Federal Register / Vol. 89, No. 219 / Wednesday, November 13, 2024 / Proposed Rules 89519 

(e) Determining the strategies for 

identifying potential NHS pavement and 

bridge projects that maximize overall 

program benefits within the financial 

constraints; and 

(f) Recommending programs and 

implementation schedules to manage 

the condition of NHS pavement and 

bridge assets within policy and budget 

constraints. 

§ 515.19 Organizational integration of 

asset management. 

(a) The purpose of this section is to 

describe how a State DOT may integrate 

asset management into its organizational 

mission, culture and capabilities at all 

levels. The activities described in 

paragraphs (b) through (d) of this 

section are not requirements. 

(b) A State DOT should establish 

organizational strategic goals and 

include the goals in its organizational 

strategic implementation plans with an 

explanation as to how asset 

management will help it to achieve 

those goals. 

(c) A State DOT should conduct a 

periodic self-assessment of the agency’s 

capabilities to conduct asset 

management, as well as its current 

efforts in implementing an asset 

management plan. The self-assessment 

should consider, at a minimum, the 

adequacy of the State DOT’s strategic 

goals and policies with respect to asset 

management, whether asset 

management is considered in the 

agency’s planning and programming of 

resources, including development of the 

long-range statewide transportation plan 

and the STIP; whether the agency is 

implementing appropriate program 

delivery processes, such as 

consideration of alternative project 

delivery mechanisms, effective program 

management, and cost tracking and 

estimating; and whether the agency is 

implementing adequate data collection 

and analysis policies to support an 

effective asset management program. 

(d) Based on the results of the selfassessment, the State DOT should 

conduct a gap analysis to determine 

which areas of its asset management 

process require improvement. In 

conducting a gap analysis, the State 

DOT should: 

(1) Determine the level of 

organizational performance effort 

needed to achieve the objectives of asset 

management; 

(2) Determine the performance gaps 

between the existing level of 

performance effort and the needed level 

of performance effort; and 

(3) Develop strategies to close the 

identified organizational performance 

gaps and define the period of time over 

which the gap is to be closed. 

[FR Doc. 2024–26200 Filed 11–12–24; 8:45 am] 

BILLING CODE 4910–22–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Parts 17 and 84 

RIN 2900–AS20 

Telehealth Grant Program 

AGENCY: Department of Veterans Affairs. 

ACTION: Proposed rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) proposes to amend its 

regulation to implement a new authority 

to establish a telehealth grant program. 

This new authority requires VA to enter 

into agreements, and expand existing 

agreements, for the expansion of VA 

telehealth capabilities and provision of 

telehealth services by establishing 

telehealth access stations in rural, 

highly rural, or medically underserved 

areas, to the extent practicable. We also 

propose to amend the copayment 

regulation by exempting all telehealth 

services from the copayment 

requirement. 

DATES: Comments must be received on 

or before January 13, 2025. 

ADDRESSES: Comments may be 

submitted through www.regulations.gov. 

Except as provided below, comments 

received before the close of the 

comment period will be available at 

www.regulations.gov for public viewing, 

inspection, or copying, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post the comments 

received before the close of the 

comment period on the following 

website as soon as possible after they 

have been received: https://

www.regulations.gov. VA will not post 

on Regulations.gov public comments 

that make threats to individuals or 

institutions or suggest that the 

commenter will take actions to harm an 

individual. VA encourages individuals 

not to submit duplicative comments; 

however, we will post comments from 

multiple unique commenters even if the 

content is identical or nearly identical 

to other comments. Any public 

comment received after the comment 

period’s closing date is considered late 

and will not be considered in the final 

rulemaking. In accordance with the 

Providing Accountability Through 

Transparency Act of 2023, a 100 word 

Plain-Language Summary of this 

proposed rule is available at 

Regulations.gov, under RIN 2900–AS20. 

FOR FURTHER INFORMATION CONTACT: 

Leonie Heyworth, MD, MPH, Deputy 

Director for Clinical Services, 

Telehealth Services, Office of Connected 

Care, 810 Vermont Ave. NW, 

Washington, DC 20420, 202–461–6525. 

(This is not a toll-free telephone 

number.) 

SUPPLEMENTARY INFORMATION: On 

October 17, 2020, the Commander John 

Scott Hannon Veterans Mental Health 

Care Improvement Act of 2019 (the Act), 

Public Law 116–171, was enacted into 

law. Section 701 of the Act, codified as 

a note to section 1701 of title 38, United 

States Code (U.S.C.), mandated that VA 

enter into agreements, and expand 

existing agreements, with organizations 

that represent or serve veterans, 

nonprofit organizations, private 

businesses, and other interested parties 

for the expansion of telehealth 

capabilities and the provision of 

telehealth services to veterans through 

the award of grants. 

VA understands that veterans who 

live in rural and highly rural areas may 

not have reliable internet access. Also, 

veterans who live in medically 

underserved areas may not have 

accessible health care facilities within 

their communities. Thus, VA has 

developed a telehealth program as a 

modern, veteran-, beneficiary- and 

family-centered health care delivery 

model that leverages information and 

telecommunication technologies to 

connect patients with health care 

providers, irrespective of the State or 

location within a State where the health 

care professional or the patient is 

physically located at the time the health 

care is provided. The telehealth access 

points use a secure video application to 

bridge the digital divide by providing 

veterans health care service via 

telehealth in a fixed, secure 

environment with a reliable internet 

connection. These telehealth access 

points allow veterans to receive 

telehealth services closer to their 

residence without the inconvenience of 

having long travel times to their nearest 

VA medical facility to receive health 

care, particularly when veterans may 

lack appropriate internet access in their 

home. The convenience of the telehealth 

access point also allows veterans to be 

more engaged in their health care, 

which results in a more positive health 

outcome. 

Section 701(b)(1) of the Act requires 

VA to award grants to entities in 

carrying out agreements entered into or 

expanded under this section with 

eligible entities. Section 701(b)(2) of the 


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Act provides that, to the extent 

practicable, the Secretary shall ensure 

that grants are awarded to entities that 

serve veterans in rural and highly rural 

areas (as determined through the use of 

the Rural-Urban Commuting Areas 

coding system of the Department of 

Agriculture) or areas determined to be 

medically underserved. Section 

701(b)(3) of the Act states that grants 

awarded to an entity pursuant to section 

701(b) may be used for one or more of 

the following: purchasing, replacing, or 

upgrading hardware or software 

necessary for the provision of secure 

and private telehealth services; 

upgrading security protocols for 

consistency with VA security 

requirement; training of site attendants, 

including payment of those attendants 

for completing that training, with 

respect to military and veteran cultural 

competence (if the entity is not an 

organization that represents veterans), 

equipment required to provide 

telehealth services, privacy (including 

the Health Insurance Portability and 

Accountability Act of 1996, HIPAA, 

privacy rule as it relates to health care 

for veterans), scheduling for telehealth 

services for veterans, or any other 

unique training needs for the provision 

of telehealth services to veterans; 

upgrading existing infrastructure owned 

or leased by the entity to make rooms 

more conducive to telehealth (including 

soundproofing of an existing room, new 

electrical, telephone, or internet outlets 

in an existing room, aesthetic 

enhancements to make a more suitable 

therapeutic environment, and additions 

or modifications to windows or walls in 

an existing room, or other alterations 

needed to create a new, private room, 

including permits or inspections 

associated with space modifications); 

upgrading existing infrastructure to 

comply with the Americans with 

Disabilities Act (the ADA, 42 U.S.C. 

12101 et seq.); upgrading internet 

infrastructure and sustainment of 

internet services, and the sustainment of 

telephone services. 

The grants awarded under section 701 

of the Act are to support the 

establishment or expansion of telehealth 

access points that would allow veterans 

to receive telehealth services from VA 

professionals. VA serves beneficiaries 

beyond veterans under title 38, U.S.C. 

and other laws. The Act, however, only 

uses the term veteran, so for purposes of 

this rulemaking, VA is only proposing 

that grant funds may be used to support 

the provision of telehealth services to 

veterans. We understand, however, that 

investment in technology and facilities 

at these access points could also be used 

to support other VA beneficiaries. 

While grant funds could not be used 

to establish or expand telehealth access 

points for non-veteran beneficiaries, 

such beneficiaries could access 

telehealth services through telehealth 

access points established using grant 

funds in either of two ways. 

First, they may be able to use these 

telehealth access points to serve nonveterans incidentally. If a grantee used 

grant funds to purchase technology and 

renovate space to conform with security 

and privacy requirements for the 

purpose of delivering telehealth services 

to veterans, those costs have been 

incurred, and the use of those facilities 

for others does not result in any 

additional expense or cost. VA awards 

grants and financial support through 

other programs whose primary purpose 

is to support veterans, but which can 

also benefit non-veterans as well. For 

example, 38 U.S.C. 2011 authorizes VA 

to award grants for new construction of 

facilities, expansion, remodeling, or 

alteration of existing facilities, or 

acquisition of facilities, for use as 

service centers, transitional housing, or 

other facilities to serve homeless 

veterans. Section 2011(e)(4) specifically 

notes that applicants must provide 

reasonable assurances that the facilities 

will be used principally to provide 

veterans the services for which the 

project was designed, and that not more 

than 25 percent of the services provided 

under the project will be provided to 

individuals who are not veterans. 

Although section 701 of the Act does 

not include similar language, we do not 

believe it was the intent of Congress to 

prohibit the use of telehealth access 

points by non-veterans. This is 

particularly true given that these spaces 

may have been developed to provide 

access to telehealth services for the 

general public; placing restrictions on 

their use to only veterans would serve 

as a disincentive for potential 

applicants, who might lose a large 

portion of their beneficiary population. 

Particularly given that section 

701(b)(3)(B) prohibits the use of grant 

funds to purchase new property or for 

major construction projects, applicants 

would have to have pre-existing space, 

and they may have been using this 

space to serve non-veteran patients. We 

do not believe Congress would have 

intended to create such barriers to 

potential applicants; section 701(d) of 

the Act, for example, requires VA to 

complete an assessment of barriers faced 

by veterans in accessing telehealth 

services and how VA plans to address 

those barriers. Under this proposed rule, 

so long as the provision of telehealth 

services to non-veteran beneficiaries at 

telehealth access points supported using 

grant funds does not interfere with the 

provision of telehealth services to 

veterans, VA sees no issue with using 

these points to support other VA 

beneficiaries. 

Second, grantees may form separate 

agreements with the Department under 

a different authority to furnish 

telehealth services specifically to nonveteran beneficiaries at telehealth access 

points that were established or 

expanded using grant funds. No 

provision of law, section 701 of the Act 

included, restricts VA’s ability to form 

agreements with other eligible parties to 

create new access points, including 

telehealth access points, for non-veteran 

beneficiaries. While Congress did not 

use the term ‘‘beneficiary’’ in section 

701 of the Act, we do not interpret this 

as evidence of an intent to exclude nonveteran beneficiaries from accessing 

telehealth services under any of the 

scenarios outlined above, again so long 

as that the provision of services to such 

individuals does not interfere with the 

provision of telehealth services to 

veterans and that the provision of such 

services to veterans was the primary 

objective of the grant award. VA would 

only award grant funds for services 

allowed under section 701. 

Some telehealth access points may 

also furnish in-person services to 

veterans and other beneficiaries. We do 

not interpret anything in section 701 to 

preclude the use of such access points 

to provide in-person services to 

veterans. Modifications or 

enhancements to the telehealth access 

point made through the use of grant 

funds, such as training site attendants 

on military and veteran cultural 

competency, purchasing or upgrading 

hardware or software necessary for 

telehealth, upgrading existing 

infrastructure owned or leased by the 

entity, upgrading existing infrastructure 

to comply with the ADA, upgrading 

internet infrastructure and sustainment 

of internet services, and sustainment of 

telephone services, could also enhance 

the delivery of in-person care. Such 

investments, once made, do not result in 

additional incremental costs if they 

support the delivery of in-person care to 

veterans (or other beneficiaries). As 

noted above, so long as the principal 

purpose of the grant is to expand 

telehealth capabilities and support the 

provision of telehealth services, the 

improved delivery of in-person care is 

incidental and not prohibited. We 

welcome public comment on these 

interpretations. 

We propose to add part 84 to 38 CFR 

to establish the telehealth grant program 


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as mandated by the Act. We also 

propose to amend 38 CFR 17.108(e), as 

described further below. 

Part 17 of 38 CFR 

Section 1710(g)(1) of 38 U.S.C. states 

that VA may not furnish medical 

services (except if such care constitutes 

hospice care) under section 1710(a) 

(including home health services under 

section 1717 of the title) to a veteran 

who is eligible for hospital care under 

the chapter by reason of section 

1710(a)(3) unless the veteran agrees to 

pay to the United States in the case of 

each outpatient visit the applicable 

amount or amounts established by the 

Secretary by regulation. There are 

exceptions to this requirement; 

paragraph (3) of section 1710(g) 

establishes two situations in which 

copayments are not required, and 

sections 1722B and 1730A of 38 U.S.C. 

do as well. Specifically, section 1722B 

allows VA to waive the imposition or 

collection of copayments for telehealth 

and telemedicine visits of veterans 

under laws administered by VA. VA has 

implemented through regulation the 

copayments required by section 1710(g) 

at 38 CFR 17.108, which sets forth 

requirements regarding copayments for 

inpatient hospital care and outpatient 

medical care provided to veterans by 

VA. On March 6, 2012, prior to 

enactment of section 1722B, in a 

document published in the Federal 

Register at 77 FR 13195, VA determined 

that in-home video telehealth care 

should be exempt from copayments 

because it is not used to provide 

complex care and its use significantly 

reduces impact on VA resources 

compared to an in-person, outpatient 

visit. It also reduces any potential 

negative impact on the veteran’s health 

that might be incurred if the veteran 

were required to travel to a VA hospital 

or medical center to obtain the care 

provided via in-home video telehealth. 

Paragraph (e) of 38 CFR 17.108 provides 

for the services not subject to 

copayment requirements for inpatient 

hospital care, outpatient medical care, 

or urgent care. Paragraph (e)(16), as 

added by the 2012 rulemaking, exempts 

in-home video telehealth care from the 

copayment requirement. 

Given advances in technology, VA 

understands that veterans may use 

telehealth services in other locations 

than the veteran’s home. These other 

locations may be more convenient for 

veterans and do not represent any 

additional burden on VA, so VA also 

proposes to exempt these encounters 

from copayments under the authority of 

section 1722B. Similarly, VA has not 

imposed copayments on telephone 

visits or discussions with VA providers 

(as these are not considered 

‘‘encounters’’ for VA’s purposes), but 

VA’s regulations have not reflected this 

reality. Through this rulemaking, VA is 

exercising its authority under section 

1722B by proposing to exempt all 

telehealth services from copayment 

requirements. These services would 

include telehealth services provided in 

VA medical facilities, in-home 

telehealth visits, telephone visits, 

telehealth services provided in 

telehealth access points, and telehealth 

services received at any non-VA 

location, including homeless shelters 

and public libraries. Similarly, 

telehealth provided to eligible veterans 

by non-VA providers under the Veterans 

Community Care Program would be 

exempt from copayments, regardless of 

where the veteran is during the 

telehealth encounter. Exempting 

copayments for telehealth services 

would provide an incentive for veterans 

to utilize these services and be more 

engaged in their health care. It also 

would treat all telehealth services the 

same for purposes of applying 

copayments. Consequently, we propose 

to amend paragraph (e)(16) by 

exempting telehealth visits from a 

copayment requirement. 

Part 84 of 38 CFR 

Establishment of part 84 ensures 

organization and clarity for 

implementation of this new grant 

program. This proposed rule would 

establish regulations authorizing VA to 

award telehealth grants to eligible 

entities who would establish telehealth 

access points for veterans. 

Consistent with section 701 of the 

Act, part 84 would be titled ‘‘Telehealth 

Grant Program.’’ 

Section 84.0 Purpose 

Proposed § 84.0 would state the 

purpose of part 84. We would state that 

§§ 84.0 through 84.110 would establish 

the telehealth grant program. We would 

add that VA will enter into agreements, 

and expand existing agreements, with 

eligible entities (which would be 

defined below in § 84.5) for the 

expansion of telehealth capabilities and 

the provision of telehealth services to 

veterans through the award of grants. 

This language is very similar to section 

701(a) of the Act. In addition, we would 

state that, through the award of these 

grants, grantees will offer veterans a 

convenient space to connect with a VA 

health care professional through video 

telehealth in comfortable, private 

locations in communities where 

veterans may otherwise have long travel 

times to VA medical facilities, may have 

poor internet connectivity in their 

homes, or may face other barriers to 

accessing health care. This statement 

reflects several of the defined used of 

grants under 701(b)(3)(A), specifically: 

creating a comfortable space (see clauses 

(iv) and (v), regarding upgrading 

infrastructure to make rooms more 

conductive to telehealth and to comply 

with the ADA) and creating private 

locations (see clauses (i), (ii), (iii)(III), 

and (iv)(I), regarding purchasing, 

replacing, or upgrading hardware or 

software, upgrading security protocols, 

training with respect to privacy, and 

modifications to create a new, private 

room). We would clarify that the 

telehealth access point is not intended 

to be used for veterans who are in need 

of emergency health care services. 

Section 701(c) of the Act provides that 

an eligible entity that seeks to establish 

a telehealth access point for veterans, 

but does not require grant funding 

under this section, may enter into an 

agreement, under certain conditions, 

with VA for the establishment of such 

an access point. We do not need to 

establish regulations concerning section 

701(c) of the Act because the substance 

of the agreements will make clear to the 

affected parties their responsibilities. 

We would, therefore, add that part 84 

would only apply to telehealth grant 

agreements; however, VA may enter into 

an agreement for the establishment of a 

telehealth access point for veterans with 

an entity that seeks to establish such an 

access point but does not require grant 

funding under part 84. We would also 

make such statement in the Notice of 

Funding Opportunity. 

Section 84.5 Definitions 

Proposed § 84.5 would contain the 

definitions for key terms that would be 

applicable to part 84 and to any Notice 

of Funding Opportunity (NOFO) for the 

telehealth grant. We would list these 

definitions in alphabetical order. 

We propose to define the term 

applicant to mean an eligible entity that 

submits an application for a telehealth 

grant announced in a Notice of Funding 

Opportunity under part 84. VA would 

define the term applicant in this manner 

because only an eligible entity that 

submits an application for a telehealth 

grant under part 84 would be subject to 

any requirements of applicants. We 

would define this term similarly to 

other VA grant programs, such as the 

Supportive Services for Veteran 

Families (SSVF) program and the Staff 

Sergeant Parker Gordon Fox Suicide 

Prevention Grant Program (SPGP). See 

38 CFR 62.2 and 78.5. 

We would define the term date of 

completion to mean the earliest of either 


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the date specified in the telehealth grant 

agreement, or any supplement or 

amendment thereto, or the effective date 

of a telehealth grant termination under 

§ 84.110. This definition would be 

similar to the use of this term in other 

VA grant programs. See 38 CFR 62.2. 

We propose to define the term eligible 

entity to mean an entity that meets the 

requirements of § 84.10. We would 

define this term similarly to other VA 

grant programs, such as the Legal 

Services for Homeless Veterans and 

Veterans At-Risk for Homelessness grant 

program. See 38 CFR 79.5. 

We propose to define the term grantee 

to mean an eligible entity that is 

awarded a telehealth grant under part 

84. This definition is similar to other 

VA grant programs. See 38 CFR 62.2. 

We propose to define the term 

medically underserved to mean an area 

as designated under 42 U.S.C. 

254b(b)(3). This term would be used to 

implement section 701(b)(2) of the Act, 

which states in part that, to the extent 

practicable, the Secretary shall ensure 

that grants are awarded to entities that 

serve veterans in areas determined to be 

medically underserved. While section 

254b(b)(3)(A) defines the term medically 

underserved population, section 

254b(b)(3) generally establishes a 

process for identifying medically 

underserved areas that are designated by 

the Health Resources and Services 

Administration (HRSA), the U.S. 

Department of Health and Human 

Services sub-agency responsible for 

issuing data and maps on medically 

underserved populations and areas in a 

combined manner. See HRSA’s maps on 

medically underserved areas and 

populations at https://data.hrsa.gov/ 

tools/shortage-area/mua-find. Because 

42 U.S.C. 254b(b)(3) may be amended in 

the future, VA is not incorporating the 

actual definition in proposed § 84.05. 

Rather, VA is proposing to define 

medically underserved to mean an area 

that is designated under 42 U.S.C. 

254b(b)(3). This term is defined 

consistently with its use in section 

246(d)(2)(A) of Division J of Public Law 

115–141 (38 U.S.C. 7601, note), and is 

widely known, commonplace, and 

established. It also allows VA to defer to 

the expertise of another agency that 

specializes in analyzing and identifying 

medically underserved areas and 

populations. 

We would define Notice of Funding 

Opportunity (NOFO) to have the same 

meaning as given to this term in 2 CFR 

200.1. Section 200.1 defines NOFO to 

mean a formal announcement of the 

availability of Federal funding through 

a financial assistance program from a 

Federal awarding agency. The NOFO 

provides information on the award, who 

is eligible to apply, the evaluation 

criteria for selection of an awardee, 

required components of an application, 

and how to submit the application. The 

NOFO is any paper or electronic 

issuance that an agency uses to 

announce a funding opportunity, 

whether it is called a program 

announcement, notice of funding 

availability, broad agency 

announcement, research announcement, 

solicitation, or some other term. The 

telehealth grant program would be 

subject to the requirements of 2 CFR 

part 200, which establishes the uniform 

administrative requirements, cost 

principles, and audit requirements for 

Federal awards to non-Federal entities. 

Citing to this definition ensures 

consistency and accuracy. 

Section 200.1 of 2 CFR defines 

nonprofit organization to mean any 

corporation, trust, association, 

cooperative, or other organization, not 

including Institutes of Higher 

Education, that: (1) is operated 

primarily for scientific, educational, 

service, charitable, or similar purposes 

in the public interest; (2) is not 

organized primarily for profit; and (3) 

uses net proceeds to maintain, improve, 

or expand the operations of the 

organization. Although VA defines 

nonprofit organization differently in 

other grant programs (see § 62.2), we 

propose to use this general definition of 

nonprofit organization in § 84.05 to be 

in alignment with all other Federal grant 

programs. We would not repeat the 

definition, but rather add a cross 

reference in the event that this 

definition would change in the future. 

We would therefore define nonprofit 

organization as having the meaning 

given to that term in 2 CFR 200.1. 

We propose to define the term 

subcontractor to mean any entity or 

organization that has a contract 

agreement to furnish services at the 

telehealth access point. Subcontractors 

do not include individuals who build 

the access point (e.g., entities who are 

hired to paint or construct walls or 

partitions) or provide technical services 

(e.g., commercial internet providers or 

electric services). This definition would 

clarify who VA would recognize as a 

subcontractor, which would be relevant 

for various requirements in the 

proposed rule. 

We propose to define the term rural 

and highly rural areas to mean an area 

or community that is designated as such 

by the Rural-Urban Commuting Areas 

coding system of the U.S. Department of 

Agriculture. We would define this term 

to implement section 701(b)(2) of the 

Act, which states in part that, to the 

extent practicable, the Secretary shall 

ensure that grants are awarded to 

entities that serve veterans in rural and 

highly rural areas (as determined 

through the use of the Rural-Urban 

Commuting Areas coding system of the 

Department of Agriculture). The ruralurban commuting area (RUCA) codes 

are a Census tract-based classification 

that uses standard Census measures of 

population density, levels of 

urbanization, and journey-to-work 

commuting to characterize all U.S. 

Census tracts with respect to their rural/ 

urban status and commuting 

relationships to other tracts. RUCA 

codes define county-level metropolitan 

and micropolitan areas. The RUCA 

codes are published on the Department 

of Agriculture’s website. See https://

www.ers.usda.gov/data-products/ruralurban-commuting-area-codes.aspx. 

We propose to define the term 

telehealth access point to mean a nonVA site supported by a telehealth grant 

where a veteran can participate in a 

telehealth visit with a VA health care 

professional. As previously stated in 

this rulemaking, the telehealth grant 

would be used to establish or expand 

telehealth access points in locations that 

are not owned by VA. This definition 

would make clear that telehealth access 

points are distinct from VA health care 

facilities that provide telehealth 

services. We note that this definition 

would not prohibit VA from offering 

other VA services (e.g., hearings with 

the Board of Veterans Appeals or 

Veterans Benefits Administration 

consultations) through video 

conferencing at the telehealth access 

point. We clarify, though, that the 

provision of any such ancillary services 

beyond telehealth would be agreed to 

under separate authorities for VA to 

enter into agreements and establish such 

locations in the first place. Grant funds 

under section 701 could only be used 

for the purpose of furnishing telehealth 

services, but as noted previously, 

certain investments for the expansion or 

provision of telehealth services could 

also facilitate the delivery of other 

services at no additional incremental 

cost. Separate agreements could include 

the transfer of funds to grantees under 

separate authority if additional 

resources were needed to support these 

functions. 

We propose to define the term 

telehealth grant to mean a grant 

awarded under part 84. This definition 

would be similar to how this term is 

defined in other VA grant programs. 

See, e.g., 38 CFR 78.5 and 79.5. 


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Section 84.10 Eligible Entities 

In proposed § 84.10, we would list the 

types of entities that could be an eligible 

entity for this grant program. To be 

eligible to receive a telehealth grant, the 

entity must be: (1) an organization that 

represents or serves veterans; (2) a 

nonprofit organization; (3) a private 

business; (4) State or local government; 

or (5) another interested party. This 

would be consistent with sections 

701(a) and (b)(1) of the Act, which state 

VA shall award grants in carrying out 

agreements with organizations that 

represent or serve veterans, nonprofit 

organizations, private businesses, and 

other interested parties for the 

expansion of telehealth capabilities and 

the provision of telehealth services to 

veterans. We note that VA considers a 

private company as one that is not 

owned or operated by a State, local, or 

Federal Government. We anticipate that 

veterans service organizations and 

community establishments (such as a 

community center or faith-based 

organization) may apply for these grants 

and would be considered either 

organizations that represent or serve 

veterans or at least nonprofit 

organizations. Private businesses could 

apply as well, and VA would specify 

any requirements applicable to such 

businesses in the NOFO. Other 

interested parties are included in the 

text of section 701(a) but is not further 

defined. VA does not propose a more 

specific definition here in the interest of 

ensuring that a wide variety of possible 

organizations can apply and, if 

approved, receive a grant under this 

program. Examples of other interested 

parties might include Federally 

Qualified Health Centers, or 

associations, partnerships, or other 

collaborations of different organizations. 

VA solicits comment on whether further 

specificity should be included and 

whether certain organizations or other 

parties should be excluded under this 

definition. 

Section 84.15 Application 

Proposed § 84.15 would establish the 

application procedures for the 

telehealth grant. Section 701 of the Act 

does not provide extensive requirements 

associated with the requirements for 

applicants, as is found in other statutes. 

We infer from this gap that Congress 

delegated authority to VA to implement 

the necessary requirements to ensure 

that it could award grants consistent 

with Federal requirements regarding 

grant making and with the principles of 

sound fiscal policy. 

We would state in proposed 

paragraph (a) that an applicant must 

submit to VA a complete grant 

application package, as described in the 

NOFO. The NOFO would alert potential 

applicants of the availability of funds 

for the telehealth grant. The NOFO may 

include different application 

requirements based on a range of 

funding thresholds. For example, grant 

applications for technology and 

equipment, infrastructure upgrades, and 

sustainment may follow different 

application requirements. This 

variability would be included based on 

the potentially different uses of grant 

funds the applicant proposes. Some 

applicants may only need one-time, 

minimal support, such as new hardware 

or software or staff training. Other 

applicants may require long-term but 

still relatively minimal support (such as 

funds to sustain internet or telephone 

services that recur on a monthly basis). 

Other applicants may require long-term 

and significantly more assistance if they 

are undertaking infrastructure 

renovations that require permits or other 

substantial investments in time and 

resources. We note for general 

awareness that infrastructure projects 

using Federal funds are subject to 

additional requirements, such as the 

Build America, Buy America Act (Pub. 

L. 117–58). Grantees will be required to 

comply with the provisions of these 

separate authorities to the extent 

applicable. VA’s interest in ensuring 

appropriate financial accountability 

varies based on the amount of support 

it is providing, and in the interest of 

ensuring that applicants seeking only a 

small amount of grant funds are not 

dissuaded from applying based on the 

compliance costs that may accompany a 

larger grant amount, VA proposes 

allowing the NOFO to further specify 

different requirements based on the 

amount of funds sought by the 

applicant. The requirements stated in 

this section reflect the most extensive 

requirements that applicants would 

need to meet, but depending upon the 

terms of the NOFO and ranges of 

support applicants seek, certain 

elements of these requirements could be 

less stringent. This paragraph would be 

similar to other grant programs, such as 

the SSVF program and the SPGP. See, 

e.g., §§ 62.20(a) and 78.15. 

Proposed paragraph (b)(1) through (6) 

would state what is required for a 

telehealth grant application to be 

complete. Proposed paragraph (b)(1) 

would provide that the applicant must 

provide a plan to establish, if needed, 

the telehealth access point and a 

description of how the size, scope, and 

grant management plan are feasible. We 

recognize that some applicants may 

have already established a telehealth 

access point, so for such applicants, a 

plan to establish a point is not 

necessary. Such applicants must, 

though, provide evidence that a 

telehealth access point has already been 

established. Such evidence could 

include site address, implementation 

date, VA medical facility letter of 

support, etc. 

Proposed paragraph (b)(2) would 

provide that the applicant must submit 

supporting documentation consisting of: 

the type of entity that is applying for the 

telehealth grant pursuant to § 84.10; a 

proposed operating budget; supportive 

resources committed to the project; the 

applicant’s ability to control the 

telehealth access point and meet 

appropriate zoning, preservation, 

accessibility, safety, and environmental 

laws (including any laws or 

requirements that apply based upon the 

receipt of grant funds under part 84); 

and a description of the geographic area 

that the telehealth access point will 

serve (including the name(s) of the 

municipalities, counties (or parishes), or 

Tribal lands). In addition, the applicant 

would have to attest that the facilities 

will be used principally to provide to 

veterans the services for which the 

project was designed. Documentation 

regarding the type of entity could 

consist of a letter on State or local 

government letterhead verifying the 

entity is a State or local government, or 

in the case of a non-profit, 

documentation establishing the entity’s 

status. Private businesses could provide 

their business license or incorporation 

documents. Other interested parties 

should provide appropriate 

documentation clarifying what type of 

entity they are. The types of supportive 

resources committed to the project 

would include, but are not limited to, 

space, staffing, equipment, internet 

services, phone services, and furniture. 

Proposed paragraph (b)(3) would 

provide that the application must 

include documentation evidencing the 

experience of the applicant and any 

identified subcontractors, as defined in 

§ 84.5, relevant to creating an 

environment to provide telehealth 

services or organizational experience 

working with veterans. 

Proposed paragraph (b)(4) would 

provide that the applicant must include 

a statement containing several 

affirmations of fact. Section 701(b)(3) of 

the Act establishes certain authorized 

uses of grant funds; these were 

described in detail earlier in this 

rulemaking. We infer that Congress 

authorized the use of Federal funds for 

certain activities or improvements with 

the expectation that the telehealth 


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access points would meet these 

requirements. In addition to granting 

funds, the Act provides in section 

701(c)(2) that entities that do not require 

grant funding but that enter into an 

agreement to serve as a telehealth access 

point must ensure the access points are 

private, secure, clean, and accessible. 

In this context, proposed paragraph 

(b)(4) would require applicants to assert 

that all of the following are true: the 

project will furnish veterans a telehealth 

access point that is secure, private, 

clean, accessible, and meets the 

requirements of this grant. This is 

consistent with the authorized uses 

described in section 701(b)(3)(A)(ii), 

(iv)(I), and (v) of the Act. We note that 

if Congress wanted to ensure, pursuant 

to section 701(c)(2), that entities that do 

not require Federal funds provide access 

points that are private, secure, clean, 

and accessible, it surely intended that 

eligible entities receiving Federal funds 

provide access points meeting the same 

requirements. Proposed paragraph (b)(4) 

also requires the applicant to certify that 

it will continue to maintain and operate 

the telehealth access point supported by 

this grant until the expiration of the 

period during which VA could seek full 

recovery under § 84.100. This is 

supported by section 701(a) of the Act, 

which requires eligible entities to enter 

into agreements for the expansion of 

telehealth capabilities and the provision 

of telehealth services to veterans. If 

grantees could accept Federal funds but 

cease providing telehealth services, this 

would be contrary to the purpose 

articulated by Congress. Applicants also 

must attest that the title or lease to the 

telehealth access point will lie with the 

applicant and the applicant will, at a 

minimum, provide the equivalent 

insurance coverage for real property and 

equipment acquired or improved with 

Federal funds as provided to property 

owned by the applicant. Similar to the 

explanation provided earlier regarding 

the requirement to certify the applicant 

will continue to maintain and operate 

the telehealth access point, an 

attestation that the applicant will 

continue to retain possession of the 

property, even subject to a lease, will 

ensure that the purposes of this program 

defined by law are capable of being met. 

The insurance requirement also 

preserves the Government’s interest in 

the items or improvements made using 

grant funds. However, the proposed rule 

would state that telehealth access points 

that are located on federally owned 

property (e.g., Department of Defense, 

Indian Health Service) need not be 

insured unless required by the terms 

and conditions of the Federal property 

award. Other federally owned property 

is already subject to a sufficient surety, 

and any loss or damage to such property 

would already be incurred by the 

Government. The statement would also 

need to include an attestation that 

adequate financial support will be 

available for the duration of the grant 

agreement; this would have to be 

supported by a demonstration of 

financial stability and a detailed project 

budget, which includes, but is not 

limited to, all existing and anticipated 

sources of funds for the project. This is 

also necessary to ensure the continued 

operation of the telehealth access point 

and to ensure that Federal funds are not 

wasted. Finally, the applicant would 

have to attest that it will keep records 

and submit reports as VA may 

reasonably require, within the 

timeframes required, and, upon 

demand, allow VA access to the records 

upon which such information is based. 

As explained later in this discussion, 

proposed §§ 84.85 and 84.90 further 

describe the reporting and 

recordkeeping requirements for this 

grant program. These requirements are 

necessary to ensure that grant funds are 

being used for authorized purposes and 

the proper accounting of Federal funds. 

Proposed § 84.15(b)(5) would be 

similar to other VA grant programs (see 

§§ 61.11 and 62.20) and would require 

that the application also include 

documentation of the managerial 

capacity of the applicant to: maintain 

and operate a telehealth access point 

where veterans who use the telehealth 

access point can receive high quality 

telehealth care from VA health care 

professionals; continuously assess the 

needs of the telehealth access point and 

the feedback from veterans who use the 

telehealth access point for quality 

improvement in areas such as 

accessibility, satisfaction, and 

experience; customize the telehealth 

access point to meet the needs of 

veterans who use the telehealth access 

point; and comply with and implement 

the requirements of the telehealth grant. 

These requirements would ensure that 

the access point is meeting and 

maintaining all requirements of the 

telehealth grant and is being operated 

consistent with the purposes set forth in 

section 701(a) of the Act. 

Proposed paragraph (b)(6) would be 

similar to § 62.20(c) and would state 

that VA may request any additional 

information in writing relevant to the 

telehealth grant application. This is 

necessary to ensure that VA can verify 

or clarify information that is relevant to 

determining whether or not to award 

Federal funds to the applicant under 

section 701(a)–(b) of the Act. 

These application requirements in 

general are similar to other VA grant 

programs, such as the Grant and Per 

Diem program and SSVF program. See 

§§ 61.11 and 62.20, respectively. 

Proposed paragraph (c) would state 

that subject to funding availability, 

grantees may apply for one renewal 

grant per fiscal year, after receiving an 

initial grant. The grantee must submit to 

VA a complete renewal grant 

application as described in the NOFO. 

This requirement is similar to other VA 

grant programs, such as the SSVF 

program. See § 62.20. Additionally, 

under section 701(b)(3)(A)(vi) and (vii), 

sustainment of internet and telephone 

services are permissible uses of grants. 

Other grants, such as those involving 

renovations or other modifications to 

the physical infrastructure of a 

telehealth access point, may require 

additional funding to complete the 

project. While these are clear examples 

of grants that may make sense to be 

renewed from one fiscal year to another, 

other grants may not require further 

support, such as when a grant is needed 

only to purchase, replace, or upgrade 

hardware or software. The NOFO will 

describe any authorized uses of a 

renewal grant. 

Section 84.20 Threshold Requirements 

Prior To Scoring Telehealth Grant 

Applicants 

Proposed § 84.20 would set forth 

threshold requirements that applicants 

must meet before their applications can 

be scored pursuant to § 84.25 and would 

be similar to other VA grant programs 

such as SSVF. See § 62.21. In 

authorizing VA to award grants under 

section 701(a) and (b) of the Act, 

Congress implicitly delegated to VA the 

authority to determine the terms and 

conditions for receipt of an award. 

Proposed § 84.20 would provide for the 

threshold requirements and be similar 

to other existing VA grant programs, 

such as the SSVF program (see § 62.21). 

These requirements would be minimum 

requirements that would have to be met 

before VA could score applications, and 

eligible entities could use these to know 

whether they meet these threshold 

requirements in advance of submitting 

an application. The threshold 

requirements are intended to be an 

administrative checklist with which 

eligible entities would confirm 

compliance prior to submitting a 

telehealth grant application. VA 

anticipates this would reduce the 

amount of time and resources that VA 

will dedicate to evaluating and scoring 

applicants while also providing clear 

notice to eligible entities about their 

obligations and necessary qualifications 


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This would facilitate the award of grants 

under section 701(a) and (b)(1) by 

ensuring applicants provide necessary 

information to allow VA to consider and 

score their application. 

We would state that VA would only 

score applicants that meet the following 

threshold requirements listed in 

paragraphs (a) through (h). Applicants 

would have to: (1) file the application 

within the time period established in 

the NOFO, and any additional 

information or documentation requested 

by VA under § 84.15(b)(6) would have to 

be provided within the time frame 

established by VA; (2) complete the 

application in all parts; (3) meet the 

eligibility criteria in § 84.10; (4) request 

a telehealth grant only for uses 

authorized under § 84.45; (5) ensure the 

veterans the applicant proposes to serve 

are eligible to receive telehealth services 

under title 38 of the United States Code; 

(6) agree to comply with the 

requirements of the telehealth grant; (7) 

not have an outstanding obligation to 

the Federal Government that is in 

arrears and not have an overdue or 

unsatisfactory response to an audit; and 

(8) not be in default by being in noncompliance with the terms and 

conditions of the agreement of any 

previous Federal assistance. These 

requirements, again, would ensure that 

grants awarded under part 84 would be 

a responsible use of Federal funds and 

would be for the purposes outlined in 

section 701(a) and (b) of the Act. 

Section 84.25 Scoring Criteria for the 

Telehealth Grant Applicants 

In proposed § 84.25, VA would 

establish the criteria to be used to score 

applicants who are applying for a 

telehealth grant. VA would need to 

establish these criteria because the 

amount of funds available for grants 

each year will be limited and VA may 

receive a higher number of applicants 

than there are available grant funds. 

Scoring criteria would allow VA to 

award grants to those applicants who 

are most qualified and would ensure 

that VA administers grants in a manner 

consistent with section 701 of the Act. 

Section 701 of the Act did not provide 

criteria for scoring applicants for the 

telehealth grant. As such, we propose to 

utilize the scoring criteria of similar VA 

grant programs and tailor such criteria 

to the telehealth grant. See, e.g., the 

SSVF program’s scoring criteria at 38 

CFR 62.22. In requiring VA to award 

grants, Congress understood that VA 

would need to establish standards to 

determine which applicants should 

receive grant awards. Congress also 

specifically recognized that VA would 

need to prioritize applicants when it 

required in section 701(b)(2) of the Act 

that VA, to the extent practicable, 

ensure grants are awarded to entities 

that serve veterans in rural and highly 

rural areas or areas determined to be 

medically underserved. 

While this section does not include 

specific point values for each criterion, 

the regulation provides that such point 

values will be set forth in the NOFO. 

This will allow VA to retain flexibility 

in determining those point values each 

year of the grant program in the event 

that such point values need to change. 

This is similar to other VA grant 

programs. See, e.g., the SPGP 

regulations at 38 CFR 78.25. 

Proposed § 84.25(a) would state that 

VA will award points based on the 

background, qualifications, experience, 

and past performance of the applicant 

and any subcontractors identified by the 

applicant, if relevant, as demonstrated 

by the criteria listed in paragraphs (a)(1) 

through (3). These criteria would 

demonstrate the applicant’s knowledge 

and experience in working with 

veterans and their ability to implement 

the telehealth grant. These attributes 

would be demonstrative of the 

applicant’s ability to manage the 

telehealth access point consistent with 

authorized purposes. 

Proposed § 84.25(a)(1) would address 

the applicant’s background and 

organizational history by requiring that 

the applicant include (1) the applicant’s 

and any identified subcontractors’ 

background and organizational history 

that would help them maintain and 

operate a telehealth access point for 

veterans; (2) evidence that the applicant, 

and any identified subcontractors, 

maintain organizational structures with 

clear lines of reporting and defined 

responsibilities; and (3) the applicant’s, 

and any identified subcontractors’, 

history of complying with agreements 

and not defaulting on financial 

obligations. These criteria are needed to 

ensure funds are being applied 

appropriately toward the telehealth 

grant and are similar to other grant 

programs. See § 78.25. 

Proposed § 84.25(a)(2) would set forth 

what VA would consider in scoring the 

applicant’s staff qualifications. This 

would include that evidence the 

applicant’s staff, and any identified 

subcontractors’ staff, have experience 

working with veterans or individuals 

receiving health care, as well as 

organizational experience in 

establishing an environment suitable for 

providing health care services. 

Proposed § 84.25(a)(3) would set forth 

what VA would consider in scoring the 

organizational qualifications and past 

performance of the applicant. This 

would include that the applicant, and 

any identified subcontractors, have 

organizational experience partnering 

with health care organizations to create 

an environment to provide telehealth 

services; the applicant, and any 

identified subcontractors, have 

organizational experience coordinating 

or administering telehealth services; and 

the applicant, and any identified 

subcontractors, have organizational 

experience working with veterans. 

These criteria would demonstrate the 

applicant’s knowledge and experience 

in working with veterans and their 

ability to implement the telehealth 

grant. These criteria would be similar to 

§ 62.22(a)(3). 

Proposed § 84.25(b) would explain 

that VA would award points based on 

the applicant’s plan to establish, 

maintain and operate the telehealth 

access point, as demonstrated by the 

criteria listed in paragraphs (b)(1) 

through (7). 

Proposed § 84.25(b)(1) would explain 

how VA would score the need for the 

program. Applicants could demonstrate 

this by showing the need for a telehealth 

access point in a rural, highly rural, or 

medically underserved area. If the 

applicant is not proposing to provide 

telehealth services in a rural or highly 

rural area, or an area determined to be 

medically underserved, the applicant 

instead could demonstrate an 

understanding of the area and provide 

evidence that a telehealth access point 

is needed to meet the unique needs of 

veterans and the community to be 

served. As previously stated in this 

rulemaking, the purpose of the 

telehealth grant is to establish, maintain 

and operate a telehealth access point in 

locations that are rural, highly rural, or 

medically underserved, to the extent 

practicable. The applicant must 

demonstrate that telehealth access 

points would be in locations that are in 

accordance with the purpose of the 

telehealth grant and meet the needs of 

the community they serve. Applicants 

that can show they would provide 

telehealth services in rural, highly rural, 

or medically underserved areas would 

be prioritized, to the extent practicable 

and consistent with the terms of the 

NOFO. 

Proposed § 84.25(b)(2) would explain 

that VA would score the applicant’s 

outreach plan based on whether the 

applicant has a feasible communications 

plan to inform veterans about the 

telehealth access point and the services 

provided. This outreach is necessary to 

ensure that the telehealth access point 

can provide telehealth services to 

veterans, consistent with section 701(a) 

of the Act. 


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Proposed § 84.25(b)(3) would state 

that VA would score the applicant’s 

plan to establish, maintain, and operate 

the telehealth access point based on 

whether the size, scope, and grant 

management plan are feasible and 

whether the applicant’s plan is designed 

and scoped to meet the needs of 

veterans in their community through the 

provision of telehealth services. We 

would consider whether telehealth 

access point provides flexible hours of 

operation to maximize the telehealth 

access point’s utilization. We would 

require this information because VA 

would want veterans to make the most 

use of the telehealth access point, which 

would require the applicant to be 

knowledgeable of the needs of veterans 

that would be using the telehealth 

access point. For example, some 

veterans may request use of the 

telehealth access point in the morning 

while others would prefer late 

afternoons. Applicants who could 

demonstrate they have a plan to 

accommodate scheduling flexibility 

would be scored more favorably than 

those who could not. 

Proposed § 84.25(b)(4) would explain 

what VA would consider in scoring the 

applicant’s plan to establish, maintain 

and operate a telehealth access point 

and use grant funding within the 

timeline specified in their application. 

We also would consider whether the 

applicant has a hiring plan in place to 

meet the applicant’s implementation 

timeline or has existing staff to meet 

such timeline, if necessary. 

Proposed § 84.25(b)(5) would state 

that the applicant must submit a letter 

of support from a local VA medical 

facility or facilities confirming the need 

for the telehealth access point and the 

intent of such VA facilities to work with 

the grantee. This letter, prepared either 

by a single facility or in combination by 

several facilities, would acknowledge 

the need for the telehealth access point 

and the intent of such facility or 

facilities to work with the applicant if 

the applicant is awarded a grant. This is 

essential because telehealth services 

necessarily involve the delivery of 

health care from one location to another. 

This letter ensures that VA facilities that 

would be furnishing telehealth services 

to the access point agree that there is a 

need for an access point in that area and 

that these facilities will work with the 

applicant, if awarded a grant, to provide 

telehealth services to the veteran in 

cooperation with the entity. 

Proposed § 84.25(b)(6) would state 

that VA will score applicants based on 

their capacity to safely maintain and 

operate a telehealth access point. This 

would include staff resources. Similar to 

§ 78.25(b)(6), this would ensure that 

funds are awarded to entities that can 

provide telehealth services to veterans 

through a grant. 

Lastly, proposed § 84.25(b)(7) would 

state that VA will score applicants based 

on their feasibility to sustain telehealth 

access point operations. Similar to 

§ 78.25(b)(7), this would ensure that 

funds are awarded to entities that can 

provide telehealth services to veterans 

through a grant. 

Proposed § 84.25(c) would state that 

VA will award points based on the 

applicant’s quality assurance and 

evaluation plan, as demonstrated by the 

criteria in paragraphs (c)(1) through (4). 

We would require that these measures 

be in place to continuously assess and 

improve, as necessary, services 

provided to veterans and to make 

certain that the applicants address any 

issues that may arise at the telehealth 

access point. 

Proposed § 84.25(c)(1) would explain 

that VA would score the applicant’s 

ability to evaluate the services provided 

at the telehealth access point. This 

would be based on whether the 

applicant provided clear, realistic, and 

measurable goals that reflect the grant’s 

aim of providing a telehealth access 

point to veterans against which the 

applicant’s program performance can be 

evaluated, as well as the applicant’s 

plans to continually assess the 

telehealth access point to identify 

opportunities for quality improvement 

in areas such as accessibility, 

satisfaction, and experience. 

Proposed § 84.25(c)(2) would explain 

how VA would score the applicant’s 

ability to monitor key elements of the 

grant award and the telehealth access 

point. Proposed § 84.25(c)(2)(i) would 

state that VA would score whether the 

applicant has adequate controls in place 

to regularly monitor all aspects of the 

execution of the grant (including any 

subcontractors) for compliance with all 

applicable laws, regulations, and 

guidelines. This will help ensure that 

grant funds are used appropriately and 

responsibly. 

Proposed § 84.25(c)(2)(ii) would state 

that VA would score the applicant’s 

plan to provide an environment that is 

private, secure, clean and complies with 

the ADA where veterans can participate 

in their telehealth appointments. As 

noted previously, VA interprets section 

701 of the Act to require these 

conditions for all participating 

telehealth access points. 

Proposed § 84.25(c)(2)(iii) would 

provide that the applicant must also 

have financial and operational controls 

in place to ensure the proper use of 

telehealth grant funding. This 

information would be required to ensure 

that the grantee is meeting the terms of 

the agreement and maintaining 

operations of the telehealth access 

point. 

Lastly, proposed § 84.25(c)(2)(iv) 

would provide that the applicant must 

have a plan for ensuring that their staff 

and any subcontractors are 

appropriately trained on, and the 

telehealth access point maintains 

compliance with, all fire and safety 

requirements as specified by State and 

local laws and regulations. We would 

not state the specific fire and safety 

requirements because telehealth access 

points may be placed in a variety of 

locations, which may not require the 

same standards. This is similar to other 

grant programs. See § 61.15. 

We would state in § 84.25(c)(3) that 

VA would score the application based 

on whether the applicant has a plan to 

establish a system to remediate aspects 

of the grant program that are noncompliant with the terms of the 

telehealth grant agreement when they 

are identified. Once an issue has been 

spotted, the applicant must have a plan 

in place to fix it to continue to be 

compliant with the terms of the 

agreement. This is necessary to ensure 

that grant funds are used appropriately 

and responsibly. 

Lastly, § 84.25(c)(4) would state that 

the applicant’s program management 

team must have the capability and a 

system in place to provide to VA timely 

and accurate reports at the frequency set 

by VA. This is necessary to ensure that 

grant funds are used appropriately and 

responsibly. 

Proposed § 84.25(d) would state that 

VA will award points based on the 

applicant’s financial capability and 

plan, as demonstrated by the criteria 

listed in paragraphs (d)(1) and (2). 

Proposed § 84.25(d)(1) would require 

that the applicant, and any identified 

subcontractors, are financially stable. 

This criterion would ensure that the 

funds for the telehealth grant are 

properly administered. 

We would state in proposed 

§ 84.25(d)(2) that the applicant must 

have a realistic budget for utilizing grant 

funding and would require applicants to 

submit their implementation timeframe 

to operate the telehealth access point. In 

addition, the applicant’s program would 

have to be cost-effective and could be 

effectively and fully implemented onbudget. VA would award a telehealth 

grant based in part on the projected 

budget of the applicant. Failure to 

maintain the proposed budget could 

result in breach of the grant agreement. 

This is necessary to ensure that grant 


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funds are used appropriately and 

responsibly. 

Proposed § 84.25(e) would state that 

VA will award points based on the 

applicant’s area or community 

associations and relations, as 

demonstrated by the criteria in 

paragraphs (e)(1) through (4). Proposed 

§ 84.25(e)(1) would require that the 

applicant have a plan for developing 

associations or have existing experience 

with Federal (including VA), State, 

local, and Tribal government agencies, 

as well as private entities, for the 

purposes of providing a telehealth 

access point to veterans, as applicable. 

This information would demonstrate 

associations or plans to develop 

relationships with the community that 

the applicant plans to serve, including 

any type of outreach activities to engage 

veterans in their community. 

Proposed § 84.25(e)(2) would require 

that the applicant (or applicant’s staff), 

and any identified subcontractors (or 

subcontractors’ staff), as relevant, have 

fostered successful working 

relationships and experience with 

public and private organizations 

providing services to veterans. This 

experience would ensure the applicant 

has a network of resources to help it 

establish, maintain and operate a 

telehealth access point for veterans now 

and in the future. 

Proposed § 84.25(e)(3) would require 

that the applicant have a presence in the 

area or community they intend to serve, 

and that the applicant understands the 

dynamics of the area or community they 

intend to serve. These criteria would 

ensure that the applicant understands 

the veterans whom they propose to 

serve and would facilitate engagement 

with these veterans to deliver telehealth 

services to them. 

Lastly, proposed § 84.25(e)(4) would 

require applicants to demonstrate that 

their experience in the area or 

community they intend to serve will 

enhance the effectiveness of the 

applicant’s program. This, again, is 

necessary to ensure that grant funds are 

awarded to entities that can furnish 

telehealth services to veterans. 

Section 84.30 Selection of Applicants 

To Receive a Telehealth Grant 

Proposed § 84.30 would state the 

selection process VA would use to 

identify applicants who would be 

offered a telehealth grant under part 84. 

Section 701 of the Act does not establish 

specific provisions for the selection of 

applicants, but Congress clearly 

intended VA to evaluate and select 

candidates, so we infer that section 

701(a) and (b) implicitly delegated this 

authority to VA. VA is proposing to 

follow a selection process that is similar 

to the selection process used in the 

SSVF program (described in § 62.25) 

and other grant programs, as that 

process has proven to be an effective 

and equitable means for choosing 

applicants. We are, therefore, basing the 

proposed § 84.30 on current § 62.25, but 

we have adapted the language for the 

telehealth grant. In proposed § 84.30, we 

would state that VA will use the process 

in this section to select applicants to 

receive telehealth grants. The process 

would then be set forth in proposed 

paragraphs (a) through (e). 

Proposed paragraph (a) would explain 

that VA will score all applicants that 

meet the threshold requirements set 

forth in § 84.20 using the scoring criteria 

set forth in § 84.25. This is similar to 

other grant programs. See § 78.30(a). 

This ensures that applicants will only 

be scored if they meet the basic 

requirements already discussed. 

Proposed paragraph (b) would state 

that VA will group applicants within 

the applicable funding priorities if 

funding priorities are set forth in the 

NOFO. This is similar to other grant 

programs. See § 78.30(b). This ensures 

that applications are evaluated relative 

to other, similar applications. 

Pursuant to proposed paragraph (c), 

VA would rank those applicants who 

receive at least the minimum amount of 

total points and points per category set 

forth in the NOFO, within their 

respective funding priority group, if 

any. The applicants would be ranked in 

order from highest to lowest scores, 

within their respective funding priority 

group, if any. This is similar to other 

grant programs. See § 78.30(c). This 

ensures that applicants who are selected 

meet certain minimum requirements. 

Pursuant to proposed paragraph (d), 

VA would use the applicant’s ranking as 

the primary basis for selection for 

funding. However, VA will prioritize 

entities that serve veterans in rural and 

highly rural areas or areas determined to 

be medically underserved, as 

practicable. This clarification is in 

alignment with section 701(b)(2) of the 

Act, which provides that, to the extent 

practicable, the Secretary shall ensure 

that grants are awarded to entities that 

serve veterans in rural and highly rural 

areas (as determined through the use of 

the Rural-Urban Commuting Areas 

coding system of the Department of 

Agriculture) or areas determined to be 

medically underserved. 

Lastly, we would state in paragraph 

(e) that, subject to paragraph (d), VA 

would fund the highest-ranked 

applicants for which funding is 

available, within the highest funding 

priority group, if any. If multiple 

applications are received from the same 

geographic area, the applicant’s 

rankings would be the primary basis for 

selection. If funding priorities have been 

established, to the extent funding is 

available, and still subject to paragraph 

(d), VA would select applicants in the 

next highest funding priority group 

based on their rank within that group. 

This would ensure that, consistent with 

the requirement in section 701(b)(2) of 

the Act and paragraph (d), VA selects 

those applicants that have provided the 

strongest applications, within funding 

priorities, which should help ensure 

that Federal funds are put to the best 

use. 

In proposed paragraph (f), we would 

explain that if an applicant would have 

been selected but for a procedural error 

committed by VA, VA could select that 

applicant for funding in the next 

applicable funding round or when 

sufficient funds otherwise become 

available (provided the applicant still 

wants to participate in the program). If 

there is no material change in the 

information, a new application would 

not be required. This would ease any 

administrative burden on applicants 

when VA committed a procedural error 

and could be used in situations where 

there is no material change in the 

information that would have resulted in 

the applicant’s selection for a grant 

under part 84. 

Section 84.35 Scoring Criteria for 

Grantees Applying for Renewal of 

Telehealth Grants 

Proposed § 84.35 would state the 

scoring criteria for grantees applying for 

renewal of telehealth grants. VA would 

award renewal grants in situations 

where there is a continued need of a 

grant to maintain and operate a 

telehealth access point based on the 

veteran population that accesses these 

points. Such situations could include 

continued renovations or sustainment of 

internet or telephone services. VA 

would evaluate the grantee’s prior year’s 

use of the grant to maintain and operate 

a telehealth access point to determine 

the need for a renewal grant. Renewal 

grants may be awarded even if the 

number of veterans accessing the 

telehealth access point is small but the 

continued use of the telehealth access 

point has been beneficial to veterans’ 

health care needs. Section 701 of the 

Act did not have provisions for the 

scoring of telehealth grants renewals, 

and we would, therefore, use the 

provisions of similar VA grant programs 

such as the SSVF program because these 

provisions are essential to the effective 

and efficient administration of a grant 

program and because we infer that 


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Congress implicitly delegated this 

authority, as discussed above. See 

§ 62.24. 

While this section would not include 

specific point values for the criteria, 

such point values will be set forth in the 

NOFO. This would allow VA to retain 

flexibility in determining those point 

values each year of this grant program 

and would be consistent with the 

process for an initial award under part 

84. 

Proposed § 84.35(a) would state that 

VA will assess the success of the 

grantee’s program, as measured by 

veteran satisfaction with the services 

provided by the grantee and how the 

grantee met the telehealth grant goals 

and requirements for VA to deliver 

telehealth services to veterans at that 

telehealth access point in accordance 

with the agreement. These measures 

should provide a clear basis to 

determine the success of the program 

based on veteran feedback and VA’s 

experience with the grantee in terms of 

delivering telehealth care through the 

access point. 

Proposed paragraph (b) would state 

that VA will assess the costeffectiveness of the grantee’s telehealth 

access point, as demonstrated by how 

the hours for the point attendant (the 

grantee staff assisting veterans in using 

the telehealth access point) correlate 

with the veterans’ telehealth 

appointments and how the telehealth 

access point was implemented 

effectively using the available funding 

in the designated timeframe. 

Proposed paragraph (c) would state 

that VA will assess the extent to which 

the grantee complies with all applicable 

laws, regulations, and guidelines for the 

administration of the telehealth access 

point. This is necessary to ensure that 

grant funds are supporting efforts 

consistent with all legal requirements. 

Section 84.40 Selecting Grantees for 

Renewal of Telehealth Grants 

Proposed § 84.40 would establish the 

selection criteria for renewal of 

telehealth grants. Section 701 of the Act 

did not have provisions for the selection 

of telehealth grants renewals, but we 

infer this was an implicit delegation of 

authority by Congress because this 

would be needed for the administration 

of the grant program required by section 

701(a) of the Act. We would, therefore, 

base the requirements in this proposed 

section on the provisions of similar VA 

grant programs, such as the SSVF 

program (see § 62.25). These provisions 

are essential to the effective and 

efficient administration of a grant 

program. 

Proposed paragraph (a) would state 

that, provided the grantee continues to 

meet the threshold requirements (in 

proposed § 84.20), VA would use the 

scoring criteria (in proposed § 84.35) to 

evaluate the renewal grant application. 

This is similar to other grant programs, 

such as the SSVF program. See 

§ 62.25(a). 

Proposed paragraph (b) would explain 

that VA will rank those grantees who 

receive at least the minimum amounts 

of total points and points per category 

set forth in the NOFO. The grantees will 

be ranked in order from highest to 

lowest scores within their respective 

funding priority group, if applicable. 

This is similar to other grant programs, 

such as the SSVF program. See 

§ 62.25(b). This would also be similar to 

how new applicants would be evaluated 

under part 84. 

Proposed paragraph (c) would state 

that VA will use the grantee’s ranking as 

the primary basis for the selection for 

funding. Similar to new applicants, 

though, VA would prioritize entities 

that serve veterans in rural and highly 

rural areas or areas determined to be 

medically underserved, to the extent 

practicable. VA would fund the highestranked grantees for which funding is 

available within their respective 

funding priority group, if applicable. 

This also would be similar to other grant 

programs and how new applicants 

would be evaluated under part 84. 

Pursuant to proposed paragraph (d), 

VA would retain the discretion to award 

any deobligated funds to an applicant or 

existing grantee. This is similar to other 

grant programs, such as the SSVF 

program. See § 62.25(d). We would 

further explain in proposed paragraph 

(d)(1) that if VA chose to award 

deobligated funds to an applicant or 

existing grantee, VA could first award 

the deobligated funds to the applicant or 

grantee with the highest grant score 

under the relevant NOFO that applies 

for, or is awarded a renewal grant in, the 

same community as, or a proximate 

community to, the affected community. 

Such applicant or grantee would need to 

have the capacity and agree to provide 

prompt services to the affected 

community. Under this section, the 

relevant NOFO would be the most 

recently published NOFO which covers 

the geographic area that includes the 

affected community. In proposed 

paragraph (d)(2), we would explain that 

if the first such applicant or grantee 

offered the deobligated funds refuses the 

funds, VA would offer to award the 

funds to the next highest-ranked such 

applicant or grantee, per the criteria in 

paragraph (d)(1), and continue on in 

rank order until the deobligated funds 

are awarded. Under proposed paragraph 

(d)(3), VA could offer to award funds 

under other conditions, or could choose 

to not award the deobligated funds at 

all, when VA determines appropriate 

based on other relevant factors. For 

example, if a grantee had been 

maintaining and operating a telehealth 

access point in a community and VA 

opened a new clinic in that community, 

the continued need for a telehealth 

access point there may be limited. It 

may be more appropriate for another 

location to receive those funds to 

provide telehealth services to other 

veterans with limited access to care. We 

believe this is the most likely reason to 

shift funds from one community to 

another, but it is not necessarily the 

only reason, so we leave open the 

possibility that we may need to 

reallocate deobligated funds to other 

communities. There may also be 

situations where it would not make 

sense to award deobligated funds, such 

as near the end of a fiscal year when 

only limited funds would remain. VA 

would consider other relevant factors in 

making these decisions and act 

accordingly. 

Paragraph (e) would authorize VA to 

select an existing grantee for available 

funding, in the next applicable funding 

round or when sufficient funds 

otherwise become available, based on 

the grantee’s previously submitted 

renewal application, if that grantee is 

not initially selected for renewal 

because of a procedural error by VA 

(and provided the applicant is still 

interested in participating in the 

program). If there is no material change 

in the information, a new application 

would not be required. This would ease 

any administrative burden on grantees 

and could be used in situations where 

there is no material change in the 

renewal grant application that would 

have resulted in the grantee’s selection 

for renewal of a grant under part 84. 

This is similar to other grant programs, 

such as the SSVF program. See § 62.61. 

It is also similar to the provisions 

regarding new applicants described 

above. 

Section 84.45 Awards for the 

Telehealth Grant 

Proposed § 84.45 would establish how 

awards for telehealth grants could be 

used, related exclusions, and VA’s 

ability to enter into agreements with 

organizations for the establishment of 

telehealth access points. 

Proposed paragraph (a) would list the 

permissible uses of grant funds awarded 

under part 84. This would be consistent 

with section 701(b)(3) of the Act, which 

provides for the general use of grant 


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funds. Paragraphs (a)(1) through (7) are 

consistent with clauses (i) through (vii) 

in section 701(b)(3)(A) of the Act. 

Proposed paragraph (a)(1) would 

reflect the criterion from section 

701(b)(3)(A)(i), which states that 

telehealth grant funds may be used for 

purchasing, replacing, or upgrading 

hardware or software necessary for the 

provision of secure and private 

telehealth services. Proposed paragraph 

(a)(1) would clarify that the equipment 

and software must be compatible with 

telehealth requirements as described in 

the NOFO and be purchased under 

warranty. We would not place these 

requirements in regulation as 

technological advances would require 

VA to constantly update its regulations 

to reflect the new hardware and 

software requirements. Grantees may 

contact VA with any questions they may 

have regarding the correct hardware or 

software needed in the telehealth access 

point prior to their purchase. In 

addition, purchasing the equipment and 

software under warranty safeguards the 

grantee against any manufacturer’s 

defect that might render the equipment 

or software faulty. We also encourage 

grantees to purchase an extended 

warranty for the hardware and software 

to safeguard against any costs beyond 

the manufacturer’s warranty. VA is 

aware that some grantees may not have 

the technological expertise to set up the 

hardware and software in the telehealth 

access points and as such, we would 

also clarify that the telehealth grant 

funds may be used to purchase services 

to configure and set up granteepurchased equipment. This would be 

needed to ensure installation and 

functionality of the equipment. In 

addition, VA would provide direct 

technical support for the initial 

connection to a VA-secure application, 

and continued VA technical support for 

issues that may arise with the 

connection to the VA-secure application 

during the term of the grant. We 

emphasize, though, that this technical 

support would only extend to issues 

regarding VA’s platform or its network 

and would not extend to any technical 

issues the grantee is experiencing on its 

side of the connection. 

We understand that some 

organizations expressed interest in VA 

providing equipment and software 

directly to applicants, but we have not 

proposed to do so here. VA’s other grant 

programs involve the distribution of 

financial resources to grantees so they 

can obtain goods and services as needed 

to perform the functions of the grant 

program. Adhering to this model for this 

grant program is appropriate for several 

reasons. First, disbursing funds is a 

more well-established and well-known 

process that would avoid potential 

delays or issues with implementation. 

Second, VA would have no way of 

knowing in advance the quantity of 

hardware and software reasonably 

expected to be required by the grantees 

that would request VA-purchased 

hardware and software. If not all of the 

VA-purchased hardware and software 

were awarded to grantees, VA would be 

left with excess equipment that would 

be rendered outdated after a few years 

due to changes in technology. Not only 

would this mean a loss of revenue for 

VA, but, more importantly, it would 

decrease the amount of grant funds 

available for grantees. This would leave 

communities that are in need of a 

telehealth access point without the 

ability to provide health care services to 

veterans. Third, and as noted 

previously, VA encourages grantees to 

use awards to purchase warranties and 

service plans to ensure that 

technological support and services are 

available when needed. This preserves a 

cleaner distinction between VA 

involvement and the grantee’s 

operations. As such, we will not be 

awarding VA-purchased hardware or 

software as part of the grant agreement 

with the grantee. If grantees identify 

significant issues with this approach, 

VA can consider whether another 

approach would be legally permissible 

and more appropriate. 

Proposed paragraph (a)(2) would be 

consistent with section 701(b)(3)(A)(ii), 

which states that the telehealth grant 

may be used for upgrading security 

protocols for consistency with the 

security requirements of the Department 

of Veterans Affairs. We would state that 

telehealth grants may be used for 

upgrading security protocols for 

consistency with VA security 

requirements and digital applications. 

We would further state that these 

security requirements would be 

described in the NOFO. Telehealth 

access point services would be 

delivered through the VA Video 

Connect secure application or other 

programs. We would not use the term 

VA Video Connect in this rule in the 

event the platform name changes in the 

future to avoid amending the regulation. 

Security protocols may include 

antivirus or information security 

programs, encryption, or other programs 

or requirements. 

Proposed paragraph (a)(3) would be 

consistent with section 701(b)(3)(A)(iii) 

of the Act, which states that telehealth 

grants may be used for the training of 

site attendants, including payment of 

those attendants for completing that 

training. We would state that telehealth 

grant funds may be used for the 

payment for the training of telehealth 

access point attendants, including 

payment of those attendants for 

completing that training, with respect 

to: (1) military and veteran cultural 

competence, if the entity is not an 

organization that represents veterans; (2) 

equipment required to provide 

telehealth services; (3) privacy, 

including the Health Insurance 

Portability and Accountability Act 

(HIPAA) of 1996 privacy rule under 45 

CFR part 160 and part 164, subparts A 

and E, as it relates to health care for 

veterans; (4) scheduling for telehealth 

services for veterans; or (5) any other 

unique training needs for the provision 

of services to veterans in a telehealth 

access point. 

We note that section 701(b)(3)(A)(iii) 

only authorizes the use of grants to pay 

for wages or salaries of site attendants 

when they are engaged in training 

described in that clause. We interpret 

this to mean that grant funds may not 

be used otherwise to pay for salary or 

wages for site attendants when they are 

not engaged in training. We understand 

this limitation could prove an obstacle 

for some potential applicants for grants 

under part 84, so we are taking this 

opportunity to clarify that while grant 

funds cannot be used to pay salaries or 

wages for site attendants, VA could 

enter into separate agreements under 

separate authorities for these services. 

VA has general authority to appoint staff 

to provide support to veterans receiving 

health care through telehealth. VA 

similarly can contract for others to 

provide telehealth services, or to 

support the delivery of telehealth 

services, to veterans. While grant funds 

under part 84 are not authorized to pay 

salaries and wages, VA could enter into 

separate agreements, such as contracts, 

with grantees to cover these costs. These 

separate agreements would not be grant 

agreements under part 84 and would not 

be governed by the terms and conditions 

of part 84 or the grant agreement 

themselves. These separate agreements 

would be authorized by provisions of 

law other than section 701 of the Act 

and would be governed by those laws, 

any applicable regulations, and the 

terms of these separate agreements. As 

such, we are not including the payment 

of salaries or wages for site attendants 

in this rulemaking, but we do provide 

this clarification so that eligible entities 

who are interested in applying for a 

telehealth grant but who also need 

financial assistance to pay staff to 

administer the telehealth access points 

understand the limits of the grant 

program and the alternative 


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arrangements VA is considering to try to 

address this potential issue. 

Proposed paragraph (a)(4) would be 

consistent with section 701(b)(3)(A)(iv) 

of the Act, which provides that the 

telehealth grant may be used for 

upgrading existing infrastructure owned 

or leased by the entity to make rooms 

more conducive to telehealth care, 

including: (1) additions or modifications 

to windows or walls in an existing 

room, or other alterations as needed to 

create a new, private room, including 

permits or inspections required in 

association with space modifications; 

(2) soundproofing of an existing room; 

(3) new electrical, telephone, or internet 

outlets in an existing room; or (4) 

aesthetic enhancements to establish a 

more suitable therapeutic environment. 

We would state that telehealth grant 

funds may be used for these purposes 

generally, and regarding aesthetic 

enhancements, we would specifically 

include, but not limit to, enhancements 

such as seating for both the veteran and 

caregiver, bariatric seating, and 

adequate lighting. These are examples of 

enhancements that would make the 

environment more suitable for 

therapeutic purposes by supporting the 

needs of the veteran (and by extension, 

a caregiver of a veteran). We note that 

a caregiver, as used in this context, is 

not limited to a caregiver recognized by 

or participating in a program of 

caregiver assistance administered by 

VA. 

Proposed paragraphs (a)(5) through (7) 

would be consistent with section 

701(b)(3)(A)(v) through (vii) of the Act, 

which state that telehealth grants may 

be used for upgrading existing 

infrastructure to comply with the ADA; 

upgrading internet infrastructure and 

sustainment of internet services; and 

sustainment of telephone services. 

Proposed paragraph (b) would address 

other exclusions to the use of grant 

funds. Section 701(b)(3)(B) of the Act 

states that telehealth grant funds may 

not be used for the purchase of new 

property or for major construction 

projects, as determined by the Secretary. 

We would mirror this exclusion in 

proposed paragraph (b) by stating that 

telehealth grant funds may not be used 

for the purchase of new property or for 

major construction projects, or for the 

acquisition of new space through other 

arrangements (such as a lease 

agreement), as determined by VA. 

Funds could not be used to acquire new 

space through other arrangements, such 

as a lease agreement. We would add that 

major construction would consist of 

new construction, or activities that 

would increase the square footage of an 

existing facility (e.g., relocation of 

existing exterior walls, roofs, or floors). 

We would not further define major 

construction in the regulation, but we 

could provide clarification in the 

NOFO. We would retain flexibility to 

provide further clarity through the 

NOFO to allow for adjustment to 

changing conditions or situations, both 

generally and specifically based on the 

needs of veterans, applicants, and 

grantees. 

Section 84.50 General Operation 

Requirements 

Proposed §§ 84.50 through 84.110 

provide general parameters for this grant 

program that are similar to requirements 

established in other VA grant programs. 

These are administrative provisions 

regarding grant administration. As noted 

previously, there is little in section 701 

of the Act that addresses the issues that 

would be covered by these provisions 

directly, but we interpret that as an 

implicit delegation by Congress to VA, 

as these requirements are necessary for 

the consistent and appropriate 

administration of this grant program. 

Sound administration is necessary to 

ensure VA and grantees are financially 

responsible in the use of Federal funds. 

Proposed § 84.50 would establish 

general operation requirements for 

telehealth access points and grantees. 

These requirements would make certain 

that all grantees adhere to the same 

standards for maintaining the telehealth 

access points and administering the 

grants. This section would be similar to 

other VA grant programs such as the 

SSVF program. See § 62.36. 

We would state in proposed 

paragraph (a) that grantees must 

maintain the confidentiality of veterans 

utilizing the telehealth access point. 

Maintaining the confidentiality of 

veterans is paramount in keeping with 

VA’s standards of provision of services 

to veterans. We would add that the 

grantees could not keep any records on 

the veterans who use the telehealth 

access point. These records are 

maintained exclusively by VA. As 

previously stated in this rule, VA will 

provide services at the telehealth access 

points through a secure internet 

application. The grantees will not have 

access to the veteran’s information. We 

would state, however, that this 

prohibition only applies to veteran 

records, however, grantees must 

maintain a record of the hours the point 

attendant provides services to veterans. 

These records would be used by VA to 

make certain that the grantee is utilizing 

telehealth grant funds appropriately and 

the point attendant is only performing 

duties related to the telehealth access 

point. 

Proposed paragraph (b) would 

establish the grantees’ responsibility to 

operate and maintain the telehealth 

access point. This requirement would be 

needed to make certain that the grantee 

is providing the required services in the 

telehealth access point. 

We would state in proposed 

paragraph (c)(1) that the grantee must 

notify each veteran that the telehealth 

services are being provided by VA. We 

would require grantees to notify 

veterans that telehealth services are 

being provided by VA because under 

section 701(a) of the Act, grantees are 

required to support VA’s provision of 

telehealth services to veterans. 

We would also state in proposed 

paragraph (c)(2) that the grantee must 

notify the veteran of any conditions or 

restrictions on the receipt of telehealth 

services by the veteran. We would allow 

grantees to create such rules and 

standards as are necessary for the safe 

and effective operation of the telehealth 

access point. We would add that the 

grantee has the right to prohibit services 

to veterans who have demonstrated 

disruptive behavior within their facility. 

This would ensure the safety of the 

telehealth access point attendants, other 

veterans utilizing the point, and 

caregivers of such veterans. 

We would state in proposed 

paragraph (d) that the grantee must 

participate in telehealth program 

evaluation interviews and surveys. This 

participation will help to improve 

services and enhance veterans’ 

experience. 

We would state in proposed 

paragraph (e) that grantees must 

regularly assess that the grant funds are 

utilized according to the agreement. 

This is necessary to ensure proper 

accounting for and use of Federal funds. 

Failure to utilize grant funds according 

to the agreement would be a breach of 

the agreement. 

We would state in proposed 

paragraph (f) that grantees must ensure 

that telehealth grants are administered 

in accordance with the requirements of 

part 84, the telehealth grant agreement, 

and other applicable laws and 

regulations. Further, grantees would be 

responsible for ensuring that any 

subcontractors, carry out activities in 

compliance with this telehealth grant 

program agreement, laws, and 

regulations. 

Proposed paragraph (g) would state 

that the grantees must follow, 

implement, and adhere to all 

requirements in the grant agreement and 

in 2 CFR part 200 on the use and 

disposition of property improved and/or 

equipment acquired under the 

telehealth grant program. Regulations at 


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2 CFR part 200 generally provide for the 

use and disposition of property once the 

grantee is no longer participating in the 

telehealth grant program. If potential 

applicants are interested in which 

regulations may be potentially relevant, 

VA would direct such individuals to 

review 2 CFR 200.311(c), 200.312, 

200.313, and 200.439. VA’s draft grant 

agreements will include specific terms 

setting forth disposition requirements 

for grantees and will be consistent with 

these regulations. 

The disposition of property includes 

any additions or modifications to 

windows or walls in an existing room, 

or other alterations as needed to create 

a new, private room for the telehealth 

access point. Disposition would also 

include any federally owned telehealth 

equipment or equipment acquired with 

telehealth grant funds. The recoupment 

of funds used for property 

improvements made or equipment 

acquired under the telehealth grant 

would also be stated in the NOFO. VA 

would provide for the specifics 

regarding the improvement, 

maintenance, and disposition of 

upgraded infrastructure or purchased 

equipment in the telehealth grant 

agreement. 

Section 84.55 Fee Prohibition 

Proposed § 84.55 would state that 

grantees must not charge a fee to 

veterans for providing VA services in 

telehealth access points that are funded 

with amounts from the telehealth grant. 

Under section 701(a) of the Act, grantees 

are required to support VA’s provision 

of telehealth services to veterans. As 

proposed elsewhere in this rule, VA 

would eliminate copayment liability on 

the part of veterans who use telehealth 

services for VA care; prohibiting 

grantees from charging veterans for 

these services would ensure parity and 

support the ultimate goal of this 

program; to increase veterans’ access to 

care. We also believe this would be 

consistent with current practice. We do 

not believe Congress intended to allow 

grantees to charge veterans for the use 

of telehealth access points; this type of 

decision would be a significant 

departure from other VA care and 

would deter utilization of these 

locations, which would be contrary to 

the goal of increased access. Further, 

section 701 of the Act does not 

authorize the collection of fees by 

grantees, and we do not believe 

Congress would have been silent on 

such a major issue if it had intended for 

grantees to receive such payments. This 

is consistent with the intent of the Act 

and similar to other VA grant programs, 

such as the SSVF program. See 38 CFR 

62.37. 

Section 84.60 Notice of Funding 

Opportunity (NOFO) 

As previously stated in this 

rulemaking, a NOFO would alert 

eligible entities that there are funds 

available for the telehealth grant. 

Proposed § 84.60 would explain what 

would be included in a NOFO. This 

would align with other VA grant 

programs, such as the SSVF program 

(see § 62.40). This would also be 

consistent with the requirements and 

recommendations within 2 CFR part 200 

regarding notices of funding 

opportunity (see 2 CFR 200.204). 

In proposed § 84.60, we would state 

that when funds are available for the 

telehealth grant, VA will publish a 

NOFO. We would also state that VA has 

the authority to modify the duration, 

amount, or both of an existing telehealth 

grant agreement, subject to availability 

of funding and grantee performance, as 

set forth in § 84.65. We would make this 

statement to allow VA to modify an 

existing telehealth grant depending on 

the performance of the grantee to 

provide services at the telehealth access 

point. The NOFO would identify: (1) the 

location for obtaining the applications 

for the telehealth grant; (2) the date, 

time, and place for submitting 

completed telehealth grant applications; 

(3) the estimated amount and type of 

grant funding available; (4) any 

priorities for or exclusions from funding 

to meet the requirements of the 

telehealth grant and VA goals for 

providing telehealth services to 

veterans; (5) the length of term for the 

telehealth grant award; (6) specific point 

values to be awarded for each criterion 

listed in §§ 84.25 and 84.35; (7) the 

minimum number of total points and 

points per category that an applicant or 

grantee, as applicable, must receive for 

a telehealth grant to be funded; (8) any 

maximum award amounts for the 

telehealth grant; (9) the timeframes and 

manner for payments under the 

telehealth grant; and (10) other 

information necessary for the telehealth 

grant application process as determined 

by VA. These provisions would ensure 

that eligible entities have all necessary 

information to submit a complete and 

timely application for a telehealth grant 

under part 84. 

Section 84.65 Telehealth Grant 

Agreements 

As previously explained in this 

rulemaking, section 701(a) of the Act 

provides that VA shall enter into 

agreements, and expand existing 

agreements, with organizations that 

represent or serve veterans, nonprofit 

organizations, private businesses, and 

other interested parties for the 

expansion of telehealth capabilities and 

the provision of telehealth services to 

veterans through the award of grants for 

telehealth. Proposed § 84.65 would 

provide what the telehealth grant 

agreement entails and would align with 

2 CFR 200.201 and other VA grant 

programs, such as the SSVF program. 

See § 62.50. 

Proposed paragraph (a) would apply 

to grant agreements for the initial 

telehealth grant. We would state that 

after an applicant is selected for a 

telehealth grant in accordance with 

§ 84.30, VA will draft a telehealth grant 

agreement to be executed by VA and the 

applicant. Upon execution of the 

telehealth grant agreement, VA would 

obligate grant funds to cover the amount 

of the approved grant, subject to the 

availability of funding. We would also 

state that the telehealth grant agreement 

would provide that the grantee agrees, 

and will ensure that each subcontractor, 

as relevant, agrees, to: (1) operate the 

telehealth access point in accordance 

with the provisions of part 84 and the 

applicant’s telehealth grant application; 

(2) comply with such other terms and 

conditions, including recordkeeping 

and reports for program monitoring and 

evaluation purposes, as VA may 

establish for purposes of providing 

services in a telehealth access point in 

an effective and efficient manner; and 

(3) provide such additional information 

as deemed appropriate by VA. These 

requirements would ensure compliance 

with legal requirements associated with 

the grant and with proper and effective 

administration of a telehealth access 

point. 

Proposed paragraph (b) would apply 

to instances where the grantee has 

already received an initial grant for 

telehealth and is applying for renewal of 

a telehealth grant. We would state that 

after a grantee is selected for renewal of 

a telehealth grant in accordance with 

§ 84.40, VA would draft a telehealth 

grant agreement to be executed by VA 

and the grantee. Upon execution of the 

telehealth grant agreement, VA would 

obligate grant funds to cover the amount 

of the approved telehealth grant, subject 

to the availability of funding. To avoid 

redundancy in regulations, we would 

state that the agreement for the renewal 

of the telehealth grant will contain the 

same provisions described in paragraph 

(a). As with paragraph (a), these 

requirements would ensure compliance 

with legal requirements associated with 

the grant and with proper and effective 

administration of a telehealth access 

point. 


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We would provide in paragraph (c) 

that grantees may not use funds 

provided under part 84 to replace 

Federal, State, Tribal, or local funds 

previously used, or designated for use, 

to establish a telehealth access point. 

Grantees must only use funds for the 

purposes stated in part 84. This is 

necessary to ensure that grant funds are 

not used as a substitute for other 

available resources. 

Lastly, we would provide in proposed 

paragraph (d) that subject to §§ 84.60 

and 84.100, the availability of funding, 

and grantee performance, VA may 

modify an existing telehealth grant 

agreement by one or both of the 

following: (1) extending or reducing the 

period for which the telehealth grant 

was established; and (2) increasing or 

decreasing the amount of funds 

awarded. These modifications would be 

contingent upon the grantee’s provision 

of services at the telehealth access point. 

Also, any extension of funds would be 

provided based on the availability of 

funds. VA would provide in the NOFO 

the terms under which extensions 

would be granted. Any reduction in 

funds or period of the telehealth grant 

agreement would be subject to the 

provisions in § 84.100. 

Section 84.70 Program or Budget 

Change and Corrective Action Plans 

Proposed § 84.70 sets forth the 

requirements for changes to the 

telehealth grant agreement that propose 

significant changes that would alter the 

terms of the agreement. These 

requirements would be similar to how 

VA manages program and budget 

changes and corrective action plans in 

other VA grant programs, such as the 

SSVF program. See § 62.60. The 

requirements would also allow VA to 

ensure that grant funds are used 

appropriately and maintain control over 

the quality of the services provided by 

the grantee. This section is also 

consistent with 2 CFR 200.308, which 

establishes policy and processes for 

revision of budget and program plans 

for Federal awards. VA does not intend 

to waive any modifications that would 

require prior written VA approval as 

authorized by 2 CFR 200.308(e). 

Proposed paragraph (a) would cover 

instances in which a grantee requests a 

modification to their telehealth grant 

agreement. We would state that a 

grantee must submit to VA a written 

request to modify a telehealth grant 

agreement for any proposed significant 

change that will alter the agreement. We 

would also state that if VA approves 

such change, VA will issue a written 

amendment to the telehealth grant 

agreement. In addition, grantees would 

have to receive VA’s approval prior to 

implementing a significant change. This 

would ensure that the grant agreement 

is current and accurate. 

We would state in proposed 

paragraph (a)(1) what would constitute 

a significant change to the telehealth 

grant agreement. A significant change 

would include, but not be limited to, a 

change in the grantee or any 

subcontractors, identified in the 

telehealth grant agreement; a change in 

the area or community served by the 

grantee; or addition or removal of 

equipment, connectivity, or other 

services provided by the grantee; and a 

change in budget line items that are 

more than 10 percent of the total 

telehealth grant award. These are 

common examples of possible changes, 

but they are not an exhaustive list; VA 

proposes to retain flexibility to address 

novel circumstances as they arise. If 

applicants or grantees have questions 

about whether a change would 

constitute a significant change, they 

may contact VA for assistance. 

Proposed paragraph (a)(2) would state 

that VA’s approval of changes would be 

contingent upon the grantee’s amended 

application retaining a high enough 

rank to have been competitively 

selected for funding in the year that the 

application was granted. This would 

ensure that grant funds are used for 

purposes that would have received an 

award if the modified terms had been 

the initially proposed terms. 

We would state in proposed 

paragraph (a)(3) that each telehealth 

grant modification request must contain 

a description of the revised proposed 

use of telehealth grant funds. This, 

again, would ensure that the grant 

agreement accurately reflects the 

intended use of funds and operation of 

the telehealth access point. 

Proposed paragraph (b) would 

provide for corrective action plans that 

a grantee must submit to VA if the 

grantee’s expenditures vary from the 

expenditures listed in the agreement. 

We would state that VA may require 

that the grantee initiate, develop, and 

submit to VA for approval a Corrective 

Action Plan (CAP) if actual telehealth 

grant expenditures vary from the 

amount disbursed to a grantee or actual 

telehealth grant activities vary from the 

telehealth grant agreement. Reporting 

frequency may be on a bi-monthly, 

monthly, or quarterly basis. We would 

add in proposed paragraph (b)(1) that 

the CAP must identify the expenditure 

or activity source that has caused the 

deviation, describe the reason(s) for the 

variance, provide specific proposed 

corrective action(s), and provide a 

timetable for accomplishment of the 

corrective action(s). We would also state 

in proposed paragraph (b)(2) that, after 

receipt of the CAP, VA would send a 

letter to the grantee indicating that the 

CAP is approved or disapproved. If 

disapproved, VA would make beneficial 

suggestions to improve the proposed 

CAP and request resubmission or take 

other actions in accordance with this 

program. This would ensure that grant 

funds are used for appropriate and 

authorized purposes, and that such 

funds are used responsibly. 

Proposed paragraph (c) would provide 

that grantees must inform VA in writing 

of any key personnel changes, local or 

national, (e.g., new executive director, 

telehealth grant program director, or 

chief financial officer) and grantee 

address changes within 30 days of the 

change. This would ensure that critical 

changes that might affect the 

maintenance and operation of the 

telehealth access point are 

communicated to VA in a timely 

manner. 

Section 84.75 Faith-Based 

Organizations 

Proposed § 84.75 would state that 

organizations that are faith-based are 

eligible, on the same basis as any other 

organization, to participate in the 

telehealth grant under part 84 in 

accordance with 38 CFR part 50. Part 50 

explains that faith-based organizations 

are eligible to participate in VA’s grantmaking programs on the same basis as 

any other organizations, that VA will 

not discriminate against faith-based 

organizations in the selection of service 

providers, and that faith-based and 

other organizations may request 

accommodations from program 

requirements and may be afforded such 

accommodations in accordance with 

Federal law. 

VA would apply the provisions of 38 

CFR part 50 to the telehealth grant. 

However, we would not restate the 

provisions of part 50 in proposed part 

84 but would merely cite to it. VA 

recently amended part 50 on March 4, 

2024 (89 FR 15671), and in the event 

that part 50 is further amended in the 

future, VA would not need to amend 

part 84. 

Section 84.80 Financial Management 

Proposed § 84.80 would provide for 

the grantee’s financial management of 

the telehealth grant and would be 

similar to other VA grant programs, 

such as the SSVF program. See § 62.70. 

These provisions are necessary to 

ensure that grantees comply with 

applicable Federal law, regulations, and 

policy and that grant funds are used 

appropriately. 


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Proposed paragraph (a) would state 

that grantees must comply with 

applicable requirements of the Uniform 

Administrative Requirements, Cost 

Principles, and Audit Requirements for 

Federal Awards under 2 CFR part 200. 

As noted previously, 2 CFR part 200 

establishes the uniform administrative 

requirements, cost principles, and audit 

requirements for Federal awards to nonFederal entities. 

Proposed paragraph (b) would state 

that grantees must use a financial 

management system that provides 

adequate fiscal control and accounting 

records and meets the requirements set 

forth in 2 CFR part 200. 

Proposed paragraph (c) would state 

payment up to the amount specified in 

the telehealth grant must be made only 

for allowable, allocable, and reasonable 

costs in establishing, maintaining, and 

operating the telehealth access point. 

We would add that the determination of 

allowable costs must be made in 

accordance with the applicable Federal 

Cost Principles set forth in 2 CFR part 

200. 

Proposed paragraph (d) would state 

that, in accordance with 2 CFR 200.414, 

applicants that do not have a negotiated 

indirect cost rate (NICRA) may (1) 

request a de minimis rate, which is in 

accordance with the amounts set forth 

in 2 CFR 200.414(f). In the alternative, 

applicants may (2) apply the NICRA 

established with their cognizant agency 

for indirect costs (as defined in 2 CFR 

200.1) or may (3) request to negotiate an 

indirect cost rate with VA. 

Section 84.85 Telehealth Grant 

Reports 

Proposed paragraph § 84.85 would 

establish the reporting requirements for 

the telehealth grant. Such reporting 

requirements would ensure that grant 

funds are being used consistent with the 

Act and with part 84. In addition, the 

reports would allow VA to be 

transparent and show that it is being a 

good fiscal steward of the taxpayer 

dollar. Additionally, this is similar to 

how VA administers other grant 

programs such as the SSVF program. 

See § 62.71. Reporting requirements 

tasked to grantees will be in accordance 

with their risk level associated with 

their risk assessment and set forth in the 

NOFO. Examples may include bimonthly, monthly, or quarterly reports 

of grant funding awarded. 

Proposed paragraph (a) would state 

that VA may require grantees to provide, 

in any form as may be prescribed, such 

reports or answers in writing to specific 

questions, surveys, or questionnaires as 

VA determines necessary to carry out 

the telehealth grant. 

Proposed paragraph (b) would state, 

grantees must report on the deviations 

to grant expenditures to VA on a basis 

determined by VA (e.g., bi-monthly, 

monthly, or quarterly) in accordance 

with the results of their risk assessment; 

this would be set forth in the NOFO. We 

would add a note to proposed paragraph 

(b) to direct the reader to information on 

corrective action plans, which may be 

required in this circumstance, and to see 

§ 84.70. 

Proposed paragraph (c) would require 

grantees, at least once per year, to 

submit to VA a report that describes 

grant agreement compliance, legal and 

regulatory compliance, the activities for 

which the telehealth grant funds were 

used, including but not limited to, the 

equipment costs, renovation expenses, 

attendant expenses, any other types of 

ongoing expenses for services provided 

during the year covered by the report, 

and any other information that VA may 

request. 

To be fully informed on how the 

grantee utilizes the telehealth grant 

funds, we would state in proposed 

paragraph (d) that VA may request 

additional reports to allow VA to fully 

assess the provision or coordination of 

the provision of services under part 84. 

Proposed paragraph (e) would state 

that all pages of the reports must cite the 

assigned telehealth grant number and be 

submitted in a timely manner as set 

forth in the grant agreement. 

Proposed paragraph (f) would state 

that grantees agree to allow VA to post 

information from reports on the internet 

or use such information in other ways 

deemed appropriate by VA (including, 

but not limited to, activities regarding 

litigation). Grantees should clearly mark 

confidential information to assist VA in 

redacting such information when 

appropriate. We would expressly call 

out litigation activities as one use for 

which grantees would have to consent 

to VA’s use of information, but we 

emphasize this is not the only 

potentially permissible use. We would 

add that grantees must clearly mark 

information that is confidential to 

individual veterans so VA could 

exclude such information from any 

public use. We do not anticipate that 

any such information would be 

included given the prohibition on the 

retention of records on the veterans who 

use the telehealth access point under 

proposed § 84.50(a), but we propose 

including this language out of an 

abundance of caution. 

Section 84.90 Recordkeeping 

Proposed § 84.90 would provide 

recordkeeping requirements for the 

telehealth grant. This provision would 

be similar to other VA grant programs 

such as the SSVF program (see § 62.72) 

and 2 CFR 200.334, requiring Federal 

award recipients to keep financial 

records, supporting documents, 

statistical records, and all other nonFederal entity records pertinent to a 

Federal award for a three-year retention 

period. We would state that grantees 

must ensure that records are maintained 

for at least a three-year period (unless a 

longer period is otherwise required) to 

document compliance with the 

telehealth grant. We would add that 

grantees must produce such records at 

VA’s request. 

Section 84.95 Technical and 

Technological Assistance 

VA understands that eligible entities 

may need technical assistance in 

complying with requirements of part 84. 

VA currently provides technical 

assistance to other grantees through 

other programs. See, e.g., § 62.73. 

Proposed paragraph (a) would state that 

VA will provide technical assistance, as 

necessary, to eligible entities to meet the 

requirements of part 84. This assistance 

is available to eligible entities, not just 

grantees, and can include assistance 

with applying for a grant under part 84 

or administering a grant awarded under 

part 84. 

In addition, we recognize that 

grantees may sometimes experience 

technological issues or challenges when 

connecting to VA’s secure application 

and may need technological assistance 

throughout the length of the telehealth 

grant agreement. We would state 

proposed paragraph (b), that VA will 

provide technological assistance, as 

necessary, to grantees to ensure that the 

grantee’s equipment is able to connect 

to the VA system and network as 

necessary to support the delivery of 

telehealth services. As noted above, 

proposed § 84.45(a)(1) would require 

that all equipment must be compatible 

with telehealth requirements as 

described in the NOFO and be 

purchased under warranty. The 

provision of technological assistance to 

grantees is implicitly authorized by 

section 701 of the Act, as it would 

frustrate the purpose of this program if 

grantees were experiencing 

technological issues unique to accessing 

VA’s system and VA was unable to 

assist in resolving these issues. This 

assistance is also no different than what 

VA provides for other members of the 

public attempting to use VA platforms 

or networks; if there are service outages 

or disruptions, these issues are reported 

to VA, and VA works to address them 

to restore operability. We emphasize, 

though, as noted above, that this 


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assistance would be limited to VA’s 

secure platform and its network; any 

issues regarding the grantee’s equipment 

or network would not be addressed 

through VA’s technological assistance 

described here. VA encourages grantees 

to purchase warranties and service 

plans, as appropriate, to resolve 

technological issues with their networks 

or equipment. 

Proposed paragraph (c) would state 

that the technical and technological 

assistance will be provided either 

directly by VA or through grants or 

contracts with appropriate public or 

nonprofit private entities. Like 

paragraph (b), this assistance would be 

limited to issues with VA’s platform or 

network. This proposed section would 

align with other VA grant programs, at 

least in relation to the provision of 

technical assistance, while also 

addressing unique issues raised by this 

program. It would also be consistent 

with how VA provides similar support 

to the public with other platforms to 

ensure operability. 

Section 84.100 Withholding, 

Suspension, Deobligation, Termination, 

and Recovery of Funds by VA 

If a grantee fails to comply with the 

terms of the telehealth agreement, VA 

could withhold, suspend, deobligate, 

terminate, or recover grant funds. 

Section 84.100(a) would explain that 

VA would enforce part 84 through such 

actions as may be appropriate. 

Appropriate actions would include 

withholding, suspension, deobligation, 

termination, recovery of funds by VA, 

and actions in accordance with 2 CFR 

part 200. 

Part 200 of 2 CFR describes such 

actions. See 2 CFR 200.208, 200.305, 

200.339 through 200.343, and 200.346. 

As telehealth grants are subject to the 

requirements of 2 CFR part 200, VA 

explicitly references 2 CFR part 200 in 

proposed § 84.100 to ensure that 

grantees understand and know where to 

locate these requirements related to 

withholding, suspension, deobligation, 

termination, and recovery of funds. VA 

refers to 2 CFR part 200 rather than 

include those requirements in this 

section as those requirements in 2 CFR 

part 200 may change. Referencing 2 CFR 

part 200 provides VA the ability to 

implement those changes without 

having to conduct further rulemaking. 

VA acknowledges that when certain 

actions (such as suspension and 

termination) are taken against grantees 

pursuant to this section and 2 CFR part 

200, a disruption in services to veterans 

may occur. We would state in proposed 

§ 84.100(b)(1) that upon taking a remedy 

for noncompliance under paragraph (a), 

grantees have 30 days to object and 

provide information and documentation 

challenging the action, subject to three 

conditions: (1) objections must be 

provided to VA in writing; (2) VA’s 

decision stands while an objection is 

under consideration; and (3) other VA 

decisions (such as competing award 

decisions, continuation award 

decisions, decisions made with the 

consent of the recipient) are not subject 

to this opportunity to object. 

Specifically regarding this third 

condition, VA could begin making other 

decisions, such as reallocating funds 

under an existing or future NOFO. 

We would add in proposed 

§ 84.100(b)(2) that the grant agreement 

will provide additional requirements 

and responsibilities for grantees in the 

event of noncompliance under 

paragraph (a). This will ensure that the 

disruption and impact upon veterans is 

minimized as much as possible. 

Section 84.105 Oversight 

To verify that the telehealth grant is 

utilized in accordance with the 

agreement, VA may inspect the 

telehealth access points and records of 

any entity that has received a telehealth 

grant when VA deems necessary to 

determine compliance with §§ 84.0 

through 84.110. We would state such 

requirement in this section, which 

would align with other VA grant 

programs, such as the SSVF program 

(see § 62.63). We would add that the 

authority to inspect does not authorize 

VA to manage or control the 

organization. We would also state that 

monitoring and oversight requirements 

for each grantee would be determined 

by a pre-award risk assessment under 2 

CFR 200.206. This would reduce the 

burden for complying with oversight 

requests for those grantees whose 

awards are below certain thresholds 

established in the NOFO. 

Section 84.110 Telehealth Grant 

Closeout Procedures 

Proposed § 84.110 would describe the 

telehealth grant closeout procedures. 

Section 84.110 explains that telehealth 

grants would be closed out in 

accordance with 2 CFR part 200. 

Procedures for closing out Federal 

awards are currently located at 2 CFR 

200.344 and 200.345. As telehealth 

grants are subject to the requirements of 

2 CFR part 200, VA explicitly references 

2 CFR part 200 in § 84.110 to ensure that 

grantees understand and know where to 

locate these requirements. VA refers to 

2 CFR part 200 rather than include the 

current citations to those requirements 

or outline the actual closeout 

requirements in this section because 2 

CFR part 200 may change. Referencing 

2 CFR part 200 provides VA the ability 

to implement those changes without 

having to conduct further rulemaking. 

Executive Orders 12866, 13563 and 

14094 

Executive Order 12866 (Regulatory 

Planning and Review) directs 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). 

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 

14094 (Executive Order on Modernizing 

Regulatory Review) supplements and 

reaffirms the principles, structures, and 

definitions governing contemporary 

regulatory review established in 

Executive Order 12866 of September 30, 

1993 (Regulatory Planning and Review), 

and Executive Order 13563 of January 

18, 2011 (Improving Regulation and 

Regulatory Review). The Office of 

Information and Regulatory Affairs has 

determined that this rulemaking is not 

a significant regulatory action under 

Executive Order 12866, as amended by 

Executive Order 14094. The Regulatory 

Impact Analysis associated with this 

rulemaking can be found as a 

supporting document at 

www.regulations.gov. 

Regulatory Flexibility Act 

The Secretary hereby certifies that 

this proposed rule will not have a 

significant economic impact on 

participating eligible entities who are 

awarded grants by VA or small 

businesses. To the extent there is any 

such impact, it will result in financial 

assistance and revenue for them as they 

purchase, upgrade, or install new 

technologies or infrastructure. 

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

the initial and final regulatory flexibility 

analysis requirements of 5 U.S.C. 603 

and 604 do not apply. 

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 the 

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 


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one year. This proposed rule would 

have no such effect on State, local, and 

Tribal governments, or on the private 

sector. 

Paperwork Reduction Act 

This proposed rule includes 

provisions constituting a new collection 

of information under the Paperwork 

Reduction Act of 1995 (44 U.S.C. 3501– 

3521) that require approval by the Office 

of Management and Budget (OMB). 

Accordingly, under 44 U.S.C. 3507(d), 

VA has submitted a copy of this 

rulemaking action to OMB for review 

and approval. 

OMB assigns control numbers to 

collections 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 currently valid OMB control 

number. If OMB does not approve the 

collection of information as requested, 

VA will immediately remove the 

provisions containing the collection of 

information or take such other action as 

is directed by OMB. 

Comments on the new collection of 

information contained in this 

rulemaking should be submitted 

through www.regulations.gov. 

Comments should indicate that they are 

submitted in response to ‘‘RIN 2900– 

AS20; Telehealth Grant Program’’ and 

should be sent within 60 days of 

publication of this rulemaking. The 

collection of information associated 

with this rulemaking can be viewed at: 

www.reginfo.gov/public/do/PRAMain. 

OMB is required to make a decision 

concerning the collection of information 

contained in this rulemaking between 

30 and 60 days after publication of this 

rulemaking in the Federal Register (FR). 

Therefore, a comment to OMB is best 

assured of having its full effect if OMB 

receives it within 30 days of 

publication. This does not affect the 

deadline for the public to comment on 

the provisions of this rulemaking. 

The Department considers comments 

by the public on new collections of 

information in: 

• Evaluating whether the new 

collections of information are necessary 

for the proper performance of the 

functions of the Department, including 

whether the information will have 

practical utility; 

• Evaluating the accuracy of the 

Department’s estimate of the burden of 

the new collection of information, 

including the validity of the 

methodology and assumptions used; 

• Enhancing the quality, usefulness, 

and clarity of the information to be 

collected; and 

• Minimizing the burden of the 

collection of information on those who 

are to respond, including through the 

use of appropriate automated, 

electronic, mechanical, or other 

technological collection techniques or 

other forms of information technology, 

e.g., permitting electronic submission of 

responses. 

The collections of information 

associated with this rulemaking 

contained in 38 CFR 84.15, 84.50, 84.75, 

and 84.85 are described immediately 

following this paragraph, under its 

respective title. 

Title: Telehealth Grant Program Grant 

Application. 

OMB Control No.: 2900–TBD (New). 

CFR Provision: 38 CFR 84.15. 

• Summary of collection of 

information: The new collection of 

information in 38 CFR 84.15 requires 

that applications be submitted to be 

evaluated and considered for a grant 

under new part 84. Applications require 

specific information so that VA can 

properly evaluate such applications for 

telehealth grants. We note that the 

average burden per response is the 

highest threshold requirement, but this 

estimate would be a lower time burden 

for lower threshold applicants. 

• Description of need for information 

and proposed use of information: This 

collection of information is necessary to 

award telehealth grants to eligible 

entities. 

• Description of likely respondents: 

Organizations that represent or serve 

veterans, nonprofit organizations, 

private businesses, and other interested 

parties for the expansion of telehealth 

capabilities and the provision of 

telehealth services to veterans through 

the award of telehealth grants. 

• Estimated number of respondents: 

65. 

• Estimated frequency of responses: 

Once annually. 

• Estimated average burden per 

response: 1500 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 1625 hours. 

• * Estimated annual cost to 

respondents: $51,155.00. 

Title: Telehealth Grant Program Grant 

Renewal Application. 

OMB Control No.: 2900–TBD (New). 

CFR Provision: 38 CFR 84.15. 

• Summary of collection of 

information: The new collection of 

information in 38 CFR 84.15 requires 

that renewal applications be submitted 

to be evaluated and considered for a 

renewal of a grant under new part 84. 

Applications require specific 

information so that VA can properly 

evaluate such applications for renewal 

of telehealth grants. We note that the 

average burden per response is the 

highest threshold requirement, but this 

estimate would be a lower time burden 

for lower threshold applicants. 

• Description of need for information 

and proposed use of information: This 

collection of information is necessary to 

award renewal telehealth grants to 

grantees. 

• Description of likely respondents: 

Grantees that seek renewal of their 

telehealth grant. 

• Estimated number of respondents: 

50. 

• Estimated frequency of responses: 

Once annually. 

• Estimated average burden per 

response: 600 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 500 hours. 

• *Estimated annual cost to 

respondents: $15,740.00. 

Title: Telehealth Grant Program 

Veterans Satisfaction Survey. 

OMB Control No.: 2900–TBD (New). 

CFR Provision: 38 CFR 84.50. 

• Summary of collection of 

information: The new collection of 

information in 38 CFR 84.50 requires 

grantees to conduct satisfaction surveys 

from veterans. 

• Description of need for information 

and proposed use of information: The 

collection of information by VA is 

necessary to evaluate whether veterans 

are satisfied with the services provided 

by the grantee and the effectiveness of 

such services. 

• Description of likely respondents: 

Veterans who receive telehealth services 

at telehealth access points. 

• Estimated number of respondents: 

500. 

• Estimated frequency of responses: 

Once annually. 

• Estimated average burden per 

response: 5 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 42 hours. 

• * Estimated annual cost to 

respondents: $1,322.16. 

Title: Telehealth Grant Program 

Grantee Satisfaction Survey. 

OMB Control No.: 2900–XXXX (New/ 

TBD). 

CFR Provision: 38 CFR 84.85. 

Summary of collection of information: 

The new collection of information in 38 

CFR 84.85 has been developed to 

capture telehealth grantee reports. As 

stated, VA may require grantees to 

provide, in any form as may be 

prescribed, reports or answers in writing 

to specific questions, surveys, or 

questionnaires as VA determines 

necessary to carry out the telehealth 

grant program and agreement. 


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• Description of need for information 

and proposed use of information: This 

collection of information is necessary to 

provide more effective customer service 

and identify areas of improvement. 

• Description of likely respondents: 

Grantees. 

• Estimated number of respondents: 

50. 

• Estimated frequency of responses: 

Once annually. 

• Estimated average burden per 

response: 20 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 17 hours. 

• * Estimated annual cost to 

respondents: $535.16. 

Title: Telehealth Grant Program 

Annual Performance Report. 

OMB Control No.: 2900–XXXX (New/ 

TBD). 

CFR Provision: 38 CFR 84.85. 

• Summary of collection of 

information: The new collection of 

information in 38 CFR 84.85 requires 

grantees to provide reports, as VA 

requests, to assess the provision of 

services under this grant program. 

• Description of need for information 

and proposed use of information: The 

collection of information is necessary to 

determining compliance with the 

requirements for the telehealth grant 

program and agreement and to assess 

the provision of services under this 

grant program and the grant agreement. 

• Description of likely respondents: 

Grantees. 

• Estimated number of respondents: 

50. 

• Estimated frequency of responses: 

Once annually. 

• Estimated average burden per 

response: 45 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 38 hours. 

• * Estimated annual cost to 

respondents: $1,196.24. 

Title: Telehealth Grant Program Other 

Performance Report. 

OMB Control No.: 2900–XXXX (New/ 

TBD). 

CFR Provision: 38 CFR 84.85. 

• Summary of collection of 

information: The new collection of 

information in 38 CFR 84.85 requires 

grantees to provide reports, as VA 

requests, to assess the provision of 

services under this grant program. 

• Description of need for information 

and proposed use of information: The 

collection of information is necessary to 

determine compliance with the 

requirements for the telehealth grant 

and to assess the provision of services 

under this grant program and the grant 

agreement. 

• Description of likely respondents: 

Grantees. 

• Estimated number of respondents: 

50. 

• Estimated frequency of responses: 2 

times annually. 

• Estimated average burden per 

response: 30 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 50 hours. 

• * Estimated annual cost to 

respondents: $1,574.00. 

Title: Telehealth Grant Program 

Annual Financial Expenditure Report. 

OMB Control No.: 2900–XXXX (New/ 

TBD). 

CFR Provision: 38 CFR 84.85. 

Summary of collection of information: 

The new collection of information in 38 

CFR 84.85 requires grantees to provide 

reports, as VA requests, to assess the 

provision of services under this grant 

program. At least once per year, each 

grantee must submit to VA a report that 

describes grant agreement compliance, 

legal and regulatory compliance, the 

activities for which the telehealth grant 

funds were used including, but not 

limited to, the equipment costs, 

renovation expenses, attendant 

expenses, any other types of ongoing 

expenses for services provided during 

the year covered by the report, and any 

other information that VA may request. 

• Description of need for information 

and proposed use of information: The 

collection of information is necessary to 

determine compliance with the 

requirements for the telehealth grant 

and to assess the ongoing expenditures 

under this grant program and the grant 

agreement. 

• Description of likely respondents: 

Grantees. 

• Estimated number of respondents: 

50. 

• Estimated frequency of responses: 

Once annually. 

• Estimated average burden per 

response: 45 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 38 hours. 

• * Estimated annual cost to 

respondents: $1,196.24. 

Title: Telehealth Grant Program Other 

Financial Expenditure Report. 

OMB Control No.: 2900–XXXX (New/ 

TBD). 

CFR Provision: 38 CFR 84.85. 

• Summary of collection of 

information: The new collection of 

information in 38 CFR 84.85 requires 

grantees to provide reports, as VA 

requests, to assess the provision of 

services under this grant program. If 

actual telehealth grant expenditures 

vary from the amount disbursed to a 

grantee or actual telehealth grant 

activities vary from the grantee’s 

program description provided in the 

telehealth grant agreement, grantees 

must report the deviation to VA. 

Reporting frequency may be on a bimonthly, monthly, or quarterly basis. 

For the frequency of responses, we 

estimate that this reporting would be on 

a quarterly basis. We note that the 

average burden per response is the 

highest threshold requirement, but this 

estimate would be a lower time burden 

for lower threshold applicants. 

• Description of need for information 

and proposed use of information: The 

collection of information is necessary to 

determining compliance with the 

requirements for the telehealth grant 

and to assess the provision of services 

and the ongoing expenditures under this 

grant program and the grant agreement. 

• Description of likely respondents: 

Grantees. 

• Estimated number of respondents: 

50. 

• Estimated frequency of responses: 

Quarterly = 4 times annually. 

• Estimated average burden per 

response: 30 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 100 hours. 

• * Estimated annual cost to 

respondents: $3148.00. 

Title: Compliance—Program & Budget 

Changes. 

OMB Control No.: 2900–XXXX (New/ 

TBD). 

CFR Provision: 38 CFR 84.70 and 

84.85. 

• Summary of collection of 

information: The new collection of 

information in 38 CFR 84.85 requires 

grantees to provide reports, as VA 

requests, to assess the provision of 

services under this grant program. These 

compliance reports also include 

program changes and corrective action 

plans under 38 CFR 84.70. 

• Description of need for information 

and proposed use of information: The 

collection of information is necessary to 

determine compliance with the 

requirements for the telehealth grant 

and to assess the provision of services 

under this grant program and the grant 

agreement. 

• Description of likely respondents: 

Grantees. 

• Estimated number of respondents: 

10. 

• Estimated frequency of responses: 2 

times annually. 

• Estimated average burden per 

response: 15 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 5 hours. 

• * Estimated annual cost to 

respondents: $157.40. 

Title: Compliance—Corrective Action 

Plan. 


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OMB Control No.: 2900–XXXX (New/ 

TBD). 

CFR Provision: 38 CFR 84.70 and 

84.85. 

• Summary of collection of 

information: The new collection of 

information in 38 CFR 84.85 requires 

grantees to provide reports, as VA 

requests, to assess the provision of 

services under this grant program. These 

compliance reports also include 

program changes and corrective action 

plans under 38 CFR 84.70. 

• Description of need for information 

and proposed use of information: The 

collection of information is necessary to 

determine compliance with the 

requirements for the telehealth grant 

and to assess the provision of services 

under this grant program and the grant 

agreement. 

• Description of likely respondents: 

Grantees. 

• Estimated number of respondents: 

5. 

• Estimated frequency of responses: 

Once annually. 

• Estimated average burden per 

response: 30 minutes. 

• Estimated total annual reporting 

and recordkeeping burden: 3 hours. 

• * Estimated annual cost to 

respondents: $94.44. 

• * The total respondent information 

collection burden cost associated with 

this regulation is estimated to be 

$76,118.64 (2,418 burden hours × 

$31.48 per hour). To estimate the total 

information collection burden cost, VA 

used the 2023 Bureau of Labor Statistics 

(BLS) mean hourly wage for hourly 

wage for ‘‘all occupations’’ of $31.48 per 

hour. This information is available at 

https://www.bls.gov/oes/current/oes_

nat.htm. 

Assistance Listing 

The Assistance Listing number and 

title for the program affected by this 

document is 64.009, Veterans Medical 

Care Benefits. 

List of Subjects 

38 CFR Part 17 

Administrative practice and 

procedure, Health care, Health facilities, 

Mental health programs, Veterans. 

38 CFR Part 84 

Administrative practice and 

procedure, Government contracts, Grant 

programs—health, Grant programs— 

veterans, Health care, Health facilities, 

Health professions, Health records, 

Veterans. 

Signing Authority 

Denis McDonough, Secretary of 

Veterans Affairs, approved and signed 

this document on October 31, 2024, 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. 

Luvenia Potts, 

Regulation Development Coordinator, Office 

of Regulation Policy & Management, Office 

of General Counsel, Department of Veterans 

Affairs. 

For the reasons stated in the 

preamble, the Department of Veterans 

Affairs proposes to amend 38 CFR 

chapter I as follows: 

PART 17—MEDICAL 

■ 1. The authority citation for part 17 

continues to read, in part, as follows: 

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

specific sections. 

* * * * * 

■ 2. Amend § 17.108 by revising 

paragraph (e)(16) to read as follows: 

§ 17.108 Copayments for inpatient hospital 

care and outpatient medical care. 

* * * * * 

(e) * * * 

(16) Telehealth visits; 

* * * * * 

■ 3. Add part 84 to read as follows: 

PART 84—TELEHEALTH GRANT 

PROGRAM 

Sec. 

84.0 Purpose. 

84.5 Definitions. 

84.10 Eligible entity. 

84.15 Application. 

84.20 Threshold requirements prior to 

scoring telehealth grant applicants. 

84.25 Scoring criteria for the telehealth 

grant applicants. 

84.30 Selection of applicants to receive a 

telehealth grant. 

84.35 Scoring criteria for grantees applying 

for renewal of telehealth grants. 

84.40 Selecting grantees for renewal of 

telehealth grants. 

84.45 Awards for telehealth grants. 

84.50 General operation requirements. 

84.55 Fee prohibition. 

84.60 Notice of Funding Opportunity. 

84.65 Telehealth grant agreements. 

84.70 Program or budget changes and 

Corrective Action Plans. 

84.75 Faith-based organizations. 

84.80 Financial management. 

84.85 Telehealth grant reports. 

84.90 Recordkeeping. 

84.95 Technical and technological 

assistance. 

84.100 Withholding, suspension, 

deobligation, termination, recovery of 

funds by VA, and disposition of property 

or equipment. 

84.105 Oversight. 

84.110 Telehealth grant closeout 

procedures. 

Authority: 38 U.S.C. 501 and sec. 701, 

Pub. L. 116–171, 134 Stat. 778 (38 U.S.C. 

1701 (note)). 

§ 84.0 Purpose. 

The purpose of this part is to establish 

the telehealth grant program. The 

Department of Veterans Affairs (VA) 

will enter into agreements, and expand 

existing agreements, with eligible 

entities for the expansion of telehealth 

capabilities and the provision of 

telehealth services to veterans through 

the award of grants. Through the award 

of these grants, grantees will offer 

veterans a convenient space to connect 

with a VA health care professional 

through video telehealth in comfortable 

private locations in communities where 

veterans may otherwise have long travel 

times to VA medical facilities, may have 

poor internet connectivity in their 

homes, or may face other barriers to 

accessing health care. The telehealth 

access point is not intended to be used 

by veterans who are in need of 

emergency health care services. This 

part only applies to telehealth grant 

agreements; however, VA may enter into 

an agreement for the establishment of a 

telehealth access point for veterans with 

an eligible entity that seeks to establish 

such an access point but does not 

require grant funding under this part. 

§ 84.5 Definitions. 

The following definitions apply to 

this part and any Notice of Funding 

Opportunity (NOFO) issued under this 

part: 

Applicant means an eligible entity 

that submits an application for a grant 

announced in a NOFO under this part. 

Date of completion means the earliest 

of the following dates: 

(1) The date specified in the 

telehealth grant agreement, or any 

supplement or amendment thereto; or 

(2) The effective date of a telehealth 

grant termination under § 84.110. 

Eligible entity means an entity that 

meets the requirements under § 84.10. 

Grantee means an eligible entity that 

is awarded a telehealth grant under this 

part. 

Medically underserved means an area 

that is designated under 42 U.S.C. 

254b(b)(3). 

Nonprofit organization has the 

meaning as given to this term in 2 CFR 

200.1. 

Notice of Funding Opportunity 

(NOFO) has the meaning as given to this 

term in 2 CFR 200.1. 

Rural and highly rural area means an 

area or community that is designated as 

such by the Rural-Urban Commuting 

Areas coding system of the U.S. 

Department of Agriculture. 


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Subcontractor means any entity or 

organization that has a contract 

agreement to furnish services at the 

telehealth access point. Subcontractors 

do not include individuals who build 

the access point (e.g., entities who are 

hired to paint or put up walls or 

partitions) or provide technical services 

(e.g., commercial internet providers or 

electric services). 

Telehealth access point means a nonVA site supported by a telehealth grant 

where a veteran can participate in a 

telehealth visit with a VA health care 

professional. 

Telehealth grant means a grant 

awarded under this part. 

§ 84.10 Eligible entity. 

To be eligible to receive a telehealth 

grant, an entity must be: 

(a) An organization that represents or 

serves veterans; 

(b) A nonprofit organization; 

(c) A private business; 

(d) A State or local government; or 

(e) Other interested party. 

§ 84.15 Application. 

(a) General. An applicant must submit 

to VA a complete grant application 

package, as described in the NOFO. The 

NOFO may include different application 

requirements based on a range of 

funding thresholds. For example, grant 

applications for technology and 

equipment, infrastructure upgrades, and 

sustainment may follow different 

application requirements. The 

requirements in this section represent 

the most extensive requirements that 

applicants would need to meet. 

(b) Content of application. The 

telehealth grant application package 

will require the following: 

(1) A plan to establish, if needed, the 

telehealth access point (or evidence that 

a telehealth access point has already 

been established) and a description of 

how the size, scope, and grant 

management plan are feasible; 

(2) Supporting documentation 

consisting of the following: 

(i) The type of entity that is applying 

for the telehealth grant pursuant to 

§ 84.10; 

(ii) A proposed operating budget; 

(iii) Supportive resources committed 

to the project, which includes, but is not 

limited to, space, staffing, equipment, 

internet services, phone services, and 

furniture; 

(iv) The applicant’s ability to control 

the telehealth access point and meet 

appropriate zoning, preservation, 

accessibility, safety, and environmental 

laws; 

(v) A description of the geographic 

area that the telehealth access point will 

serve (include the name(s) of the 

municipalities, counties (or parishes), or 

Tribal lands); and 

(vi) An attestation that the facilities 

will be used principally to provide to 

veterans the services for which the 

project was designed; 

(3) Documentation evidencing the 

experience of the applicant and any 

identified subcontractors relevant to 

creating an environment to provide 

telehealth services or organizational 

experience working with veterans; 

(4) A statement from the applicant 

asserting that all of the following are 

true: 

(i) The project will furnish veterans a 

telehealth access point that is private, 

secure, clean, accessible, and meets the 

requirements of this grant; 

(ii) The applicant will continue to 

maintain and operate the telehealth 

access point supported by this grant 

until the expiration of the period during 

which VA could seek full recovery 

under § 84.100; 

(iii) The title or lease to the point will 

lie with the applicant and the applicant 

will, at a minimum, provide the 

equivalent insurance coverage for real 

property and equipment acquired or 

improved with Federal funds as 

provided to property owned by the 

applicant. Telehealth access points that 

are located in federally owned property 

(e.g., Federally Qualified Health 

Centers, Department of Defense, and 

Indian Health Services) need not be 

insured unless required by the terms 

and conditions of the Federal property 

award; 

(iv) Adequate financial support will 

be available for the duration of the grant 

agreement that must be supported by a 

demonstration of financial stability and 

a detailed project budget, which 

includes, but is not limited to, all 

existing and anticipated sources of 

funds for the project; and 

(v) The applicant will keep records 

and submit reports as VA may 

reasonably require, within the 

timeframes required, and, upon 

demand, allow VA access to the records 

upon which such information is based; 

(5) Documentation of the managerial 

capacity of the applicant to: 

(i) Maintain and operate a telehealth 

access point where veterans who use the 

telehealth access point can receive high 

quality telehealth care from VA health 

care professionals; 

(ii) Continuously assess the needs of 

the telehealth access point and the 

veterans who use the telehealth access 

point for quality improvement in areas 

such as accessibility, satisfaction, and 

experience; 

(iii) Customize the telehealth access 

point to meet the needs of veterans who 

use the telehealth access point; and 

(iv) Comply with and implement the 

requirements of the telehealth grant; and 

(6) Any additional information in 

writing relevant to the telehealth grant 

application as requested by VA. 

(c) Renewal application. Subject to 

funding availability, grantees may apply 

for one renewal grant per fiscal year, 

after receiving an initial grant. The 

grantee must submit to VA a complete 

renewal application as described in the 

NOFO. 

(The Office of Management and 

Budget has approved the information 

collection provisions in this section 

under control number 2900–TBD.) 

§ 84.20 Threshold requirements prior to 

scoring for the telehealth grant applicants. 

VA will only score applicants that 

meet the following threshold 

requirements: 

(a) The application is filed within the 

time period established in the NOFO, 

and any additional information or 

documentation requested by VA under 

§ 84.15(b)(6) is provided within the time 

frame established by VA; 

(b) The application is completed in all 

parts; 

(c) The applicant meets the eligibility 

criteria in § 84.10; 

(d) The activities for which the 

telehealth grant is requested are eligible 

for funding under this grant under 

§ 84.45; 

(e) The veterans the applicant 

proposes to serve are eligible to receive 

telehealth services under title 38 of the 

United States Code; 

(f) The applicant agrees to comply 

with the requirements of the telehealth 

grant; 

(g) The applicant does not have an 

outstanding obligation to the Federal 

Government that is in arrears and does 

not have an overdue or unsatisfactory 

response to an audit; and 

(h) The applicant is not in default by 

being in non-compliance with the terms 

and conditions of the agreement of any 

previous Federal assistance. 

§ 84.25 Scoring criteria for the telehealth 

grant applicants. 

VA will score applicants who are 

applying for a telehealth grant. VA will 

set forth specific point values to be 

awarded for each criterion in the NOFO. 

VA will use the following criteria to 

score applicants who are applying for a 

telehealth grant: 

(a) VA will award points based on the 

background, qualifications, experience, 

and past performance of the applicant 

and any subcontractors identified by the 


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applicant, if relevant, as demonstrated 

by the following: 

(1) Background and organizational 

history. (i) Applicant’s and any 

identified subcontractors’ background 

and organizational history that would 

help them maintain and operate a 

telehealth access point for veterans. 

(ii) Evidence that the applicant, and 

any identified subcontractors, maintain 

organizational structures with clear 

lines of reporting and defined 

responsibilities. 

(iii) Applicant’s, and any identified 

subcontractors’, history of complying 

with agreements and not defaulting on 

financial obligations. 

(2) Staff qualifications. (i) Applicant’s 

staff, and any identified subcontractors’ 

staff, have experience working with 

veterans or health care recipients. 

(ii) Applicant’s staff, and any 

identified subcontractors’ staff, have 

organizational experience in 

establishing an environment suitable for 

providing health care services. 

(3) Organizational qualifications and 

past performance. (i) Applicant, and 

any identified subcontractors, have 

experience partnering with health care 

organizations to create an environment 

to provide telehealth services. 

(ii) Applicant, and any identified 

subcontractors, have organizational 

experience coordinating or 

administering telehealth services. 

(iii) Applicant, and any identified 

subcontractors, have organizational 

experience working with veterans. 

(b) VA will award points based on the 

applicant’s plan to establish, maintain, 

and operate the telehealth access point, 

as demonstrated by the following: 

(1) Need for program. (i) Applicant 

demonstrates a need for the telehealth 

access point in a rural, highly rural, or 

medically underserved area, to the 

extent practicable, where the telehealth 

access point will be located. 

(ii) Applicant demonstrates an 

understanding of the area and provides 

evidence that a telehealth access point 

is needed to meet the unique needs of 

veterans and the community to be 

served. 

(2) Outreach plan. Applicant has a 

feasible communications plan to inform 

veterans about the telehealth access 

point and the services provided. 

(3) Plan to establish the telehealth 

access point. (i) Applicant’s plan to 

establish, maintain, and operate the 

telehealth access point and a 

description of how the size, scope, and 

grant management plan are feasible. 

(ii) Applicant’s program is designed 

and scoped to meet the needs of 

veterans in their community through the 

provision of telehealth services. We 

would consider whether the telehealth 

access point availability provides 

flexible hours of operation to maximize 

the telehealth access point’s utilization. 

(4) Implementation timeline. (i) 

Applicant’s plan to establish, maintain, 

and operate a telehealth access point 

and use grant funding within the 

timeline specified in their application. 

(ii) Applicant has a hiring plan in 

place to meet the applicant’s 

implementation timeline or has existing 

staff to meet such timeline, if necessary. 

(5) Collaboration and communication 

with VA. The applicant must submit a 

letter of support from a local VA 

medical facility or facilities confirming 

the need for the telehealth access point 

and the intent of such facility or 

facilities to work with the applicant if 

the applicant is awarded a grant. 

(6) Capacity to maintain and operate 

a telehealth access point. Applicant has 

sufficient capacity, including staff 

resources, to safely maintain and 

operate a telehealth access point. 

(7) Sustainment plan. The applicant 

has a feasible plan to sustain telehealth 

access point operations. 

(c) VA will award points based on the 

applicant’s quality assurance and 

evaluation plan, as demonstrated by the 

following: 

(1) Program evaluation. (i) Applicant 

has created clear, realistic, and 

measurable goals that reflect the grant’s 

aim of providing a telehealth access 

point to veterans against which the 

applicant’s program performance can be 

evaluated. 

(ii) Applicant plans to continually 

assess the telehealth access point to 

identify opportunities for quality 

improvement in areas such as 

accessibility, satisfaction, and 

experience. 

(2) Monitoring. (i) Applicant has 

adequate controls in place to regularly 

monitor all aspects of the execution of 

the grant, including any subcontractors, 

for compliance with all applicable laws, 

regulations, and guidelines. 

(ii) Applicant has a plan to provide an 

environment that is private, secure, 

clean, and complies with the Americans 

with Disabilities Act of 1990 (42 U.S.C. 

12101 et seq.) where veterans can 

participate in their telehealth 

appointments. 

(iii) Applicant has adequate financial 

and operational controls in place to 

ensure the proper use of telehealth grant 

funding. 

(iv) Applicant has a plan for ensuring 

that their staff and any subcontractors 

are appropriately trained on, and the 

telehealth access point maintains 

compliance with, all fire and safety 

requirements as specified by State and 

local laws and regulations. 

(3) Remediation. Applicant has a plan 

to establish a system to remediate 

aspects of the grant program that are 

non-compliant with the terms of 

telehealth grant agreement when they 

are identified. 

(4) Management and reporting. 

Applicant’s program management team 

has the capability and a system in place 

to provide to VA timely and accurate 

reports at the frequency set by VA. 

(d) VA will award points based on the 

applicant’s financial capability and 

plan, as demonstrated by the following: 

(1) Organizational finances. 

Applicant, and any identified 

subcontractors, are financially stable. 

(2) Financial feasibility of utilizing 

telehealth grant funds. (i) Applicant has 

a realistic budget for utilizing grant 

funding and will submit their 

implementation timeframe to operate 

the telehealth access point. 

(ii) Applicant’s program is costeffective and can be effectively and fully 

implemented on-budget. 

(e) VA will award points based on the 

applicant’s area or community 

associations and relations, as 

demonstrated by the following: 

(1) Area or community associations. 

Applicant has a plan for developing 

associations or has existing experience 

with Federal (including VA), State, 

local, and Tribal government agencies, 

and private entities for the purposes of 

providing a telehealth access point to 

veterans, as applicable. 

(2) Past working relationships. 

Applicant (or applicant’s staff), and any 

identified subcontractors (or 

subcontractors’ staff), as relevant, have 

fostered successful working 

relationships and experience with 

public and private organizations 

providing services to veterans. 

(3) Local presence and knowledge. (i) 

Applicant has a presence in the area or 

community they intend to serve; and 

(ii) Applicant understands the 

dynamics of the area or community they 

intend to serve. 

(4) Integration of experience and plan 

to establish the telehealth access point. 

Applicant’s experience in the area or 

community they intend to serve will 

enhance the effectiveness of the 

applicant’s program. 

§ 84.30 Selection of applicants to receive a 

telehealth grant. 

VA will use the following process to 

select applicants to receive telehealth 

grants: 

(a) VA will score all applicants that 

meet the threshold requirements set 

forth in § 84.20 using the scoring criteria 

set forth in § 84.25. 


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(b) VA will group applicants within 

the applicable funding priorities if 

funding priorities are set forth in the 

NOFO. 

(c) VA will rank those applicants who 

receive at least the minimum amount of 

total points and points per category set 

forth in the NOFO, within their 

respective funding priority group, if 

any. The applicants will be ranked in 

order from highest to lowest scores, 

within their respective funding priority 

group, if any. 

(d) VA will use the applicant’s 

ranking as the primary basis for 

selection for funding. However, VA will 

prioritize entities that serve veterans in 

rural and highly rural areas or areas 

determined to be medically 

underserved, to the extent practicable. 

(e) Subject to paragraph (d) of this 

section, VA will fund the highestranked applicants for which funding is 

available, within the highest funding 

priority group, if any. If multiple 

applications are received from the same 

geographic area, the applicants’ 

rankings will be the primary basis for 

selection. If funding priorities have been 

established, to the extent funding is 

available, and still subject to paragraph 

(d), VA will select applicants in the next 

highest funding priority group based on 

their rank within that group. 

(f) If an applicant would have been 

selected but for a procedural error 

committed by VA, VA may select that 

applicant for funding in the next 

applicable funding round or when 

sufficient funds otherwise become 

available (provided the applicant still 

wants to participate in the program). If 

there is no material change in the 

information, a new application would 

not be required. 

§ 84.35 Scoring criteria for grantees 

applying for renewal of telehealth grants. 

VA will score applicants who are 

applying for a renewal of a telehealth 

grant. VA will set forth specific point 

values to be awarded for each criterion 

in the NOFO. VA will use the following 

criteria to score grantees applying for 

renewal of a telehealth grant: 

(a) VA will award points based on the 

success of the grantee’s program, as 

determined by VA. Success would be 

measured by: 

(1) Veteran satisfaction with the 

services provided by the grantee; and 

(2) How the grantee met the telehealth 

grant goals and requirements for VA to 

deliver telehealth services to veterans at 

that telehealth access point in 

accordance with the agreement. 

(b) VA will award points based on the 

cost-effectiveness of the grantee’s 

program, as demonstrated by how: 

(1) The hours for the point attendant 

correlate with the veterans’ telehealth 

appointments; and 

(2) The telehealth access point was 

implemented effectively using the 

available funding in the designated 

timeframe. 

(c) VA will award points based on the 

extent to which the grantee complies 

with applicable laws, regulations, and 

guidelines for the administration of the 

telehealth access point. 

§ 84.40 Selecting grantees for renewal of 

telehealth grants. 

VA will use the following process to 

select grantees applying for renewal of 

telehealth grants: 

(a) Provided the grantee continues to 

meet the threshold requirements set 

forth in § 84.20, VA will score the 

grantee using the scoring criteria set 

forth in § 84.35. 

(b) VA will rank those grantees who 

receive at least the minimum amounts 

of total points and points per category 

set forth in the NOFO. The grantees will 

be ranked in order from highest to 

lowest scores within their respective 

funding priority group, if applicable. 

(c) VA will use the grantee’s ranking 

as the primary basis for selection for 

funding. However, VA will prioritize 

entities that serve veterans in rural and 

highly rural areas or areas determined to 

be medically underserved, to the extent 

practicable. VA will fund the highestranked grantees for which funding is 

available within their respective 

funding priority group, if applicable. 

(d) At its discretion, VA may award 

any deobligated funds to an applicant or 

existing grantee. If VA chooses to award 

deobligated funds to an applicant or 

existing grantee, funds will be awarded 

as follows: 

(1) VA may offer to award the 

deobligated funds to the applicant or 

grantee with the highest grant score 

under the relevant NOFO that applies 

for, or is awarded a renewal grant in, the 

same community as, or a proximate 

community to, the affected community. 

Such applicant or grantee must have the 

capacity and agree to provide prompt 

services to the affected community. 

Under this section, the relevant NOFO 

is the most recently published NOFO 

which covers the geographic area that 

includes the affected community. 

(2) If the first such applicant or 

grantee offered the deobligated funds 

refuses the funds, VA may offer to 

award the funds to the next highestranked such applicant or grantee, per 

the criteria in paragraph (d)(1) of this 

section, and continue on in rank order 

until the deobligated funds are awarded. 

(3) VA, at its discretion, may choose 

to award the deobligated funds under 

other conditions, or may choose to not 

award the deobligated funds at all, 

when VA determines appropriate based 

on consideration of other relevant 

factors. 

(e) If a grantee would have been 

selected but for a procedural error 

committed by VA, VA may select that 

grantee for funding in the next 

applicable funding round or when 

sufficient funds otherwise become 

available (provided the applicant still 

wants to participate in the program). If 

there is no material change in the 

information, a new application would 

not be required. 

§ 84.45 Awards for telehealth grants. 

(a) Use of funds. Telehealth grants 

may be used for one or more of the 

following: 

(1) Purchasing, replacing, or 

upgrading hardware or software solely 

dedicated to the telehealth grant 

program necessary for the provision of 

secure and private telehealth services. 

Equipment and software must be 

compatible with telehealth requirements 

as described in the NOFO and must be 

purchased under warranty. Funds may 

be used to purchase services to 

configure and set up grantee-purchased 

equipment. VA will provide direct 

technical support for initial connection 

to a VA-secure application, and 

continued VA technical support for 

issues that may arise with the 

connection to the VA-secure application 

during the term of the grant. 

(2) Upgrading security protocols for 

consistency with VA security 

requirements and digital applications, 

as described in the NOFO. 

(3) Payment for the training of 

telehealth access point attendants, 

including payment of those attendants 

for completing that training, with 

respect to: 

(i) Military and veteran cultural 

competence, if the entity is not an 

organization that represents veterans; 

(ii) Equipment required to provide 

telehealth services; 

(iii) Privacy, including the Health 

Insurance Portability and 

Accountability Act of 1996 privacy rule 

under 45 CFR part 160 and part 164, 

subparts A and E, as it relates to health 

care for veterans; 

(iv) Scheduling for telehealth services 

for veterans; or 

(v) Any other unique training needs 

for the provision of services to veterans 

in a telehealth access point. 


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(4) Upgrading existing infrastructure 

owned or leased by the entity to make 

rooms more conducive to telehealth 

care, including: 

(i) Additions or modifications to 

windows or walls in an existing room, 

or other alterations as needed to create 

a new, private room, including permits 

or inspections required in association 

with space modifications; 

(ii) Soundproofing of an existing 

room; 

(iii) New electrical, telephone, or 

internet outlets in an existing room; or 

(iv) Aesthetic enhancements to 

establish a more suitable therapeutic 

environment, including, but not limited 

to, seating for both the veteran and 

caregiver, bariatric seating, and 

adequate lighting. 

(5) Upgrading existing infrastructure 

to comply with the Americans with 

Disabilities Act (42 U.S.C. 12101 et 

seq.). 

(6) Upgrading internet infrastructure 

and sustainment of internet services. 

(7) Sustainment of telephone services. 

(b) Exclusions. Telehealth grants may 

not be used for the purchase of new 

property or for major construction 

projects, or for the acquisition of new 

space through other arrangements (such 

as a lease agreement), as determined by 

VA. Major construction may consist of 

new construction, or activities that 

would increase the square footage of an 

existing facility (e.g., relocation of 

existing exterior walls, roofs, or floors). 

VA may further define major 

construction in the NOFO. 

§ 84.50 General operation requirements. 

(a) Confidentiality. Grantees must 

maintain the confidentiality of veterans 

utilizing the telehealth access point. The 

grantees will not keep any records on 

the veterans who use the telehealth 

access point. This prohibition only 

applies to veteran records, however, 

grantees must maintain a record of the 

hours the point attendant provides 

services to veterans. 

(b) Grantee’s responsibilities. Grantee 

is responsible for the operation and 

maintenance of the telehealth access 

point. 

(c) Notification to veterans. The 

grantee must notify each veteran of the 

following: 

(1) The telehealth services are being 

provided by VA and the grantee may not 

charge the veteran for use of their space. 

(2) Any conditions or restrictions on 

the receipt of telehealth services by the 

veteran. The grantee has the right to 

prohibit services to veterans who have 

demonstrated disruptive behavior 

within their facility. 

(d) Evaluation interviews and surveys. 

The grantee must participate in 

telehealth program evaluation 

interviews and surveys. 

(e) Assessment of funds. Grantees 

must regularly assess that the grant 

funds are utilized according to the 

agreement. 

(f) Administration of telehealth 

grants. Grantees must ensure that 

telehealth grants are administered in 

accordance with the requirements of 

this part, the telehealth grant agreement, 

and other applicable laws and 

regulations. Grantees are responsible for 

ensuring that any subcontractors carry 

out activities in compliance with this 

program. 

(g) Use and disposition of property 

and/or equipment. The grantees must 

follow, implement, and adhere to all 

requirements in the grant agreement and 

in 2 CFR part 200 on the use and 

disposition of property improved and/or 

equipment acquired under the 

telehealth grant program. 

(The Office of Management and 

Budget has approved the information 

collection provisions in this section 

under control number 2900–TBD.) 

§ 84.55 Fee prohibition. 

Grantees must not charge a fee to 

veterans for providing VA services in 

telehealth access points that are funded 

with amounts from the telehealth grant. 

§ 84.60 Notice of Funding Opportunity. 

When funds are available for the 

telehealth grant, VA will publish a 

NOFO. VA has the authority to modify 

the duration, amount, or both of an 

existing telehealth grant agreement, 

subject to availability of funding and 

grantee performance, as set forth in 

§ 84.65. The NOFO will identify: 

(a) The location for obtaining the 

applications for the telehealth grant; 

(b) The date, time, and place for 

submitting completed telehealth grant 

applications; 

(c) The estimated amount and type of 

grant funding available; 

(d) Any priorities for or exclusions 

from funding to meet the requirements 

of the telehealth grant and VA goals for 

providing telehealth services to 

veterans; 

(e) The length of term for the 

telehealth grant award; 

(f) Specific point values to be awarded 

for each criterion listed in §§ 84.25 and 

84.35; 

(g) The minimum number of total 

points and points per category that an 

applicant or grantee, as applicable, must 

receive for a telehealth grant to be 

funded; 

(h) Any maximum award amounts for 

the telehealth grant; 

(i) The timeframes and manner for 

payments under the telehealth grant; 

and 

(j) Other information necessary for the 

telehealth grant application process as 

determined by VA. 

§ 84.65 Telehealth grant agreements. 

(a) After an applicant is selected for 

a telehealth grant in accordance with 

§ 84.30, VA will draft a telehealth grant 

agreement to be executed by VA and the 

applicant. Upon execution of the 

telehealth grant agreement, VA will 

obligate grant funds to cover the amount 

of the approved grant, subject to the 

availability of funding. The telehealth 

grant agreement will provide that the 

grantee agrees, and will ensure that each 

subcontractor, as relevant, agrees, to: 

(1) Operate the telehealth access point 

in accordance with the provisions of 

this part and the applicant’s telehealth 

grant application; 

(2) Comply with such other terms and 

conditions, including recordkeeping 

and reports for program monitoring and 

evaluation purposes, as VA may 

establish for purposes of providing 

services in a telehealth access point in 

an effective and efficient manner; and 

(3) Provide such additional 

information as deemed appropriate by 

VA. 

(b) After a grantee is selected for 

renewal of a telehealth grant in 

accordance with § 84.40 VA will draft a 

telehealth grant agreement to be 

executed by VA and the grantee. Upon 

execution of the telehealth grant 

agreement, VA will obligate grant funds 

to cover the amount of the approved 

telehealth grant, subject to the 

availability of funding. The agreement 

for the renewal of the telehealth grant 

will contain the same provisions 

described in paragraph (a) of this 

section. 

(c) No funds provided under this part 

may be used to replace Federal, State, 

Tribal, or local funds previously used, 

or designated for use, to establish a 

telehealth access point. 

(d) Subject to §§ 84.60 and 84.100, the 

availability of funding, and grantee 

performance, VA may modify an 

existing telehealth grant agreement by 

one or both of the following: 

(1) Extending or reducing the period 

for which the telehealth grant was 

established; and 

(2) Increasing or decreasing the 

amount of funds awarded. 

§ 84.70 Program or budget changes and 

Corrective Action Plans. 

(a) Change in telehealth grant 

agreement. A grantee must submit to VA 

a written request to modify a telehealth 


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grant agreement for any proposed 

significant change that will alter the 

agreement. If VA approves such change, 

VA will issue a written amendment to 

the telehealth grant agreement. A 

grantee must receive VA’s approval 

prior to implementing a significant 

change. 

(1) Significant changes include, but 

are not limited to: 

(i) A change in the grantee or any 

subcontractors, identified in the 

telehealth grant agreement; 

(ii) A change in the area or 

community served by the grantee; or 

(iii) Additions or removal of 

equipment, connectivity, or other 

services provided by the grantee; and 

(iv) A change in budget line items that 

are more than 10 percent of the total 

telehealth grant award. 

(2) VA’s approval of changes is 

contingent upon the grantee’s amended 

application retaining a high enough 

rank to have been competitively 

selected for funding in the year that the 

application was granted. 

(3) Each telehealth grant modification 

request must contain a description of 

the revised proposed use of telehealth 

grant funds. 

(b) Corrective Action Plan. VA may 

require that the grantee initiate, 

develop, and submit to VA for approval 

a Corrective Action Plan (CAP) if actual 

telehealth grant expenditures vary from 

the amount disbursed to a grantee or 

actual telehealth grant activities vary 

from the telehealth grant agreement. 

Reporting frequency may be on a bimonthly, monthly, or quarterly basis. 

(1) The CAP must identify the 

expenditure or activity source that has 

caused the deviation, describe the 

reason(s) for the variance, provide 

specific proposed corrective action(s), 

and provide a timetable for 

accomplishment of the corrective 

action(s). 

(2) After receipt of the CAP, VA will 

send a letter to the grantee indicating 

that the CAP is approved or 

disapproved. If disapproved, VA will 

make beneficial suggestions to improve 

the proposed CAP and request 

resubmission or take other actions in 

accordance with this program. 

(c) Key personnel change. Grantees 

must inform VA in writing of any key 

personnel changes, local or national, 

(e.g., new executive director, telehealth 

grant program director, or chief 

financial officer) and grantee address 

changes within 30 days of the change. 

(The Office of Management and 

Budget has approved the information 

collection provisions in this section 

under control number 2900–TBD.) 

§ 84.75 Faith-based organizations. 

Organizations that are faith-based are 

eligible, on the same basis as any other 

organization, to participate in the 

telehealth grant under this part in 

accordance with 38 CFR part 50. 

§ 84.80 Financial management. 

(a) Grantees must comply with 

applicable requirements of the Uniform 

Administrative Requirements, Cost 

Principles, and Audit Requirements for 

Federal Awards under 2 CFR part 200. 

(b) Grantees must use a financial 

management system that provides 

adequate fiscal control and accounting 

records and meets the requirements set 

forth in 2 CFR part 200. 

(c) Payment up to the amount 

specified in the telehealth grant must be 

made only for allowable, allocable, and 

reasonable costs in establishing, 

maintaining, and operating the 

telehealth access point. The 

determination of allowable costs must 

be made in accordance with the 

applicable Federal Cost Principles set 

forth in 2 CFR part 200. 

(d) In accordance with 2 CFR 200.414, 

applicants that do not have a negotiated 

indirect cost rate (NICRA) may: 

(1) Request a de minimis rate, which 

is in accordance with the amounts set 

forth in 2 CFR 200.414(f); 

(2) Apply the NICRA established with 

their cognizant agency; or 

(3) Request to negotiate an indirect 

cost rate with VA. 

§ 84.85 Telehealth grant reports. 

(a) VA may require grantees to 

provide, in any form as may be 

prescribed, such reports or answers in 

writing to specific questions, surveys, or 

questionnaires as VA determines 

necessary to carry out the telehealth 

grant. 

(b) If actual telehealth grant 

expenditures vary from the amount 

disbursed to a grantee or actual 

telehealth grant activities vary from the 

grantee’s program description provided 

in the telehealth grant agreement, 

grantees must report the deviation to 

VA. Reporting frequency may be on a bimonthly, monthly, or quarterly basis. 

Note 1 to paragraph (b): For information 

on Corrective Action Plans, which may be 

required by this paragraph (b), see § 84.70. 

(c) At least once per year, each grantee 

must submit to VA a report that 

describes grant agreement compliance, 

legal and regulatory compliance, the 

activities for which the telehealth grant 

funds were used including but not 

limited to, the equipment costs, 

renovation expenses, attendant 

expenses, any other types of ongoing 

expenses for services provided during 

the year covered by the report, and any 

other information that VA may request. 

(d) VA may request additional reports 

to allow VA to fully assess the provision 

or coordination of the provision of 

services under this part. 

(e) All pages of the reports must cite 

the assigned telehealth grant number 

and be submitted in a timely manner as 

set forth in the grant agreement. 

(f) Grantees agree to allow VA to post 

information from reports on the internet 

or use such information in other ways 

deemed appropriate by VA (including, 

but not limited to, activities regarding 

litigation). Grantees must clearly mark 

information that is confidential to 

individual veterans so that VA could 

exclude such information from any 

public use. 

(The Office of Management and 

Budget has approved the information 

collection requirements in this section 

under control number 2900–TBD.) 

§ 84.90 Recordkeeping. 

Grantees must ensure that records are 

maintained for at least a 3-year period 

(unless a longer period is otherwise 

required) to document compliance with 

the telehealth grant. Grantees must 

produce such records at VA’s request. 

§ 84.95 Technical and technological 

assistance. 

(a) VA will provide technical 

assistance, as necessary, to eligible 

entities to meet the requirements of this 

part. 

(b) VA will provide technological 

assistance, as necessary, to ensure that 

the grantee’s equipment is able to 

connect to the VA system and network 

as necessary to support the delivery of 

telehealth services. 

(c) Such technical and technological 

assistance will be provided either 

directly by VA or through grants or 

contracts with appropriate public or 

nonprofit private entities. 

§ 84.100 Withholding, suspension, 

deobligation, termination, recovery of funds 

by VA, and disposition of property or 

equipment. 

(a) General. VA will enforce this part 

through such actions as may be 

appropriate. Appropriate actions 

include withholding, suspension, 

deobligation, termination, recovery of 

funds by VA, and actions in accordance 

with 2 CFR part 200. 

(b) Opportunities to object. (1) Upon 

VA taking a remedy for noncompliance 

under paragraph (a) of this section, 

grantees have 30 days to object and 

provide information and documentation 

challenging the action, subject to the 

following conditions: 


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(i) Objections must be provided to VA 

in writing. 

(ii) VA’s decision stands while an 

objection is under consideration. 

(iii) Other VA decisions (such as 

competing award decisions, 

continuation award decisions, decisions 

made with the consent of the grantee) 

are not subject to this opportunity to 

object. 

(2) The grant agreement will provide 

additional requirements and 

responsibilities for grantees in the event 

of noncompliance under paragraph (a) 

of this section. 

§ 84.105 Oversight. 

VA may inspect the telehealth access 

points and records of any entity that has 

received a telehealth grant when VA 

deems necessary to determine 

compliance with this part. The authority 

to inspect does not authorize VA to 

manage or control the organization. 

Monitoring and oversight requirements 

for each grantee will be determined by 

a pre-award risk assessment in 

alignment with 2 CFR 200.206. 

§ 84.110 Telehealth grant closeout 

procedures. 

Telehealth grants will be closed out in 

accordance with 2 CFR part 200. 

[FR Doc. 2024–25892 Filed 11–12–24; 8:45 am] 

BILLING CODE 8320–01–P 

FEDERAL COMMUNICATIONS 

COMMISSION 

47 CFR Part 76 

[MB Docket No. 23–203; Report No. 3220; 

FR ID 260366] 

Petition for Reconsideration of Action 

in Rulemaking Proceeding; Correction 

AGENCY: Federal Communications 

Commission. 

ACTION: Petition for Reconsideration; 

correction. 

SUMMARY: The Federal Communications 

Commission corrects Dates for the filing 

of replies to oppositions to the Petition 

for Reconsideration, published in the 

Federal Register of November 1, 2024, 

announcing the dates for filing 

oppositions and replies to the Petition 

for Reconsideration of Action. The 

document contained an error in the 

DATES section. 

DATES: November 13, 2024. 

FOR FURTHER INFORMATION CONTACT: For 

further information, please contact 

Joseph Price, Policy Division, Media 

Bureau, at 202–418–1423 or 

Joseph.Price@fcc.gov. 

SUPPLEMENTARY INFORMATION: 

Correction 

In the Federal Register of November 

1, 2024, in FR Doc. 2024–25497, on page 

87322, in the third column, correct the 

DATES caption to read:DATES: 

Oppositions to the Petition must be filed 

on or before November 18, 2024. Replies 

to oppositions to the Petition must be 

filed on or before November 29, 2024. 

Federal Communications Commission. 

Marlene Dortch, 

Secretary. 

[FR Doc. 2024–26213 Filed 11–12–24; 8:45 am] 

BILLING CODE 6712–01–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 217 

[Docket No. 241104–0288] 

RIN 0648–BN12 

Takes of Marine Mammals Incidental to 

Specified Activities; Taking Marine 

Mammals Incidental to the Lower 

Columbia River Dredged Material 

Management Plan, Oregon and 

Washington 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Proposed rule, request for 

comments. 

SUMMARY: NMFS has received a request 

from the U.S. Army Corps of Engineers, 

for Incidental Take Regulations (ITR) 

and Letter of Authorization (LOA) 

pursuant to the Marine Mammal 

Protection Act. The requested 

regulations would govern the 

authorization of take of small numbers 

of marine mammals over 5 years (2027– 

2032) incidental to the Lower Columbia 

River Dredged Material Management 

Plan in Oregon and Washington. NMFS 

requests public comments and will 

consider them prior to making any final 

decision on the requested ITR and 

issuance of the LOA; agency responses 

to comments will be summarized in the 

final rule, if issued. 

DATES: Comments and information must 

be received no later than December 13, 

2024. 

ADDRESSES: A plain language summary 

of this proposed rule is available at: 

https://www.regulations.gov/docket/ 

NOAA-NMFS-2024-0123. 

• Electronic Submissions: Submit all 

electronic public comments via the 

Federal e-Rulemaking Portal. Go to 

https://www.regulations.gov and enter 

NOAA–NMFS–2024–0123 in the Search 

box (note: copying and pasting the 

FDMS Docket Number directly from this 

document may not yield search results). 

Click on the ‘‘Comment’’ icon, complete 

the required fields, and enter or attach 

your comments. 

Instructions: Comments sent by any 

other method, to any other address or 

individual, or received after the end of 

the comment period, may not be 

considered by the National Marine 

Fisheries Service (NMFS). All 

comments received are a part of the 

public record and will generally be 

posted for public viewing at: https://

www.regulations.gov without change. 

All personal identifying information 

(e.g., name, address, etc.), confidential 

business information, or otherwise 

sensitive information submitted 

voluntarily by the sender will be 

publicly accessible. NMFS will accept 

anonymous comments (enter ‘‘N/A’’ in 

the required fields if you wish to remain 

anonymous). 

FOR FURTHER INFORMATION CONTACT: 

Robert Pauline, Office of Protected 

Resources, NMFS, (301) 427–8401. 

SUPPLEMENTARY INFORMATION: A copy of 

the U.S. Army Corps of Engineers’ 

(USACE) application any supporting 

documents, as well as a list of the 

references cited in this document, may 

be obtained online at: https://

www.fisheries.noaa.gov/action/ 

incidental-take-authorization-us-armycorps-engineers-lower-columbia-riverdredged-material. In case of problems 

accessing these documents, please call 

the contact listed above (see FOR

FURTHER INFORMATION CONTACT). 

Purpose and Need for Regulatory 

Action 

This proposed rule, if adopted, would 

establish a framework under the 

authority of the Marine Mammal 

Protection Act (MMPA) (16 U.S.C. 1361 

et seq.) to authorize, for a 5-year period 

(2027–2032), take of marine mammals 

incidental to the USACE’s construction 

activities associated with the Lower 

Columbia River (LCR) Dredged 

Materials Management Plan (DMMP). 

NMFS received an application (the 

Application) from the USACE 

requesting 5-year regulations and an 

LOA to take 3 species of marine 

mammals. Take would occur by 

harassment only, incidental to impact 

and vibratory pile driving. Except with 

respect to certain activities not pertinent 

here, section 3(18) of the MMPA defines 

‘‘harassment’’ as any act of pursuit, 

torment, or annoyance, which (i) has the 

potential to injure a marine mammal or 


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