83 FR 48380 - Definition of Domiciliary Care

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 83, Issue 186 (September 25, 2018)

The Department of Veterans Affairs (VA) adopts as final, with no changes, a proposed rule amending the definition of domiciliary care to encompass VA's Mental Health Residential Rehabilitation Treatment Program (MH RRTP). This rule aligns regulations with VA's administrative decision in 2005 to designate MH RRTP as a type of domiciliary care. We also proposed clarifying that domiciliary care provides temporary, not permanent, residence to affected veterans. We provided a 60-day comment period on this proposed rule and received 4 comments, all of which were generally supportive of the proposed changes. We make no changes based on public comments and adopt the proposed rule as final.

[Federal Register Volume 83, Number 186 (Tuesday, September 25, 2018)]
[Rules and Regulations]
[Pages 48380-48382]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-20707]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AP00


Definition of Domiciliary Care

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) adopts as final, with 
no

[[Page 48381]]

changes, a proposed rule amending the definition of domiciliary care to 
encompass VA's Mental Health Residential Rehabilitation Treatment 
Program (MH RRTP). This rule aligns regulations with VA's 
administrative decision in 2005 to designate MH RRTP as a type of 
domiciliary care. We also proposed clarifying that domiciliary care 
provides temporary, not permanent, residence to affected veterans. We 
provided a 60-day comment period on this proposed rule and received 4 
comments, all of which were generally supportive of the proposed 
changes. We make no changes based on public comments and adopt the 
proposed rule as final.

DATES: Effective Date: This rule is effective on October 25, 2018.

FOR FURTHER INFORMATION CONTACT: Jamie R. Ploppert, National Director, 
Mental Health Residential Treatment Programs (10P4M), Veterans Health 
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, 
Washington, DC 20420; (757) 722-9991 extension 1123. (This is not a 
toll-free number.)

SUPPLEMENTARY INFORMATION: Title 38, United States Code, section 
1710(b)(2) authorizes VA to provide needed domiciliary care to veterans 
whose annual income does not exceed the applicable maximum annual rate 
of VA pension and to veterans who have no adequate means of support. 
Prior to the proposed changes to the definition ``domiciliary care'' 
was defined at 38 CFR 17.30(b) as the furnishing of a home to a 
veteran, embracing the furnishing of shelter, food, clothing and other 
comforts of home, including necessary medical services, as well as 
travel and incidental expenses pursuant to 38 CFR 70.10. Veterans 
eligible for domiciliary care include only: Those whose annual income 
does not exceed the maximum annual rate of pension payable to a veteran 
in need of regular aid and attendance; or those who have no adequate 
means of support, as this phrase is defined in 38 CFR 17.47(b)(2), who 
can perform the activities specified in 38 CFR 17.46(b) but who suffer 
from a chronic disability, disease, or defect that results in the 
veteran being unable to earn a living for a prospective period. See 38 
CFR 17.47(b)(2) and (c).
    The domiciliary program is authorized to provide eligible veterans 
with a home and coordinated ambulatory medical care as needed. 
Typically, domiciliaries are co-located with VA medical centers or 
exist as designated bed-settings within the centers.
    While the above-referenced statutory definitions and eligibility 
criteria still apply as do the regulatory criteria of Sec. Sec.  
17.46(b) and 17.47(b)(2), the scope of services furnished under the 
program has evolved significantly, requiring revision of Sec. Sec.  
17.30(b) and 17.47(c). We proposed to amend the definition of 
domiciliary care to reflect that change.
    The scope of clinical services available to VA domiciliary 
residents has necessarily become specialized over time due to the 
characteristics of the patient populations served by the residential 
rehabilitation treatment model. In 2005, VA's supervision of 
domiciliary care facilities was moved from the Office of Geriatrics and 
Extended Care to the Office of Mental Health Services. In 2010, VA 
merged domiciliary care facilities and RRTPs (which began in 1995) into 
one system of residential care under the MH RRTP designation to fully 
integrate mental health residential rehabilitation and treatment and 
domiciliary care. MH RRTPs provide comprehensive supervised treatment 
and rehabilitative services to veterans with mental health or substance 
use disorders, and coexisting medical or psychosocial needs such as 
homelessness and unemployment. MH RRTPs identify and address goals of 
rehabilitation, recovery, health maintenance, improved quality of life, 
and community integration in addition to specific treatment of medical 
conditions, mental illnesses, addictive disorders, and homelessness. 
These services are intended to restore, to the maximum extent possible, 
the physical, mental, and psychological functioning of veterans 
receiving residential rehabilitation treatment. VA domiciliaries are 
used currently for VA's Domiciliary Residential Rehabilitation 
Treatment Programs; Domiciliary Care for Homeless Veterans Program, 
Health Maintenance Domiciliary beds program; General Domiciliary or 
Psychosocial Residential Rehabilitation Treatment Program; Domiciliary 
Substance Abuse programs; and Domiciliary Post-Traumatic Stress 
Disorder (PTSD) programs.
    On April 6, 2018, we proposed amending the definition of 
domiciliary care in Sec.  17.30(b) to also include MH RRTP. (83 FR 
14804). We also proposed clarifying in both Sec. Sec.  17.30(b) and 
17.47(c) that domiciliary care provides a temporary home, not 
permanent. This clarification is consistent with VA's long-standing 
practice of providing domiciliary care as a non-permanent living 
arrangement for eligible veterans.
    We provided a 60-day period in which the public had the opportunity 
to submit comments on the proposed rule. The comment period ended on 
June 5, 2018, and we received 4 comments, all of which were generally 
supportive of the proposed changes. One commenter stated that he 
supported the effort to provide clear and concise rules regarding the 
scope of domiciliary care. Another commenter stated that providing 
domiciliary care consistent with the proposed rule supports the 
services that homeless veterans need such as mental health, counseling, 
and substance treatment while providing a chance to implement change in 
their life and creating realistic timelines to facilitate progress.
    We appreciate the comments and believe that the MH RRTP provides 
important and necessary support to those veterans requiring such 
services. We make no changes based on public comments.
    Based on the rationale set forth in the proposed rule and in this 
document, VA adopts the proposed rule as final, 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 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 final rule directly affects 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 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

[[Page 48382]]

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,'' which requires review by the Office of Management 
and Budget (OMB), as ``any regulatory action that is likely to result 
in a rule that may: (1) Have an annual effect on the economy of $100 
million or more or adversely affect in a material way the economy, a 
sector of the economy, productivity, competition, jobs, the 
environment, public health or safety, or State, local, or tribal 
governments or communities; (2) Create a serious inconsistency or 
otherwise interfere with an action taken or planned by another agency; 
(3) Materially alter the budgetary impact of entitlements, grants, user 
fees, or loan programs or the rights and obligations of recipients 
thereof; or (4) Raise novel legal or policy issues arising out of legal 
mandates, the President's priorities, or the principles set forth in 
this Executive Order.'' 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. This rule is not an E.O. 13771 
regulatory action because this rule is not significant under E.O. 
12866.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before issuing any rule that may result in the expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any one year. This final rule will have no such effect on 
State, local, and tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance numbers and titles for 
the programs affected by this document are 64.005--Grants to States for 
Construction of State Home Facilities; 64.008--Veterans Domiciliary 
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; 64.024--VA 
Homeless Providers Grant and Per Diem Program; 64.026--Veterans State 
Adult Day Health Care; 64.033--VA Supportive Services for Veteran 
Families Program; 64.035--Veterans Transportation 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; 64.049--VHA Community Living Center; 64.050--VHA 
Diagnostic Care; 64.054--Research and Development.

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 approved this document and 
authorized the undersigned to sign and submit the document to the 
Office of the Federal Register for publication electronically as an 
official document of the Department of Veterans Affairs. Robert L. 
Wilkie, Secretary, Department of Veterans Affairs, approved this 
document on September 19, 2018, for publication.

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

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

PART 17--MEDICAL

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

    Authority: 38 U.S.C. 501, and as noted in specific sections.
    Section 17.35 is also issued under 38 U.S.C. 1724.
    Section 17.38 is also issued under 38 U.S.C. 101, 501, 1701, 
1705, 1710, 1710A, 1721, 1722, 1782, and 1786.
    Section 17.125 is also issued under 38 U.S.C. 7304.
    Section 17.169 is also issued under 38 U.S.C. 1712C.
    Sections 17.380, 17.390 and 17.412 are also issued under sec. 
260, Public Law 114-223, 130 Stat. 857.
    Section 17.410 is also issued under 38 U.S.C. 1787.
    Section 17.415 is also issued under 38 U.S.C. 7301, 7304, 7402, 
and 7403.
    Section 17.417 also issued under 38 U.S.C. 1701 (note), 1709A, 
1712A (note), 1722B, 7301, 7330A, 7401-7403, 7406 (note).
    Sections 17.640 and 17.647 are also issued under sec. 4, Public 
Law 114-2, 129 Stat. 30.
    Sections 17.641 through 17.646 are also issued under 38 U.S.C. 
501(a) and sec. 4, Public Law 114-2, 129 Stat. 30.
    Section 17.655 also issued under 38 U.S.C. 501(a), 7304, 7405.

0
2. Amend Sec.  17.30 by revising paragraph (b) to read as follows:


Sec.  17.30  Definitions.

* * * * *
    (b) Domiciliary care. The term domiciliary care--
    (1) Means the furnishing of:
    (i) A temporary home to a veteran, embracing the furnishing of 
shelter, food, clothing and other comforts of home, including necessary 
medical services; or
    (ii) A day hospital program consisting of intensive supervised 
rehabilitation and treatment provided in a therapeutic residential 
setting for residents with mental health or substance use disorders, 
and co-occurring medical or psychosocial needs such as homelessness and 
unemployment.
    (2) Includes travel and incidental expenses pursuant to Sec.  
70.10.

(Authority: 38 U.S.C. 1701(4))

Sec.  17.47   [Amended]

0
3. Amend Sec.  17.47(c) by removing the word ``home'' and adding in its 
place the words ``temporary home''.

[FR Doc. 2018-20707 Filed 9-24-18; 8:45 am]
 BILLING CODE 8320-01-P