83_FR_29569 83 FR 29447 - Medical Care in Foreign Countries and Filing for Reimbursement for Community Care Not Previously Authorized by VA

83 FR 29447 - Medical Care in Foreign Countries and Filing for Reimbursement for Community Care Not Previously Authorized by VA

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 83, Issue 122 (June 25, 2018)

Page Range29447-29449
FR Document2018-13487

The Department of Veterans Affairs (VA) adopts as final, with no changes, a proposed rule amending its medical regulations related to hospital care and medical services in foreign countries. We simplified and clarified the scope of these regulations, address medical services provided to eligible veterans in the Republic of the Philippines, and removed provisions related to grants to the Republic of the Philippines that are no longer supported by statutory authority. VA also amends its medical regulations related to filing claims for reimbursement of medical expenses incurred for VA care not previously authorized. We provided a 60-day period to receive comments from the public on the proposed changes, and received no comments. VA adopts the proposed rule as final, with no changes.

Federal Register, Volume 83 Issue 122 (Monday, June 25, 2018) 
[Federal Register Volume 83, Number 122 (Monday, June 25, 2018)]
[Rules and Regulations]
[Pages 29447-29449]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-13487]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP55


Medical Care in Foreign Countries and Filing for Reimbursement 
for Community Care Not Previously Authorized by VA

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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

SUMMARY: The Department of Veterans Affairs (VA) adopts as final, with 
no changes, a proposed rule amending its medical regulations related to 
hospital care and medical services in foreign countries. We simplified 
and clarified the scope of these regulations, address medical services 
provided to eligible veterans in the Republic of the Philippines, and 
removed provisions related to grants to the Republic of the Philippines 
that are no longer supported by statutory authority. VA also amends its 
medical regulations related to filing claims for reimbursement of 
medical expenses incurred for VA care not previously authorized. We 
provided a 60-day period to receive comments from the public on the 
proposed changes, and received no comments. VA adopts the proposed rule 
as final, with no changes.

DATES: This final rule is effective July 25, 2018.

FOR FURTHER INFORMATION CONTACT: Joseph Duran, Director, Policy and 
Planning, Office of Community Care (10D1A1), Veterans Health 
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, 
Washington, DC 20420, (303) 372-4629. (This is not a toll-free number) 
or [email protected].

SUPPLEMENTARY INFORMATION: Section 1724 of title 38 United States Code 
(U.S.C.) prohibits VA from furnishing hospital care or medical services 
outside any State except under specific circumstances. VA is authorized 
under 38 U.S.C. 1724(b)(1) to furnish care and services to an eligible 
veteran outside any State if VA ``determines that such care and 
services are needed for the treatment of a service-connected disability 
of the veteran or as part of a rehabilitation program under chapter 31 
of this title.'' VA furnishes health care to eligible veterans in the 
Republic of the Philippines under this authority. In addition, 38 
U.S.C. 1724(c) provides that ``within the limits'' of the Veterans 
Memorial Medical Center at Manila, Republic of the Philippines, VA may 
enter into contracts to furnish necessary hospital care to a veteran 
for any non-service-connected disability if such veteran is unable to 
defray the expenses of necessary hospital care. VA may also operate an 
outpatient clinic in the Republic of the Philippines to furnish 
necessary medical services to a veteran who has a service-connected 
disability. 38 U.S.C. 1724(e). Several sections of title 38 Code of 
Federal Regulations (CFR) part 17 address VA's authority to provide for 
hospital care and medical services for eligible veterans outside the 
United States, as well as submission of claims for reimbursement for 
services obtained from community care providers outside the United 
States.
    On January 31, 2018, VA proposed to revise or amend these 
regulations to consolidate similar content, clarify provisions, and 
ensure that these regulations reflect current VA practice and statutory 
authority. (83 FR 4454). We proposed simplifying language in Sec.  
17.35 to make it easier to understand, adding a new paragraph (b) to 
address hospital care and outpatient services provided to eligible 
veterans in the Republic of the Philippines as authorized in 38 U.S.C. 
1724, and paragraph (c) to provide guidance on which sections of part 
17 apply to claims for payment or reimbursement of services not 
previously authorized by the Foreign Medical Program. We proposed 
amending Sec.  17.125 which focuses on filing claims. We proposed 
stating that in those cases where VA payment for such services has not 
been authorized in advance, claims for payment for such health care 
services provided in a State should be submitted to the VA medical 
facility nearest to where those services were provided. We also 
proposed amending that section to provide specific guidance on where 
and how to file claims.
    We proposed removing Sec. Sec.  17.140 and 17.141 as the subject 
matter of delegation of authority would be covered by proposed 
revisions to Sec.  17.125. Finally, we proposed removing Sec. Sec.  
17.350 through 17.370 which addressed grants to the Republic of the 
Philippines, as our authority to provide these grants under 38 U.S.C. 
1732(b) has expired. VA still retains authority under 38 U.S.C. 1731 to 
assist the Republic of the Philippines in fulfilling its responsibility 
in providing medical care and treatment for Commonwealth Army veterans 
and new Philippine Scouts in need of such care and treatment for 
service-connected disabilities and non-service-connected disabilities 
under certain conditions.
    We provided a 60-day period to the public to comment on the 
proposed rule. The comment period closed April 2, 2018, and we received 
no comments. Based on the rationale set forth in the proposed rule and 
in this document, VA is adopting the provisions of the proposed rule as 
a final rule with no changes.

Effect of Rulemaking

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

Paperwork Reduction Act

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

Regulatory Flexibility Act

    The Secretary hereby certifies that this final regulatory amendment 
does 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 rulemaking does not directly affect any small 
entities. Only VA beneficiaries and certain community care providers 
would be directly affected. Therefore, pursuant to 5 U.S.C. 605(b), 
this amendment is be exempt from the initial and final regulatory 
flexibility analysis requirements of sections 603 and 604.

Executive Orders 12866, 13563, and 13771

    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).

[[Page 29448]]

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.''
    VA has examined the economic, interagency, budgetary, legal, and 
policy implications of this regulatory action and determined that the 
action is not 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 website at 
http://www.va.gov/orpm by following the link for VA Regulations 
Published from FY 2004 through FYTD. [For information about 
economically significant regulations, see Impact Analysis Procedures 
guide on the 00REG intranet site.]
    Executive Order 13771 (Reducing Regulation and Controlling 
Regulatory Costs) requires an agency, unless prohibited by law, to 
identify at least two existing regulations to be repealed when the 
agency publicly proposes for notice and comment, or otherwise 
promulgates, a new regulation. In furtherance of this requirement, 
section 2(c) of E.O. 13771 requires that the new incremental costs 
associated with new regulations shall, to the extent permitted by law, 
be offset by the elimination of existing costs associated with at least 
two prior regulations. This final rule is not subject to the 
requirements of E.O. 13771 because there is no incremental cost 
associated with this rule.

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 expenditure by 
State, local, or tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any given year. This final rule has no such effect on 
State, local, or tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance program number and title 
for this rule are as follows: 64.008--Veterans Domiciliary Care; 
64.011--Veterans Dental Care; 64.012--Veterans Prescription Service; 
64.013--Veterans Prosthetic Appliances; 64.029--Purchase Care Program; 
64.040--VHA Inpatient Medicine; 64.041--VHA Outpatient Specialty Care; 
64.042--VHA Inpatient Surgery; 64.043--VHA Mental Health Residential; 
64.044--VHA Home Care; 64.045--VHA Outpatient Ancillary Services; 
64.046--VHA Inpatient Psychiatry; 64.047--VHA Primary Care; 64.048--VHA 
Mental Health clinics; and 64.050--VHA Diagnostic Care.

List of Subjects in 38 CFR Part 17

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

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. Jacquelyn 
Hayes-Byrd, Acting Chief of Staff, Department of Veterans Affairs, 
approved this document on June 19, 2018, for publication.

    Dated: June 19, 2018
Consuela Benjamin,
Regulation Development Coordinator, Office of Regulation Policy & 
Management, Office of the Secretary, Department of Veterans Affairs.

    For the reasons stated in the preamble, the Department of Veterans 
Affairs amends 38 CFR part 17 as follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 is amended by adding statutory 
authority citations for Sec. Sec.  17.35 and 17.125 in numerical order 
to read as follows:

    Authority:  38 U.S.C. 501, and as noted in specific sections.
    Section 17.35 is also issued under 38 U.S.C. 1724.
* * * * *
    Section 17.125 is also issued under 38 U.S.C. 7304.

* * * * *


0
2. Revise Sec.  17.35 to read as follows:


Sec.  17.35   Hospital care and outpatient services in foreign 
countries.

    (a) Under the VA Foreign Medical Program, VA may furnish hospital 
care and outpatient services to any veteran outside of the United 
States, without regard to the veteran's citizenship:
    (1) If necessary for treatment of a service-connected disability, 
or any disability associated with and held to be aggravating a service-
connected disability;
    (2) If the care and services are furnished to a veteran 
participating in a rehabilitation program under 38 U.S.C. chapter 31 
who requires care and services for the reasons enumerated in Sec.  
17.47(i)(2).
    (b) Under the Foreign Medical Program, the care and services 
authorized under paragraph (a) of this section are available in the 
Republic of the Philippines to a veteran who meets the requirements of 
paragraph (a) of this section. VA may also provide outpatient services 
to a veteran referenced in paragraph (a)(1) in the VA outpatient clinic 
in Manila for the treatment of such veteran's service-connected 
conditions within the limits of the clinic. Non-service connected 
conditions of a veteran who has a service-connected disability may be 
treated within the limits of the VA outpatient clinic in Manila.
    (c) Claims for payment or reimbursement for services not previously 
authorized by VA under this section are governed by Sec. Sec.  17.123-
17.127 and 17.129-17.132.

0
3. Revise Sec.  17.125 to read as follows:

[[Page 29449]]

Sec.  17.125   Where to file claims.

    Generally, VA must preauthorize VA payment for health care services 
provided in the community when such care is provided in a State as that 
term is defined in 38 U.S.C. 101(20).
    (a) Where VA payment for such services has not been authorized in 
advance, claims for payment for such health care services provided in a 
State should be submitted to the VA medical facility nearest to where 
those services were provided.
    (b) Claims for payment for hospital care and outpatient services 
authorized under Sec.  17.35(a) and provided in Canada must be 
submitted to Veterans Affairs Canada, Foreign Countries Operations 
Unit, 2323 Riverside Dr., 2nd Floor, Ottawa, Ontario, Canada K1A OP5.
    (c) All other claims for payment for hospital care and outpatient 
services authorized under Sec.  17.35(a) and provided outside a State 
must be submitted to the Foreign Medical Program, P.O. Box 469061, 
Denver, CO 80246-9061.


Sec.  17.140   [Removed]

0
4. Remove Sec.  17.140 and the undesignated center heading 
``Delegations of Authority'', immediately preceding it.


Sec.  17.141   [Removed]

0
5. Remove Sec.  17.141.

0
6. Add an undesignated center heading, ``Delegation of Authority'' 
immediately preceding Sec.  17.142.

0
7. Remove the undesignated center heading, ``Grants to the Republic of 
the Philippines'', immediately preceding Sec.  17.350.


Sec. Sec.  17.350-17.352, 17.355, 17.362-17.367, 17.369, and 17.370   
[Removed]

0
8. Remove Sec. Sec.  17.350 through 17.352, 17.355, 17.362 through 
17.367, 17.369, and 17.370.

[FR Doc. 2018-13487 Filed 6-22-18; 8:45 am]
 BILLING CODE 8320-01-P

Federal Register / Vol. 83, No. 122 / Monday, June 25, 2018 / Rules and Regulations 29447 Federal Register, the Coast Guard will care and services are needed for the 38 U.S.C. 1731 to assist the Republic of provide the maritime community with treatment of a service-connected the Philippines in fulfilling its extensive advanced notification of disability of the veteran or as part of a responsibility in providing medical care enforcement of these safety zones via rehabilitation program under chapter 31 and treatment for Commonwealth Army the Local Notice to Mariners. of this title.’’ VA furnishes health care veterans and new Philippine Scouts in Dated: June 19, 2018. to eligible veterans in the Republic of need of such care and treatment for M.M. Balding, the Philippines under this authority. In service-connected disabilities and non- addition, 38 U.S.C. 1724(c) provides service-connected disabilities under Captain, U.S. Coast Guard, Captain of the Port Puget Sound. that ‘‘within the limits’’ of the Veterans certain conditions. Memorial Medical Center at Manila, We provided a 60-day period to the [FR Doc. 2018–13518 Filed 6–22–18; 8:45 am] Republic of the Philippines, VA may public to comment on the proposed BILLING CODE 9110–04–P enter into contracts to furnish necessary rule. The comment period closed April hospital care to a veteran for any non- 2, 2018, and we received no comments. service-connected disability if such Based on the rationale set forth in the DEPARTMENT OF VETERANS veteran is unable to defray the expenses proposed rule and in this document, VA AFFAIRS of necessary hospital care. VA may also is adopting the provisions of the operate an outpatient clinic in the proposed rule as a final rule with no 38 CFR Part 17 Republic of the Philippines to furnish changes. RIN 2900–AP55 necessary medical services to a veteran who has a service-connected disability. Effect of Rulemaking Medical Care in Foreign Countries and 38 U.S.C. 1724(e). Several sections of Title 38 of the Code of Federal Filing for Reimbursement for title 38 Code of Federal Regulations Regulations, as revised by this final Community Care Not Previously (CFR) part 17 address VA’s authority to rulemaking, represents VA’s Authorized by VA provide for hospital care and medical implementation of its legal authority on AGENCY: Department of Veterans Affairs. services for eligible veterans outside the this subject. Other than future United States, as well as submission of amendments to this regulation or ACTION: Final rule. claims for reimbursement for services governing statutes, no contrary guidance SUMMARY: The Department of Veterans obtained from community care or procedures are authorized. All Affairs (VA) adopts as final, with no providers outside the United States. existing or subsequent VA guidance changes, a proposed rule amending its On January 31, 2018, VA proposed to must be read to conform with this medical regulations related to hospital revise or amend these regulations to rulemaking if possible or, if not care and medical services in foreign consolidate similar content, clarify possible, such guidance is superseded countries. We simplified and clarified provisions, and ensure that these by this rulemaking. the scope of these regulations, address regulations reflect current VA practice and statutory authority. (83 FR 4454). Paperwork Reduction Act medical services provided to eligible veterans in the Republic of the We proposed simplifying language in This final rule contains no provisions Philippines, and removed provisions § 17.35 to make it easier to understand, constituting a collection of information related to grants to the Republic of the adding a new paragraph (b) to address under the Paperwork Reduction Act of Philippines that are no longer supported hospital care and outpatient services 1995 (44 U.S.C. 3501–3521). by statutory authority. VA also amends provided to eligible veterans in the Regulatory Flexibility Act its medical regulations related to filing Republic of the Philippines as authorized in 38 U.S.C. 1724, and The Secretary hereby certifies that claims for reimbursement of medical paragraph (c) to provide guidance on this final regulatory amendment does expenses incurred for VA care not which sections of part 17 apply to not have a significant economic impact previously authorized. We provided a claims for payment or reimbursement of on a substantial number of small entities 60-day period to receive comments from services not previously authorized by as they are defined in the Regulatory the public on the proposed changes, and the Foreign Medical Program. We Flexibility Act, 5 U.S.C. 601–612. This received no comments. VA adopts the proposed amending § 17.125 which rulemaking does not directly affect any proposed rule as final, with no changes. focuses on filing claims. We proposed small entities. Only VA beneficiaries DATES: This final rule is effective July stating that in those cases where VA and certain community care providers 25, 2018. would be directly affected. Therefore, payment for such services has not been FOR FURTHER INFORMATION CONTACT: authorized in advance, claims for pursuant to 5 U.S.C. 605(b), this Joseph Duran, Director, Policy and payment for such health care services amendment is be exempt from the Planning, Office of Community Care provided in a State should be submitted initial and final regulatory flexibility (10D1A1), Veterans Health to the VA medical facility nearest to analysis requirements of sections 603 Administration, Department of Veterans where those services were provided. We and 604. Affairs, 810 Vermont Avenue NW, also proposed amending that section to Washington, DC 20420, (303) 372–4629. Executive Orders 12866, 13563, and provide specific guidance on where and (This is not a toll-free number) or 13771 how to file claims. Joseph.Duran2@va.gov. We proposed removing §§ 17.140 and Executive Orders 12866 and 13563 SUPPLEMENTARY INFORMATION: Section 17.141 as the subject matter of direct agencies to assess the costs and 1724 of title 38 United States Code delegation of authority would be benefits of available regulatory (U.S.C.) prohibits VA from furnishing covered by proposed revisions to alternatives and, when regulation is amozie on DSK3GDR082PROD with RULES hospital care or medical services outside § 17.125. Finally, we proposed removing necessary, to select regulatory any State except under specific §§ 17.350 through 17.370 which approaches that maximize net benefits circumstances. VA is authorized under addressed grants to the Republic of the (including potential economic, 38 U.S.C. 1724(b)(1) to furnish care and Philippines, as our authority to provide environmental, public health and safety services to an eligible veteran outside these grants under 38 U.S.C. 1732(b) has effects, and other advantages; any State if VA ‘‘determines that such expired. VA still retains authority under distributive impacts; and equity). VerDate Sep<11>2014 16:14 Jun 22, 2018 Jkt 244001 PO 00000 Frm 00011 Fmt 4700 Sfmt 4700 E:\FR\FM\25JNR1.SGM 25JNR1

29448 Federal Register / Vol. 83, No. 122 / Monday, June 25, 2018 / Rules and Regulations Executive Order 13563 (Improving Unfunded Mandates Dated: June 19, 2018 Regulation and Regulatory Review) Consuela Benjamin, emphasizes the importance of The Unfunded Mandates Reform Act Regulation Development Coordinator, Office quantifying both costs and benefits, of 1995 requires, at 2 U.S.C. 1532, that of Regulation Policy & Management, Office reducing costs, harmonizing rules, and agencies prepare an assessment of of the Secretary, Department of Veterans promoting flexibility. Executive Order anticipated costs and benefits before Affairs. 12866 (Regulatory Planning and issuing any rule that may result in For the reasons stated in the Review) defines a ‘‘significant expenditure by State, local, or tribal preamble, the Department of Veterans regulatory action,’’ requiring review by governments, in the aggregate, or by the Affairs amends 38 CFR part 17 as the Office of Management and Budget private sector, of $100 million or more follows: (OMB), unless OMB waives such (adjusted annually for inflation) in any review, as ‘‘any regulatory action that is given year. This final rule has no such PART 17—MEDICAL likely to result in a rule that may: (1) effect on State, local, or tribal Have an annual effect on the economy ■ 1. The authority citation for part 17 is governments, or on the private sector. of $100 million or more or adversely amended by adding statutory authority affect in a material way the economy, a Catalog of Federal Domestic Assistance citations for §§ 17.35 and 17.125 in sector of the economy, productivity, numerical order to read as follows: competition, jobs, the environment, The Catalog of Federal Domestic Authority: 38 U.S.C. 501, and as noted in public health or safety, or State, local, Assistance program number and title for specific sections. or tribal governments or communities; this rule are as follows: 64.008— Section 17.35 is also issued under 38 (2) Create a serious inconsistency or Veterans Domiciliary Care; 64.011— U.S.C. 1724. otherwise interfere with an action taken Veterans Dental Care; 64.012—Veterans * * * * * or planned by another agency; (3) Prescription Service; 64.013—Veterans Section 17.125 is also issued under 38 Materially alter the budgetary impact of Prosthetic Appliances; 64.029— U.S.C. 7304. entitlements, grants, user fees, or loan Purchase Care Program; 64.040—VHA * * * * * programs or the rights and obligations of Inpatient Medicine; 64.041—VHA recipients thereof; or (4) Raise novel Outpatient Specialty Care; 64.042— ■ 2. Revise § 17.35 to read as follows: legal or policy issues arising out of legal VHA Inpatient Surgery; 64.043—VHA § 17.35 Hospital care and outpatient mandates, the President’s priorities, or Mental Health Residential; 64.044— services in foreign countries. the principles set forth in this Executive VHA Home Care; 64.045—VHA (a) Under the VA Foreign Medical Order.’’ Outpatient Ancillary Services; 64.046— Program, VA may furnish hospital care VA has examined the economic, VHA Inpatient Psychiatry; 64.047— and outpatient services to any veteran interagency, budgetary, legal, and policy VHA Primary Care; 64.048—VHA outside of the United States, without implications of this regulatory action Mental Health clinics; and 64.050— regard to the veteran’s citizenship: and determined that the action is not a VHA Diagnostic Care. (1) If necessary for treatment of a significant regulatory action under service-connected disability, or any Executive Order 12866. VA’s impact List of Subjects in 38 CFR Part 17 disability associated with and held to be analysis can be found as a supporting Administrative practice and aggravating a service-connected document at http:// procedure, Alcohol abuse, Alcoholism, disability; www.regulations.gov, usually within 48 (2) If the care and services are hours after the rulemaking document is Claims, Day care, Dental health, Drug furnished to a veteran participating in a published. Additionally, a copy of the abuse, Foreign relations, Government rehabilitation program under 38 U.S.C. rulemaking and its impact analysis are contracts, Grant programs—health, available on VA’s website at http:// chapter 31 who requires care and Grant programs—veterans, Health care, services for the reasons enumerated in www.va.gov/orpm by following the link Health facilities, Health professions, for VA Regulations Published from FY § 17.47(i)(2). Health records, Homeless, Medical and (b) Under the Foreign Medical 2004 through FYTD. [For information dental schools, Medical devices, about economically significant Program, the care and services Medical research, Mental health authorized under paragraph (a) of this regulations, see Impact Analysis programs, Nursing homes, Philippines, Procedures guide on the 00REG intranet section are available in the Republic of Reporting and recordkeeping the Philippines to a veteran who meets site.] Executive Order 13771 (Reducing requirements, Scholarships and the requirements of paragraph (a) of this Regulation and Controlling Regulatory fellowships, Travel and transportation section. VA may also provide outpatient Costs) requires an agency, unless expenses, Veterans. services to a veteran referenced in prohibited by law, to identify at least paragraph (a)(1) in the VA outpatient Signing Authority clinic in Manila for the treatment of two existing regulations to be repealed when the agency publicly proposes for The Secretary of Veterans Affairs, or such veteran’s service-connected notice and comment, or otherwise designee, approved this document and conditions within the limits of the promulgates, a new regulation. In authorized the undersigned to sign and clinic. Non-service connected furtherance of this requirement, section submit the document to the Office of the conditions of a veteran who has a 2(c) of E.O. 13771 requires that the new Federal Register for publication service-connected disability may be incremental costs associated with new treated within the limits of the VA electronically as an official document of regulations shall, to the extent permitted outpatient clinic in Manila. amozie on DSK3GDR082PROD with RULES the Department of Veterans Affairs. by law, be offset by the elimination of (c) Claims for payment or Jacquelyn Hayes-Byrd, Acting Chief of reimbursement for services not existing costs associated with at least Staff, Department of Veterans Affairs, two prior regulations. This final rule is previously authorized by VA under this approved this document on June 19, section are governed by §§ 17.123– not subject to the requirements of E.O. 2018, for publication. 17.127 and 17.129–17.132. 13771 because there is no incremental cost associated with this rule. ■ 3. Revise § 17.125 to read as follows: VerDate Sep<11>2014 16:14 Jun 22, 2018 Jkt 244001 PO 00000 Frm 00012 Fmt 4700 Sfmt 4700 E:\FR\FM\25JNR1.SGM 25JNR1

Federal Register / Vol. 83, No. 122 / Monday, June 25, 2018 / Rules and Regulations 29449 § 17.125 Where to file claims. ACTION: Final rule. comments. There were four electronic Generally, VA must preauthorize VA comments submitted through https:// payment for health care services SUMMARY: The Environmental Protection www.regulations.gov. We reviewed the provided in the community when such Agency (EPA) is approving the State comments and we have determined that care is provided in a State as that term Implementation Plan (SIP) submittal none are germane to this action. is defined in 38 U.S.C. 101(20). from the Alaska Department of Therefore, we are finalizing our action (a) Where VA payment for such Environmental Conservation (Alaska as proposed. services has not been authorized in DEC) demonstrating that the SIP meets advance, claims for payment for such certain interstate transport requirements II. Final Action health care services provided in a State of the Clean Air Act (CAA) for the The EPA is approving Alaska’s March should be submitted to the VA medical National Ambient Air Quality Standards 10, 2016, SIP submission as facility nearest to where those services (NAAQS) promulgated in 2010 for demonstrating sources in Alaska do not were provided. nitrogen dioxide (NO2) and sulfur significantly contribute to (b) Claims for payment for hospital dioxide (SO2). The EPA has determined nonattainment, or interfere with care and outpatient services authorized that Alaska’s SIP contains adequate maintenance, of the 2010 NO2 and SO2 under § 17.35(a) and provided in provisions to ensure that air emissions NAAQS in any other state. Based on our Canada must be submitted to Veterans in Alaska do not significantly contribute review, we find the Alaska SIP meets Affairs Canada, Foreign Countries to nonattainment or interfere with the the CAA section 110(a)(2)(D)(i)(I) Operations Unit, 2323 Riverside Dr., maintenance of the 2010 NO2 and SO2 interstate transport requirements for the 2nd Floor, Ottawa, Ontario, Canada K1A NAAQS in any other state. 2010 NO2 and SO2 NAAQS. OP5. DATES: This final rule is effective July (c) All other claims for payment for III. Statutory and Executive Order 25, 2018. Reviews hospital care and outpatient services ADDRESSES: The EPA has established a authorized under § 17.35(a) and Under the CAA, the Administrator is docket for this action under Docket ID provided outside a State must be required to approve a SIP submission No. EPA–R10–OAR–2016–0590. All submitted to the Foreign Medical that complies with the provisions of the documents in the docket are listed on Program, P.O. Box 469061, Denver, CO Act and applicable federal regulations. the https://www.regulations.gov 80246–9061. 42 U.S.C. 7410(k); 40 CFR 52.02(a). website. Although listed in the index, some information is not publicly Thus, in reviewing SIP submissions, the § 17.140 [Removed] available, e.g., CBI or other information EPA’s role is to approve state choices, ■ 4. Remove § 17.140 and the provided that they meet the criteria of undesignated center heading whose disclosure is restricted by statute. Certain other material, such as the CAA. Accordingly, this action ‘‘Delegations of Authority’’, merely approves state law as meeting immediately preceding it. copyrighted material, is not placed on the internet and will be publicly federal requirements and does not § 17.141 [Removed] available only in hard copy form. impose additional requirements beyond Publicly available docket materials are those imposed by state law. For that ■ 5. Remove § 17.141. reason, this action: available through https:// ■ 6. Add an undesignated center • Is not a ‘‘significant regulatory www.regulations.gov, or please contact heading, ‘‘Delegation of Authority’’ action’’ subject to review by the Office the person identified in the FOR FURTHER immediately preceding § 17.142. of Management and Budget under INFORMATION CONTACT section for ■ 7. Remove the undesignated center Executive Orders 12866 (58 FR 51735, additional availability information. heading, ‘‘Grants to the Republic of the October 4, 1993) and 13563 (76 FR 3821, FOR FURTHER INFORMATION CONTACT: John January 21, 2011); Philippines’’, immediately preceding § 17.350. Chi at (206) 553–1185, or chi.john@ • is not an Executive Order 13771 (82 epa.gov. FR 9339, February 2, 2017) regulatory §§ 17.350–17.352, 17.355, 17.362–17.367, SUPPLEMENTARY INFORMATION: action because SIP approvals are 17.369, and 17.370 [Removed] exempted under Executive Order 12866; Throughout this document whenever ■ 8. Remove §§ 17.350 through 17.352, ‘‘we,’’ ‘‘us,’’ or ‘‘our’’ is used, it is • does not impose an information 17.355, 17.362 through 17.367, 17.369, intended to refer to the EPA. collection burden under the provisions and 17.370. Information is organized as follows: of the Paperwork Reduction Act (44 [FR Doc. 2018–13487 Filed 6–22–18; 8:45 am] U.S.C. 3501 et seq.); Table of Contents • is certified as not having a BILLING CODE 8320–01–P I. Background significant economic impact on a II. Final Action substantial number of small entities ENVIRONMENTAL PROTECTION III. Statutory and Executive Order Reviews under the Regulatory Flexibility Act (5 AGENCY U.S.C. 601 et seq.); I. Background • does not contain any unfunded 40 CFR Part 52 On April 23, 2018, the EPA proposed mandate or significantly or uniquely to approve Alaska’s March 10, 2016, SIP affect small governments, as described [EPA–R10–OAR–2016–0590; FRL–9979– submission as meeting CAA section in the Unfunded Mandates Reform Act 87—Region 10] 110(a)(2)(D)(i)(I) interstate transport of 1995 (Pub. L. 104–4); Air Plan Approval; AK; Interstate provisions for the 2010 NO2 and 2010 • does not have Federalism SO2 NAAQS (83 FR 17627). Please see implications as specified in Executive amozie on DSK3GDR082PROD with RULES Transport Requirements for the 2010 our proposed rulemaking for further Order 13132 (64 FR 43255, August 10, Nitrogen Dioxide and Sulfur Dioxide explanation and the basis for our 1999); National Ambient Air Quality finding (April 23, 2018, 83 FR 17627). • is not an economically significant Standards The public comment period for the regulatory action based on health or AGENCY: Environmental Protection EPA’s proposed action ended on May safety risks subject to Executive Order Agency (EPA). 23, 2018. We received no adverse 13045 (62 FR 19885, April 23, 1997); VerDate Sep<11>2014 16:14 Jun 22, 2018 Jkt 244001 PO 00000 Frm 00013 Fmt 4700 Sfmt 4700 E:\FR\FM\25JNR1.SGM 25JNR1


Document Created: 2018-06-23 02:28:39
Document Modified: 2018-06-23 02:28:39
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionRules and Regulations
ActionFinal rule.
DatesThis final rule is effective July 25, 2018.
ContactJoseph Duran, Director, Policy and Planning, Office of Community Care (10D1A1), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (303) 372-4629. (This is not a toll-free number) or [email protected]
FR Citation83 FR 29447 
RIN Number2900-AP55
CFR AssociatedAdministrative Practice and Procedure; Alcohol Abuse; Alcoholism; Claims; Day Care; Dental Health; Drug Abuse; Foreign Relations; Government Contracts; Grant Programs-Health; Grant Programs-Veterans; Health Care; Health Facilities; Health Professions; Health Records; Homeless; Medical and Dental Schools; Medical Devices; Medical Research; Mental Health Programs; Nursing Homes; Philippines; Reporting and Recordkeeping Requirements; Scholarships and Fellowships; Travel and Transportation Expenses and Veterans
2025 Federal Register | Disclaimer | Privacy Policy
USC | CFR | eCFR