83 FR 30819 - Announcement for Public Meeting Regarding Health Care Access Standards
DEPARTMENT OF VETERANS AFFAIRS Federal Register Volume 83, Issue 126 (June 29, 2018)
Federal Register Volume 83, Issue 126 (June 29, 2018)
| Page Range | 30819-30821 | |
| FR Document | 2018-13951 |
[Federal Register Volume 83, Number 126 (Friday, June 29, 2018)] [Notices] [Pages 30819-30821] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2018-13951] ----------------------------------------------------------------------- DEPARTMENT OF VETERANS AFFAIRS Announcement for Public Meeting Regarding Health Care Access Standards AGENCY: Department of Veterans Affairs. ACTION: Announcement of public meeting. ----------------------------------------------------------------------- SUMMARY: The Department of Veterans Affairs (VA) is holding a public meeting to seek information from pertinent entities relating to implementation of 1703B of title 38, United States Code, as added by section 104(a) of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 (the VA MISSION Act) which directs VA to establish access standards for furnishing hospital care, medical services, and extended care services to covered veterans for purposes of the Veterans Community Care Program. In establishing these access standards, VA is required to consult with all pertinent Federal, private sector, and non-governmental entities. VA requests information from the public regarding the development of these access standards, including but not limited to information on the use of access standards for the design of health plan provider networks, referrals from network providers to out-of-network providers, the appeals process for exemptions from benefit limits to out-of-network providers, the existence of standards for appointment wait times, the use of travel distance for establishing service areas, the development or use of guidelines to [[Page 30820]] refer patients to out of network providers, and the measurement of performance against federal and state regulatory standards. Responses to this notice will support industry research and VA's development of access standards. DATES: VA will hold the public meeting on July 13, 2018, in Arlington, VA. The meeting will start at 9:00 a.m. and conclude on or before 5:00 p.m. Check-in will begin at 8:00 a.m. ADDRESSES: The meeting will be held at the VHA National Conference Center at 2011 Crystal Drive, Arlington, VA 22202. This facility is accessible to individuals with disabilities. * In-person attendance will be limited to 50 individuals. Advanced registration for individuals and groups is strongly encouraged (see registration instructions below). For listening purposes only (phone lines will be muted), the meeting will be available via audio which can be accessed by dialing 1-800-767-1750 access code 21398. Please submit all written comments no later than Monday, July 30, by any of the following methods:Federal Rulemaking Portal: Go to http://www.regulations.gov. Follow the online instructions for submitting comments. Mail, Hand Delivery, Courier: Postmarked no later than July 30, 2018, to: Director of Regulations Management (00REG), Department of Veterans Affairs, 810 Vermont Ave. NW, Room 1063B, Washington, DC 20420. Note: Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except Federal Holidays). Please call (202) 461-4902 (this is not a toll-free number) for an appointment. Fax: (202) 273-9026, ATTENTION: Director of Regulations Management (00REG). All submissions must include the agency name and docket number. Note that all comments received will be posted and can be viewed online through the Federal Docket Management System at http://www.regulations.gov. FOR FURTHER INFORMATION CONTACT: Christina Hosenfeld, Management Analyst, Office of the Deputy Under Secretary for Health for Community Care, Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202) 461-4112. This is not a toll free number. SUPPLEMENTARY INFORMATION: The John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, Public Law 115-182, (the VA MISSION Act) created a new 1703B in title 38, United States Code (U.S.C.), that contains requirements for VA to facilitate the establishment and use of access standards. Section 1703B(c) specifically requires VA to consult with all pertinent Federal entities, entities in the private sector, and other nongovernmental entities in establishing access standards. This public meeting serves as one of the means for VA to consult with these groups and entities. We note that VA has published a request for information in the Federal Register in order to provide these groups and entities an opportunity to provide additional information. The request for information mentioned above can be found in www.regulations.gov under the title of ``Notice of Request for Information Regarding Health Care Access Standards.'' Comments should indicate that they are submitted in response to ``Notice of Request for Information Regarding Health Care Access Standards.'' VA will use the statements and testimonials presented at the public hearing to help determine the access standards in compliance with the VA MISSION Act. VA will then submit a report, no later than March 3, 2019, as required by section 1703B(d)(1), detailing the access standards to the appropriate committees of Congress. The access standards will ultimately be published in the Federal Register and will be made available on a VA internet website. In order to submit a report to Congress detailing the access standards by March 3, 2019, VA must expedite this consultation, which will be foundational to the process of determining the access standards. Registration: In-person attendance and participation in this meeting is limited to 50 individuals. VA has the right to refuse registration for in-person attendance once the maximum capacity of 50 individuals has been reached. Individuals interested in attending in- person should request registration by emailing Krinessa Pinkett at krinessa.pinkett@va.gov. A confirmation message will be provided within 1-2 business days after a request has been received, and individuals will be notified via email by July 9, 2017, confirming their attendance in-person. Attendees wanting to offer oral comments, testimonies, and/ or technical remarks should indicate their intentions upon registration. Individual registration: VA encourages individual registrations for those not affiliated with or representing a group, association, or organization. Group registration: Identification of the name of the group, association, or organization should be indicated in your registration request. Due to the meeting location's maximum capacity, VA may limit the size of a group's registration to allow receipt of comments, testimonies, and/or technical remarks from a broad, diverse group of stakeholders. Oral comments, testimonies, and/or technical remarks may be limited from a group, association or organization with more than two (2) individuals representing the same group, association, or organization. Efforts will be made to accommodate all attendees who wish to attend in-person. However, VA will give priority for in-person attendance to pertinent Federal, private sector, and non-governmental entities who request registration before July 5, 4:00 p.m. ET, and wish to provide oral comments, testimonies, and/or technical remarks. Please provide the number and names of people your organization would like to send in-person, and VA will accommodate as space allows; organizations should list names in the order of importance of their attendance to ensure that VA allows admission for the right representatives. The length of time allotted for attendees to provide oral comments, testimonies and/or technical remarks during the meeting may be subject to the number of in-person attendees, and to ensure ample time is allotted to those registered attendees. There will be no opportunity for audio-visual presentations during the meeting. Written comments will be accepted by those attending in-person (see above instructions for submitting written comments). Audio (for listening purposes only): Limited to the first 200 participants, on a first come, first served basis. Advanced registration is not required. Audio attendees will not be allowed to offer oral comments, testimonies, and/or technical remarks as the phone line will be muted. Written comments will be accepted from those participating via audio (see above instructions for submitting written comments). Note: VA will conduct the public meeting informally, and technical rules of evidence will not apply. VA will arrange for a written transcript of the meeting and keep the official record open for 15 days after the meeting to allow submission of supplemental information. You may make arrangements for copies of the transcript directly with the reporter, and the transcript will also be posted in the docket of the rule as part of the official [[Page 30821]] record when the rule is published. Should it be necessary to cancel the meeting due to inclement weather or other emergencies, VA will take available measures to notify registered participants. Agenda 08:00-09:00 Arrival/Check-In 09:00-12:00 Morning Public Meeting Session 12:00-13:00 Lunch Break (Note: Meals will not be provided by VA.) 13:00-17:00 Afternoon Public Meeting Session 17:00 Adjourn Public Meeting Topics Pursuant to section 1703B(c) of title 38, U.S.C., as added by section 104(a) of Public Law 115-182, (the VA MISSION Act), VA requests information that will assist in developing the access standards required by section 1703B(a)(1). This includes information regarding the development of these access standards, including but not limited to information on the use of access standards for the design of health plan provider networks, referrals from network providers to out-of- network providers, the appeals process for exemptions from benefit limits to out-of-network providers, the existence of standards for appointment wait times, the use of travel distance for establishing service areas, the development or use of guidelines to refer patients to out of system providers, and the measurement of performance against regulatory standards. Specifically, VA requests information from health plans and systems related to the below: 1. Do health plans use internal access standards for the design of provider networks and the application of in network/out of network benefits that are more stringent than regulatory standards (time or distance of travel, appointment wait times, provider/member ratios)? If so, what are these internal standards? How does the health plan measure performance against regulatory and internal access standards? How does the health plan respond to findings when access standards are not being met? Are current regulatory access standards cost-effective while maintaining quality standards? Do health plans have a process to handle routine requests from members or referring providers for exemptions to benefit limits when members seek out of network care or a lower tier provider? 2. Do health plans allow for appeals by providers or members to request exemptions from benefit limits related to out of network care or care by a lower tier provider? Is external review allowed for such appeals? 3. What are health plan practices regarding internal, regulatory, and/or accreditation standards for appointment wait times, including variance by specialty or type of service? How does the health plan use travel distance or time and/or provider-to-population ratios in deciding which geographic areas to consider as primary or secondary service areas? 4. Are clinicians within the health system given guidelines or rules on when to refer patients to out of system providers? For example, are clinicians encouraged to refer out of system if in-system wait times are longer than standard, travel time or distance to an in- system provider is too long, the patient's ability to travel is compromised or the frequency of treatment makes travel to an in-network provider difficult? 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 25, 2018, for publication. Dated: June 25, 2018. Jeffrey M. Martin, Impact Analyst, Office of Regulation Policy & Management, Office of the Secretary, Department of Veterans Affairs. [FR Doc. 2018-13951 Filed 6-28-18; 8:45 am] BILLING CODE 8320-01-P
![Federal Register / Vol. 83, No. 126 / Friday, June 29, 2018 / Notices 30819
Analyst, Office of the Deputy Under includes information regarding the treatment makes travel to an in-network
Secretary for Health for Community development of these access standards, provider difficult?
Care, Veterans Health Administration, including but not limited to
Signing Authority
Department of Veterans Affairs, 810 information, with regard to health plans,
Vermont Avenue NW, Washington, DC on the use of access standards for the The Secretary of Veterans Affairs, or
20420, (202) 461–4112. This is not a toll design of health plan provider networks, designee, approved this document and
free number. referrals from network providers to out- authorized the undersigned to sign and
SUPPLEMENTARY INFORMATION: The John of-network providers, the appeals submit the document to the Office of the
S. McCain III, Daniel K. Akaka, and process for exemptions from benefit Federal Register for publication
Samuel R. Johnson VA Maintaining limits to out-of-network providers, and electronically as an official document of
Internal Systems and Strengthening with respect to health systems, the the Department of Veterans Affairs.
Integrated Outside Networks Act of existence of standards for appointment Jacquelyn Hayes-Byrd, Acting Chief of
2018, Public Law 115–182, (the VA wait times, the use of travel distance for Staff, Department of Veterans Affairs,
MISSION Act) creates a new 38 U.S.C. establishing service areas, the approved this document on June 25,
1703B that contains requirements for development or use of guidelines to 2018, for publication.
VA to facilitate the establishment and refer patients to out of system providers, Dated: June 25, 2018.
use of access standards. Section and the measurement of performance Jeffrey M. Martin,
1703B(c) specifically requires VA to against regulatory standards. Impact Analyst, Office of Regulation Policy
consult with all pertinent Federal Specifically, VA requests information & Management, Office of the Secretary,
entities, entities in the private sector, from health plans and systems related to Department of Veterans Affairs.
and other nongovernmental entities in the below: [FR Doc. 2018–13952 Filed 6–28–18; 8:45 am]
establishing access standards. This 1. Do health plans use internal access BILLING CODE 8320–01–P
notice and request for information standards for the design of provider
serves as one of the means for VA to networks and the application of in
consult with these groups and entities. network/out of network benefits that are DEPARTMENT OF VETERANS
We note that VA will also hold a public more stringent than regulatory standards AFFAIRS
hearing on Friday, July 13, 2018, to (time or distance of travel, appointment
provide these groups and entities an wait times, provider/member ratios)? If Announcement for Public Meeting
opportunity to provide additional so, what are these internal standards? Regarding Health Care Access
information. VA will use the comments How does the health plan measure Standards
it receives to help determine the access performance against regulatory and AGENCY: Department of Veterans Affairs.
standards in compliance with the VA internal access standards? How does the
ACTION:Announcement of public
MISSION Act. VA will then submit a health plan respond to findings when
meeting.
report, no later than March 3, 2019, as access standards are not being met? Are
required by section 1703B(d)(1), current regulatory access standards cost- SUMMARY: The Department of Veterans
detailing the access standards to the effective while maintaining quality Affairs (VA) is holding a public meeting
appropriate committees of Congress. standards? Do health plans have a to seek information from pertinent
The access standards will ultimately be process to handle routine requests from entities relating to implementation of
published in the Federal Register and members or referring providers for 1703B of title 38, United States Code, as
will be made available on a VA internet exemptions to benefit limits when added by section 104(a) of the John S.
website. members seek out of network care or a McCain III, Daniel K. Akaka, and
In order to submit a report to Congress lower tier provider? Samuel R. Johnson VA Maintaining
detailing the access standards by March 2. Do health plans allow for appeals Internal Systems and Strengthening
3, 2019, VA must expedite this by providers or members to request Integrated Outside Networks (MISSION)
consultation, which will be exemptions from benefit limits related Act of 2018 (the VA MISSION Act)
foundational to the process of to out of network care or care by a lower which directs VA to establish access
determining the access standards. tier provider? Is external review allowed standards for furnishing hospital care,
Hence, this notice and request for for such appeals? medical services, and extended care
information has a comment period of 30 3. What are health plan practices services to covered veterans for
days. VA believes that 30 days is regarding internal, regulatory, and/or purposes of the Veterans Community
sufficient to provide comments, as the accreditation standards for appointment Care Program. In establishing these
groups and entities with expertise in wait times, including variance by access standards, VA is required to
access standards will likely have the specialty or type of service? How does consult with all pertinent Federal,
information readily available or can the health plan use travel distance or private sector, and non-governmental
quickly compile and submit such time and/or provider-to-population entities. VA requests information from
information. ratios in deciding which geographic the public regarding the development of
This notice is a request for areas to consider as primary or these access standards, including but
information only. Commenters are secondary service areas? not limited to information on the use of
encouraged to provide complete but 4. Are clinicians within the health access standards for the design of health
concise responses to the questions system given guidelines or rules on plan provider networks, referrals from
outlined below. VA may choose to when to refer patients to out of system network providers to out-of-network
sradovich on DSK3GMQ082PROD with NOTICES
contact individual commenters, and providers? For example, are clinicians providers, the appeals process for
such communications would serve to encouraged to refer out of system if in- exemptions from benefit limits to out-of-
further clarify their written comments. system wait times are longer than network providers, the existence of
Request for Information: VA requests standard, travel time or distance to an standards for appointment wait times,
information that will assist in in-system provider is too long, the the use of travel distance for
developing the access standards patient’s ability to travel is establishing service areas, the
required by the VA MISSION Act. This compromised or the frequency of development or use of guidelines to
VerDate Sep<11>2014 17:58 Jun 28, 2018 Jkt 244001 PO 00000 Frm 00137 Fmt 4703 Sfmt 4703 E:\FR\FM\29JNN1.SGM 29JNN1](https://thefederalregister.org/doc/83_FR_30945/page/1.svg)
![Federal Register / Vol. 83, No. 126 / Friday, June 29, 2018 / Notices 30821
record when the rule is published. members seek out of network care or a July 11, 2018, from 10:00 a.m. to 12:00
Should it be necessary to cancel the lower tier provider? p.m. EST. The meeting is open to the
meeting due to inclement weather or 2. Do health plans allow for appeals public.
other emergencies, VA will take by providers or members to request The purpose of the Council is to
available measures to notify registered exemptions from benefit limits related advise the Secretary on matters affecting
participants. to out of network care or care by a lower partnerships between VA and its
tier provider? Is external review allowed academic affiliates.
Agenda for such appeals?
08:00–09:00 Arrival/Check-In 3. What are health plan practices On July 11, 2018, the Council will
09:00–12:00 Morning Public Meeting regarding internal, regulatory, and/or explore the current modernization effort
Session accreditation standards for appointment within the Veterans Health
12:00–13:00 Lunch Break (Note: Meals wait times, including variance by Administration (VHA); receive a
will not be provided by VA.) specialty or type of service? How does briefing on the VHA electronic health
13:00–17:00 Afternoon Public Meeting the health plan use travel distance or record modernization program; discuss
Session time and/or provider-to-population provisions of the recently enacted
17:00 Adjourn ratios in deciding which geographic Public Law 115–182 that impacts VA’s
areas to consider as primary or clinical education mission; and receive
Public Meeting Topics updates on the waiver process for VA
secondary service areas?
Pursuant to section 1703B(c) of title 4. Are clinicians within the health employees engaging in teaching
38, U.S.C., as added by section 104(a) of system given guidelines or rules on activities with for-profit educational
Public Law 115–182, (the VA MISSION when to refer patients to out of system institutions; the activities of the
Act), VA requests information that will providers? For example, are clinicians Council’s Subcommittee on Diversity
assist in developing the access encouraged to refer out of system if in- and Inclusion; the June 13, 2018
standards required by section system wait times are longer than Roundtable of Graduate Medical
1703B(a)(1). This includes information standard, travel time or distance to an Education hosted by the House
regarding the development of these in-system provider is too long, the Committee on Veterans’ Affairs; and the
access standards, including but not patient’s ability to travel is recent efforts of the VA Strategic
limited to information on the use of compromised or the frequency of Academic Advisory Council. The
access standards for the design of health treatment makes travel to an in-network Council will receive public comments
plan provider networks, referrals from provider difficult? from 11:50 p.m. to 12:00 p.m. EST.
network providers to out-of-network Interested persons may attend and/or
providers, the appeals process for Signing Authority present oral statements to the Council.
exemptions from benefit limits to out-of- The Secretary of Veterans Affairs, or The dial in number to attend the
network providers, the existence of designee, approved this document and conference call is: 1–800–767–1750. At
standards for appointment wait times, authorized the undersigned to sign and the prompt, enter access code 66983
the use of travel distance for submit the document to the Office of the then press #. Individuals seeking to
establishing service areas, the Federal Register for publication present oral statements are invited to
development or use of guidelines to electronically as an official document of submit a 1–2 page summary of their
refer patients to out of system providers, the Department of Veterans Affairs. comments at the time of the meeting for
and the measurement of performance Jacquelyn Hayes-Byrd, Acting Chief of inclusion in the official meeting record.
against regulatory standards. Staff, Department of Veterans Affairs, Oral presentations will be limited to five
Specifically, VA requests information approved this document on June 25, minutes or less, depending on the
from health plans and systems related to 2018, for publication. number of participants. Interested
the below: parties may also provide written
1. Do health plans use internal access Dated: June 25, 2018.
Jeffrey M. Martin, comments for review by the Council
standards for the design of provider prior to the meeting or at any time, by
networks and the application of in Impact Analyst, Office of Regulation Policy
& Management, Office of the Secretary, email to Steve.Trynosky@va.gov, or by
network/out of network benefits that are mail to Stephen K. Trynosky J.D.,
more stringent than regulatory standards Department of Veterans Affairs.
[FR Doc. 2018–13951 Filed 6–28–18; 8:45 am] M.P.H., M.M.A.S., Designated Federal
(time or distance of travel, appointment Officer, Office of Academic Affiliations
wait times, provider/member ratios)? If BILLING CODE 8320–01–P
(10A2D), 810 Vermont Avenue NW,
so, what are these internal standards? Washington, DC 20420. Any member of
How does the health plan measure the public wishing to participate or
performance against regulatory and DEPARTMENT OF VETERANS
AFFAIRS seeking additional information should
internal access standards? How does the contact Mr. Trynosky via email or by
health plan respond to findings when phone at (202) 461–6723.
VA National Academic Affiliations
access standards are not being met? Are
Council, Notice of Meeting Dated: June 26, 2018.
current regulatory access standards cost-
effective while maintaining quality The Department of Veterans Affairs Jelessa M. Burney,
standards? Do health plans have a (VA) gives notice under the Federal Federal Advisory Committee Management
process to handle routine requests from Advisory Committee Act that the VA Officer.
sradovich on DSK3GMQ082PROD with NOTICES
members or referring providers for National Academic Affiliations Council [FR Doc. 2018–14002 Filed 6–28–18; 8:45 am]
exemptions to benefit limits when (NAAC) will meet via conference call on BILLING CODE P
VerDate Sep<11>2014 17:58 Jun 28, 2018 Jkt 244001 PO 00000 Frm 00139 Fmt 4703 Sfmt 9990 E:\FR\FM\29JNN1.SGM 29JNN1](https://thefederalregister.org/doc/83_FR_30945/page/3.svg)
Document Created: 2018-06-29 01:13:48
Document Modified: 2018-06-29 01:13:48
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Announcement of public meeting. | |
| Dates | VA will hold the public meeting on July 13, 2018, in Arlington, VA. The meeting will start at 9:00 a.m. and conclude on or before 5:00 p.m. Check-in will begin at 8:00 a.m. | |
| Contact | Christina Hosenfeld, Management Analyst, Office of the Deputy Under Secretary for Health for Community Care, Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202) 461-4112. This is not a toll free number. | |
| FR Citation | 83 FR 30819 |
2024 Federal Register | Disclaimer | Privacy Policy
USC | CFR | eCFR