the use of fertility treatment. The 
ART treatments referred to in this law are those relating to 
reproductive assistance provided to a member of the Armed Forces who 
incurs a serious injury or illness on active duty pursuant to title 10 
of the United States Code (U.S.C.) section 1074(c)(4)(A), as described 
in a policy memorandum issued by the Assistant Secretary of Defense for 
Health Affairs on April 3, 2012, titled ``Policy for Assisted 
Reproductive Services for the Benefit of Seriously or Severely Ill/
Injured (Category II or III) Active Duty Service Members,'' and the 
guidance issued to implement such policy, including any limitations on 
the amount of such benefits available to such a member. See Public Law 
114-223, section 260(b)(2) and (3). The implementing guidance is 
contained in a document attached to the policy memorandum. We will 
refer to the April 3, 2012, policy memorandum and guidance issued by 
the Department of Defense (DoD) to implement that policy collectively 
as DoD policy guidance. DoD has established a system for categorizing 
injured servicemembers for purposes of coordinating care. Those in 
Category II have a serious injury or illness, are unlikely to return to 
duty within a time specified by their Military Department, and may be 
medically separated from the military. Servicemembers in Category III 
have a severe or catastrophic injury or illness, are highly unlikely to 
return to duty, and will most likely be medically separated from the 
military.
    ART is defined at Public Law 114-223, section 260(b)(3) to mean the 
benefits relating to reproductive assistance in DoD policy guidance, 
including any limitations on the amount of such benefits in that 
policy. DoD policy guidance addresses assisted reproductive services 
available to servicemembers, providing specific guidance on the 
availability of IVF, as well as a wide range of services that VA 
considers as fertility treatment. Under this statute, VA is authorized 
to provide ART benefits, consistent with DoD policy guidance, to a 
veteran with a service-connected disability that results in the 
inability of the veteran to procreate without the use of fertility 
treatment, as well as the spouse of that veteran. The conference report 
accompanying this legislation makes clear that the implementing 
guidance developed by the Secretary shall not be materially different 
from, and in no way more expansive than, DoD's policy. Joint 
Explanatory Statement. 162 Congressional Record at S6011 (2016).
    The Veterans' Health Care Eligibility Reform Act of 1996, Public 
Law 104-262, mandated that VA implement a national enrollment system to 
manage the delivery of healthcare services. A key component of managing 
delivery of healthcare services to eligible veterans is identifying the 
medical services provided by VA. The medical benefits package, defining 
the medical services provided to all enrolled veterans by VA, is found 
at 38 CFR 17.38. VA may provide services under the medical benefits 
package that are determined by appropriate healthcare professionals to 
be needed to promote, preserve, or restore the health of the individual 
and to be in accord with generally accepted standards of medical 
practice.
    As part of the medical benefits package, VA provides many different 
types of fertility treatments and procedures to veterans. These include 
infertility counseling, laboratory blood

[[Page 6274]]

testing, surgical correction of structural pathology, reversal of a 
vasectomy or tubal ligation, medication, and various other diagnostic 
studies or treatments and procedures. This list is not all-inclusive. 
Most of the ART evaluation and treatment modalities offered by VA are 
consistent with DoD policy guidance. The exception is IVF. DoD offers 
IVF to servicemembers who have sustained serious or severe illness/
injury while on active duty that led to the loss of their natural 
procreative ability, while IVF is excluded from VA's medical benefits 
package under Sec.  17.38(c)(2). IVF is the process of fertilization by 
manually fertilizing an egg, and then transferring the embryo to the 
uterus. IVF is a common and medically accepted procedure for addressing 
infertility that cannot be overcome with other types of infertility 
treatment. Although we are not revising the medical benefits package 
itself, we are revising paragraph (c)(2) to add a note referencing the 
benefit available in Sec.  17.380, as discussed below. We believe that 
this clarification will help veterans better understand the benefits 
available from VA.
    Pursuant to Public Law 114-223 section 260, VA is adding new Sec.  
17.380 which states that IVF may be provided when clinically 
appropriate to a veteran who has a service-connected disability that 
results in the inability of the veteran to procreate without the use of 
fertility treatment, as well as a spouse of such veteran. Per 38 U.S.C. 
101(2), the term veteran means a person who served in the active 
military, naval, or air service, and who was discharged or released 
therefrom under conditions other than dishonorable. Under this 
provision, IVF services available to such veterans are the same as 
those provided by DoD to a member of the Armed Forces who incurs a 
serious injury or illness on active duty pursuant to 10 U.S.C. 
1074(c)(4)(A), as described in DoD policy guidance, including any 
limitations on the amount of such benefits available to such a member. 
For the purposes of this section, ``a service-connected disability that 
results in the inability of the veteran to procreate without the use of 
fertility treatment'' means, for a male veteran, a service-connected 
injury or illness that prevents the successful delivery of sperm to an 
egg; and, for a female veteran with ovarian function and a patent 
uterine cavity, a service-connected injury or illness that prevents the 
egg from being successfully fertilized by a sperm. This definition 
parallels requirements in DoD policy guidance for an active duty 
service member who is seriously or severely ill/injured (Category II or 
III) to receive fertility counseling and treatment using ART. Public 
Law 114-223 provides appropriations for FY 2017. The benefits 
authorized under section 260 are thereby limited to FY2017. Paragraph 
(b) of Sec.  17.380 states that the authority to provide IVF to covered 
veterans under this section expires September 30, 2017. If the 
authority is extended, we will amend this section accordingly.
    In addition, VA adds a new Sec.  17.412. This new section states 
that VA may provide fertility counseling and treatment using ART to a 
spouse of a veteran with a service-connected disability that results in 
the inability of the veteran to procreate without the use of fertility 
treatment to the extent such services are available to enrolled 
veterans under the medical benefits package. It also states that VA may 
provide IVF to a spouse of a veteran with a service-connected 
disability that results in the inability of the veteran to procreate 
without the use of fertility treatment. Such health care services may 
be provided when clinically appropriate and consistent with the 
benefits relating to reproductive assistance provided to a member of 
the Armed Forces who incurs a serious injury or illness on active duty 
as described in DoD policy guidance.
    Paragraph (b) states that authority to provide fertility counseling 
and treatment including IVF to spouses of covered veterans under this 
section expires September 30, 2017. If the authority is extended we 
will amend this section accordingly.
    DoD policy guidance addresses various issues including eligibility 
for ART, testing to predict fertility potential, infertility testing 
and treatment (including correction of the physical cause of 
infertility), provisions on the total number of IVF cycles that may be 
provided, and required processes and procedures. VA intends to issue 
policy and develop clinical guidelines consistent with DoD policy 
guidance.
    Finally, we also revise the center heading immediately preceding 
Sec.  17.410 to read ``Hospital Care and Medical Services for Spouses 
and Families.'' VA provides medical care to certain families of Camp 
LeJeune veterans under Sec.  17.410, and the center heading referred to 
those services. The current rulemaking adds a new section immediately 
following Sec.  17.410, and VA believes the center heading should be 
revised to avoid any confusion.

Administrative Procedure Act

    In accordance with U.S.C. 553(b)(B) and (d)(3), the Secretary of 
Veterans Affairs has concluded that there is good cause to publish this 
rule as an interim final rule without prior opportunity for public 
comment and to publish this rule with an immediate effective date. As 
stated above, this rule makes IVF treatment available to certain 
veterans, and fertility counseling and treatment using ART to the 
spouses of those veterans. The Secretary finds that it is impracticable 
and contrary to the public interest to delay this rule for the purpose 
of soliciting advance public comment or to have a delayed effective 
date. This rulemaking will benefit those veterans and spouses most in 
need of ART services including IVF, and delay might cause a significant 
hardship for affected veterans and spouses. The Joint Theater Trauma 
Registry (JTTR) reflects the most common single cause of battle 
injuries is explosive devices (36.3%). Such trauma frequently results 
in genitourinary injury. For example, 1 in 5 warriors were evacuated 
from Operation Enduring Freedom (OEF) combat in October 2011 with a 
genitourinary injury. This increasingly common trauma can have 
catastrophic reproductive results. While the JTTR tracks combat trauma 
only for OEF and Operation Iraqi Freedom, genitourinary or spinal cord 
injury, or pelvic trauma related to combat injuries was also common in 
previous combat operations, and these injuries may make it impossible 
for affected veterans to procreate without the use of fertility 
treatment. In many cases ART, including IVF, is the only viable option 
for procreation. Further, since age is a factor in successful 
fertilization and completion of a pregnancy, rulemaking delay may 
result in some veterans or spouses losing fertility potential prior to 
a later effective date. In addition, this rulemaking will ensure that 
covered veterans leaving service at this time, and their spouses, will 
experience continuity of care when transferring from health care 
provided by DoD to that provided by VA, with no difference in the level 
or types of available ART. For the above reason, the Secretary issues 
this rule as an interim final rule. VA will consider and address 
comments that are received within 60 days of the date this interim 
final rule is published in the Federal Register.

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

[[Page 6275]]

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 interim 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 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 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 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; 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.

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.

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 December 23, 2016, for publication.

Janet Coleman,
Chief, Regulation Policy & Management, Office of the Secretary, 
Department of Veterans Affairs.

    For the reasons set out in the preamble, VA amends 38 CFR part 17 
as follows:

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.
    Sections 17.380 and 17.412 are also issued under sec. 260, Pub. 
L. 114-223, 130 Stat. 857.
    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, Pub. L. 
114-2, 129 Stat. 30.
    Sections 17.641 through 17.646 are also issued under 38 U.S.C. 
501(a) and sec. 4, Pub. L. 114-2, 129 Stat. 30.


0
2. Amend Sec.  17.38 by:
0
a. Revising paragraph (c)(2).
0
b. Removing the sectional authority citation.
    The revision reads as follows:


Sec.  17.38  Medical benefits package.

* * * * *
    (c) * * *
    (2) In vitro fertilization. Note: See Sec.  17.380.
* * * * *

0
3. Add an undesignated center heading and Sec.  17.380 to read as 
follows:

In Vitro Fertilization Treatment


Sec.  17.380  In vitro fertilization treatment.

    (a)(1) In vitro fertilization may be provided when clinically 
appropriate to--
    (i) A veteran who has a service-connected disability that results 
in the inability of the veteran to procreate without the use of 
fertility treatment; and,

[[Page 6276]]

    (ii) The spouse of such veteran, as provided in Sec.  17.412.
    (2) For the purposes of this section, ``a service-connected 
disability that results in the inability of the veteran to procreate 
without the use of fertility treatment'' means, for a male veteran, a 
service-connected injury or illness that prevents the successful 
delivery of sperm to an egg; and, for a female veteran with ovarian 
function and a patent uterine cavity, a service-connected injury or 
illness that prevents the egg from being successfully fertilized by 
sperm.
    (3) In vitro fertilization treatment will be provided under this 
section when clinically appropriate and to the same extent such 
treatment is provided to a member of the Armed Forces who incurs a 
serious injury or illness on active duty pursuant to 10 U.S.C. 
1074(c)(4)(A), as described in the April 3, 2012, memorandum issued by 
the Assistant Secretary of Defense for Health Affairs on the subject of 
``Policy for Assisted Reproductive Services for the Benefit of 
Seriously or Severely Ill/Injured (Category II or III) Active Duty 
Service Members,'' and the guidance issued by the Department of Defense 
to implement such policy, including any limitations on the amount of 
such benefits available to such a member.
    (b) Authority to provide in vitro fertilization treatment to 
covered veterans under this section expires September 30, 2017.

0
4. Revise the undesignated center heading immediately preceding Sec.  
17.410 to read as follows:

Hospital Care and Medical Services for Spouses and Families

0
5. Add Sec.  17.412 to read as follows:


Sec.  17.412  Fertility counseling and treatment for certain spouses.

    (a)(1) VA may provide fertility counseling and treatment to a 
spouse of a veteran described in Sec.  17.380 to the extent such 
services are available to a veteran under Sec.  17.38, and consistent 
with the benefits relating to reproductive assistance provided to a 
member of the Armed Forces who incurs a serious injury or illness on 
active duty pursuant to 10 U.S.C. 1074(c)(4)(A), as described in the 
April 3, 2012, memorandum issued by the Assistant Secretary of Defense 
for Health Affairs on the subject of ``Policy for Assisted Reproductive 
Services for the Benefit of Seriously or Severely Ill/Injured (Category 
II or III) Active Duty Service Members,'' and the guidance issued by 
the Department of Defense to implement such policy, including any 
limitations on the amount of such benefits available to such a member.
    (2) VA may provide in vitro fertilization to a spouse of a veteran 
described in Sec.  17.380 when clinically appropriate and consistent 
with the benefits relating to reproductive assistance provided to a 
member of the Armed Forces who incurs a serious injury or illness on 
active duty pursuant to 10 U.S.C. 1074(c)(4)(A), as described in the 
April 3, 2012, memorandum issued by the Assistant Secretary of Defense 
for Health Affairs on the subject of ``Policy for Assisted Reproductive 
Services for the Benefit of Seriously or Severely Ill/Injured (Category 
II or III) Active Duty Service Members,'' and the guidance issued by 
the Department of Defense to implement such policy, including any 
limitations on the amount of such benefits available to such a member.
    (b) Authority to provide fertility counseling and treatment, 
including in vitro fertilization under this section, expires September 
30, 2017.

[FR Doc. 2017-00280 Filed 1-18-17; 8:45 am]
 BILLING CODE 8320-01-P



                                                                   Federal Register / Vol. 82, No. 12 / Thursday, January 19, 2017 / Rules and Regulations                                          6273

                                                  DEPARTMENT OF VETERANS                                  Management, Room 1068, between the                     memorandum. We will refer to the April
                                                  AFFAIRS                                                 hours of 8:00 a.m. and 4:30 p.m.                       3, 2012, policy memorandum and
                                                                                                          Monday through Friday (except                          guidance issued by the Department of
                                                  38 CFR Part 17                                          holidays). Please call (202) 461–4902 for              Defense (DoD) to implement that policy
                                                                                                          an appointment. (This is not a toll-free               collectively as DoD policy guidance.
                                                  RIN 2900–AP94
                                                                                                          number.) In addition, during the                       DoD has established a system for
                                                  Fertility Counseling and Treatment for                  comment period, comments may be                        categorizing injured servicemembers for
                                                  Certain Veterans and Spouses                            viewed online through the Federal                      purposes of coordinating care. Those in
                                                                                                          Docket Management System (FDMS) at                     Category II have a serious injury or
                                                  AGENCY:    Department of Veterans Affairs.              http://www.regulations.gov.                            illness, are unlikely to return to duty
                                                  ACTION:   Interim final rule.                           FOR FURTHER INFORMATION CONTACT:                       within a time specified by their Military
                                                                                                          Patricia M. Hayes, Ph.D., Chief                        Department, and may be medically
                                                  SUMMARY:    The Department of Veterans                  Consultant, Women’s Health Services,                   separated from the military.
                                                  Affairs (VA) amends its regulation                      Patient Care Services, Veterans Health                 Servicemembers in Category III have a
                                                  regarding fertility counseling and                      Administration, Department of Veterans                 severe or catastrophic injury or illness,
                                                  treatment available to certain veterans                 Affairs, 810 Vermont Ave. NW.,                         are highly unlikely to return to duty,
                                                  and spouses. VA currently provides                      Washington, DC 20420. (202) 461–0373.                  and will most likely be medically
                                                  certain infertility services other than in              (This is not a toll-free number.)                      separated from the military.
                                                  vitro fertilization (IVF) to veterans as                                                                          ART is defined at Public Law 114–
                                                                                                          SUPPLEMENTARY INFORMATION: Section
                                                  part of the medical benefits package.                                                                          223, section 260(b)(3) to mean the
                                                                                                          260 of the Continuing Appropriations
                                                  IVF is the process of fertilization by                                                                         benefits relating to reproductive
                                                                                                          and Military Construction, Veterans
                                                  manually fertilizing an egg, and then                                                                          assistance in DoD policy guidance,
                                                                                                          Affairs, and Related Agencies                          including any limitations on the amount
                                                  transferring the embryo to the uterus.
                                                                                                          Appropriations Act, 2017, and Zika                     of such benefits in that policy. DoD
                                                  This interim final rulemaking adds a
                                                                                                          Response and Preparedness Act (Public                  policy guidance addresses assisted
                                                  new section authorizing IVF for a
                                                                                                          Law 114–223) states that VA may use                    reproductive services available to
                                                  veteran with a service-connected
                                                                                                          appropriated funds available to VA for                 servicemembers, providing specific
                                                  disability that results in the inability of
                                                                                                          the Medical Services account to provide                guidance on the availability of IVF, as
                                                  the veteran to procreate without the use
                                                                                                          fertility counseling and treatment using               well as a wide range of services that VA
                                                  of fertility treatment. In addition, we
                                                                                                          assisted reproductive technology (ART)                 considers as fertility treatment. Under
                                                  add a new section stating that VA may
                                                                                                          to a covered veteran or the spouse of a                this statute, VA is authorized to provide
                                                  provide fertility counseling and
                                                                                                          covered veteran, or adoption                           ART benefits, consistent with DoD
                                                  treatment using assisted reproductive
                                                                                                          reimbursement to a covered veteran.                    policy guidance, to a veteran with a
                                                  technologies (ART), including IVF, to a
                                                                                                          This rulemaking expands the types of                   service-connected disability that results
                                                  spouse of a veteran with a service-
                                                                                                          ART treatment available to certain                     in the inability of the veteran to
                                                  connected disability that results in the
                                                                                                          veterans and makes fertility counseling                procreate without the use of fertility
                                                  inability of the veteran to procreate
                                                                                                          and treatment including ART treatment                  treatment, as well as the spouse of that
                                                  without the use of fertility treatment.
                                                                                                          available to spouses of those veterans,                veteran. The conference report
                                                  VA will provide ART treatment,
                                                                                                          consistent with this statutory authority.              accompanying this legislation makes
                                                  including IVF, to these veterans and
                                                                                                          Reimbursement of adoption expenses                     clear that the implementing guidance
                                                  spouses as specified in the Continuing
                                                                                                          will be the subject of a separate                      developed by the Secretary shall not be
                                                  Appropriations and Military
                                                                                                          rulemaking.                                            materially different from, and in no way
                                                  Construction, Veterans Affairs, and                        According to this law, Veterans who
                                                  Related Agencies Appropriations Act,                                                                           more expansive than, DoD’s policy.
                                                                                                          will receive this benefit are those with               Joint Explanatory Statement. 162
                                                  2017, and Zika Response and                             a service-connected disability that
                                                  Preparedness Act to the extent such                                                                            Congressional Record at S6011 (2016).
                                                                                                          results in the inability of the veteran to                The Veterans’ Health Care Eligibility
                                                  services are consistent with the services               procreate without the use of fertility
                                                  available to enrolled veterans under the                                                                       Reform Act of 1996, Public Law 104–
                                                                                                          treatment. The ART treatments referred                 262, mandated that VA implement a
                                                  medical benefits package.                               to in this law are those relating to                   national enrollment system to manage
                                                  DATES: Effective Date: This rule is                     reproductive assistance provided to a                  the delivery of healthcare services. A
                                                  effective on January 19, 2017.                          member of the Armed Forces who                         key component of managing delivery of
                                                     Comment date: Comments must be                       incurs a serious injury or illness on                  healthcare services to eligible veterans
                                                  received on or before March 20, 2017.                   active duty pursuant to title 10 of the                is identifying the medical services
                                                  ADDRESSES: Written comments may be                      United States Code (U.S.C.) section                    provided by VA. The medical benefits
                                                  submitted by email through http://                      1074(c)(4)(A), as described in a policy                package, defining the medical services
                                                  www.regulations.gov; by mail or hand-                   memorandum issued by the Assistant                     provided to all enrolled veterans by VA,
                                                  delivery to Director, Regulation Policy                 Secretary of Defense for Health Affairs                is found at 38 CFR 17.38. VA may
                                                  and Management (00REG), Department                      on April 3, 2012, titled ‘‘Policy for                  provide services under the medical
                                                  of Veterans Affairs, 810 Vermont                        Assisted Reproductive Services for the                 benefits package that are determined by
                                                  Avenue NW., Room 1068, Washington,                      Benefit of Seriously or Severely Ill/                  appropriate healthcare professionals to
                                                  DC 20420; or by fax to (202) 273–9026.                  Injured (Category II or III) Active Duty               be needed to promote, preserve, or
asabaliauskas on DSK3SPTVN1PROD with RULES




                                                  (This is not a toll-free number.)                       Service Members,’’ and the guidance                    restore the health of the individual and
                                                  Comments should indicate that they are                  issued to implement such policy,                       to be in accord with generally accepted
                                                  submitted in response to ‘‘RIN                          including any limitations on the amount                standards of medical practice.
                                                  2900AP94—Fertility Counseling and                       of such benefits available to such a                      As part of the medical benefits
                                                  Treatment for Certain Veterans and                      member. See Public Law 114–223,                        package, VA provides many different
                                                  Spouses.’’ Copies of comments received                  section 260(b)(2) and (3). The                         types of fertility treatments and
                                                  will be available for public inspection in              implementing guidance is contained in                  procedures to veterans. These include
                                                  the Office of Regulation Policy and                     a document attached to the policy                      infertility counseling, laboratory blood


                                             VerDate Sep<11>2014   20:34 Jan 18, 2017   Jkt 241001   PO 00000   Frm 00077   Fmt 4700   Sfmt 4700   E:\FR\FM\19JAR1.SGM   19JAR1


                                                  6274             Federal Register / Vol. 82, No. 12 / Thursday, January 19, 2017 / Rules and Regulations

                                                  testing, surgical correction of structural              severely ill/injured (Category II or III) to           Administrative Procedure Act
                                                  pathology, reversal of a vasectomy or                   receive fertility counseling and                          In accordance with U.S.C. 553(b)(B)
                                                  tubal ligation, medication, and various                 treatment using ART. Public Law 114–                   and (d)(3), the Secretary of Veterans
                                                  other diagnostic studies or treatments                  223 provides appropriations for FY                     Affairs has concluded that there is good
                                                  and procedures. This list is not all-                   2017. The benefits authorized under                    cause to publish this rule as an interim
                                                  inclusive. Most of the ART evaluation                   section 260 are thereby limited to                     final rule without prior opportunity for
                                                  and treatment modalities offered by VA                  FY2017. Paragraph (b) of § 17.380 states               public comment and to publish this rule
                                                  are consistent with DoD policy                          that the authority to provide IVF to                   with an immediate effective date. As
                                                  guidance. The exception is IVF. DoD                     covered veterans under this section                    stated above, this rule makes IVF
                                                  offers IVF to servicemembers who have                   expires September 30, 2017. If the                     treatment available to certain veterans,
                                                  sustained serious or severe illness/                    authority is extended, we will amend                   and fertility counseling and treatment
                                                  injury while on active duty that led to                 this section accordingly.                              using ART to the spouses of those
                                                  the loss of their natural procreative                                                                          veterans. The Secretary finds that it is
                                                                                                             In addition, VA adds a new § 17.412.
                                                  ability, while IVF is excluded from VA’s                                                                       impracticable and contrary to the public
                                                  medical benefits package under                          This new section states that VA may
                                                                                                          provide fertility counseling and                       interest to delay this rule for the
                                                  § 17.38(c)(2). IVF is the process of                                                                           purpose of soliciting advance public
                                                  fertilization by manually fertilizing an                treatment using ART to a spouse of a
                                                                                                          veteran with a service-connected                       comment or to have a delayed effective
                                                  egg, and then transferring the embryo to                                                                       date. This rulemaking will benefit those
                                                  the uterus. IVF is a common and                         disability that results in the inability of
                                                                                                          the veteran to procreate without the use               veterans and spouses most in need of
                                                  medically accepted procedure for                                                                               ART services including IVF, and delay
                                                  addressing infertility that cannot be                   of fertility treatment to the extent such
                                                                                                          services are available to enrolled                     might cause a significant hardship for
                                                  overcome with other types of infertility                                                                       affected veterans and spouses. The Joint
                                                  treatment. Although we are not revising                 veterans under the medical benefits
                                                                                                          package. It also states that VA may                    Theater Trauma Registry (JTTR) reflects
                                                  the medical benefits package itself, we                                                                        the most common single cause of battle
                                                  are revising paragraph (c)(2) to add a                  provide IVF to a spouse of a veteran
                                                                                                          with a service-connected disability that               injuries is explosive devices (36.3%).
                                                  note referencing the benefit available in                                                                      Such trauma frequently results in
                                                  § 17.380, as discussed below. We                        results in the inability of the veteran to
                                                                                                                                                                 genitourinary injury. For example, 1 in
                                                  believe that this clarification will help               procreate without the use of fertility
                                                                                                                                                                 5 warriors were evacuated from
                                                  veterans better understand the benefits                 treatment. Such health care services
                                                                                                                                                                 Operation Enduring Freedom (OEF)
                                                  available from VA.                                      may be provided when clinically
                                                                                                                                                                 combat in October 2011 with a
                                                     Pursuant to Public Law 114–223                       appropriate and consistent with the
                                                                                                                                                                 genitourinary injury. This increasingly
                                                  section 260, VA is adding new § 17.380                  benefits relating to reproductive                      common trauma can have catastrophic
                                                  which states that IVF may be provided                   assistance provided to a member of the                 reproductive results. While the JTTR
                                                  when clinically appropriate to a veteran                Armed Forces who incurs a serious                      tracks combat trauma only for OEF and
                                                  who has a service-connected disability                  injury or illness on active duty as                    Operation Iraqi Freedom, genitourinary
                                                  that results in the inability of the                    described in DoD policy guidance.                      or spinal cord injury, or pelvic trauma
                                                  veteran to procreate without the use of                    Paragraph (b) states that authority to              related to combat injuries was also
                                                  fertility treatment, as well as a spouse of             provide fertility counseling and                       common in previous combat operations,
                                                  such veteran. Per 38 U.S.C. 101(2), the                 treatment including IVF to spouses of                  and these injuries may make it
                                                  term veteran means a person who                         covered veterans under this section                    impossible for affected veterans to
                                                  served in the active military, naval, or                expires September 30, 2017. If the                     procreate without the use of fertility
                                                  air service, and who was discharged or                  authority is extended we will amend                    treatment. In many cases ART,
                                                  released therefrom under conditions                     this section accordingly.                              including IVF, is the only viable option
                                                  other than dishonorable. Under this                        DoD policy guidance addresses                       for procreation. Further, since age is a
                                                  provision, IVF services available to such                                                                      factor in successful fertilization and
                                                                                                          various issues including eligibility for
                                                  veterans are the same as those provided                                                                        completion of a pregnancy, rulemaking
                                                                                                          ART, testing to predict fertility
                                                  by DoD to a member of the Armed                                                                                delay may result in some veterans or
                                                                                                          potential, infertility testing and
                                                  Forces who incurs a serious injury or                                                                          spouses losing fertility potential prior to
                                                                                                          treatment (including correction of the
                                                  illness on active duty pursuant to 10                                                                          a later effective date. In addition, this
                                                                                                          physical cause of infertility), provisions
                                                  U.S.C. 1074(c)(4)(A), as described in                                                                          rulemaking will ensure that covered
                                                                                                          on the total number of IVF cycles that
                                                  DoD policy guidance, including any                                                                             veterans leaving service at this time, and
                                                                                                          may be provided, and required
                                                  limitations on the amount of such                                                                              their spouses, will experience
                                                                                                          processes and procedures. VA intends
                                                  benefits available to such a member. For                                                                       continuity of care when transferring
                                                                                                          to issue policy and develop clinical
                                                  the purposes of this section, ‘‘a service-                                                                     from health care provided by DoD to
                                                                                                          guidelines consistent with DoD policy
                                                  connected disability that results in the                                                                       that provided by VA, with no difference
                                                  inability of the veteran to procreate                   guidance.
                                                                                                                                                                 in the level or types of available ART.
                                                  without the use of fertility treatment’’                   Finally, we also revise the center                  For the above reason, the Secretary
                                                  means, for a male veteran, a service-                   heading immediately preceding § 17.410                 issues this rule as an interim final rule.
                                                  connected injury or illness that prevents               to read ‘‘Hospital Care and Medical                    VA will consider and address comments
                                                  the successful delivery of sperm to an                  Services for Spouses and Families.’’ VA                that are received within 60 days of the
asabaliauskas on DSK3SPTVN1PROD with RULES




                                                  egg; and, for a female veteran with                     provides medical care to certain families              date this interim final rule is published
                                                  ovarian function and a patent uterine                   of Camp LeJeune veterans under                         in the Federal Register.
                                                  cavity, a service-connected injury or                   § 17.410, and the center heading
                                                  illness that prevents the egg from being                referred to those services. The current                Effect of Rulemaking
                                                  successfully fertilized by a sperm. This                rulemaking adds a new section                            Title 38 of the Code of Federal
                                                  definition parallels requirements in DoD                immediately following § 17.410, and VA                 Regulations, as revised by this final
                                                  policy guidance for an active duty                      believes the center heading should be                  rulemaking, represents VA’s
                                                  service member who is seriously or                      revised to avoid any confusion.                        implementation of its legal authority on


                                             VerDate Sep<11>2014   20:34 Jan 18, 2017   Jkt 241001   PO 00000   Frm 00078   Fmt 4700   Sfmt 4700   E:\FR\FM\19JAR1.SGM   19JAR1


                                                                   Federal Register / Vol. 82, No. 12 / Thursday, January 19, 2017 / Rules and Regulations                                                 6275

                                                  this subject. Other than future                         recipients thereof; or (4) Raise novel                 Mental health programs, Nursing
                                                  amendments to this regulation or                        legal or policy issues arising out of legal            homes, Reporting and recordkeeping
                                                  governing statutes, no contrary guidance                mandates, the President’s priorities, or               requirements, Travel and transportation
                                                  or procedures are authorized. All                       the principles set forth in this Executive             expenses, Veterans.
                                                  existing or subsequent VA guidance                      Order.’’
                                                                                                             The economic, interagency,                          Signing Authority
                                                  must be read to conform with this
                                                  rulemaking if possible or, if not                       budgetary, legal, and policy                             The Secretary of Veterans Affairs, or
                                                  possible, such guidance is superseded                   implications of this regulatory action                 designee, approved this document and
                                                  by this rulemaking.                                     have been examined, and it has been                    authorized the undersigned to sign and
                                                                                                          determined not to be a significant                     submit the document to the Office of the
                                                  Paperwork Reduction Act                                 regulatory action under Executive Order                Federal Register for publication
                                                    This interim final rule contains no                   12866. VA’s impact analysis can be                     electronically as an official document of
                                                  provisions constituting a collection of                 found as a supporting document at                      the Department of Veterans Affairs. Gina
                                                  information under the Paperwork                         http://www.regulations.gov, usually                    S. Farrisee, Deputy Chief of Staff,
                                                  Reduction Act of 1995 (44 U.S.C. 3501–                  within 48 hours after the rulemaking                   Department of Veterans Affairs,
                                                  3521).                                                  document is published. Additionally, a                 approved this document on December
                                                  Regulatory Flexibility Act                              copy of the rulemaking and its impact                  23, 2016, for publication.
                                                                                                          analysis are available on VA’s Web site
                                                     The Secretary hereby certifies that                                                                         Janet Coleman,
                                                                                                          at http://www.va.gov/orpm/, by
                                                  this interim final rule will not have a                 following the link for ‘‘VA Regulations                Chief, Regulation Policy & Management,
                                                  significant economic impact on a                                                                               Office of the Secretary, Department of
                                                                                                          Published From FY 2004 Through Fiscal                  Veterans Affairs.
                                                  substantial number of small entities as                 Year to Date.’’
                                                  they are defined in the Regulatory                                                                               For the reasons set out in the
                                                  Flexibility Act, 5 U.S.C. 601–612. This                 Unfunded Mandates                                      preamble, VA amends 38 CFR part 17 as
                                                  interim final rule will directly affect                    The Unfunded Mandates Reform Act                    follows:
                                                  only individuals and will not directly                  of 1995 requires, at 2 U.S.C. 1532, that
                                                  affect small entities. Therefore, pursuant              agencies prepare an assessment of                      PART 17—MEDICAL
                                                  to 5 U.S.C. 605(b), this rulemaking is                  anticipated costs and benefits before
                                                  exempt from the initial and final                                                                              ■ 1. The authority citation for part 17 is
                                                                                                          issuing any rule that may result in the                revised to read as follows:
                                                  regulatory flexibility analysis                         expenditure by State, local, and tribal
                                                  requirements of 5 U.S.C. 603 and 604.                   governments, in the aggregate, or by the                  Authority: 38 U.S.C. 501, and as noted in
                                                                                                                                                                 specific sections.
                                                  Executive Order 12866 and 13563                         private sector, of $100 million or more
                                                                                                                                                                    Section 17.38 also issued under 38 U.S.C.
                                                                                                          (adjusted annually for inflation) in any               101, 501, 1701, 1705, 1710, 1710A, 1721,
                                                     Executive Orders 12866 and 13563                     one year. This interim final rule will
                                                  direct agencies to assess the costs and                                                                        1722, 1782, and 1786.
                                                                                                          have no such effect on State, local, and                  Sections 17.380 and 17.412 are also issued
                                                  benefits of available regulatory                        tribal governments, or on the private                  under sec. 260, Pub. L. 114–223, 130 Stat.
                                                  alternatives and, when regulation is                    sector.                                                857.
                                                  necessary, to select regulatory                                                                                   Section 17.415 is also issued under 38
                                                  approaches that maximize net benefits                   Catalog of Federal Domestic Assistance                 U.S.C. 7301, 7304, 7402, and 7403.
                                                  (including potential economic,                            The Catalog of Federal Domestic                         Sections 17.640 and 17.647 are also issued
                                                  environmental, public health and safety                 Assistance numbers and titles for the                  under sec. 4, Pub. L. 114–2, 129 Stat. 30.
                                                  effects, and other advantages;                          programs affected by this document are                    Sections 17.641 through 17.646 are also
                                                  distributive impacts; and equity).                                                                             issued under 38 U.S.C. 501(a) and sec. 4,
                                                                                                          64.007, Blind Rehabilitation Centers;
                                                  Executive Order 13563 (Improving                                                                               Pub. L. 114–2, 129 Stat. 30.
                                                                                                          64.008, Veterans Domiciliary Care;
                                                  Regulation and Regulatory Review)                       64.009, Veterans Medical Care Benefits;                ■ 2. Amend § 17.38 by:
                                                  emphasizes the importance of                            64.010, Veterans Nursing Home Care;                    ■ a. Revising paragraph (c)(2).
                                                  quantifying both costs and benefits,                    64.011, Veterans Dental Care; 64.012,                  ■ b. Removing the sectional authority
                                                  reducing costs, harmonizing rules, and                  Veterans Prescription Service; 64.013,                 citation.
                                                  promoting flexibility. Executive Order                  Veterans Prosthetic Appliances; 64.014,                   The revision reads as follows:
                                                  12866 (Regulatory Planning and                          Veterans State Domiciliary Care; 64.015,               § 17.38    Medical benefits package.
                                                  Review) defines a ‘‘significant                         Veterans State Nursing Home Care;
                                                  regulatory action,’’ requiring review by                                                                       *     *     *      *     *
                                                                                                          64.018, Sharing Specialized Medical                      (c) * * *
                                                  the Office of Management and Budget                     Resources; 64.019, Veterans                              (2) In vitro fertilization. Note: See
                                                  (OMB), unless OMB waives such                           Rehabilitation Alcohol and Drug                        § 17.380.
                                                  review, as ‘‘any regulatory action that is              Dependence; 64.022, Veterans Home
                                                  likely to result in a rule that may: (1)                                                                       *     *     *      *     *
                                                                                                          Based Primary Care; and 64.024, VA
                                                  Have an annual effect on the economy                                                                           ■ 3. Add an undesignated center
                                                                                                          Homeless Providers Grant and Per Diem
                                                  of $100 million or more or adversely                    Program.                                               heading and § 17.380 to read as follows:
                                                  affect in a material way the economy, a                                                                        In Vitro Fertilization Treatment
                                                  sector of the economy, productivity,                    List of Subjects in 38 CFR Part 17
                                                  competition, jobs, the environment,                       Administrative practice and                          § 17.380    In vitro fertilization treatment.
asabaliauskas on DSK3SPTVN1PROD with RULES




                                                  public health or safety, or State, local,               procedure, Alcohol abuse, Alcoholism,                    (a)(1) In vitro fertilization may be
                                                  or tribal governments or communities;                   Claims, Day care, Dental health, Drug                  provided when clinically appropriate
                                                  (2) Create a serious inconsistency or                   abuse, Government contracts, Grant                     to—
                                                  otherwise interfere with an action taken                programs—health, Grant programs—                         (i) A veteran who has a service-
                                                  or planned by another agency; (3)                       veterans, Health care, Health facilities,              connected disability that results in the
                                                  Materially alter the budgetary impact of                Health professions, Health records,                    inability of the veteran to procreate
                                                  entitlements, grants, user fees, or loan                Homeless, Medical and Dental schools,                  without the use of fertility treatment;
                                                  programs or the rights and obligations of               Medical devices, Medical research,                     and,


                                             VerDate Sep<11>2014   20:34 Jan 18, 2017   Jkt 241001   PO 00000   Frm 00079   Fmt 4700   Sfmt 4700   E:\FR\FM\19JAR1.SGM   19JAR1


                                                  6276             Federal Register / Vol. 82, No. 12 / Thursday, January 19, 2017 / Rules and Regulations

                                                     (ii) The spouse of such veteran, as                  limitations on the amount of such                      1990 (1990 Act), Public Law 101–410,
                                                  provided in § 17.412.                                   benefits available to such a member.                   104 Stat. 890 (28 U.S.C. 2461 note), to
                                                     (2) For the purposes of this section, ‘‘a               (2) VA may provide in vitro                         improve the effectiveness of civil
                                                  service-connected disability that results               fertilization to a spouse of a veteran                 monetary penalties and to maintain
                                                  in the inability of the veteran to                      described in § 17.380 when clinically                  their deterrent effect. Section 3 of the
                                                  procreate without the use of fertility                  appropriate and consistent with the                    1990 Act specifically includes the Postal
                                                  treatment’’ means, for a male veteran, a                benefits relating to reproductive                      Service in the definition of ‘‘agency’’
                                                  service-connected injury or illness that                assistance provided to a member of the                 subject to its provisions.
                                                  prevents the successful delivery of                     Armed Forces who incurs a serious                         Beginning in 2017, the 2015 Act
                                                  sperm to an egg; and, for a female                      injury or illness on active duty pursuant              requires the Postal Service to make an
                                                  veteran with ovarian function and a                     to 10 U.S.C. 1074(c)(4)(A), as described               annual adjustment for inflation to civil
                                                  patent uterine cavity, a service-                       in the April 3, 2012, memorandum                       penalties that meet the definition of
                                                  connected injury or illness that prevents               issued by the Assistant Secretary of                   ‘‘civil monetary penalty’’ under the
                                                  the egg from being successfully                         Defense for Health Affairs on the subject              1990 Act. The Postal Service must make
                                                  fertilized by sperm.                                    of ‘‘Policy for Assisted Reproductive                  the annual adjustment for inflation and
                                                     (3) In vitro fertilization treatment will            Services for the Benefit of Seriously or               publish the adjustment in the Federal
                                                  be provided under this section when                     Severely Ill/Injured (Category II or III)              Register by January 15. Each penalty
                                                  clinically appropriate and to the same                  Active Duty Service Members,’’ and the                 will be adjusted as instructed by the
                                                  extent such treatment is provided to a                  guidance issued by the Department of                   Office of Management and Budget
                                                  member of the Armed Forces who                          Defense to implement such policy,                      (OMB) based on the Consumer Price
                                                  incurs a serious injury or illness on                   including any limitations on the amount                Index (CPI–U) from the most recent
                                                  active duty pursuant to 10 U.S.C.                       of such benefits available to such a                   October. OMB has furnished detailed
                                                  1074(c)(4)(A), as described in the April                member.                                                instructions regarding the annual
                                                  3, 2012, memorandum issued by the                          (b) Authority to provide fertility                  adjustment for 2017 in memorandum
                                                  Assistant Secretary of Defense for                      counseling and treatment, including in                 M–17–11, Implementation of the 2017
                                                  Health Affairs on the subject of ‘‘Policy               vitro fertilization under this section,                Annual Adjustment Pursuant to the
                                                  for Assisted Reproductive Services for                  expires September 30, 2017.                            Federal Civil Penalties Inflation
                                                  the Benefit of Seriously or Severely Ill/                                                                      Adjustment Act Improvements Act of
                                                                                                          [FR Doc. 2017–00280 Filed 1–18–17; 8:45 am]
                                                  Injured (Category II or III) Active Duty                                                                       2015 (December 16, 2016), https://
                                                                                                          BILLING CODE 8320–01–P
                                                  Service Members,’’ and the guidance                                                                            www.whitehouse.gov/sites/default/files/
                                                  issued by the Department of Defense to                                                                         omb/memoranda/2017/m-17-11_0.pdf.
                                                  implement such policy, including any                                                                           This year, OMB has advised that an
                                                                                                          POSTAL SERVICE                                         adjustment multiplier of 1.01636 will be
                                                  limitations on the amount of such
                                                  benefits available to such a member.                                                                           used. The new penalty amount must be
                                                                                                          39 CFR Part 233                                        rounded to the nearest dollar.
                                                     (b) Authority to provide in vitro
                                                                                                                                                                    The 2015 Act allows the interim final
                                                  fertilization treatment to covered                      Inspection Service Authority; Civil
                                                                                                                                                                 rule and annual inflation adjustments to
                                                  veterans under this section expires                     Monetary Penalty Inflation Adjustment
                                                                                                                                                                 be published without prior public
                                                  September 30, 2017.
                                                                                                          AGENCY:    Postal Service.                             notice or opportunity for public
                                                  ■ 4. Revise the undesignated center                                                                            comment.
                                                                                                          ACTION:   Interim final rule.
                                                  heading immediately preceding § 17.410
                                                  to read as follows:                                                                                            Adjustments to Postal Service Civil
                                                                                                          SUMMARY:   This rule updates postal
                                                                                                                                                                 Monetary Penalties
                                                  Hospital Care and Medical Services for                  regulations to implement the annual
                                                  Spouses and Families                                    inflation adjustments to civil monetary                   Civil monetary penalties may be
                                                                                                          penalties that may be imposed under                    assessed for postal offenses under
                                                  ■   5. Add § 17.412 to read as follows:                 consumer protection and mailability                    sections 106 and 108 of the Deceptive
                                                                                                          provisions enforced by the Postal                      Mail Prevention and Enforcement Act,
                                                  § 17.412 Fertility counseling and treatment                                                                    Public Law 106–168, 113 Stat. 1811,
                                                  for certain spouses.                                    Service pursuant to the Deceptive Mail
                                                                                                          Prevention and Enforcement Act and                     1814 (see, 39 U.S.C. 3012(a), (c)(1), (d),
                                                     (a)(1) VA may provide fertility                      the Postal Accountability and                          and 3017(g)(2), (h)(1)(A)); and section
                                                  counseling and treatment to a spouse of                 Enhancement Act. These adjustments                     1008 of the Postal Accountability and
                                                  a veteran described in § 17.380 to the                  are required under the Federal Civil                   Enhancement Act, Public Law 109–435,
                                                  extent such services are available to a                 Penalties Inflation Adjustment Act of                  120 Stat. 3259–3261 (see, 39 U.S.C. 3018
                                                  veteran under § 17.38, and consistent                   1990, as amended by the Federal Civil                  (c)(1)(A)). The statutory civil monetary
                                                  with the benefits relating to                           Penalties Inflation Adjustment Act                     penalties subject to the 2015 Act and the
                                                  reproductive assistance provided to a                   Improvements Act of 2015. This notice                  amount of each penalty the annual
                                                  member of the Armed Forces who                          also includes the statutory civil                      adjustment for inflation are as follows:
                                                  incurs a serious injury or illness on                   monetary penalties subject to the 2015
                                                  active duty pursuant to 10 U.S.C.                                                                              39 U.S.C. 3012(a)—False
                                                                                                          Act.                                                   Representations and Lottery Orders
                                                  1074(c)(4)(A), as described in the April
                                                                                                          DATES: Effective date: January 19, 2017.
                                                  3, 2012, memorandum issued by the                                                                                Under 39 U.S.C. 3005(a)(1)–(3), the
asabaliauskas on DSK3SPTVN1PROD with RULES




                                                  Assistant Secretary of Defense for                      FOR FURTHER INFORMATION CONTACT:                       Postal Service may issue administrative
                                                  Health Affairs on the subject of ‘‘Policy               Steven Sultan, (202) 268–7385.                         orders prohibiting persons from using
                                                  for Assisted Reproductive Services for                  SUPPLEMENTARY INFORMATION: The                         the mail to obtain money through false
                                                  the Benefit of Seriously or Severely Ill/               Federal Civil Penalties Inflation                      representations or lotteries. Persons who
                                                  Injured (Category II or III) Active Duty                Adjustment Act Improvements Act of                     evade, attempt to evade, or fail to
                                                  Service Members,’’ and the guidance                     2015 (2015 Act), Public Law 114–74,                    comply with an order to stop such
                                                  issued by the Department of Defense to                  129 Stat. 584, amended the Federal Civil               prohibited practices may be liable to the
                                                  implement such policy, including any                    Penalties Inflation Adjustment Act of                  United States for a civil penalty under


                                             VerDate Sep<11>2014   20:34 Jan 18, 2017   Jkt 241001   PO 00000   Frm 00080   Fmt 4700   Sfmt 4700   E:\FR\FM\19JAR1.SGM   19JAR1



Document Created: 2018-02-01 15:16:21
Document Modified: 2018-02-01 15:16:21
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
ActionInterim final rule.
DatesEffective Date: This rule is effective on January 19, 2017.
ContactPatricia M. Hayes, Ph.D., Chief Consultant, Women's Health Services, Patient Care Services, Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Ave. NW., Washington, DC 20420. (202) 461-0373. (This is not a toll-free number.)
FR Citation82 FR 6273 
RIN Number2900-AP94
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

2025 Federal Register | Disclaimer | Privacy Policy
USC | CFR | eCFR