44290 Federal Register / Vol. 74, No. 166 / Friday, August 28, 2009 / Rules and Regulations 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 17 

RIN 2900–AL68 

Medication Prescribed by Non-VA 

Physicians 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule. 

SUMMARY: This document amends and 

adopts an interim final rule that governs 

the provision of medications to veterans 

when medication is prescribed by 

physicians who are not employees of 

nor are they providing care under 

contract with the Department of 

Veterans Affairs (VA). In a document 

published in the Federal Register on 

July 25, 2003, VA issued an interim 

final rule establishing a temporary 

program while also maintaining the 

program that it had in place before the 

interim final rule. Because the need 

cited in the interim final rule has abated 

and because the provisions added by the 

interim final rule were self-limiting in 

time and scope, we are removing these 

provisions which established the now 

obsolete temporary program. 

DATES: Effective Date: August 28, 2009. 

FOR FURTHER INFORMATION CONTACT: 

Brian McCarthy, Office of Patient Care 

Services, Veterans Health 

Administration, Department of Veterans 

Affairs, 810 Vermont Ave., NW., 

Washington, DC 20420, 202–461–6759. 

(This is not a toll-free number.) 

SUPPLEMENTARY INFORMATION: In a 

document published in the Federal 

Register on July 25, 2003 (68 FR 43927), 

VA issued an interim final rule that 

amended 38 CFR 17.96, a regulation 

allowing VA to fill certain prescriptions 

ordered by non-VA physicians. 

When the interim final rule was 

published, VA was experiencing 

increases in enrollment and demand for 

health care services. The increased 

demand was caused, at least in part, by 

veterans enrolling in the VA health care 

system to obtain pharmacy benefits at 

no cost or at a reasonable cost. 

Consistent with the primary purpose of 

VHA, which is to provide integrated 

comprehensive health care for veterans, 

and not simply to act as a conduit for 

providing prescription medications, VA 

usually provides only medications 

prescribed by VA physicians or VA 

contractors retained for that purpose. 

When a veteran first enrolls in the VA 

health care system and requests an 

appointment for care, VA schedules an 

initial appointment with a primary care 

physician. Among other things, during 

that first appointment the physician 

generally learns from the veteran what 

medication the veteran is taking, if any, 

assesses the need for medication, and 

writes prescriptions for any needed 

medication. 

Due to the increased demand for 

health care services, VA was unable to 

provide some initial primary care visits 

in a timely manner. In certain locations, 

veterans were placed on a wait list for 

an initial primary care visit. Many of 

those veterans had existing 

prescriptions, written by non-VA 

physicians, that VA primary care 

physicians could confirm and renew 

when the veterans were able to have 

initial primary care visits. The interim 

final rule, in paragraphs (a) through (h), 

set forth rules that established a 

temporary program to fill prescriptions 

ordered by non-VA physicians prior to 

the veteran’s initial primary care visit. 

The temporary program was limited to 

veterans who were enrolled in the VA 

health care system prior to July 25, 2003 

and who requested an initial primary 

care appointment prior to July 25, 2003 

with the next available appointment 

date more than 30 days from the date of 

the request. By 2004, VA had virtually 

eliminated the primary care wait list so 

there was no longer a need for the 

temporary program. In addition, no 

veterans remain eligible for the 

temporary program in any event. 

Paragraph (i) of the interim final rule 

restated verbatim what had been § 17.96 

before the publication of the interim 

final rule. These original and continuing 

provisions apply to the filling of 

prescriptions by non-VA physicians for 

veterans receiving increased 

compensation or pension, without 

regard to whether the veteran has had 

an initial primary care visit. 

We received one comment during the 

interim final rule’s comment period, 

which ended on September 8, 2003. The 

commenter, the National Association of 

Chain Drug Stores, stressed the 

importance of pharmacy medication 

reviews as well as the need to ensure 

complete and accurate information is 

obtained regarding a patient’s 

prescription and medical history. VA 

shares this view and has policies and 

procedures in place to coordinate care 

and ensure patient safety. It is 

unnecessary to further amend the 

regulation to reflect existing policies. 

This final rule removes paragraphs (a) 

through (h) of the interim final rule, 

thus returning the law to the state that 

it was in before the interim final rule 

was promulgated. We are also making 

non-substantive changes to restore the 

original organization of § 17.96. 

Administrative Procedure Act 

Pursuant to 5 U.S.C. 553, we have 

found for this rule that notice and 

public procedure are impracticable, 

unnecessary, and contrary to the public 

interest. Because this rule merely 

removes provisions rendered obsolete 

by their own terms and continues 

provisions in effect prior to the 

promulgation of the interim final rule, 

this rulemaking is exempt from the prior 

notice-and-comment and delayedeffective-date requirements of 5 U.S.C. 

553. 

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 

(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. 

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 

Executive Order classifies a ‘‘significant 

regulatory action,’’ requiring review by 

the Office of Management and Budget 

(OMB) unless OMB waives such review, 

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 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. VA has 

examined the economic, interagency, 

budgetary, legal, and policy 

implications of this final rule and has 

concluded that it does not constitute a 

significant regulatory action under the 

Executive Order. 


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Federal Register / Vol. 74, No. 166 / Friday, August 28, 2009 / Rules and Regulations 44291 

Paperwork Reduction Act 

This document contains no provisions 

constituting a collection of information 

under the Paperwork Reduction Act of 

1995 (44 U.S.C. 3501–3521). 

OMB assigns a control number for 

each collection of information it 

approves. VA may not conduct or 

sponsor, and a person is not required to 

respond to, a collection of information 

unless it displays a current valid OMB 

control number. The interim final rule 

contained collections of information 

which were approved by OMB under 

the following OMB control number: 

2900–0646 (Medication Prescribed by 

Non-VA Physicians). VHA allowed 

OMB control number 2900–0646 to 

expire in August 2006 because the 

temporary program had been 

discontinued. 

Regulatory Flexibility Act 

The Secretary of Veterans Affairs 

hereby certifies that this regulatory 

amendment 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. The rule would 

not affect any small entities. Only 

individuals could be directly affected. 

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

this final rule is exempt from the initial 

and final regulatory flexibility analyses 

requirements of sections 603 and 604. 

Catalog of Federal Domestic Assistance 

The Catalog of Federal Domestic 

Assistance program numbers and titles for 

this rule are as follows: 64.005, Grants to 

States for Construction of State Home 

Facilities; 64.007, Blind Rehabilitation 

Centers; 64.008, Veterans Domiciliary Care; 

64.009, Veterans Medical Care Benefits; 

64.010, Veterans Nursing Home 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; 64.016, Veterans State 

Hospital Care; 64.018, Sharing Specialized 

Medical Resources; 64.019, Veterans 

Rehabilitation, Alcohol and Drug 

Dependence; and 64.022, Veterans Home 

Based Primary Care. 

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. 

Approved: August 7, 2009. 

John R. Gingrich, 

Chief of Staff, Department of Veterans Affairs. 

■ For the reasons set out 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, 1721, and as 

stated in specific sections. 

§ 17.96 [Amended] 

■ 2. Amend § 17.96 by: 

■ a. Removing paragraphs (a) through 

(h); 

■ b. Redesignating paragraphs (i) 

introductory text, (i)(1), (i)(1)(i), (i)(1)(ii) 

and (i)(2) as the introductory text to the 

section and paragraphs (a) introductory 

text, (a)(1), (a)(2), and (b) respectively; 

and 

■ c. In newly designated introductory 

text to the section, removing the 

heading ‘‘Medications for veterans 

receiving increased compensation or 

pension.’’ 

[FR Doc. E9–20792 Filed 8–27–09; 8:45 am] 

BILLING CODE 8320–01–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[EPA–R09–OAR–2009–0385; FRL–8948–6] 

Revisions to the California State 

Implementation Plan, San Joaquin 

Valley Unified Air Pollution Control 

District and Santa Barbara County Air 

Pollution Control District 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Direct final rule. 

SUMMARY: EPA is taking direct final 

action to approve revisions to the San 

Joaquin Valley Unified Air Pollution 

Control District (SJVUAPCD) and Santa 

Barbara County Air Pollution Control 

District (SBCAPCD) portions of the 

California State Implementation Plan 

(SIP). Under authority of the Clean Air 

Act as amended in 1990 (CAA or the 

Act), we are approving these local rules 

that address changes for clarity and 

consistency. 

DATES: This rule is effective on October 

27, 2009 without further notice, unless 

EPA receives adverse comments by 

September 28, 2009. If we receive such 

comments, we will publish a timely 

withdrawal in the Federal Register to 

notify the public that this direct final 

rule will not take effect. 

ADDRESSES: Submit comments, 

identified by docket number EPA–R09– 

OAR–2009–0385, by one of the 

following methods: 

1. Federal eRulemaking Portal: 

http://www.regulations.gov. Follow the 

on-line instructions. 

2. E-mail: steckel.andrew@epa.gov. 

3. Mail or deliver: Andrew Steckel 

(Air-4), U.S. Environmental Protection 

Agency Region IX, 75 Hawthorne Street, 

San Francisco, CA 94105–3901. 

Instructions: All comments will be 

included in the public docket without 

change and may be made available 

online at http://www.regulations.gov, 

including any personal information 

provided, unless the comment includes 

Confidential Business Information (CBI) 

or other information whose disclosure is 

restricted by statute. Information that 

you consider CBI or otherwise protected 

should be clearly identified as such and 

should not be submitted through 

http://www.regulations.gov or e-mail. 

http://www.regulations.gov is an 

‘‘anonymous access’’ system, and EPA 

will not know your identity or contact 

information unless you provide it in the 

body of your comment. If you send email directly to EPA, your e-mail 

address will be automatically captured 

and included as part of the public 

comment. If EPA cannot read your 

comment due to technical difficulties 

and cannot contact you for clarification, 

EPA may not be able to consider your 

comment. 

Docket: The index to the docket for 

this action is available electronically at 

http://www.regulations.gov and in hard 

copy at EPA Region IX, 75 Hawthorne 

Street, San Francisco, California. While 

all documents in the docket are listed in 

the index, some information may be 

publicly available only at the hard copy 

location (e.g., copyrighted material), and 

some may not be publicly available in 

either location (e.g., CBI). To inspect the 

hard copy materials, please schedule an 

appointment during normal business 

hours with the contact listed in the FOR

FURTHER INFORMATION CONTACT section. 

FOR FURTHER INFORMATION CONTACT: 

Cynthia G. Allen, EPA Region IX, (415) 

947–4120, allen.cynthia@epa.gov. 

SUPPLEMENTARY INFORMATION: 

Throughout this document, ‘‘we,’’ ‘‘us’’ 

and ‘‘our’’ refer to EPA. 

Table of Contents 

I. The State’s Submittal 

A. What rules did the State submit? 


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