Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices 701 

material shall be used to perform 

domestic Federal contracts for 

construction, with certain exceptions. 

VA policy is to not accept foreign 

construction material. However, if a 

bidder chooses to submit a bid that 

includes foreign material, VA will 

consider such bids if the material is 

specifically identified and the price of 

the material is provided. VAAR clause 

852.236–89, Buy American Act, advises 

bidders of these provisions and requires 

bidders who want to offer foreign 

construction material to list the material 

and its price. Bidders who do not intend 

to offer foreign material do not need to 

submit any information under this 

clause. The information is required to 

allow VA to make an informed decision 

as to whether or not to accept a bid that 

includes foreign construction material. 

In actual practice, very few bidders ever 

offer foreign materials and, when they 

do, very few of those offers are accepted. 

An agency 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. The Federal Register 

Notice with a 60-day comment period 

soliciting comments on this collection 

of information was published at 82 FR 

142 on July 26, 2017, pages 34747 and 

34748. 

Affected Public: Business or other forprofit and not-for-profit institutions. 

Estimated Annual Burden: VAAR 

clause 852.236–89, Buy American Act— 

22 hours. 

Estimated Average Burden per 

Respondent: VAAR clause 852.236–89, 

Buy American Act—30 minutes. 

Frequency of Response: On occasion. 

Estimated Number of Respondents: 

VAAR clause 852.236–89, Buy 

American Act—43. 

By direction of the Secretary. 

Cynthia Harvey-Pryor, 

Department Clearance Officer, Office of 

Quality, Privacy and Risk, Department of 

Veterans Affairs. 

[FR Doc. 2018–00002 Filed 1–4–18; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

Notice of Request for Information on 

the Department of Veterans Affairs 

Program of Comprehensive Assistance 

for Family Caregivers (PCAFC) 

AGENCY: Department of Veterans Affairs. 

ACTION: Request for information. 

SUMMARY: The Department of Veterans 

Affairs (VA) is requesting information 

regarding its Program of Comprehensive 

Assistance for Family Caregivers 

(PCAFC). Through PCAFC, VA provides 

certain medical, travel, training, and 

stipend benefits to designated family 

caregivers of eligible veterans and 

servicemembers who were seriously 

injured in the line of duty on or after 

September 11, 2001. This notice 

requests information and comments 

from interested parties to help inform 

PCAFC of any changes needed to 

increase consistency across the program, 

as well as ensure it supports those 

family caregivers of veterans 

servicemembers most in need. 

DATES: Comments in response to this 

request for information must be received 

by VA on or before February 5, 2018. 

ADDRESSES: Written comments may be 

submitted through http://

www.Regulations.gov; by mail or hand 

delivery to the Director, Office of 

Regulation Policy and Management 

(00REG), Department of Veterans 

Affairs, 810 Vermont Avenue NW, 

Room 1068, Washington, DC 20420; or 

by fax to (202) 273–9026. Comments 

should indicate that they are submitted 

in response to ‘‘Notice of Request for 

Information on the Department of 

Veterans Affairs Program of 

Comprehensive Assistance for Family 

Caregivers (PCAFC)’’. Copies of 

comments received will be available for 

public inspection in the Office of 

Regulation Policy and Management 

(00REG), Department of Veterans 

Affairs, 810 Vermont Ave. NW, Room 

1063B, Washington, DC 20420, between 

the hours of 8:00 a.m. and 4:30 p.m., 

Monday through Friday (except Federal 

holidays). Please call (202) 461–4902 

(this is not a toll-free number) for an 

appointment. During the comment 

period, comments may also be viewed 

online through the Federal Docket 

Management System at 

www.Regulations.gov. 

FOR FURTHER INFORMATION CONTACT: 

Margaret Kabat, National Director, 

Caregiver Support Program, 10P4C, 

Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue NW, Washington, DC 

20420, 202–461–6780 (this is not a toll 

free number). 

SUPPLEMENTARY INFORMATION: The 

Program of Comprehensive Assistance 

for Family Caregivers (PCAFC) was 

established by Title I of Public Law 

111–163, Caregivers and Veterans 

Omnibus Health Services Act of 2010, 

and is codified in section 1720G(a) of 

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

has been administering PCAFC 

continuously since May 5, 2011 and has 

implemented this program through its 

regulations in part 71 of title 38, Code 

of Federal Regulations (CFR). The 

purpose of PCAFC is to support family 

caregivers of eligible veterans (as 

defined in 38 U.S.C. 1720G(a)(2) and 38 

CFR 71.20 to include certain 

servicemembers) through the provision 

of caregiver benefits, including training, 

respite care, counseling, technical 

support, beneficiary travel (in certain 

circumstances), a monthly stipend 

payment, and access to health care (if 

qualified) through the Civilian Health 

and Medical Program of the Department 

of Veterans Affairs (CHAMPVA). 38 

U.S.C. 1720G(a)(3), 38 CFR 71.40. 

For purposes of this notice 

hereinafter, the term ‘‘veteran’’ refers to 

veterans and servicemembers who apply 

for or participate in the Program of 

Comprehensive Assistance for Family 

Caregivers. 

We are issuing this notice in order to 

solicit input on several components of 

the program, as further explained below. 

This notice and request for information 

serves as a means for VA to consult with 

key stakeholders on whether and how 

PCAFC should be modified to provide 

the highest quality care and support to 

veterans and their family caregivers in 

a consistent manner. We will use the 

information to inform any updates to 

this program and its implementing 

regulations. To the extent that there are 

any comments related to, or which 

would require changing, the relevant 

statutory authorities, those comments 

are outside the scope of this notice, as 

those would require Congressional 

action. The intent of this notice is for 

VA to garner input from the public on 

whether and how to change its 

regulations under the current statute. 

This notice and request for 

information has a comment period of 45 

days, during which individuals, groups, 

and entities may reply to the questions 

presented below. VA believes that 45 

days is sufficient to provide comments, 

as the individuals, groups, and entities 

interested in this program likely have 

information and opinions readily 

available or can quickly compile and 

submit such information. Commenters 

are encouraged to provide complete but 

concise responses to the questions 

outlined below. Please note that VA will 

not respond to comments or questions 

regarding policy plans, decisions, or 

issues with regard to this notice. VA 

may choose to contact individual 

commenters, and such communications 

would serve to further clarify their 

written comments. 

In order to improve PCAFC, we are 

seeking information on the following 

topics and issues: 


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702 Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices 

Initial and Ongoing Eligibility of 

Veterans and Servicemembers 

In order to be eligible for PCAFC 

under the statute, the individual must 

be a veteran or a servicemember 

undergoing medical discharge from the 

Armed Forces and must have a serious 

injury (including traumatic brain injury, 

psychological trauma, or other mental 

disorder) incurred or aggravated in the 

line of duty in the active military, naval, 

or air service on or after September 11, 

2001. 38 U.S.C. 1720G(a)(2)(A)–(B), 38 

CFR 71.20(a)–(b). We have defined 

‘‘serious injury’’ as ‘‘any injury, 

including traumatic brain injury, 

psychological trauma, or other mental 

disorder, incurred or aggravated in the 

line of duty in the active military, naval, 

or air service on or after September 11, 

2001, that renders the veteran or 

servicemember in need of personal care 

services.’’ 38 CFR 71.15. We have 

interpreted 38 U.S.C. 1720G to require 

this causal relationship between the 

need for personal care services and the 

serious injury. 76 FR 26150. 

Additionally, 38 U.S.C. 1720G 

requires that eligibility be premised on 

an individual’s need for personal care 

services because of (1) an inability to 

perform one or more activities of daily 

living, (2) a need for supervision or 

protection based on symptoms or 

residuals of neurological or other 

impairment or injury, or (3) such other 

matters as the Secretary considers 

appropriate. 38 U.S.C. 1720G(a)(2)(C)(i)– 

(iii). This requirement is set forth in 38 

CFR 71.20(c), in which we require that 

the serious injury renders the veteran in 

need of personal care services for a 

minimum period of six continuous 

months based on specified criteria. 

Otherwise, the criteria under § 71.20(c) 

do not distinguish between, or require, 

any specific degree of need for 

assistance (e.g., in frequency, 

complexity, or scope). 

In order to be eligible for the program, 

we also require that a clinical 

determination be made that it is in the 

best interest of the individual to 

participate in the program. 38 CFR 

71.20(d). This determination currently 

requires the clinician to consider 

whether participation in the program 

significantly enhances the individual’s 

ability to live safely in a home setting, 

supports the individual’s potential 

progress in rehabilitation, if such 

potential exists, and creates an 

environment that supports the health 

and well-being of the individual. 38 

CFR 71.15. VA has found variability in 

how these three considerations are 

applied by clinicians assessing whether 

participation in PCAFC is in a veteran’s 

best interest. 

Once a veteran has been determined 

to be eligible for the program and a 

family caregiver has been approved and 

designated, the veteran’s well-being is 

monitored by VA no less often than 

every 90 days, unless otherwise 

clinically indicated. 38 CFR 71.40(b)(2). 

Currently, there is no regulatory 

requirement to reassess eligibility. If, 

however, the veteran’s level of 

functioning improves, lessening the 

need for assistance of a family caregiver, 

VA may determine that the veteran no 

longer meets the eligibility criteria for 

PCAFC. Because approval and 

designation of a family caregiver is 

conditioned on the eligibility criteria 

being met, in the instance that a veteran 

is determined to be ineligible for the 

program, VA will revoke the family 

caregiver’s designation, and the 

caregiver benefits will cease. 38 CFR 

71.25(f), 71.45(c). 

Continuation of Benefits After 

Revocation 

Under PCAFC, caregiver benefits may 

continue for a period of time after 

revocation of the family caregiver’s 

designation in limited situations. For 

example, under § 71.45(b)(4), caregiver 

benefits continue for 30 days after the 

date of revocation initiated by the 

veteran or his or her surrogate, subject 

to certain exceptions. Additionally, 

under § 71.45(c), caregiver benefits 

continue for 90 days after revocation 

initiated by VA, subject to certain 

exceptions. We provide these extended 

periods of benefits to allow a family 

caregiver, who did not request the 

revocation, a transition period before 

benefits are discontinued (particularly, 

for certain benefits like health care). We 

believe these extended benefits periods 

are consistent with the purpose of 38 

U.S.C. 1720G and represent an 

appropriate and compassionate way to 

interpret and enforce the law. 76 FR 

26155–26156. The 30- and 90-day 

periods set forth in § 71.45(b)(4) and (c), 

respectively, are the only instances in 

which the regulations provide for 

extended caregiver benefits beyond the 

date of revocation. 

While a family caregiver can 

voluntarily leave the program at any 

time, when a family caregiver initiates 

revocation, his or her caregiver benefits 

terminate at the present or future date 

of revocation as specified by the family 

caregiver. 38 CFR 71.45(a). While a 

family caregiver is not required to 

provide a basis for revocation, a family 

caregiver’s voluntary revocation may 

involve instances when the family 

caregiver leaves because of a situation 

involving actions of the veteran. VA is 

seeking input on whether there are any 

circumstances in which a family 

caregiver’s benefits should be extended 

beyond the revocation date when the 

family caregiver makes the decision to 

be removed as the family caregiver as 

well as the length of such an extension. 

Determination of Stipend Payment 

Methodology for Primary Family 

Caregivers 

Section 1720G(a)(3)(A)(ii)(V) of title 

38, U.S.C., requires VA to provide a 

monthly stipend to primary family 

caregivers of eligible veterans. Under 

the statute, VA is required to base the 

stipend amount on the amount and 

degree of personal care services 

provided; to the extent practicable, 

ensure that the amount is not less than 

the monthly amount a commercial home 

health care entity would pay an 

individual in the geographic area of the 

veteran to provide equivalent personal 

care services; and in the instance that 

the geographic area does not have a 

commercial home health entity, VA 

must take into consideration the costs of 

commercial providers of personal care 

services in those geographic areas with 

similar costs of living. See 38 U.S.C. 

1720G(a)(3)(C). 

Under the implementing regulations, 

VA relies on the U.S. Department of 

Labor’s Bureau of Labor Statistics (BLS) 

hourly wage rate for home health aides 

at the 75th percentile in the veteran’s 

geographic area of residence, which is 

multiplied by the Consumer Price Index 

for All Urban Consumers. 38 CFR 71.15, 

71.40(c)(4). We have used the BLS wage 

rate to meet the intent of the statute to 

ensure that primary family caregivers 

are not paid less than home health aides 

in the applicable geographic area. 76 FR 

26154. These rates, however, fluctuate 

annually in conjunction with changing 

geographical area designations, which 

can result in alterations to stipend 

amounts. 

VA also calculates the stipend amount 

based on a veteran’s assigned tier level 

which is determined by a clinical 

assessment of functional needs, as 

further detailed in 38 CFR 71.40(c)(4). 

Specifically, VA determines the 

veteran’s level of dependency based on 

the degree to which he or she is unable 

to perform one or more activities of 

daily living or the degree to which he 

or she is in need of supervision or 

protection based on symptoms or 

residuals of neurological or other 

impairment or injury. VA conducts a 

clinical assessment, which is scored and 

summed. Based on the sum of all 

ratings, the veteran is assigned a tier 

level. Each tier level is assigned a 


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Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices 703 

number of hours, up to forty hours per 

week. The primary family caregiver 

receives a stipend based on the assigned 

tier level. Currently, this is a 

determination based upon the needs of 

the veteran, not the family caregiver, 

and it distinguishes among three 

different tiers. 

Request for Information 

Through this notice, we are soliciting 

information on PCAFC. We ask 

respondents to address the following 

questions, where possible, in the 

context of the discussion in this 

document. Commenters do not need to 

address every question and should focus 

on those that relate to their expertise or 

perspectives. To the extent possible, 

please clearly indicate which 

question(s) you address in your 

response. As previously mentioned, 

responses to this request will inform our 

updates to PCAFC. Accordingly, we 

request comments on the following: 

1. Should VA change how ‘‘serious 

injury’’ is defined for the purposes of 

eligibility? 

a. Should the severity of injury be 

considered in determining eligibility to 

ensure VA is supporting family 

caregivers of Veterans most in need? If 

so, how should the level of severity be 

determined? 

b. How should VA define veterans 

who are most in need? 

c. Should eligibility be limited to only 

those veterans who without a family 

caregiver providing personal care 

services would otherwise require 

institutionalization? If so, how should 

this be determined? 

2. One of the bases upon which a 

veteran can be determined to need 

personal care services is his or her need 

for supervision or protection based on 

symptoms or residuals of neurological 

or other impairment or injury. 

a. What should be the criteria to 

assess a veteran’s need for supervision 

or protection? 

b. What standardized tools should be 

used to assess a veteran’s need for 

supervision or protection because of a 

mental health condition? 

3. To be eligible for the program, 

participation must be determined to be 

in the ‘‘best interest’’ of the veteran. 

How should ‘‘best interest’’ be defined? 

a. How can VA improve consistency 

in ‘‘best interest’’ determinations for 

participation in the program? 

b. Are there any conditions under 

which participation would not be in a 

veteran’s best interest? 

4. Once approved for PCAFC, should 

the veteran’s eligibility be reassessed at 

specific time intervals or based on 

certain clinical indicators? 

a. If so, what intervals and/or what 

clinical indicators should be used? 

b. Should reassessments be standard 

for every participant? Are there 

conditions under which continued 

eligibility should be presumed and a 

reassessment not needed? If so, what 

would these conditions be? 

5. When VA determines that a veteran 

or family caregiver is no longer eligible 

for PCAFC or the family caregiver or 

veteran no longer wishes to participate 

in PCAFC, the family caregiver’s 

designation is ‘‘revoked’’. The term 

‘‘revok[ed]’’ is used in the statute (38 

U.S.C. 1720G(a)(9)(C)(ii)(II)); however, 

stakeholders have expressed concerns 

that this term is not supportive of 

participants. What terminology should 

VA use in reference to those 

participants who are determined to be 

no longer eligible for the program? 

a. Should VA use such language as 

removal, discharge, or graduate in 

reference to participants who become 

ineligible for the program? 

6. Should the timeframes for 

continuation of benefits for family 

caregivers who are revoked from the 

Program be modified? 

a. If so, how? 

b. Under what circumstances should 

family caregiver benefits be continued 

after revocation? For example, should 

VA continue providing benefits to a 

family caregiver who requests 

revocation due to an unsafe 

environment created by a veteran, such 

as an instance involving intimate 

partner violence committed by a 

veteran? How long should the benefits 

be continued under such 

circumstances? 

7. VA’s methodology of stipend 

calculations using the U.S. Department 

of Labor’s Bureau of Labor Statistics 

(BLS) wage rates is complex and creates 

variability in stipend amounts annually 

across localities. How should VA 

calculate stipend rates? 

a. What other standards or rates 

should VA consider using to calculate 

stipends? 

b. Should VA use one BLS rate per 

state, i.e., one rate that is applicable to 

all veterans residing in a particular 

state? 

c. Should VA have one stipend 

amount for all primary family 

caregivers? 

8. A veteran is assigned a stipend tier 

based on the amount and degree of 

personal care services provided. How 

should VA assess and determine the 

amount and degree of personal care 

services provided to the veteran by the 

family caregiver? 

a. How should ‘‘degree of’’ need be 

determined, for both physical needs and 

those related to the need for supervision 

and protection? 

b. Should ‘‘degree of’’ need be based 

on either physical needs or needs 

related to psychological disorder? Or 

should all factors be considered 

together? 

c. Should the three tier system be 

changed? If so, how should it be 

changed? 

Paperwork Reduction Act 

This request for information 

constitutes a general solicitation of 

public comments as stated in the 

implementing regulations of the 

Paperwork Reduction Act of 1995 at 5 

CFR 1320.3(h)(4). Therefore, this request 

for information does not impose 

information collection requirements 

(i.e., reporting, recordkeeping or thirdparty disclosure requirements). 

Consequently, there is no need for 

review by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

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

Signing Authority 

The Secretary of Veterans Affairs, or 

designee, approved this document and 

authorized the undersigned to sign and 

submit the document to the Office of 

Federal Register for publication 

electronically as an official document of 

the Department of Veterans Affairs. Gina 

S. Farrisee, Deputy Chief of Staff, 

Department of Veterans Affairs, 

approved this document on December 6, 

2017, for publication. 

Dated: December 6, 2017. 

Jeffrey Martin, 

Impact Analyst, Office of Regulation Policy 

& Management, Office of the Secretary, 

Department of Veterans Affairs. 

[FR Doc. 2018–00004 Filed 1–4–18; 8:45 am] 

BILLING CODE 8320–01–P 


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