**GAO-03-432R**                      Feb 07, 2003                  

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## Highlights

GAO reviewed the Department of Veterans Affairs (VA) new rule on payment or reimbursement for emergency treatment furnished at non-VA facilities. GAO found that (1) the rule establishes the provisions for payment or reimbursement for certain non-VA emergency services furnished to veterans for nonservice-connected conditions; and (2) VA complied with applicable requirements in promulgating the rule.

##  Department of Veterans Affairs: Payment or Reimbursement for Emergency Treatment Furnished at Non-VA Facilities, GAO-03-432R, February 7, 2003

B-291892February 7, 2003The Honorable Arlen Specter     Chairman     The Honorable Bob Graham     Ranking Minority Member     Committee on Veterans' Affairs     United States SenateThe Honorable Christopher H. Smith     Chairman     The Honorable Lane Evans     Ranking Minority Member     Committee on Veterans' Affairs     House of Representatives     Subject:*Department of Veterans Affairs: Payment or Reimbursement for Emergency Treatment Furnished at Non-VA Facilities*Pursuant to section 801(a)(2)(A) of title 5, United States Code, this is our report on a major rule promulgated by the Department of Veterans    Affairs (VA), entitled Payment or Reimbursement for Emergency Treatment Furnished at Non-VA Facilities (RIN: 2900-AK08).  We received the rule on January 17, 2003.  It was    published in the Federal Register as a final rule on January 24, 2003.  68 Fed. Reg. 3401.     The final rule establishes the provisions for payment or reimbursement for certain non-VA emergency services furnished to veterans for nonservice-connected conditions.     Enclosed is our assessment of the VA's compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule.  Our review indicates that    the VA complied with the applicable requirements.     If you have any questions about this report, please contact James W. Vickers, Assistant General Counsel, at (202) 512-8210.  The official responsible for GAO evaluation work relating to the    subject matter of the rule is William Scanlon, Managing Director, Health Care.  Mr. Scanlon can be reached at (202) 512-7114.                 signed     Kathleen E. Wannisky     Managing Associate General Counsel     Enclosurecc: John H. Thompson     Deputy General Counsel     Department of Veterans Affairs            ENCLOSURE     ANALYSIS UNDER 5 U.S.C.  801(a)(1)(B)(i)-(iv) OF A MAJOR RULE     ISSUED BY THE     DEPARTMENT OF VETERANS AFFAIRS     ENTITLED     "PAYMENT OR REIMBURSEMENT FOR EMERGENCY TREATMENT     FURNISHED AT NON-VA FACILITIES"     (RIN: 2900-AK08)(i) Cost-benefit analysis     The VA estimates that the 5-year cost of the final rule from appropriated funds will be $2.1 billion in benefit costs and $21 million in government operating expenses.(ii) Agency actions relevant to the Regulatory Flexibility Act, 5 U.S.C.  603-605, 607, and 609     The Secretary of Veterans Affairs has certified that the final rule will not have a significant economic impact on a substantial number of small entities.(iii) Agency actions relevant to sections 202-205 of the Unfunded Mandates Reform Act of 1995, 2 U.S.C.  1532-1535     As defined in title II, the final rule does not contain either an intergovernmental or private sector mandate of more than $100 million in any one year.(iv) Other relevant information or requirements under acts and executive orders     Administrative Procedure Act, 5 U.S.C.  551 etseq.     The final rule follows the issuance of an interim final rule published July 12, 2001, in the Federal Register.  66 Fed. Reg. 36467.  The VA received comments in response to the interim    final rule, which are discussed in the preamble to the final rule.     Paperwork Reduction Act, 44 U.S.C.  3501-3520     The final rule contains information collections that are subject to review by the Office of Management and Budget (OMB) under the Paperwork Review Act.  OMB has approved the three    collections in connection with the issuance of the prior interim final rule and assigned OMB control no. 2900-0620.      Statutory authorization for the rule     The final rule is promulgated under the authority contained in section 111 of the Veterans Millennium Health Care and Benefits Act (Pub. L. 106-117), codified at 38 U.S.C. 1725, and 38 U.S.C.    501 and 1721.     Executive Order No. 12866     The final rule has been reviewed by OMB and found to be an economically significant regulatory action under the order.

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