11338 Federal Register / Vol. 76, No. 41 / Wednesday, March 2, 2011 / Rules and Regulations 

Standard), approved June 7, 1996; IBR 

approved for §§ 1281.3, and 1281.16. 

* * * * * 

Dated: February 24, 2011. 

David S. Ferriero, 

Archivist of the United States. 

[FR Doc. 2011–4612 Filed 3–1–11; 8:45 am] 

BILLING CODE 7515–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 17 

RIN 2900–AN41 

Hospital and Outpatient Care for 

Veterans Released From Incarceration 

to Transitional Housing 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule. 

SUMMARY: This document affirms as 

final a proposed rule that amends the 

Department of Veterans Affairs (VA) 

medical regulations to authorize VA to 

provide hospital and outpatient care to 

a veteran in a program that provides 

temporary housing upon release from 

incarceration in a prison or jail. The 

final rule permits VA to work with these 

veterans while they are in these 

programs with the goal of continuing to 

work with them after their release, 

which will assist in preventing 

homelessness in this population of 

veterans. 

DATES: This final rule is effective April 

1, 2011. 

FOR FURTHER INFORMATION CONTACT: 

James McGuire, Program Manager, 

Healthcare for Re-entry Veterans, 

Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue, NW., Washington, DC 

20420, (202) 461–1591. (This is not a 

toll free number.) 

SUPPLEMENTARY INFORMATION: Under 38 

U.S.C. 1710(h), VA is not required ‘‘to 

furnish care to a veteran to whom 

another agency of Federal, State, or local 

government has a duty under law to 

provide care in an institution of such 

government.’’ VA implemented this 

statute in 38 CFR 17.38(c)(5). Generally, 

§ 17.38(c)(5) bars VA from providing 

‘‘[h]ospital and outpatient care for a 

veteran who is either a patient or inmate 

in an institution of another government 

agency if that agency has a duty to give 

the care or services.’’ Typically, 

government agencies have a duty to 

provide medical care to inmates who 

have been released from incarceration in 

a prison or jail to a temporary housing 

program (such as a community 

residential re-entry center or halfway 

house). 

This duty may exist even though the 

responsible government agency expects 

residents in these programs to arrange 

for their own medical care. Irrespective 

of whether a duty exists, however, VA 

wants to be able to provide hospital and 

outpatient care to eligible veterans in 

these programs. Under § 17.38(c)(5), VA 

cannot provide care to veterans in these 

programs if the other government 

agency has a duty to provide the care 

unless that agency is willing to pay VA 

for the care by contract. 

In a proposed rule published May 12, 

2010, we proposed to amend § 17.38 to 

establish that the exclusion in paragraph 

(c)(5) does not apply to any veteran who 

is released from incarceration to a 

temporary housing program. We 

explained that this amendment is 

necessary to authorize VA hospital and 

outpatient care for these veterans who 

often require additional assistance in 

successfully transitioning from 

incarceration. 

VA wants to provide care to these 

veterans because VA has found that 

upon release from jail or prison these 

veterans are particularly at risk of not 

receiving adequate medical care, and in 

many cases become homeless, as a 

result of not receiving such care, after 

their release from temporary housing 

programs. Under 38 U.S.C. 2022(a), VA 

is charged with reaching out ‘‘to 

veterans at risk of homelessness, 

including particularly veterans who are 

being discharged or released from 

institutions after * * * imprisonment.’’ 

Outreach workers for the Veterans 

Health Administration report that 

veterans with acute or chronic medical 

or psychiatric problems who are treated 

while incarcerated, often have difficulty 

obtaining similar treatment during a 

transitional period. In particular, if 

mental health issues are not addressed 

during the transitional period, upon 

release, many of these veterans are 

rendered incapable of finding or 

maintaining appropriate housing. 

In addition to being an important 

component of VA’s duty to attempt to 

prevent veterans from becoming 

homeless, establishing that the 

exclusion in 38 CFR 17.38(c)(5) does not 

apply to veterans who are residents in 

temporary housing programs offers 

potentially significant public benefits 

and will further the success of other VA 

policies. For example, section 20 of 

VHA Handbook 1160.01 specifically 

requires VA to ‘‘engage with veterans 

being released from prison in need of 

care.’’ VHA Handbook 1160.01, section 

20(a)(2). As significant numbers of 

veterans in these programs have 

difficulty obtaining medical treatment 

comparable to the treatment they 

received in prison, some begin to 

believe the only way they can obtain 

treatment is to violate the terms of their 

release and return to prison. A 2008 

Urban Institute study of a large re-entry 

population cohort, found health care 

played a key role in the first months of 

community re-adjustment and reduced 

recidivism. Mallik-Kane, K, and Visher, 

C.A., Health and prisoner re-entry: How 

physical, mental, and substance abuse 

conditions shape the process of reintegration. Urban Institute Justice 

Policy Center: Washington, DC (2008). 

In particular, the study noted that access 

to medications for chronic health and 

mental health conditions is a low-cost 

powerful tool in preventing recidivism. 

We received three comments on the 

proposed rule. All of the comments 

support the substance of the proposed 

rule. One commenter recommended that 

VA add a number of services to its 

medical benefits package, and made 

strategic recommendations for VA 

housing programs. This rulemaking 

simply removes a bar that prevented 

veterans, who are released from 

incarceration into temporary housing, 

from receiving outpatient and hospital 

care under the medical benefits package. 

Because the commenter suggested that 

additional services be added to this 

package, we do not believe that these 

comments are within the scope of this 

rulemaking. However, to the extent that 

the commenter seeks to connect 

veterans to needed care and support 

services, we note that VA currently 

provides a number of programs that 

provide housing and other support 

services to veterans. Nothing prevents 

formerly incarcerated veterans from 

taking advantage of any of the programs 

for which they qualify. 

For the foregoing reasons, VA amends 

38 CFR 17.38 to revise the exclusion in 

the VA medical benefits package for a 

veteran who is a patient or inmate in an 

institution of another government 

agency so that the exclusion does not 

apply to a veteran who is a resident of 

a temporary housing program. For 

purposes of this rule, a ‘‘temporary 

housing program,’’ includes community 

residential re-entry centers, halfway 

houses, and similar residential facilities. 

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 an 

expenditure by state, local and tribal 

governments, in the aggregate, or by the 

private sector, of $100 million or more 

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Federal Register / Vol. 76, No. 41 / Wednesday, March 2, 2011 / Rules and Regulations 11339 

(adjusted annually for inflation) in any 

given year. This rule has no such effect 

on state, local and tribal governments, 

or on the private sector. 

Executive Order 12866 

Executive Order 12866 directs 

agencies to assess all costs and benefits 

of available regulatory alternatives, and 

when regulation is necessary to select 

regulatory approaches that maximize 

net benefits (including potential 

economic, environmental, public health 

and safety, and other advantages; 

distributive impacts; and equity). The 

Order classifies a ‘‘significant regulatory 

action,’’ requiring review by the Office 

of Management and Budget (OMB), as a 

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, state, local, or tribal governments 

or communities; (2) create a serious 

inconsistency or otherwise interfere 

with an action planned or taken 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 the Executive Order. 

The economic, interagency, 

budgetary, legal, and policy 

implications of this rule have been 

examined, and it has been determined 

not to be a significant regulatory action 

under Executive Order 12866. 

Paperwork Reduction Act 

This rule does not contain any 

collections of information under the 

Paperwork Reduction Act (44 U.S.C. 

3501–3520). 

Regulatory Flexibility Act 

The Secretary hereby certifies that 

this rule does not have a significant 

economic impact on a substantial 

number of small entities as they are 

defined in the Regulatory Flexibility 

Act, 5 U.S.C. 601–612. This rule only 

affects individuals, not small entities. 

Therefore, pursuant to 5 U.S.C. 605(b), 

this rule is exempt from the initial and 

final regulatory flexibility analysis 

requirements of sections 603 and 604. 

Catalog of Federal Domestic Assistance 

The Catalog of Federal Domestic 

Assistance numbers and titles for the 

programs affected by this document are 

64.009, Veterans Medical Care Benefits; 

64.011, Veterans Dental Care; 64.012, 

Veterans Prescription Service; 64.013, 

Veterans Prosthetic Appliances; 64.019, 

Veterans Rehabilitation Alcohol and 

Drug Dependence; and 64.022, Veterans 

Home Based Primary Care. 

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. John 

R, Gingrich, Chief of Staff, approved this 

document on February 24, 2011 for 

publication. 

List of Subjects in 38 CFR Part 17 

Administrative practice and 

procedure, Alcohol abuse, Alcoholism, 

Claims, Day care, Dental health, Drug 

abuse, Foreign relations, Government 

contracts, Grant programs—health, 

Grant programs—veterans, Health care, 

Health facilities, Health professions, 

Health records, Homeless, Medical and 

dental schools, Medical devices, 

Medical research, Mental health 

programs, Nursing homes, Philippines, 

Reporting and recordkeeping 

requirements, Scholarships and 

fellowships, Travel and transportation 

expenses, Veterans. 

Dated: February 25, 2011. 

William F. Russo, 

Director, Regulations Management, 

Department of Veterans Affairs. 

For the reasons stated in the 

preamble, VA amends 38 CFR part 17 as 

follows: 

PART 17—MEDICAL 

■ 1. The authority citation for part 17 

continues to read as follows: 

Authority: 38 U.S.C. 501, and as noted in 

specific sections. 

■ 2. Revise § 17.38(c)(5) to read as 

follows: 

§ 17.38 Medical benefits package. 

* * * * * 

(c) * * * 

(5) Hospital and outpatient care for a 

veteran who is either a patient or inmate 

in an institution of another government 

agency if that agency has a duty to give 

the care or services. This exclusion does 

not apply to veterans who are released 

from incarceration in a prison or jail 

into a temporary housing program (such 

as a community residential re-entry 

center or halfway house). 

* * * * * 

[FR Doc. 2011–4686 Filed 3–1–11; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 51 

RIN 2900–AN59 

Update to NFPA 101, Life Safety Code, 

for State Home Facilities 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule. 

SUMMARY: This document adopts as a 

final rule without change the proposed 

rule to amend the Department of 

Veterans Affairs (VA) regulations 

governing the physical environment of 

State Home facilities. The final rule will 

require State Home facilities that receive 

a per diem for providing nursing home 

care to eligible veterans to meet certain 

provisions of the 2009 edition of the 

National Fire Protection Association’s 

NFPA 101, Life Safety Code. The change 

is designed to assure that State Home 

facilities meet current industry-wide 

standards regarding life safety and fire 

safety. 

DATES: Effective Date: This final rule is 

effective April 1, 2011. 

The Director of the Federal Register 

approved the incorporation by reference 

of certain publications listed in this rule 

as of April 1, 2011. 

FOR FURTHER INFORMATION CONTACT: 

Theresa Hayes at (202) 461–6771, Office 

of Geriatrics and Extended Care, 

Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue, NW., Washington, DC 

20420. (The telephone number above is 

not a toll-free number.) 

SUPPLEMENTARY INFORMATION: In a 

document published in the Federal 

Register on April 7, 2010 (75 FR 17644), 

VA proposed to amend 38 CFR 51.200, 

which governs the physical 

environment of facilities for which VA 

pays per diem to a state for providing 

nursing home care to eligible veterans. 

We proposed to update the regulation to 

require State Home facilities to meet 

certain provisions of the National Fire 

Protection Association’s NFPA 101, Life 

Safety Code (2009 edition) (NFPA 101), 

and proposed to incorporate that edition 

by reference. We provided a 60-day 

comment period and received one 

comment. 

The comment was from the National 

Fire Protection Association. The 

commenter noted that there are several 

differences between the 2006 and 2009 

editions of NFPA 101. The commenter 

noted that the 2009 edition clarifies the 

circumstances in which a ‘‘change in 

occupancy’’ classification would be 

considered when an existing building is 

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