Federal Register / Vol. 83, No. 122 / Monday, June 25, 2018 / Rules and Regulations 29447 

Federal Register, the Coast Guard will 

provide the maritime community with 

extensive advanced notification of 

enforcement of these safety zones via 

the Local Notice to Mariners. 

Dated: June 19, 2018. 

M.M. Balding, 

Captain, U.S. Coast Guard, Captain of the 

Port Puget Sound. 

[FR Doc. 2018–13518 Filed 6–22–18; 8:45 am] 

BILLING CODE 9110–04–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 17 

RIN 2900–AP55 

Medical Care in Foreign Countries and 

Filing for Reimbursement for 

Community Care Not Previously 

Authorized by VA 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) adopts as final, with no 

changes, a proposed rule amending its 

medical regulations related to hospital 

care and medical services in foreign 

countries. We simplified and clarified 

the scope of these regulations, address 

medical services provided to eligible 

veterans in the Republic of the 

Philippines, and removed provisions 

related to grants to the Republic of the 

Philippines that are no longer supported 

by statutory authority. VA also amends 

its medical regulations related to filing 

claims for reimbursement of medical 

expenses incurred for VA care not 

previously authorized. We provided a 

60-day period to receive comments from 

the public on the proposed changes, and 

received no comments. VA adopts the 

proposed rule as final, with no changes. 

DATES: This final rule is effective July 

25, 2018. 

FOR FURTHER INFORMATION CONTACT: 

Joseph Duran, Director, Policy and 

Planning, Office of Community Care 

(10D1A1), Veterans Health 

Administration, Department of Veterans 

Affairs, 810 Vermont Avenue NW, 

Washington, DC 20420, (303) 372–4629. 

(This is not a toll-free number) or 

Joseph.Duran2@va.gov. 

SUPPLEMENTARY INFORMATION: Section 

1724 of title 38 United States Code 

(U.S.C.) prohibits VA from furnishing 

hospital care or medical services outside 

any State except under specific 

circumstances. VA is authorized under 

38 U.S.C. 1724(b)(1) to furnish care and 

services to an eligible veteran outside 

any State if VA ‘‘determines that such 

care and services are needed for the 

treatment of a service-connected 

disability of the veteran or as part of a 

rehabilitation program under chapter 31 

of this title.’’ VA furnishes health care 

to eligible veterans in the Republic of 

the Philippines under this authority. In 

addition, 38 U.S.C. 1724(c) provides 

that ‘‘within the limits’’ of the Veterans 

Memorial Medical Center at Manila, 

Republic of the Philippines, VA may 

enter into contracts to furnish necessary 

hospital care to a veteran for any nonservice-connected disability if such 

veteran is unable to defray the expenses 

of necessary hospital care. VA may also 

operate an outpatient clinic in the 

Republic of the Philippines to furnish 

necessary medical services to a veteran 

who has a service-connected disability. 

38 U.S.C. 1724(e). Several sections of 

title 38 Code of Federal Regulations 

(CFR) part 17 address VA’s authority to 

provide for hospital care and medical 

services for eligible veterans outside the 

United States, as well as submission of 

claims for reimbursement for services 

obtained from community care 

providers outside the United States. 

On January 31, 2018, VA proposed to 

revise or amend these regulations to 

consolidate similar content, clarify 

provisions, and ensure that these 

regulations reflect current VA practice 

and statutory authority. (83 FR 4454). 

We proposed simplifying language in 

§ 17.35 to make it easier to understand, 

adding a new paragraph (b) to address 

hospital care and outpatient services 

provided to eligible veterans in the 

Republic of the Philippines as 

authorized in 38 U.S.C. 1724, and 

paragraph (c) to provide guidance on 

which sections of part 17 apply to 

claims for payment or reimbursement of 

services not previously authorized by 

the Foreign Medical Program. We 

proposed amending § 17.125 which 

focuses on filing claims. We proposed 

stating that in those cases where VA 

payment for such services has not been 

authorized in advance, claims for 

payment for such health care services 

provided in a State should be submitted 

to the VA medical facility nearest to 

where those services were provided. We 

also proposed amending that section to 

provide specific guidance on where and 

how to file claims. 

We proposed removing §§ 17.140 and 

17.141 as the subject matter of 

delegation of authority would be 

covered by proposed revisions to 

§ 17.125. Finally, we proposed removing 

§§ 17.350 through 17.370 which 

addressed grants to the Republic of the 

Philippines, as our authority to provide 

these grants under 38 U.S.C. 1732(b) has 

expired. VA still retains authority under 

38 U.S.C. 1731 to assist the Republic of 

the Philippines in fulfilling its 

responsibility in providing medical care 

and treatment for Commonwealth Army 

veterans and new Philippine Scouts in 

need of such care and treatment for 

service-connected disabilities and nonservice-connected disabilities under 

certain conditions. 

We provided a 60-day period to the 

public to comment on the proposed 

rule. The comment period closed April 

2, 2018, and we received no comments. 

Based on the rationale set forth in the 

proposed rule and in this document, VA 

is adopting the provisions of the 

proposed rule as a final rule with no 

changes. 

Effect of Rulemaking 

Title 38 of the Code of Federal 

Regulations, as revised by this final 

rulemaking, represents VA’s 

implementation of its legal authority on 

this subject. Other than future 

amendments to this regulation or 

governing statutes, no contrary guidance 

or procedures are authorized. All 

existing or subsequent VA guidance 

must be read to conform with this 

rulemaking if possible or, if not 

possible, such guidance is superseded 

by this rulemaking. 

Paperwork Reduction Act 

This final rule contains no provisions 

constituting a collection of information 

under the Paperwork Reduction Act of 

1995 (44 U.S.C. 3501–3521). 

Regulatory Flexibility Act 

The Secretary hereby certifies that 

this final regulatory amendment 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 

rulemaking does not directly affect any 

small entities. Only VA beneficiaries 

and certain community care providers 

would be directly affected. Therefore, 

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

amendment is be exempt from the 

initial and final regulatory flexibility 

analysis requirements of sections 603 

and 604. 

Executive Orders 12866, 13563, and 

13771 

Executive Orders 12866 and 13563 

direct agencies to assess the costs and 

benefits of available regulatory 

alternatives and, when regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, and other advantages; 

distributive impacts; and equity). 


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29448 Federal Register / Vol. 83, No. 122 / Monday, June 25, 2018 / Rules and Regulations 

Executive Order 13563 (Improving 

Regulation and Regulatory Review) 

emphasizes the importance of 

quantifying both costs and benefits, 

reducing costs, harmonizing rules, and 

promoting flexibility. Executive Order 

12866 (Regulatory Planning and 

Review) defines a ‘‘significant 

regulatory action,’’ 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 

otherwise interfere with an action taken 

or planned by another agency; (3) 

Materially alter the budgetary impact of 

entitlements, grants, user fees, or loan 

programs or the rights and obligations of 

recipients thereof; or (4) Raise novel 

legal or policy issues arising out of legal 

mandates, the President’s priorities, or 

the principles set forth in this Executive 

Order.’’ 

VA has examined the economic, 

interagency, budgetary, legal, and policy 

implications of this regulatory action 

and determined that the action is not a 

significant regulatory action under 

Executive Order 12866. VA’s impact 

analysis can be found as a supporting 

document at http://

www.regulations.gov, usually within 48 

hours after the rulemaking document is 

published. Additionally, a copy of the 

rulemaking and its impact analysis are 

available on VA’s website at http://

www.va.gov/orpm by following the link 

for VA Regulations Published from FY 

2004 through FYTD. [For information 

about economically significant 

regulations, see Impact Analysis 

Procedures guide on the 00REG intranet 

site.] 

Executive Order 13771 (Reducing 

Regulation and Controlling Regulatory 

Costs) requires an agency, unless 

prohibited by law, to identify at least 

two existing regulations to be repealed 

when the agency publicly proposes for 

notice and comment, or otherwise 

promulgates, a new regulation. In 

furtherance of this requirement, section 

2(c) of E.O. 13771 requires that the new 

incremental costs associated with new 

regulations shall, to the extent permitted 

by law, be offset by the elimination of 

existing costs associated with at least 

two prior regulations. This final rule is 

not subject to the requirements of E.O. 

13771 because there is no incremental 

cost associated with this rule. 

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 

expenditure by State, local, or tribal 

governments, in the aggregate, or by the 

private sector, of $100 million or more 

(adjusted annually for inflation) in any 

given year. This final rule has no such 

effect on State, local, or tribal 

governments, or on the private sector. 

Catalog of Federal Domestic Assistance 

The Catalog of Federal Domestic 

Assistance program number and title for 

this rule are as follows: 64.008— 

Veterans Domiciliary Care; 64.011— 

Veterans Dental Care; 64.012—Veterans 

Prescription Service; 64.013—Veterans 

Prosthetic Appliances; 64.029— 

Purchase Care Program; 64.040—VHA 

Inpatient Medicine; 64.041—VHA 

Outpatient Specialty Care; 64.042— 

VHA Inpatient Surgery; 64.043—VHA 

Mental Health Residential; 64.044— 

VHA Home Care; 64.045—VHA 

Outpatient Ancillary Services; 64.046— 

VHA Inpatient Psychiatry; 64.047— 

VHA Primary Care; 64.048—VHA 

Mental Health clinics; and 64.050— 

VHA Diagnostic 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. 

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. 

Jacquelyn Hayes-Byrd, Acting Chief of 

Staff, Department of Veterans Affairs, 

approved this document on June 19, 

2018, for publication. 

Dated: June 19, 2018 

Consuela Benjamin, 

Regulation Development Coordinator, Office 

of Regulation Policy & Management, Office 

of the Secretary, Department of Veterans 

Affairs. 

For the reasons stated in the 

preamble, the Department of Veterans 

Affairs amends 38 CFR part 17 as 

follows: 

PART 17—MEDICAL 

■ 1. The authority citation for part 17 is 

amended by adding statutory authority 

citations for §§ 17.35 and 17.125 in 

numerical order to read as follows: 

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

specific sections. 

Section 17.35 is also issued under 38 

U.S.C. 1724. 

* * * * * 

Section 17.125 is also issued under 38 

U.S.C. 7304. 

* * * * * 

■ 2. Revise § 17.35 to read as follows: 

§ 17.35 Hospital care and outpatient 

services in foreign countries. 

(a) Under the VA Foreign Medical 

Program, VA may furnish hospital care 

and outpatient services to any veteran 

outside of the United States, without 

regard to the veteran’s citizenship: 

(1) If necessary for treatment of a 

service-connected disability, or any 

disability associated with and held to be 

aggravating a service-connected 

disability; 

(2) If the care and services are 

furnished to a veteran participating in a 

rehabilitation program under 38 U.S.C. 

chapter 31 who requires care and 

services for the reasons enumerated in 

§ 17.47(i)(2). 

(b) Under the Foreign Medical 

Program, the care and services 

authorized under paragraph (a) of this 

section are available in the Republic of 

the Philippines to a veteran who meets 

the requirements of paragraph (a) of this 

section. VA may also provide outpatient 

services to a veteran referenced in 

paragraph (a)(1) in the VA outpatient 

clinic in Manila for the treatment of 

such veteran’s service-connected 

conditions within the limits of the 

clinic. Non-service connected 

conditions of a veteran who has a 

service-connected disability may be 

treated within the limits of the VA 

outpatient clinic in Manila. 

(c) Claims for payment or 

reimbursement for services not 

previously authorized by VA under this 

section are governed by §§ 17.123– 

17.127 and 17.129–17.132. 

■ 3. Revise § 17.125 to read as follows: 


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Federal Register / Vol. 83, No. 122 / Monday, June 25, 2018 / Rules and Regulations 29449 

§ 17.125 Where to file claims. 

Generally, VA must preauthorize VA 

payment for health care services 

provided in the community when such 

care is provided in a State as that term 

is defined in 38 U.S.C. 101(20). 

(a) Where VA payment for such 

services has not been authorized in 

advance, claims for payment for such 

health care services provided in a State 

should be submitted to the VA medical 

facility nearest to where those services 

were provided. 

(b) Claims for payment for hospital 

care and outpatient services authorized 

under § 17.35(a) and provided in 

Canada must be submitted to Veterans 

Affairs Canada, Foreign Countries 

Operations Unit, 2323 Riverside Dr., 

2nd Floor, Ottawa, Ontario, Canada K1A 

OP5. 

(c) All other claims for payment for 

hospital care and outpatient services 

authorized under § 17.35(a) and 

provided outside a State must be 

submitted to the Foreign Medical 

Program, P.O. Box 469061, Denver, CO 

80246–9061. 

§ 17.140 [Removed] 

■ 4. Remove § 17.140 and the 

undesignated center heading 

‘‘Delegations of Authority’’, 

immediately preceding it. 

§ 17.141 [Removed] 

■ 5. Remove § 17.141. 

■ 6. Add an undesignated center 

heading, ‘‘Delegation of Authority’’ 

immediately preceding § 17.142. 

■ 7. Remove the undesignated center 

heading, ‘‘Grants to the Republic of the 

Philippines’’, immediately preceding 

§ 17.350. 

§§ 17.350–17.352, 17.355, 17.362–17.367, 

17.369, and 17.370 [Removed] 

■ 8. Remove §§ 17.350 through 17.352, 

17.355, 17.362 through 17.367, 17.369, 

and 17.370. 

[FR Doc. 2018–13487 Filed 6–22–18; 8:45 am] 

BILLING CODE 8320–01–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[EPA–R10–OAR–2016–0590; FRL–9979– 

87—Region 10] 

Air Plan Approval; AK; Interstate 

Transport Requirements for the 2010 

Nitrogen Dioxide and Sulfur Dioxide 

National Ambient Air Quality 

Standards 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Final rule. 

SUMMARY: The Environmental Protection 

Agency (EPA) is approving the State 

Implementation Plan (SIP) submittal 

from the Alaska Department of 

Environmental Conservation (Alaska 

DEC) demonstrating that the SIP meets 

certain interstate transport requirements 

of the Clean Air Act (CAA) for the 

National Ambient Air Quality Standards 

(NAAQS) promulgated in 2010 for 

nitrogen dioxide (NO2) and sulfur 

dioxide (SO2). The EPA has determined 

that Alaska’s SIP contains adequate 

provisions to ensure that air emissions 

in Alaska do not significantly contribute 

to nonattainment or interfere with the 

maintenance of the 2010 NO2 and SO2

NAAQS in any other state. 

DATES: This final rule is effective July 

25, 2018. 

ADDRESSES: The EPA has established a 

docket for this action under Docket ID 

No. EPA–R10–OAR–2016–0590. All 

documents in the docket are listed on 

the https://www.regulations.gov 

website. Although listed in the index, 

some information is not publicly 

available, e.g., CBI or other information 

whose disclosure is restricted by statute. 

Certain other material, such as 

copyrighted material, is not placed on 

the internet and will be publicly 

available only in hard copy form. 

Publicly available docket materials are 

available through https://

www.regulations.gov, or please contact 

the person identified in the FOR FURTHER

INFORMATION CONTACT section for 

additional availability information. 

FOR FURTHER INFORMATION CONTACT: John 

Chi at (206) 553–1185, or chi.john@

epa.gov. 

SUPPLEMENTARY INFORMATION: 

Throughout this document whenever 

‘‘we,’’ ‘‘us,’’ or ‘‘our’’ is used, it is 

intended to refer to the EPA. 

Information is organized as follows: 

Table of Contents 

I. Background 

II. Final Action 

III. Statutory and Executive Order Reviews 

I. Background 

On April 23, 2018, the EPA proposed 

to approve Alaska’s March 10, 2016, SIP 

submission as meeting CAA section 

110(a)(2)(D)(i)(I) interstate transport 

provisions for the 2010 NO2 and 2010 

SO2 NAAQS (83 FR 17627). Please see 

our proposed rulemaking for further 

explanation and the basis for our 

finding (April 23, 2018, 83 FR 17627). 

The public comment period for the 

EPA’s proposed action ended on May 

23, 2018. We received no adverse 

comments. There were four electronic 

comments submitted through https://

www.regulations.gov. We reviewed the 

comments and we have determined that 

none are germane to this action. 

Therefore, we are finalizing our action 

as proposed. 

II. Final Action 

The EPA is approving Alaska’s March 

10, 2016, SIP submission as 

demonstrating sources in Alaska do not 

significantly contribute to 

nonattainment, or interfere with 

maintenance, of the 2010 NO2 and SO2

NAAQS in any other state. Based on our 

review, we find the Alaska SIP meets 

the CAA section 110(a)(2)(D)(i)(I) 

interstate transport requirements for the 

2010 NO2 and SO2 NAAQS. 

III. Statutory and Executive Order 

Reviews 

Under the CAA, the Administrator is 

required to approve a SIP submission 

that complies with the provisions of the 

Act and applicable federal regulations. 

42 U.S.C. 7410(k); 40 CFR 52.02(a). 

Thus, in reviewing SIP submissions, the 

EPA’s role is to approve state choices, 

provided that they meet the criteria of 

the CAA. Accordingly, this action 

merely approves state law as meeting 

federal requirements and does not 

impose additional requirements beyond 

those imposed by state law. For that 

reason, this action: 

• Is not a ‘‘significant regulatory 

action’’ subject to review by the Office 

of Management and Budget under 

Executive Orders 12866 (58 FR 51735, 

October 4, 1993) and 13563 (76 FR 3821, 

January 21, 2011); 

• is not an Executive Order 13771 (82 

FR 9339, February 2, 2017) regulatory 

action because SIP approvals are 

exempted under Executive Order 12866; 

• does not impose an information 

collection burden under the provisions 

of the Paperwork Reduction Act (44 

U.S.C. 3501 et seq.); 

• is certified as not having a 

significant economic impact on a 

substantial number of small entities 

under the Regulatory Flexibility Act (5 

U.S.C. 601 et seq.); 

• does not contain any unfunded 

mandate or significantly or uniquely 

affect small governments, as described 

in the Unfunded Mandates Reform Act 

of 1995 (Pub. L. 104–4); 

• does not have Federalism 

implications as specified in Executive 

Order 13132 (64 FR 43255, August 10, 

1999); 

• is not an economically significant 

regulatory action based on health or 

safety risks subject to Executive Order 

13045 (62 FR 19885, April 23, 1997); 


amozie on DSK3GDR082PROD with RULES