83_FR_705 83 FR 701 - Notice of Request for Information on the Department of Veterans Affairs Program of Comprehensive Assistance for Family Caregivers (PCAFC)

83 FR 701 - Notice of Request for Information on the Department of Veterans Affairs Program of Comprehensive Assistance for Family Caregivers (PCAFC)

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 83, Issue 4 (January 5, 2018)

Page Range701-703
FR Document2018-00004

The Department of Veterans Affairs (VA) is requesting information regarding its Program of Comprehensive Assistance for Family Caregivers (PCAFC). Through PCAFC, VA provides certain medical, travel, training, and stipend benefits to designated family caregivers of eligible veterans and servicemembers who were seriously injured in the line of duty on or after September 11, 2001. This notice requests information and comments from interested parties to help inform PCAFC of any changes needed to increase consistency across the program, as well as ensure it supports those family caregivers of veterans servicemembers most in need.

Federal Register, Volume 83 Issue 4 (Friday, January 5, 2018)
[Federal Register Volume 83, Number 4 (Friday, January 5, 2018)]
[Notices]
[Pages 701-703]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-00004]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Program of Comprehensive Assistance for Family Caregivers 
(PCAFC)

AGENCY: Department of Veterans Affairs.

ACTION: Request for information.

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

SUMMARY: The Department of Veterans Affairs (VA) is requesting 
information regarding its Program of Comprehensive Assistance for 
Family Caregivers (PCAFC). Through PCAFC, VA provides certain medical, 
travel, training, and stipend benefits to designated family caregivers 
of eligible veterans and servicemembers who were seriously injured in 
the line of duty on or after September 11, 2001. This notice requests 
information and comments from interested parties to help inform PCAFC 
of any changes needed to increase consistency across the program, as 
well as ensure it supports those family caregivers of veterans 
servicemembers most in need.

DATES: Comments in response to this request for information must be 
received by VA on or before February 5, 2018.

ADDRESSES: Written comments may be submitted through http://www.Regulations.gov; by mail or hand delivery to the Director, Office 
of 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. Comments should indicate that they are submitted 
in response to ``Notice of Request for Information on the Department of 
Veterans Affairs Program of Comprehensive Assistance for Family 
Caregivers (PCAFC)''. Copies of comments received will be available for 
public inspection in the Office of Regulation Policy and Management 
(00REG), Department of Veterans Affairs, 810 Vermont Ave. NW, Room 
1063B, Washington, DC 20420, 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. 
During the comment period, comments may also be viewed online through 
the Federal Docket Management System at www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Margaret Kabat, National Director, 
Caregiver Support Program, 10P4C, Veterans Health Administration, 
Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 
20420, 202-461-6780 (this is not a toll free number).

SUPPLEMENTARY INFORMATION: The Program of Comprehensive Assistance for 
Family Caregivers (PCAFC) was established by Title I of Public Law 111-
163, Caregivers and Veterans Omnibus Health Services Act of 2010, and 
is codified in section 1720G(a) of title 38, United States Code 
(U.S.C.). VA has been administering PCAFC continuously since May 5, 
2011 and has implemented this program through its regulations in part 
71 of title 38, Code of Federal Regulations (CFR). The purpose of PCAFC 
is to support family caregivers of eligible veterans (as defined in 38 
U.S.C. 1720G(a)(2) and 38 CFR 71.20 to include certain servicemembers) 
through the provision of caregiver benefits, including training, 
respite care, counseling, technical support, beneficiary travel (in 
certain circumstances), a monthly stipend payment, and access to health 
care (if qualified) through the Civilian Health and Medical Program of 
the Department of Veterans Affairs (CHAMPVA). 38 U.S.C. 1720G(a)(3), 38 
CFR 71.40.
    For purposes of this notice hereinafter, the term ``veteran'' 
refers to veterans and servicemembers who apply for or participate in 
the Program of Comprehensive Assistance for Family Caregivers.
    We are issuing this notice in order to solicit input on several 
components of the program, as further explained below. This notice and 
request for information serves as a means for VA to consult with key 
stakeholders on whether and how PCAFC should be modified to provide the 
highest quality care and support to veterans and their family 
caregivers in a consistent manner. We will use the information to 
inform any updates to this program and its implementing regulations. To 
the extent that there are any comments related to, or which would 
require changing, the relevant statutory authorities, those comments 
are outside the scope of this notice, as those would require 
Congressional action. The intent of this notice is for VA to garner 
input from the public on whether and how to change its regulations 
under the current statute.
    This notice and request for information has a comment period of 45 
days, during which individuals, groups, and entities may reply to the 
questions presented below. VA believes that 45 days is sufficient to 
provide comments, as the individuals, groups, and entities interested 
in this program likely have information and opinions readily available 
or can quickly compile and submit such information. Commenters are 
encouraged to provide complete but concise responses to the questions 
outlined below. Please note that VA will not respond to comments or 
questions regarding policy plans, decisions, or issues with regard to 
this notice. VA may choose to contact individual commenters, and such 
communications would serve to further clarify their written comments.
    In order to improve PCAFC, we are seeking information on the 
following topics and issues:

[[Page 702]]

Initial and Ongoing Eligibility of Veterans and Servicemembers

    In order to be eligible for PCAFC under the statute, the individual 
must be a veteran or a servicemember undergoing medical discharge from 
the Armed Forces and must have a serious injury (including traumatic 
brain injury, psychological trauma, or other mental disorder) incurred 
or aggravated in the line of duty in the active military, naval, or air 
service on or after September 11, 2001. 38 U.S.C. 1720G(a)(2)(A)-(B), 
38 CFR 71.20(a)-(b). We have defined ``serious injury'' as ``any 
injury, including traumatic brain injury, psychological trauma, or 
other mental disorder, incurred or aggravated in the line of duty in 
the active military, naval, or air service on or after September 11, 
2001, that renders the veteran or servicemember in need of personal 
care services.'' 38 CFR 71.15. We have interpreted 38 U.S.C. 1720G to 
require this causal relationship between the need for personal care 
services and the serious injury. 76 FR 26150.
    Additionally, 38 U.S.C. 1720G requires that eligibility be premised 
on an individual's need for personal care services because of (1) an 
inability to perform one or more activities of daily living, (2) a need 
for supervision or protection based on symptoms or residuals of 
neurological or other impairment or injury, or (3) such other matters 
as the Secretary considers appropriate. 38 U.S.C. 1720G(a)(2)(C)(i)-
(iii). This requirement is set forth in 38 CFR 71.20(c), in which we 
require that the serious injury renders the veteran in need of personal 
care services for a minimum period of six continuous months based on 
specified criteria. Otherwise, the criteria under Sec.  71.20(c) do not 
distinguish between, or require, any specific degree of need for 
assistance (e.g., in frequency, complexity, or scope).
    In order to be eligible for the program, we also require that a 
clinical determination be made that it is in the best interest of the 
individual to participate in the program. 38 CFR 71.20(d). This 
determination currently requires the clinician to consider whether 
participation in the program significantly enhances the individual's 
ability to live safely in a home setting, supports the individual's 
potential progress in rehabilitation, if such potential exists, and 
creates an environment that supports the health and well-being of the 
individual. 38 CFR 71.15. VA has found variability in how these three 
considerations are applied by clinicians assessing whether 
participation in PCAFC is in a veteran's best interest.
    Once a veteran has been determined to be eligible for the program 
and a family caregiver has been approved and designated, the veteran's 
well-being is monitored by VA no less often than every 90 days, unless 
otherwise clinically indicated. 38 CFR 71.40(b)(2). Currently, there is 
no regulatory requirement to reassess eligibility. If, however, the 
veteran's level of functioning improves, lessening the need for 
assistance of a family caregiver, VA may determine that the veteran no 
longer meets the eligibility criteria for PCAFC. Because approval and 
designation of a family caregiver is conditioned on the eligibility 
criteria being met, in the instance that a veteran is determined to be 
ineligible for the program, VA will revoke the family caregiver's 
designation, and the caregiver benefits will cease. 38 CFR 71.25(f), 
71.45(c).

Continuation of Benefits After Revocation

    Under PCAFC, caregiver benefits may continue for a period of time 
after revocation of the family caregiver's designation in limited 
situations. For example, under Sec.  71.45(b)(4), caregiver benefits 
continue for 30 days after the date of revocation initiated by the 
veteran or his or her surrogate, subject to certain exceptions. 
Additionally, under Sec.  71.45(c), caregiver benefits continue for 90 
days after revocation initiated by VA, subject to certain exceptions. 
We provide these extended periods of benefits to allow a family 
caregiver, who did not request the revocation, a transition period 
before benefits are discontinued (particularly, for certain benefits 
like health care). We believe these extended benefits periods are 
consistent with the purpose of 38 U.S.C. 1720G and represent an 
appropriate and compassionate way to interpret and enforce the law. 76 
FR 26155-26156. The 30- and 90-day periods set forth in Sec.  
71.45(b)(4) and (c), respectively, are the only instances in which the 
regulations provide for extended caregiver benefits beyond the date of 
revocation.
    While a family caregiver can voluntarily leave the program at any 
time, when a family caregiver initiates revocation, his or her 
caregiver benefits terminate at the present or future date of 
revocation as specified by the family caregiver. 38 CFR 71.45(a). While 
a family caregiver is not required to provide a basis for revocation, a 
family caregiver's voluntary revocation may involve instances when the 
family caregiver leaves because of a situation involving actions of the 
veteran. VA is seeking input on whether there are any circumstances in 
which a family caregiver's benefits should be extended beyond the 
revocation date when the family caregiver makes the decision to be 
removed as the family caregiver as well as the length of such an 
extension.

Determination of Stipend Payment Methodology for Primary Family 
Caregivers

    Section 1720G(a)(3)(A)(ii)(V) of title 38, U.S.C., requires VA to 
provide a monthly stipend to primary family caregivers of eligible 
veterans. Under the statute, VA is required to base the stipend amount 
on the amount and degree of personal care services provided; to the 
extent practicable, ensure that the amount is not less than the monthly 
amount a commercial home health care entity would pay an individual in 
the geographic area of the veteran to provide equivalent personal care 
services; and in the instance that the geographic area does not have a 
commercial home health entity, VA must take into consideration the 
costs of commercial providers of personal care services in those 
geographic areas with similar costs of living. See 38 U.S.C. 
1720G(a)(3)(C).
    Under the implementing regulations, VA relies on the U.S. 
Department of Labor's Bureau of Labor Statistics (BLS) hourly wage rate 
for home health aides at the 75th percentile in the veteran's 
geographic area of residence, which is multiplied by the Consumer Price 
Index for All Urban Consumers. 38 CFR 71.15, 71.40(c)(4). We have used 
the BLS wage rate to meet the intent of the statute to ensure that 
primary family caregivers are not paid less than home health aides in 
the applicable geographic area. 76 FR 26154. These rates, however, 
fluctuate annually in conjunction with changing geographical area 
designations, which can result in alterations to stipend amounts.
    VA also calculates the stipend amount based on a veteran's assigned 
tier level which is determined by a clinical assessment of functional 
needs, as further detailed in 38 CFR 71.40(c)(4). Specifically, VA 
determines the veteran's level of dependency based on the degree to 
which he or she is unable to perform one or more activities of daily 
living or the degree to which he or she is in need of supervision or 
protection based on symptoms or residuals of neurological or other 
impairment or injury. VA conducts a clinical assessment, which is 
scored and summed. Based on the sum of all ratings, the veteran is 
assigned a tier level. Each tier level is assigned a

[[Page 703]]

number of hours, up to forty hours per week. The primary family 
caregiver receives a stipend based on the assigned tier level. 
Currently, this is a determination based upon the needs of the veteran, 
not the family caregiver, and it distinguishes among three different 
tiers.

Request for Information

    Through this notice, we are soliciting information on PCAFC. We ask 
respondents to address the following questions, where possible, in the 
context of the discussion in this document. Commenters do not need to 
address every question and should focus on those that relate to their 
expertise or perspectives. To the extent possible, please clearly 
indicate which question(s) you address in your response. As previously 
mentioned, responses to this request will inform our updates to PCAFC. 
Accordingly, we request comments on the following:
    1. Should VA change how ``serious injury'' is defined for the 
purposes of eligibility?
    a. Should the severity of injury be considered in determining 
eligibility to ensure VA is supporting family caregivers of Veterans 
most in need? If so, how should the level of severity be determined?
    b. How should VA define veterans who are most in need?
    c. Should eligibility be limited to only those veterans who without 
a family caregiver providing personal care services would otherwise 
require institutionalization? If so, how should this be determined?
    2. One of the bases upon which a veteran can be determined to need 
personal care services is his or her need for supervision or protection 
based on symptoms or residuals of neurological or other impairment or 
injury.
    a. What should be the criteria to assess a veteran's need for 
supervision or protection?
    b. What standardized tools should be used to assess a veteran's 
need for supervision or protection because of a mental health 
condition?
    3. To be eligible for the program, participation must be determined 
to be in the ``best interest'' of the veteran. How should ``best 
interest'' be defined?
    a. How can VA improve consistency in ``best interest'' 
determinations for participation in the program?
    b. Are there any conditions under which participation would not be 
in a veteran's best interest?
    4. Once approved for PCAFC, should the veteran's eligibility be 
reassessed at specific time intervals or based on certain clinical 
indicators?
    a. If so, what intervals and/or what clinical indicators should be 
used?
    b. Should reassessments be standard for every participant? Are 
there conditions under which continued eligibility should be presumed 
and a reassessment not needed? If so, what would these conditions be?
    5. When VA determines that a veteran or family caregiver is no 
longer eligible for PCAFC or the family caregiver or veteran no longer 
wishes to participate in PCAFC, the family caregiver's designation is 
``revoked''. The term ``revok[ed]'' is used in the statute (38 U.S.C. 
1720G(a)(9)(C)(ii)(II)); however, stakeholders have expressed concerns 
that this term is not supportive of participants. What terminology 
should VA use in reference to those participants who are determined to 
be no longer eligible for the program?
    a. Should VA use such language as removal, discharge, or graduate 
in reference to participants who become ineligible for the program?
    6. Should the timeframes for continuation of benefits for family 
caregivers who are revoked from the Program be modified?
    a. If so, how?
    b. Under what circumstances should family caregiver benefits be 
continued after revocation? For example, should VA continue providing 
benefits to a family caregiver who requests revocation due to an unsafe 
environment created by a veteran, such as an instance involving 
intimate partner violence committed by a veteran? How long should the 
benefits be continued under such circumstances?
    7. VA's methodology of stipend calculations using the U.S. 
Department of Labor's Bureau of Labor Statistics (BLS) wage rates is 
complex and creates variability in stipend amounts annually across 
localities. How should VA calculate stipend rates?
    a. What other standards or rates should VA consider using to 
calculate stipends?
    b. Should VA use one BLS rate per state, i.e., one rate that is 
applicable to all veterans residing in a particular state?
    c. Should VA have one stipend amount for all primary family 
caregivers?
    8. A veteran is assigned a stipend tier based on the amount and 
degree of personal care services provided. How should VA assess and 
determine the amount and degree of personal care services provided to 
the veteran by the family caregiver?
    a. How should ``degree of'' need be determined, for both physical 
needs and those related to the need for supervision and protection?
    b. Should ``degree of'' need be based on either physical needs or 
needs related to psychological disorder? Or should all factors be 
considered together?
    c. Should the three tier system be changed? If so, how should it be 
changed?

Paperwork Reduction Act

    This request for information constitutes a general solicitation of 
public comments as stated in the implementing regulations of the 
Paperwork Reduction Act of 1995 at 5 CFR 1320.3(h)(4). Therefore, this 
request for information does not impose information collection 
requirements (i.e., reporting, recordkeeping or third-party disclosure 
requirements). Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).

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 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 6, 2017, for publication.

    Dated: December 6, 2017.
Jeffrey Martin,
Impact Analyst, Office of Regulation Policy & Management, Office of the 
Secretary, Department of Veterans Affairs.
[FR Doc. 2018-00004 Filed 1-4-18; 8:45 am]
 BILLING CODE 8320-01-P



                                                                                Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices                                               701

                                               material shall be used to perform                       Assistance for Family Caregivers                       of Federal Regulations (CFR). The
                                               domestic Federal contracts for                          (PCAFC). Through PCAFC, VA provides                    purpose of PCAFC is to support family
                                               construction, with certain exceptions.                  certain medical, travel, training, and                 caregivers of eligible veterans (as
                                               VA policy is to not accept foreign                      stipend benefits to designated family                  defined in 38 U.S.C. 1720G(a)(2) and 38
                                               construction material. However, if a                    caregivers of eligible veterans and                    CFR 71.20 to include certain
                                               bidder chooses to submit a bid that                     servicemembers who were seriously                      servicemembers) through the provision
                                               includes foreign material, VA will                      injured in the line of duty on or after                of caregiver benefits, including training,
                                               consider such bids if the material is                   September 11, 2001. This notice                        respite care, counseling, technical
                                               specifically identified and the price of                requests information and comments                      support, beneficiary travel (in certain
                                               the material is provided. VAAR clause                   from interested parties to help inform                 circumstances), a monthly stipend
                                               852.236–89, Buy American Act, advises                   PCAFC of any changes needed to                         payment, and access to health care (if
                                               bidders of these provisions and requires                increase consistency across the program,               qualified) through the Civilian Health
                                               bidders who want to offer foreign                       as well as ensure it supports those                    and Medical Program of the Department
                                               construction material to list the material              family caregivers of veterans                          of Veterans Affairs (CHAMPVA). 38
                                               and its price. Bidders who do not intend                servicemembers most in need.                           U.S.C. 1720G(a)(3), 38 CFR 71.40.
                                               to offer foreign material do not need to                DATES: Comments in response to this                       For purposes of this notice
                                               submit any information under this                       request for information must be received               hereinafter, the term ‘‘veteran’’ refers to
                                               clause. The information is required to                  by VA on or before February 5, 2018.                   veterans and servicemembers who apply
                                               allow VA to make an informed decision                   ADDRESSES: Written comments may be                     for or participate in the Program of
                                               as to whether or not to accept a bid that               submitted through http://                              Comprehensive Assistance for Family
                                               includes foreign construction material.                 www.Regulations.gov; by mail or hand                   Caregivers.
                                               In actual practice, very few bidders ever               delivery to the Director, Office of
                                               offer foreign materials and, when they                  Regulation Policy and Management                          We are issuing this notice in order to
                                               do, very few of those offers are accepted.              (00REG), Department of Veterans                        solicit input on several components of
                                                  An agency may not conduct or                         Affairs, 810 Vermont Avenue NW,                        the program, as further explained below.
                                               sponsor, and a person is not required to                Room 1068, Washington, DC 20420; or                    This notice and request for information
                                               respond to a collection of information                  by fax to (202) 273–9026. Comments                     serves as a means for VA to consult with
                                               unless it displays a currently valid OMB                should indicate that they are submitted                key stakeholders on whether and how
                                               control number. The Federal Register                    in response to ‘‘Notice of Request for                 PCAFC should be modified to provide
                                               Notice with a 60-day comment period                     Information on the Department of                       the highest quality care and support to
                                               soliciting comments on this collection                  Veterans Affairs Program of                            veterans and their family caregivers in
                                               of information was published at 82 FR                   Comprehensive Assistance for Family                    a consistent manner. We will use the
                                               142 on July 26, 2017, pages 34747 and                   Caregivers (PCAFC)’’. Copies of                        information to inform any updates to
                                               34748.                                                  comments received will be available for                this program and its implementing
                                                  Affected Public: Business or other for-              public inspection in the Office of                     regulations. To the extent that there are
                                               profit and not-for-profit institutions.                 Regulation Policy and Management                       any comments related to, or which
                                                  Estimated Annual Burden: VAAR                        (00REG), Department of Veterans                        would require changing, the relevant
                                               clause 852.236–89, Buy American Act—                    Affairs, 810 Vermont Ave. NW, Room                     statutory authorities, those comments
                                               22 hours.                                               1063B, Washington, DC 20420, between                   are outside the scope of this notice, as
                                                  Estimated Average Burden per                         the hours of 8:00 a.m. and 4:30 p.m.,                  those would require Congressional
                                               Respondent: VAAR clause 852.236–89,                     Monday through Friday (except Federal                  action. The intent of this notice is for
                                               Buy American Act—30 minutes.                            holidays). Please call (202) 461–4902                  VA to garner input from the public on
                                                  Frequency of Response: On occasion.                  (this is not a toll-free number) for an                whether and how to change its
                                                  Estimated Number of Respondents:                     appointment. During the comment                        regulations under the current statute.
                                               VAAR clause 852.236–89, Buy                             period, comments may also be viewed                       This notice and request for
                                               American Act—43.                                        online through the Federal Docket                      information has a comment period of 45
                                                 By direction of the Secretary.                        Management System at                                   days, during which individuals, groups,
                                               Cynthia Harvey-Pryor,                                   www.Regulations.gov.                                   and entities may reply to the questions
                                               Department Clearance Officer, Office of                 FOR FURTHER INFORMATION CONTACT:                       presented below. VA believes that 45
                                               Quality, Privacy and Risk, Department of                Margaret Kabat, National Director,                     days is sufficient to provide comments,
                                               Veterans Affairs.                                       Caregiver Support Program, 10P4C,                      as the individuals, groups, and entities
                                               [FR Doc. 2018–00002 Filed 1–4–18; 8:45 am]              Veterans Health Administration,                        interested in this program likely have
                                               BILLING CODE 8320–01–P                                  Department of Veterans Affairs, 810                    information and opinions readily
                                                                                                       Vermont Avenue NW, Washington, DC                      available or can quickly compile and
                                                                                                       20420, 202–461–6780 (this is not a toll                submit such information. Commenters
                                               DEPARTMENT OF VETERANS                                  free number).                                          are encouraged to provide complete but
                                               AFFAIRS                                                 SUPPLEMENTARY INFORMATION: The                         concise responses to the questions
                                                                                                       Program of Comprehensive Assistance                    outlined below. Please note that VA will
                                               Notice of Request for Information on                    for Family Caregivers (PCAFC) was                      not respond to comments or questions
                                               the Department of Veterans Affairs                      established by Title I of Public Law                   regarding policy plans, decisions, or
                                               Program of Comprehensive Assistance                     111–163, Caregivers and Veterans                       issues with regard to this notice. VA
daltland on DSKBBV9HB2PROD with NOTICES




                                               for Family Caregivers (PCAFC)                           Omnibus Health Services Act of 2010,                   may choose to contact individual
                                                                                                       and is codified in section 1720G(a) of                 commenters, and such communications
                                               AGENCY:    Department of Veterans Affairs.
                                                                                                       title 38, United States Code (U.S.C.). VA              would serve to further clarify their
                                               ACTION:   Request for information.                                                                             written comments.
                                                                                                       has been administering PCAFC
                                               SUMMARY:  The Department of Veterans                    continuously since May 5, 2011 and has                    In order to improve PCAFC, we are
                                               Affairs (VA) is requesting information                  implemented this program through its                   seeking information on the following
                                               regarding its Program of Comprehensive                  regulations in part 71 of title 38, Code               topics and issues:


                                          VerDate Sep<11>2014   16:30 Jan 04, 2018   Jkt 244001   PO 00000   Frm 00048   Fmt 4703   Sfmt 4703   E:\FR\FM\05JAN1.SGM   05JAN1


                                               702                              Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices

                                               Initial and Ongoing Eligibility of                      participation in PCAFC is in a veteran’s               involving actions of the veteran. VA is
                                               Veterans and Servicemembers                             best interest.                                         seeking input on whether there are any
                                                                                                          Once a veteran has been determined                  circumstances in which a family
                                                  In order to be eligible for PCAFC                    to be eligible for the program and a                   caregiver’s benefits should be extended
                                               under the statute, the individual must                  family caregiver has been approved and                 beyond the revocation date when the
                                               be a veteran or a servicemember                         designated, the veteran’s well-being is                family caregiver makes the decision to
                                               undergoing medical discharge from the                   monitored by VA no less often than                     be removed as the family caregiver as
                                               Armed Forces and must have a serious                    every 90 days, unless otherwise                        well as the length of such an extension.
                                               injury (including traumatic brain injury,               clinically indicated. 38 CFR 71.40(b)(2).
                                               psychological trauma, or other mental                   Currently, there is no regulatory                      Determination of Stipend Payment
                                               disorder) incurred or aggravated in the                 requirement to reassess eligibility. If,               Methodology for Primary Family
                                               line of duty in the active military, naval,             however, the veteran’s level of                        Caregivers
                                               or air service on or after September 11,                functioning improves, lessening the                       Section 1720G(a)(3)(A)(ii)(V) of title
                                               2001. 38 U.S.C. 1720G(a)(2)(A)–(B), 38                  need for assistance of a family caregiver,             38, U.S.C., requires VA to provide a
                                               CFR 71.20(a)–(b). We have defined                       VA may determine that the veteran no                   monthly stipend to primary family
                                               ‘‘serious injury’’ as ‘‘any injury,                     longer meets the eligibility criteria for              caregivers of eligible veterans. Under
                                               including traumatic brain injury,                       PCAFC. Because approval and                            the statute, VA is required to base the
                                               psychological trauma, or other mental                   designation of a family caregiver is                   stipend amount on the amount and
                                               disorder, incurred or aggravated in the                 conditioned on the eligibility criteria                degree of personal care services
                                               line of duty in the active military, naval,             being met, in the instance that a veteran              provided; to the extent practicable,
                                               or air service on or after September 11,                is determined to be ineligible for the                 ensure that the amount is not less than
                                               2001, that renders the veteran or                       program, VA will revoke the family                     the monthly amount a commercial home
                                               servicemember in need of personal care                  caregiver’s designation, and the                       health care entity would pay an
                                               services.’’ 38 CFR 71.15. We have                       caregiver benefits will cease. 38 CFR                  individual in the geographic area of the
                                               interpreted 38 U.S.C. 1720G to require                  71.25(f), 71.45(c).                                    veteran to provide equivalent personal
                                               this causal relationship between the                                                                           care services; and in the instance that
                                                                                                       Continuation of Benefits After                         the geographic area does not have a
                                               need for personal care services and the
                                                                                                       Revocation                                             commercial home health entity, VA
                                               serious injury. 76 FR 26150.
                                                                                                         Under PCAFC, caregiver benefits may                  must take into consideration the costs of
                                                  Additionally, 38 U.S.C. 1720G
                                                                                                       continue for a period of time after                    commercial providers of personal care
                                               requires that eligibility be premised on
                                                                                                       revocation of the family caregiver’s                   services in those geographic areas with
                                               an individual’s need for personal care
                                                                                                       designation in limited situations. For                 similar costs of living. See 38 U.S.C.
                                               services because of (1) an inability to
                                                                                                       example, under § 71.45(b)(4), caregiver                1720G(a)(3)(C).
                                               perform one or more activities of daily
                                                                                                       benefits continue for 30 days after the                   Under the implementing regulations,
                                               living, (2) a need for supervision or
                                                                                                       date of revocation initiated by the                    VA relies on the U.S. Department of
                                               protection based on symptoms or
                                                                                                       veteran or his or her surrogate, subject               Labor’s Bureau of Labor Statistics (BLS)
                                               residuals of neurological or other
                                                                                                       to certain exceptions. Additionally,                   hourly wage rate for home health aides
                                               impairment or injury, or (3) such other                 under § 71.45(c), caregiver benefits                   at the 75th percentile in the veteran’s
                                               matters as the Secretary considers                      continue for 90 days after revocation                  geographic area of residence, which is
                                               appropriate. 38 U.S.C. 1720G(a)(2)(C)(i)–               initiated by VA, subject to certain                    multiplied by the Consumer Price Index
                                               (iii). This requirement is set forth in 38              exceptions. We provide these extended                  for All Urban Consumers. 38 CFR 71.15,
                                               CFR 71.20(c), in which we require that                  periods of benefits to allow a family                  71.40(c)(4). We have used the BLS wage
                                               the serious injury renders the veteran in               caregiver, who did not request the                     rate to meet the intent of the statute to
                                               need of personal care services for a                    revocation, a transition period before                 ensure that primary family caregivers
                                               minimum period of six continuous                        benefits are discontinued (particularly,               are not paid less than home health aides
                                               months based on specified criteria.                     for certain benefits like health care). We             in the applicable geographic area. 76 FR
                                               Otherwise, the criteria under § 71.20(c)                believe these extended benefits periods                26154. These rates, however, fluctuate
                                               do not distinguish between, or require,                 are consistent with the purpose of 38                  annually in conjunction with changing
                                               any specific degree of need for                         U.S.C. 1720G and represent an                          geographical area designations, which
                                               assistance (e.g., in frequency,                         appropriate and compassionate way to                   can result in alterations to stipend
                                               complexity, or scope).                                  interpret and enforce the law. 76 FR                   amounts.
                                                  In order to be eligible for the program,             26155–26156. The 30- and 90-day                           VA also calculates the stipend amount
                                               we also require that a clinical                         periods set forth in § 71.45(b)(4) and (c),            based on a veteran’s assigned tier level
                                               determination be made that it is in the                 respectively, are the only instances in                which is determined by a clinical
                                               best interest of the individual to                      which the regulations provide for                      assessment of functional needs, as
                                               participate in the program. 38 CFR                      extended caregiver benefits beyond the                 further detailed in 38 CFR 71.40(c)(4).
                                               71.20(d). This determination currently                  date of revocation.                                    Specifically, VA determines the
                                               requires the clinician to consider                        While a family caregiver can                         veteran’s level of dependency based on
                                               whether participation in the program                    voluntarily leave the program at any                   the degree to which he or she is unable
                                               significantly enhances the individual’s                 time, when a family caregiver initiates                to perform one or more activities of
                                               ability to live safely in a home setting,               revocation, his or her caregiver benefits              daily living or the degree to which he
                                               supports the individual’s potential                     terminate at the present or future date                or she is in need of supervision or
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                                               progress in rehabilitation, if such                     of revocation as specified by the family               protection based on symptoms or
                                               potential exists, and creates an                        caregiver. 38 CFR 71.45(a). While a                    residuals of neurological or other
                                               environment that supports the health                    family caregiver is not required to                    impairment or injury. VA conducts a
                                               and well-being of the individual. 38                    provide a basis for revocation, a family               clinical assessment, which is scored and
                                               CFR 71.15. VA has found variability in                  caregiver’s voluntary revocation may                   summed. Based on the sum of all
                                               how these three considerations are                      involve instances when the family                      ratings, the veteran is assigned a tier
                                               applied by clinicians assessing whether                 caregiver leaves because of a situation                level. Each tier level is assigned a


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                                                                                Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices                                                      703

                                               number of hours, up to forty hours per                     b. Are there any conditions under                   all veterans residing in a particular
                                               week. The primary family caregiver                      which participation would not be in a                  state?
                                               receives a stipend based on the assigned                veteran’s best interest?                                  c. Should VA have one stipend
                                               tier level. Currently, this is a                           4. Once approved for PCAFC, should                  amount for all primary family
                                               determination based upon the needs of                   the veteran’s eligibility be reassessed at             caregivers?
                                               the veteran, not the family caregiver,                  specific time intervals or based on                       8. A veteran is assigned a stipend tier
                                               and it distinguishes among three                        certain clinical indicators?                           based on the amount and degree of
                                               different tiers.                                           a. If so, what intervals and/or what                personal care services provided. How
                                                                                                       clinical indicators should be used?                    should VA assess and determine the
                                               Request for Information                                    b. Should reassessments be standard                 amount and degree of personal care
                                                  Through this notice, we are soliciting               for every participant? Are there                       services provided to the veteran by the
                                               information on PCAFC. We ask                            conditions under which continued                       family caregiver?
                                               respondents to address the following                    eligibility should be presumed and a                      a. How should ‘‘degree of’’ need be
                                               questions, where possible, in the                       reassessment not needed? If so, what                   determined, for both physical needs and
                                               context of the discussion in this                       would these conditions be?                             those related to the need for supervision
                                               document. Commenters do not need to                        5. When VA determines that a veteran                and protection?
                                               address every question and should focus                 or family caregiver is no longer eligible                 b. Should ‘‘degree of’’ need be based
                                               on those that relate to their expertise or              for PCAFC or the family caregiver or                   on either physical needs or needs
                                               perspectives. To the extent possible,                   veteran no longer wishes to participate                related to psychological disorder? Or
                                               please clearly indicate which                           in PCAFC, the family caregiver’s                       should all factors be considered
                                               question(s) you address in your                         designation is ‘‘revoked’’. The term                   together?
                                               response. As previously mentioned,                      ‘‘revok[ed]’’ is used in the statute (38                  c. Should the three tier system be
                                               responses to this request will inform our               U.S.C. 1720G(a)(9)(C)(ii)(II)); however,               changed? If so, how should it be
                                               updates to PCAFC. Accordingly, we                       stakeholders have expressed concerns                   changed?
                                               request comments on the following:                      that this term is not supportive of
                                                  1. Should VA change how ‘‘serious                    participants. What terminology should                  Paperwork Reduction Act
                                               injury’’ is defined for the purposes of                 VA use in reference to those                              This request for information
                                               eligibility?                                            participants who are determined to be                  constitutes a general solicitation of
                                                  a. Should the severity of injury be                  no longer eligible for the program?                    public comments as stated in the
                                               considered in determining eligibility to                   a. Should VA use such language as                   implementing regulations of the
                                               ensure VA is supporting family                          removal, discharge, or graduate in                     Paperwork Reduction Act of 1995 at 5
                                               caregivers of Veterans most in need? If                 reference to participants who become                   CFR 1320.3(h)(4). Therefore, this request
                                               so, how should the level of severity be                 ineligible for the program?                            for information does not impose
                                               determined?                                                6. Should the timeframes for                        information collection requirements
                                                  b. How should VA define veterans                     continuation of benefits for family                    (i.e., reporting, recordkeeping or third-
                                               who are most in need?                                   caregivers who are revoked from the                    party disclosure requirements).
                                                  c. Should eligibility be limited to only             Program be modified?                                   Consequently, there is no need for
                                               those veterans who without a family                        a. If so, how?
                                                                                                                                                              review by the Office of Management and
                                               caregiver providing personal care                          b. Under what circumstances should
                                                                                                                                                              Budget under the authority of the
                                               services would otherwise require                        family caregiver benefits be continued
                                                                                                                                                              Paperwork Reduction Act of 1995 (44
                                               institutionalization? If so, how should                 after revocation? For example, should
                                                                                                                                                              U.S.C. 3501 et seq.).
                                               this be determined?                                     VA continue providing benefits to a
                                                  2. One of the bases upon which a                     family caregiver who requests                          Signing Authority
                                               veteran can be determined to need                       revocation due to an unsafe                              The Secretary of Veterans Affairs, or
                                               personal care services is his or her need               environment created by a veteran, such                 designee, approved this document and
                                               for supervision or protection based on                  as an instance involving intimate                      authorized the undersigned to sign and
                                               symptoms or residuals of neurological                   partner violence committed by a                        submit the document to the Office of
                                               or other impairment or injury.                          veteran? How long should the benefits                  Federal Register for publication
                                                  a. What should be the criteria to                    be continued under such                                electronically as an official document of
                                               assess a veteran’s need for supervision                 circumstances?                                         the Department of Veterans Affairs. Gina
                                               or protection?                                             7. VA’s methodology of stipend
                                                                                                                                                              S. Farrisee, Deputy Chief of Staff,
                                                  b. What standardized tools should be                 calculations using the U.S. Department
                                                                                                                                                              Department of Veterans Affairs,
                                               used to assess a veteran’s need for                     of Labor’s Bureau of Labor Statistics
                                                                                                                                                              approved this document on December 6,
                                               supervision or protection because of a                  (BLS) wage rates is complex and creates
                                                                                                                                                              2017, for publication.
                                               mental health condition?                                variability in stipend amounts annually
                                                  3. To be eligible for the program,                   across localities. How should VA                         Dated: December 6, 2017.
                                               participation must be determined to be                  calculate stipend rates?                               Jeffrey Martin,
                                               in the ‘‘best interest’’ of the veteran.                   a. What other standards or rates                    Impact Analyst, Office of Regulation Policy
                                               How should ‘‘best interest’’ be defined?                should VA consider using to calculate                  & Management, Office of the Secretary,
                                                  a. How can VA improve consistency                    stipends?                                              Department of Veterans Affairs.
                                               in ‘‘best interest’’ determinations for                    b. Should VA use one BLS rate per                   [FR Doc. 2018–00004 Filed 1–4–18; 8:45 am]
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                                               participation in the program?                           state, i.e., one rate that is applicable to            BILLING CODE 8320–01–P




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Document Created: 2018-10-26 09:31:16
Document Modified: 2018-10-26 09:31:16
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionRequest for information.
DatesComments in response to this request for information must be received by VA on or before February 5, 2018.
ContactMargaret Kabat, National Director, Caregiver Support Program, 10P4C, Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, 202-461-6780 (this is not a toll free number).
FR Citation83 FR 701 

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