Federal Register / Vol. 83, No. 126 / Friday, June 29, 2018 / Notices 30819 

Analyst, Office of the Deputy Under 

Secretary for Health for Community 

Care, Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue NW, Washington, DC 

20420, (202) 461–4112. This is not a toll 

free number. 

SUPPLEMENTARY INFORMATION: The John 

S. McCain III, Daniel K. Akaka, and 

Samuel R. Johnson VA Maintaining 

Internal Systems and Strengthening 

Integrated Outside Networks Act of 

2018, Public Law 115–182, (the VA 

MISSION Act) creates a new 38 U.S.C. 

1703B that contains requirements for 

VA to facilitate the establishment and 

use of access standards. Section 

1703B(c) specifically requires VA to 

consult with all pertinent Federal 

entities, entities in the private sector, 

and other nongovernmental entities in 

establishing access standards. This 

notice and request for information 

serves as one of the means for VA to 

consult with these groups and entities. 

We note that VA will also hold a public 

hearing on Friday, July 13, 2018, to 

provide these groups and entities an 

opportunity to provide additional 

information. VA will use the comments 

it receives to help determine the access 

standards in compliance with the VA 

MISSION Act. VA will then submit a 

report, no later than March 3, 2019, as 

required by section 1703B(d)(1), 

detailing the access standards to the 

appropriate committees of Congress. 

The access standards will ultimately be 

published in the Federal Register and 

will be made available on a VA internet 

website. 

In order to submit a report to Congress 

detailing the access standards by March 

3, 2019, VA must expedite this 

consultation, which will be 

foundational to the process of 

determining the access standards. 

Hence, this notice and request for 

information has a comment period of 30 

days. VA believes that 30 days is 

sufficient to provide comments, as the 

groups and entities with expertise in 

access standards will likely have the 

information readily available or can 

quickly compile and submit such 

information. 

This notice is a request for 

information only. Commenters are 

encouraged to provide complete but 

concise responses to the questions 

outlined below. VA may choose to 

contact individual commenters, and 

such communications would serve to 

further clarify their written comments. 

Request for Information: VA requests 

information that will assist in 

developing the access standards 

required by the VA MISSION Act. This 

includes information regarding the 

development of these access standards, 

including but not limited to 

information, with regard to health plans, 

on the use of access standards for the 

design of health plan provider networks, 

referrals from network providers to outof-network providers, the appeals 

process for exemptions from benefit 

limits to out-of-network providers, and 

with respect to health systems, the 

existence of standards for appointment 

wait times, the use of travel distance for 

establishing service areas, the 

development or use of guidelines to 

refer patients to out of system providers, 

and the measurement of performance 

against regulatory standards. 

Specifically, VA requests information 

from health plans and systems related to 

the below: 

1. Do health plans use internal access 

standards for the design of provider 

networks and the application of in 

network/out of network benefits that are 

more stringent than regulatory standards 

(time or distance of travel, appointment 

wait times, provider/member ratios)? If 

so, what are these internal standards? 

How does the health plan measure 

performance against regulatory and 

internal access standards? How does the 

health plan respond to findings when 

access standards are not being met? Are 

current regulatory access standards costeffective while maintaining quality 

standards? Do health plans have a 

process to handle routine requests from 

members or referring providers for 

exemptions to benefit limits when 

members seek out of network care or a 

lower tier provider? 

2. Do health plans allow for appeals 

by providers or members to request 

exemptions from benefit limits related 

to out of network care or care by a lower 

tier provider? Is external review allowed 

for such appeals? 

3. What are health plan practices 

regarding internal, regulatory, and/or 

accreditation standards for appointment 

wait times, including variance by 

specialty or type of service? How does 

the health plan use travel distance or 

time and/or provider-to-population 

ratios in deciding which geographic 

areas to consider as primary or 

secondary service areas? 

4. Are clinicians within the health 

system given guidelines or rules on 

when to refer patients to out of system 

providers? For example, are clinicians 

encouraged to refer out of system if insystem wait times are longer than 

standard, travel time or distance to an 

in-system provider is too long, the 

patient’s ability to travel is 

compromised or the frequency of 

treatment makes travel to an in-network 

provider difficult? 

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 25, 

2018, for publication. 

Dated: June 25, 2018. 

Jeffrey M. Martin, 

Impact Analyst, Office of Regulation Policy 

& Management, Office of the Secretary, 

Department of Veterans Affairs. 

[FR Doc. 2018–13952 Filed 6–28–18; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

Announcement for Public Meeting 

Regarding Health Care Access 

Standards 

AGENCY: Department of Veterans Affairs. 

ACTION: Announcement of public 

meeting. 

SUMMARY: The Department of Veterans 

Affairs (VA) is holding a public meeting 

to seek information from pertinent 

entities relating to implementation of 

1703B of title 38, United States Code, as 

added by section 104(a) of the John S. 

McCain III, Daniel K. Akaka, and 

Samuel R. Johnson VA Maintaining 

Internal Systems and Strengthening 

Integrated Outside Networks (MISSION) 

Act of 2018 (the VA MISSION Act) 

which directs VA to establish access 

standards for furnishing hospital care, 

medical services, and extended care 

services to covered veterans for 

purposes of the Veterans Community 

Care Program. In establishing these 

access standards, VA is required to 

consult with all pertinent Federal, 

private sector, and non-governmental 

entities. VA requests information from 

the public regarding the development of 

these access standards, including but 

not limited to information on the use of 

access standards for the design of health 

plan provider networks, referrals from 

network providers to out-of-network 

providers, the appeals process for 

exemptions from benefit limits to out-ofnetwork providers, the existence of 

standards for appointment wait times, 

the use of travel distance for 

establishing service areas, the 

development or use of guidelines to 


sradovich on DSK3GMQ082PROD with NOTICES
30820 Federal Register / Vol. 83, No. 126 / Friday, June 29, 2018 / Notices 

refer patients to out of network 

providers, and the measurement of 

performance against federal and state 

regulatory standards. Responses to this 

notice will support industry research 

and VA’s development of access 

standards. 

DATES: VA will hold the public meeting 

on July 13, 2018, in Arlington, VA. The 

meeting will start at 9:00 a.m. and 

conclude on or before 5:00 p.m. Checkin will begin at 8:00 a.m. 

ADDRESSES: The meeting will be held at 

the VHA National Conference Center at 

2011 Crystal Drive, Arlington, VA 

22202. This facility is accessible to 

individuals with disabilities. 

* In-person attendance will be limited 

to 50 individuals. Advanced registration 

for individuals and groups is strongly 

encouraged (see registration instructions 

below). For listening purposes only 

(phone lines will be muted), the meeting 

will be available via audio which can be 

accessed by dialing 1–800–767–1750 

access code 21398. 

Please submit all written comments 

no later than Monday, July 30, by any 

of the following methods: 

• Federal Rulemaking Portal: Go to 

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

online instructions for submitting 

comments. 

• Mail, Hand Delivery, Courier: 

Postmarked no later than July 30, 2018, 

to: Director of Regulations Management 

(00REG), Department of Veterans 

Affairs, 810 Vermont Ave. NW, Room 

1063B, Washington, DC 20420. 

Note: Copies of comments received 

will be available for public inspection in 

the Office of Regulation Policy and 

Management, Room 1063B, 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. 

• Fax: (202) 273–9026, ATTENTION: 

Director of Regulations Management 

(00REG). All submissions must include 

the agency name and docket number. 

Note that all comments received will be 

posted and can be viewed online 

through the Federal Docket Management 

System at http://www.regulations.gov. 

FOR FURTHER INFORMATION CONTACT: 

Christina Hosenfeld, Management 

Analyst, Office of the Deputy Under 

Secretary for Health for Community 

Care, Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue NW, Washington, DC 

20420, (202) 461–4112. This is not a toll 

free number. 

SUPPLEMENTARY INFORMATION: The John 

S. McCain III, Daniel K. Akaka, and 

Samuel R. Johnson VA Maintaining 

Internal Systems and Strengthening 

Integrated Outside Networks Act of 

2018, Public Law 115–182, (the VA 

MISSION Act) created a new 1703B in 

title 38, United States Code (U.S.C.), 

that contains requirements for VA to 

facilitate the establishment and use of 

access standards. Section 1703B(c) 

specifically requires VA to consult with 

all pertinent Federal entities, entities in 

the private sector, and other 

nongovernmental entities in 

establishing access standards. This 

public meeting serves as one of the 

means for VA to consult with these 

groups and entities. We note that VA 

has published a request for information 

in the Federal Register in order to 

provide these groups and entities an 

opportunity to provide additional 

information. The request for information 

mentioned above can be found in 

www.regulations.gov under the title of 

‘‘Notice of Request for Information 

Regarding Health Care Access 

Standards.’’ Comments should indicate 

that they are submitted in response to 

‘‘Notice of Request for Information 

Regarding Health Care Access 

Standards.’’ VA will use the statements 

and testimonials presented at the public 

hearing to help determine the access 

standards in compliance with the VA 

MISSION Act. VA will then submit a 

report, no later than March 3, 2019, as 

required by section 1703B(d)(1), 

detailing the access standards to the 

appropriate committees of Congress. 

The access standards will ultimately be 

published in the Federal Register and 

will be made available on a VA internet 

website. 

In order to submit a report to Congress 

detailing the access standards by March 

3, 2019, VA must expedite this 

consultation, which will be 

foundational to the process of 

determining the access standards. 

Registration: In-person attendance 

and participation in this meeting is 

limited to 50 individuals. VA has the 

right to refuse registration for in-person 

attendance once the maximum capacity 

of 50 individuals has been reached. 

Individuals interested in attending inperson should request registration by 

emailing Krinessa Pinkett at 

krinessa.pinkett@va.gov. A confirmation 

message will be provided within 1–2 

business days after a request has been 

received, and individuals will be 

notified via email by July 9, 2017, 

confirming their attendance in-person. 

Attendees wanting to offer oral 

comments, testimonies, and/or technical 

remarks should indicate their intentions 

upon registration. 

Individual registration: VA 

encourages individual registrations for 

those not affiliated with or representing 

a group, association, or organization. 

Group registration: Identification of 

the name of the group, association, or 

organization should be indicated in 

your registration request. Due to the 

meeting location’s maximum capacity, 

VA may limit the size of a group’s 

registration to allow receipt of 

comments, testimonies, and/or technical 

remarks from a broad, diverse group of 

stakeholders. Oral comments, 

testimonies, and/or technical remarks 

may be limited from a group, 

association or organization with more 

than two (2) individuals representing 

the same group, association, or 

organization. Efforts will be made to 

accommodate all attendees who wish to 

attend in-person. However, VA will give 

priority for in-person attendance to 

pertinent Federal, private sector, and 

non-governmental entities who request 

registration before July 5, 4:00 p.m. ET, 

and wish to provide oral comments, 

testimonies, and/or technical remarks. 

Please provide the number and names of 

people your organization would like to 

send in-person, and VA will 

accommodate as space allows; 

organizations should list names in the 

order of importance of their attendance 

to ensure that VA allows admission for 

the right representatives. The length of 

time allotted for attendees to provide 

oral comments, testimonies and/or 

technical remarks during the meeting 

may be subject to the number of inperson attendees, and to ensure ample 

time is allotted to those registered 

attendees. There will be no opportunity 

for audio-visual presentations during 

the meeting. Written comments will be 

accepted by those attending in-person 

(see above instructions for submitting 

written comments). 

Audio (for listening purposes only): 

Limited to the first 200 participants, on 

a first come, first served basis. 

Advanced registration is not required. 

Audio attendees will not be allowed to 

offer oral comments, testimonies, and/or 

technical remarks as the phone line will 

be muted. Written comments will be 

accepted from those participating via 

audio (see above instructions for 

submitting written comments). 

Note: VA will conduct the public 

meeting informally, and technical rules 

of evidence will not apply. VA will 

arrange for a written transcript of the 

meeting and keep the official record 

open for 15 days after the meeting to 

allow submission of supplemental 

information. You may make 

arrangements for copies of the transcript 

directly with the reporter, and the 

transcript will also be posted in the 

docket of the rule as part of the official 


sradovich on DSK3GMQ082PROD with NOTICES
Federal Register / Vol. 83, No. 126 / Friday, June 29, 2018 / Notices 30821 

record when the rule is published. 

Should it be necessary to cancel the 

meeting due to inclement weather or 

other emergencies, VA will take 

available measures to notify registered 

participants. 

Agenda 

08:00–09:00 Arrival/Check-In 

09:00–12:00 Morning Public Meeting 

Session 

12:00–13:00 Lunch Break (Note: Meals 

will not be provided by VA.) 

13:00–17:00 Afternoon Public Meeting 

Session 

17:00 Adjourn 

Public Meeting Topics 

Pursuant to section 1703B(c) of title 

38, U.S.C., as added by section 104(a) of 

Public Law 115–182, (the VA MISSION 

Act), VA requests information that will 

assist in developing the access 

standards required by section 

1703B(a)(1). This includes information 

regarding the development of these 

access standards, including but not 

limited to information on the use of 

access standards for the design of health 

plan provider networks, referrals from 

network providers to out-of-network 

providers, the appeals process for 

exemptions from benefit limits to out-ofnetwork providers, the existence of 

standards for appointment wait times, 

the use of travel distance for 

establishing service areas, the 

development or use of guidelines to 

refer patients to out of system providers, 

and the measurement of performance 

against regulatory standards. 

Specifically, VA requests information 

from health plans and systems related to 

the below: 

1. Do health plans use internal access 

standards for the design of provider 

networks and the application of in 

network/out of network benefits that are 

more stringent than regulatory standards 

(time or distance of travel, appointment 

wait times, provider/member ratios)? If 

so, what are these internal standards? 

How does the health plan measure 

performance against regulatory and 

internal access standards? How does the 

health plan respond to findings when 

access standards are not being met? Are 

current regulatory access standards costeffective while maintaining quality 

standards? Do health plans have a 

process to handle routine requests from 

members or referring providers for 

exemptions to benefit limits when 

members seek out of network care or a 

lower tier provider? 

2. Do health plans allow for appeals 

by providers or members to request 

exemptions from benefit limits related 

to out of network care or care by a lower 

tier provider? Is external review allowed 

for such appeals? 

3. What are health plan practices 

regarding internal, regulatory, and/or 

accreditation standards for appointment 

wait times, including variance by 

specialty or type of service? How does 

the health plan use travel distance or 

time and/or provider-to-population 

ratios in deciding which geographic 

areas to consider as primary or 

secondary service areas? 

4. Are clinicians within the health 

system given guidelines or rules on 

when to refer patients to out of system 

providers? For example, are clinicians 

encouraged to refer out of system if insystem wait times are longer than 

standard, travel time or distance to an 

in-system provider is too long, the 

patient’s ability to travel is 

compromised or the frequency of 

treatment makes travel to an in-network 

provider difficult? 

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 25, 

2018, for publication. 

Dated: June 25, 2018. 

Jeffrey M. Martin, 

Impact Analyst, Office of Regulation Policy 

& Management, Office of the Secretary, 

Department of Veterans Affairs. 

[FR Doc. 2018–13951 Filed 6–28–18; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

VA National Academic Affiliations 

Council, Notice of Meeting 

The Department of Veterans Affairs 

(VA) gives notice under the Federal 

Advisory Committee Act that the VA 

National Academic Affiliations Council 

(NAAC) will meet via conference call on 

July 11, 2018, from 10:00 a.m. to 12:00 

p.m. EST. The meeting is open to the 

public. 

The purpose of the Council is to 

advise the Secretary on matters affecting 

partnerships between VA and its 

academic affiliates. 

On July 11, 2018, the Council will 

explore the current modernization effort 

within the Veterans Health 

Administration (VHA); receive a 

briefing on the VHA electronic health 

record modernization program; discuss 

provisions of the recently enacted 

Public Law 115–182 that impacts VA’s 

clinical education mission; and receive 

updates on the waiver process for VA 

employees engaging in teaching 

activities with for-profit educational 

institutions; the activities of the 

Council’s Subcommittee on Diversity 

and Inclusion; the June 13, 2018 

Roundtable of Graduate Medical 

Education hosted by the House 

Committee on Veterans’ Affairs; and the 

recent efforts of the VA Strategic 

Academic Advisory Council. The 

Council will receive public comments 

from 11:50 p.m. to 12:00 p.m. EST. 

Interested persons may attend and/or 

present oral statements to the Council. 

The dial in number to attend the 

conference call is: 1–800–767–1750. At 

the prompt, enter access code 66983 

then press #. Individuals seeking to 

present oral statements are invited to 

submit a 1–2 page summary of their 

comments at the time of the meeting for 

inclusion in the official meeting record. 

Oral presentations will be limited to five 

minutes or less, depending on the 

number of participants. Interested 

parties may also provide written 

comments for review by the Council 

prior to the meeting or at any time, by 

email to Steve.Trynosky@va.gov, or by 

mail to Stephen K. Trynosky J.D., 

M.P.H., M.M.A.S., Designated Federal 

Officer, Office of Academic Affiliations 

(10A2D), 810 Vermont Avenue NW, 

Washington, DC 20420. Any member of 

the public wishing to participate or 

seeking additional information should 

contact Mr. Trynosky via email or by 

phone at (202) 461–6723. 

Dated: June 26, 2018. 

Jelessa M. Burney, 

Federal Advisory Committee Management 

Officer. 

[FR Doc. 2018–14002 Filed 6–28–18; 8:45 am] 

BILLING CODE P 


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