30818 Federal Register / Vol. 83, No. 126 / Friday, June 29, 2018 / Notices 

DEPARTMENT OF TRANSPORTATION 

Maritime Administration 

[Docket No. MARAD–2018–0105] 

Requested Administrative Waiver of 

the Coastwise Trade Laws: Vessel 

MELISSA; Invitation for Public 

Comments 

AGENCY: Maritime Administration, DOT. 

ACTION: Notice. 

SUMMARY: The Secretary of 

Transportation, as represented by the 

Maritime Administration (MARAD), is 

authorized to grant waivers of the U.S.- 

build requirement of the coastwise laws 

under certain circumstances. A request 

for such a waiver has been received by 

MARAD. The vessel, and a brief 

description of the proposed service, is 

listed below. 

DATES: Submit comments on or before 

July 30, 2018. 

ADDRESSES: Comments should refer to 

docket number MARAD–2018–0105. 

Written comments may be submitted by 

hand or by mail to the Docket Clerk, 

U.S. Department of Transportation, 

Docket Operations, M–30, West 

Building Ground Floor, Room W12–140, 

1200 New Jersey Avenue SE, 

Washington, DC 20590. You may also 

send comments electronically via the 

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

All comments will become part of this 

docket and will be available for 

inspection and copying at the above 

address between 10:00 a.m. and 5:00 

p.m., Monday through Friday, except 

federal holidays. An electronic version 

of this document and all documents 

entered into this docket is available at 

http://www.regulations.gov. 

FOR FURTHER INFORMATION CONTACT: 

Bianca Carr, U.S. Department of 

Transportation, Maritime 

Administration, 1200 New Jersey 

Avenue SE, Room W23–453, 

Washington, DC 20590. Telephone 202– 

366–9309, email Bianca.carr@dot.gov. 

SUPPLEMENTARY INFORMATION: As 

described by the applicant the intended 

service of the vessel MELISSA is: 

—INTENDED COMMERCIAL USE OF 

VESSEL: ‘‘coast wise sightseeing, 

whale watching, sailing lessons’’ 

—GEOGRAPHIC REGION: ‘‘Hawaii, 

California’’ 

The complete application is given in 

DOT docket MARAD–2018–0105 at 

http://www.regulations.gov. Interested 

parties may comment on the effect this 

action may have on U.S. vessel builders 

or businesses in the U.S. that use U.S.- 

flag vessels. If MARAD determines, in 

accordance with 46 U.S.C. 12121 and 

MARAD’s regulations at 46 CFR part 

388, that the issuance of the waiver will 

have an unduly adverse effect on a U.S.- 

vessel builder or a business that uses 

U.S.-flag vessels in that business, a 

waiver will not be granted. Comments 

should refer to the docket number of 

this notice and the vessel name in order 

for MARAD to properly consider the 

comments. Comments should also state 

the commenter’s interest in the waiver 

application, and address the waiver 

criteria given in section 388.4 of 

MARAD’s regulations at 46 CFR part 

388. 

Privacy Act 

In accordance with 5 U.S.C. 553(c), 

DOT/MARAD solicits comments from 

the public to better inform its 

rulemaking process. DOT/MARAD posts 

these comments, without edit, to 

www.regulations.gov, as described in 

the system of records notice, DOT/ALL– 

14 FDMS, accessible through 

www.dot.gov/privacy. In order to 

facilitate comment tracking and 

response, we encourage commenters to 

provide their name, or the name of their 

organization; however, submission of 

names is completely optional. Whether 

or not commenters identify themselves, 

all timely comments will be fully 

considered. If you wish to provide 

comments containing proprietary or 

confidential information, please contact 

the agency for alternate submission 

instructions. 

Authority: 49 CFR 1.93(a), 46 U.S.C. 

55103, 46 U.S.C. 12121. 

* * * * * 

Dated: June 26, 2018. 

By order of the Maritime Administrator. 

T. Mitchell Hudson, Jr., 

Secretary, Maritime Administration. 

[FR Doc. 2018–14065 Filed 6–28–18; 8:45 am] 

BILLING CODE 4910–81–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

Notice of Request for Information 

Regarding Health Care Access 

Standards 

AGENCY: Department of Veterans Affairs. 

ACTION: Request for information. 

SUMMARY: The Department of Veterans 

Affairs (VA) is requesting information to 

assist in implementing section 1703B of 

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

to health plans 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, and the 

measurement of performance against 

federal or state regulatory standards. 

With regard to health systems, VA 

requests information from the public 

including but not limited to 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 federal or state regulatory 

standards. Responses to this notice will 

support industry research and VA’s 

evaluation of access standards. 

DATES: July 30, 2018. 

ADDRESSES: Written comments may be 

submitted through http://

www.regulations.gov; by mail or hand 

delivery to the Director, Office of 

Regulation Policy and Management 

(00REG), Department of Veterans 

Affairs, 810 Vermont Avenue NW, 

Room 1063B, Washington, DC 20420; or 

by fax to 202–273–9026. Comments 

should indicate that they are submitted 

in response to ‘‘Notice of Request for 

Information Regarding Health Care 

Access Standards’’. Copies of comments 

received will be available for public 

inspection in the Office of Regulation 

Policy and Management (00REG), 

Department of Veterans Affairs, 810 

Vermont Ave. NW, Room 1063B, 

Washington, DC 20420, 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. During the comment 

period, comments may also be viewed 

online through the Federal Docket 

Management System at 

www.regulations.gov. 

FOR FURTHER INFORMATION CONTACT: 

Christina Hosenfeld, Management 


sradovich on DSK3GMQ082PROD with NOTICES
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