50856 Federal Register / Vol. 86, No. 174 / Monday, September 13, 2021 / Rules and Regulations 

dispute, has been prepared by the 

Service. 

Dated: September 7, 2021. 

Sarah Cudahy, 

General Counsel. 

[FR Doc. 2021–19615 Filed 9–10–21; 8:45 am] 

BILLING CODE 6732–01–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

33 CFR Part 100 

[Docket No. USCG–2021–0612] 

Special Local Regulations; Recurring 

Marine Events, Sector St. Petersburg 

AGENCY: Coast Guard, DHS. 

ACTION: Notice of enforcement of 

regulation. 

SUMMARY: The Coast Guard will enforce 

special local regulations for the 

Clearwater Offshore Nationals on 

September 26, 2021, to provide for the 

safety of life on navigable waterways 

during this event. Our regulation for 

recurring marine events within Sector 

St. Petersburg identifies the regulated 

area for this event in Clearwater, FL. 

During the enforcement periods, the 

operator of any vessel in the regulated 

area must comply with directions from 

the Patrol Commander or any 

designated representative. 

DATES: The regulations in 33 CFR 

100.703, Table 1 to § 100.703, item 7, 

will be enforced from 11:30 a.m. until 

4 p.m., on September 26, 2021. 

FOR FURTHER INFORMATION CONTACT: If 

you have questions about this notice of 

enforcement, call or email Marine 

Science Technician First Class Michael 

Shackleford, Sector St. Petersburg 

Prevention Department, Coast Guard; 

telephone (813) 228–2191, email 

Michael.d.shackleford@uscg.mil. 

SUPPLEMENTARY INFORMATION: The Coast 

Guard will enforce the special local 

regulations in 33 CFR 100.703, Table 1 

to § 100.703, item 7, for the Clearwater 

Offshore Nationals regulated area from 

11:30 a.m. to 4 p.m., on September 26, 

2021. This action is being taken to 

provide for the safety of life on 

navigable waterways during this event. 

Our regulation for recurring marine 

events, Sector St. Petersburg, § 100.703, 

Table 1 to § 100.703, item 7, specifies 

the location of the regulated area for the 

Clearwater Offshore Nationals which 

encompasses portions of the Gulf of 

Mexico near Clearwater beach. During 

the enforcement periods, as reflected in 

§ 100.703(c), if you are the operator of 

a vessel in the regulated area you must 

comply with directions from the Patrol 

Commander or any designated 

representative. 

In addition to this notice of 

enforcement in the Federal Register, the 

Coast Guard plans to provide 

notification of this enforcement period 

via the Local Notice to Mariners and/or 

marine information broadcasts. 

Dated: August 31, 2021. 

Matthew A. Thompson, 

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

Port St. Petersburg. 

[FR Doc. 2021–19711 Filed 9–10–21; 8:45 am] 

BILLING CODE 9110–04–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 17 

RIN 2900–AQ45 

Veterans Care Agreements 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) adopts as final, with no 

substantive changes, an interim final 

rule revising its medical regulations to 

implement VA’s authority under section 

102 of the John S. McCain III, Daniel K. 

Akaka, and Samuel R. Johnson VA 

Maintaining Internal Systems and 

Strengthening Integrated Outside 

Networks Act of 2018 (MISSION Act), 

which authorizes VA to enter into 

agreements to furnish required hospital 

care, medical services, and extended 

care services in the community when 

such care and services are not feasibly 

available to certain individuals through 

a VA facility, a contract, or a sharing 

agreement. As specified in section 

1703A and this implementing rule, 

these agreements are called Veterans 

Care Agreements (VCA). 

DATES: This rule is effective on October 

13, 2021. 

FOR FURTHER INFORMATION CONTACT: 

Joseph Duran, Office of Community 

Care (10D), Veterans Health 

Administration, Department of Veterans 

Affairs, Ptarmigan at Cherry Creek, 

Denver, CO 80209; (303) 372–4629. 

(This is not a toll-free number.) 

SUPPLEMENTARY INFORMATION: On June 6, 

2018, the President signed into law the 

John S. McCain III, Daniel K. Akaka, and 

Samuel R. Johnson VA Maintaining 

Internal Systems and Strengthening 

Integrated Outside Networks Act of 

2018, Public Law 115–182, 132 Stat. 

1393 (2018) (codified as amended in 

scattered sections of 38 U.S.C.) 

(MISSION Act). This rule adopts as 

final, with no substantive changes, an 

interim final rule revising VA medical 

regulations to implement section 102 of 

the MISSION Act (codified as amended 

at 38 U.S.C. 1703A), which authorizes 

VA to enter into agreements to furnish 

required hospital care, medical services, 

and extended care services in the 

community when such care and services 

are not feasibly available to certain 

individuals through a VA facility, a 

contract, or a sharing agreement. As 

specified in section 1703A and this 

implementing rule, these agreements are 

called Veterans Care Agreements (VCA). 

On May 14, 2019, VA published an 

interim final rule to establish the 

parameters of VCAs authorized under 

section 1703A, to include: Establishing 

a certification process for entities and 

providers that will seek to enter into a 

VCA and furnish care or services 

pursuant to that agreement; establishing 

certain parameters governing the 

payment rates that will be set forth in 

the terms of each VCA; and establishing 

an administrative process for 

adjudicating disputes arising under or 

related to VCAs, including those 

pertaining to claims for payment for 

care or services provided under a VCA. 

84 FR 21668. VA received input from 

eight commenters in response to this 

interim final rule, only three of which 

raised issues relevant to the rule. VA’s 

responses to those three commenters are 

summarized below. 

One commenter that represents a 

membership consisting of long term and 

post-acute care providers offered four 

comments that relate to VA’s 

implementation and use of VCAs. The 

comments do not expressly or impliedly 

request any changes to the interim final 

rule, nor do they raise any issues that 

would necessitate or merit any such 

changes. 

First, the commenter noted that it 

wants to ensure its members obtain 

access to information ‘‘available at both 

the regional and national levels’’ within 

VA regarding VA’s implementation and 

use of VCAs. Relatedly, the commenter 

also indicated that it has heard from 

some of its members that they would 

like VA to establish one or more points 

of contact at the ‘‘national’’ level that 

providers could communicate with 

directly when they have questions that 

‘‘regional’’ VA offices are unable to 

answer regarding VA’s implementation 

and use of VCAs. We interpret the 

commenter’s references to information 

made available and points of contact 

established at the ‘‘national’’ and 

‘‘regional’’ levels to constitute 

references to when such information 


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1See https://www.va.gov/communitycare/ (last 

accessed 9/8/2021). 

2See https://www.va.gov/communitycare/ 

providers/EDU_Training.asp (last accessed 9/8/ 

2021). 

and resources are made available by 

national offices of the Veterans Health 

Administration (VHA) as compared to 

when they are made available by 

Veterans Integrated Service Networks 

(VISN) or by individual VHA medical 

facilities. In response to the 

commenter’s input in this regard, we 

note that VA currently uses a mix of 

organizational components and points 

of contact to make information relating 

to VA’s implementation and use of 

VCAs available to entities and 

providers. Certain information, 

resources, and points of contact are 

made available at the national 

organizational level through the website 

of VHA’s national Office of Community 

Care.1 For example, VA provides access 

to relevant provider educational and 

training resources (e.g., webinars of the 

type incidentally mentioned in the same 

comment), and a related national point 

of contact, in this manner.2 However, 

VA also currently makes certain 

information, resources, and points of 

contact available only through the 

individual VHA medical facilities that 

enter into and administer the specific 

VCAs to which such information, 

resources, and points of contact relate. 

Applications for certification under 

section 17.4110 of the interim final rule 

are processed, and VCAs are entered 

into and administered, by officials at 

local VHA medical facilities. 

Consequently, those officials and the 

local facility staff are often the most 

reliable and efficient sources of relevant 

and accurate information for an entity or 

provider that is considering or is 

currently navigating the processes of 

applying for certification, entering into 

a VCA with that local facility, and/or 

furnishing hospital care, medical 

services, or extended care services 

pursuant to a VCA that the entity or 

provider previously entered into with 

that local facility. Moreover, even in 

instances where the responsible local 

officials lack certain information 

requested by an entity or provider 

regarding those matters, it is important 

that those local officials remain the 

applicable VA points of contact for such 

entities and providers regarding those 

matters. Local officials possess the 

authority and responsibility for many 

aspects of the implementation and use 

of VCAs at each local VHA medical 

facility, so ensuring that they are privy 

to and the source of communications to 

entities and providers regarding those 

matters (e.g., status of a provider’s 

certification, terms of a provider’s VCA, 

or issues pertaining to specific 

authorizations or claims) promotes 

consistency and efficiency in VA’s use 

and administration of VCAs and 

mitigates risk of conflicting 

communications from those lacking the 

authority and responsibility for those 

aspects of VA’s implementation and use 

of the specific local VCAs and processes 

that are the subject of such 

communications. If the responsible 

officials at local VHA facilities lack 

certain information requested by an 

entity or provider regarding 

implementation and use of VCAs at that 

facility, those officials can and do 

utilize established internal 

communication channels to consult 

with VISN and national VHA offices, 

including the Office of Community 

Care, as appropriate, in identifying such 

information and formulating an 

appropriate response. 

In its second comment, the same 

commenter noted that it wants to ensure 

that the Centers for Medicare & 

Medicaid Services (CMS) and VA 

communicate how CMS’ Patient Driven 

Payment Model (PDPM), which became 

effective on October 1, 2019, and the 

VCA reimbursement structures will 

work together. As it pertains to VA, we 

interpret this comment as requesting 

that VA communicate whether and to 

what extent the rates that VA pays for 

care and services furnished by nursing 

facilities pursuant to VCAs are based 

upon or influenced by CMS’ PDPM 

case-mix classification methodology for 

calculating Part A payments under 

Medicare’s skilled nursing facility 

prospective payment system (SNF PPS). 

As established in § 17.4120 of the 

interim final rule, that information (i.e., 

the nexus between CMS’ PDPM 

methodologies and rates and VA 

payment methodologies and rates, if 

any), when applicable, will be 

communicated by VA in the price terms 

set forth in the specific VCA pursuant 

to which VA obtains the care or services 

at issue. Specifically, as established in 

§ 17.4120 of the interim final rule, the 

rates paid by VA for hospital care, 

medical services, and extended care 

services furnished pursuant to a VCA 

will be the rates set forth in the price 

terms of that specific VCA, and those 

price terms will be established in 

compliance with the general parameters 

set forth in § 17.4120(a)–(e). One such 

parameter of particular relevance to this 

comment regarding CMS’ PDPM is 

contained in § 17.4120(a), which 

provides in pertinent part that, subject 

to the caveats and exceptions set forth 

in § 17.4120(b)–(e), payment rates for 

services furnished pursuant to VCAs 

will not exceed the applicable Medicare 

prospective payment system amount, if 

any, for the period in which the service 

was provided (without any changes 

based on the subsequent development of 

information under Medicare 

authorities). Given that Medicare’s SNF 

PPS is a ‘‘prospective payment system’’ 

within the meaning of the foregoing 

limitation, and given that CMS’ PDPM 

currently governs how payment 

amounts are calculated under the SNF 

PPS, the PDPM will necessarily be 

factored into VA’s calculus when 

formulating certain VCA payment rates 

that are subject to the general limitation 

set forth in § 17.4120(a). However, while 

the general limitation in § 17.4120(a) 

can affect how VA formulates pricing 

for care and services obtained pursuant 

to VCAs, we emphasize that it is subject 

to the caveats and exceptions set forth 

in § 17.4120(b)–(e) and we note that the 

existence of that general limitation does 

not require or mean that the price terms 

set forth in any specific VCA for care 

and services furnished by nursing 

facilities will be the same as or based 

upon the payment rates, if any, for the 

same services under CMS’ PDPM. 

Instead, as previously stated, the nexus 

between CMS’ PDPM methodologies 

and rates and VA payment 

methodologies and rates, if any, will be 

communicated by VA in the price terms 

set forth in the specific VCA pursuant 

to which VA obtains the care or services 

at issue. 

In its third comment, the same 

commenter indicated that providers 

might be hesitant to enter into VCAs 

until the U.S. Department of Labor’s 

Office of Federal Contract Compliance 

Programs (OFCCP) issues a Notice of 

Proposed Rulemaking (NPRM) that 

would revise certain portions of 41 CFR 

subtitle B, chapter 60 that concern the 

obligations of TRICARE and certain 

other health care providers, as federal 

contractors and/or subcontractors, 

under the nondiscrimination and 

affirmative action provisions of 

Executive Order (E.O.) 11246 (as 

amended), section 503 of the 

Rehabilitation Act of 1973 (as 

amended), and the Vietnam Era 

Veterans’ Readjustment Assistance Act 

of 1974 (as amended). We interpret this 

comment as referring to the NPRM 

subsequently published by OFCCP at 84 

FR 59746 (Nov. 6, 2019). That NPRM 

culminated in a final rule, published by 

OFCCP at 85 FR 39834 (Jul. 2, 2020), 

that revised certain definitions set forth 

in 41 CFR 60–1.3, 60–300.2, and 60– 

741.2. Given that the rulemaking 


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3See 38 U.S.C. 1703A(a)(1)(A) (authorizing VA to 

use VCAs to obtain ‘‘hospital care, a medical 

service, or an extended care service’’ in certain 

circumstances); 38 U.S.C. 1701(5)–(6) (defining the 

terms ‘‘hospital care’’ and ‘‘medical services’’ for 

purposes of 38 U.S.C. chapter 17, which includes 

section 1703A); 38 CFR 17.4100 (defining the terms 

‘‘hospital care,’’ ‘‘medical services,’’ and ‘‘extended 

care services’’ for purposes of sections 17.4100– 

17.4135). 

referenced in this comment has been 

completed, the commenter’s concern 

that providers might be hesitant to enter 

into VCAs until the completion of that 

rulemaking process is no longer 

applicable. 

In its fourth and final comment, the 

same commenter stated that it wants to 

ensure that ‘‘services covered under VA 

contracts will continue to be covered 

under VCAs.’’ While the intended 

meaning of this comment is unclear to 

us, we note that, in accordance with the 

statutory authority for VCAs and the 

interim final rule, VA can use VCAs to 

obtain ‘‘hospital care’’ (as defined in 38 

U.S.C. 1701(5)), ‘‘medical services’’ (as 

defined 38 U.S.C. 1701(6)), and 

‘‘extended care services’’ (defined as the 

services described in 38 U.S.C. 

1710B(a)).3 We also note that the 

circumstances when VA is legally 

authorized to use VCAs to obtain 

hospital care, medical services, or 

extended care services are specified in 

38 U.S.C. 1703A(a) and in § 17.4115(a) 

of the interim final rule. Consequently, 

we do not make any changes to the 

interim final rule based on this 

comment. 

One commenter that represents a 

membership consisting of hearing 

health care professionals, including 

licensed hearing aid specialists, offered 

several comments in response to the 

interim final rule. Some of those 

comments pertain to matters that are 

outside the scope of this rulemaking and 

which do not implicate any 

considerations that would necessitate or 

merit any changes to the interim final 

rule. For example, the commenter urged 

VA to develop and implement the 

qualifications, which VA is authorized 

to prescribe pursuant to 38 U.S.C. 

7402(b)(14), for hearing aid specialists 

appointed to positions in VHA in 

accordance with 38 U.S.C. 7401. The 

commenter also urged VA to include 

hearing aid specialists appointed 

pursuant to 38 U.S.C. 7401 in the 

audiology teams that operate in VHA 

facilities. The government personnel 

matters raised in these comments, 

including whether and when VA 

develops qualifications for hearing aid 

specialists appointed to positions in 

VHA, and how VA utilizes any such 

specialists in VHA facilities, are outside 

the scope of this rulemaking and 

implicate no issues bearing on the 

contents of the interim final rule. 

The same commenter also urged VA 

to prioritize delivery of hearing-related 

health care services to veterans, both in 

VHA facilities and through ‘‘the 

Community Care Program,’’ a phrase 

that we interpret to be a reference to the 

Veterans Community Care Program 

(VCCP) established by section 101 of the 

MISSION Act (codified as amended at 

38 U.S.C. 1703). The matters raised in 

this comment, including whether and to 

what extent VA can and does prioritize 

the provision of certain types of hospital 

care, medical services, and extended 

care services in VHA facilities or 

through the VCCP, are matters outside 

the scope of this rulemaking. Moreover, 

to the extent the commenter is 

concerned about VA electing to adopt 

regulatory parameters that restrict VA’s 

ability to provide hearing-related health 

care services through VCAs, we note 

that the interim final rule contains no 

such elective restrictions. The interim 

final rule authorizes VA to use VCAs to 

obtain any of the types of hospital care, 

medical services, and extended care 

services permitted by the underlying 

statutory authority, 38 U.S.C. 1703A. 

The commenter also recommended 

that VA use licensed hearing aid 

specialists and audiologists to provide 

hearing aid evaluations, hearing aid 

fittings, and related services when 

veterans are receiving such services 

through ‘‘the Community Care 

Program,’’ a phrase that, as previously 

noted, we interpret to be a reference to 

the VCCP. The matters raised in this 

comment, including whether and to 

what extent certain specific types of 

providers furnish the care and services 

that VA obtains for covered veterans 

through the VCCP, are matters outside 

the scope of this rulemaking. Moreover, 

to the extent the commenter is 

concerned about VA electing to adopt 

regulatory parameters that restrict VA’s 

ability to use VCAs to obtain care and 

services furnished by licensed hearing 

aid specialists and audiologists, we note 

that the interim final rule contains no 

such elective restrictions. For example, 

the certification process set forth in 

§ 17.4110 of the interim final rule 

contains no requirements or approval 

criteria that would fundamentally 

preclude VA from granting certification 

to licensed hearing aid specialists and 

audiologists or that are any more 

restrictive with regard to those types of 

providers than they are for any other 

type of provider or entity seeking 

certification. 

In addition to providing the general 

comments described above, the same 

commenter also suggested two changes 

to the text of the interim final rule. First, 

the commenter suggested that VA 

replace the term ‘‘medical’’ in 

§ 17.4110(b)(1)(i) with the term ‘‘health 

care’’ so that the licensure 

documentation requirement in that 

subparagraph encompasses health care 

professionals other than physicians. In 

response, we clarify that the 

requirement in that subparagraph to 

provide documentation of ‘‘applicable 

medical licenses’’ does not preclude 

health care professionals other than 

physicians from applying for and 

receiving certification under § 17.4110. 

If the applicant does not possess a 

medical license, then there are no 

‘‘applicable medical licenses’’ of which 

the applicant must submit 

documentation under that 

subparagraph. Moreover, we also note 

that under § 17.4110(b)(1)(ii), VA can 

require applicants to submit 

documentation of relevant licenses 

other than medical licenses. 

Consequently, because the result 

apparently sought by the commenter— 

VA’s certification process 

accommodating the submission of 

documentation of licenses from health 

care professionals other than 

physicians—is already provided for in 

the existing language of the interim final 

rule, VA does not adopt the change 

recommended in this comment. The 

commenter also indicated that the 

payment rate parameters set forth in 

§ 17.4120(a)–(b) of the interim final rule, 

which are expressly tied to Medicare 

payment models, should be revised to 

allow for the establishment of fee 

schedules for services that are not 

within the scope of those Medicarerelated parameters, such as hearing tests 

for the provision of hearing aids and 

related hearing aid services. In response, 

VA notes that the payment rate 

parameters set forth in § 17.4120 of the 

interim final rule already permit the 

very result that the commenter is 

seeking. Under § 17.4120, the rates paid 

by VA for hospital care, medical 

services, or extended care services 

furnished pursuant to a VCA are the 

rates set forth in the price terms of that 

specific VCA, and, when the Medicarerelated parameters set forth in 

§ 17.4120(a)–(b) do not apply to the care 

or services at issue, VA is permitted to 

establish the payment rates for such care 

or services based on a fee schedule or 

some other formulation that is unrelated 

to Medicare payment rates and 

methodologies. Given that the result 

sought by the commenter is already 

permitted under the existing language of 

the interim final rule, VA makes no 

changes based on this comment. 


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4As previously noted, the circumstances when 

VA is legally authorized to use VCAs to obtain 

hospital care, medical services, or extended care 

services are specified in 38 U.S.C. 1703A(a) and in 

§ 17.4115(a) of the interim final rule. 

A commenter that operates a 

psychiatric facility raised multiple 

issues. First, the commenter noted that 

veterans often face specialized mental 

health needs, including ‘‘combat 

related’’ needs such as those resulting 

from post-traumatic stress disorder 

(PTSD) or traumatic brain injury (TBI). 

In light of VA’s specialized experience 

in those clinical areas, the commenter 

urged VA to share its knowledge of 

‘‘combat related illnesses’’ with mental 

health providers and indicated that VA 

should require mental health providers 

furnishing care pursuant to VCAs to be 

adequately trained to handle mental 

health needs that are unique to or more 

frequently experienced by veterans. In 

this regard, the commenter specifically 

recommended that the certification 

process in § 17.4110 of the interim final 

rule should require special training in 

the area of mental health. We interpret 

this recommendation to mean that such 

training should be required solely for 

mental health providers and should 

pertain to those clinical areas for which 

VA has special expertise, including 

PTSD and TBI. In response, we note that 

VA agrees that it is critical for veterans 

to receive competent care from qualified 

non-VA providers and that VA can 

contribute to that result in certain 

instances by providing training and/or 

education to non-VA providers in 

clinical areas for which VA has special 

expertise, including PTSD and TBI. In 

this regard, we note that VA will take 

a number of actions that will result in 

the provision of relevant training and 

education to non-VA providers 

furnishing care and services authorized 

pursuant to VCAs. For example, in 

accordance with section 133 of the 

MISSION Act (codified at 38 U.S.C. 

1701 note), VA established competency 

standards and requirements, including 

training requirements, for the provision 

of care by non-VA providers in clinical 

areas for which VA has special 

expertise, including PTSD and TBI. 

Such requirements apply to providers 

furnishing care and services pursuant to 

VCAs. Also, in accordance with section 

123 of the MISSION Act (codified at 38 

U.S.C. 1701 note), VA established a 

program to provide continuing medical 

education to non-VA medical 

professionals furnishing care to VA 

beneficiaries, including pursuant to 

VCAs. Moreover, VA provides 

appropriate oversight of care and 

services furnished pursuant to VCAs as 

VA administers those agreements. For 

example, VA established and imposed 

quality standards in accordance with 38 

U.S.C. 1703C and monitors and assess 

the quality of the care and services 

provided pursuant to VCAs in 

accordance with 38 U.S.C. 1703A(g). 

However, adding specific training 

requirements to the certification process 

in § 17.4110 through the regulation 

process, as opposed through the VCA 

agreements themselves, would not be an 

appropriate means of establishing such 

training requirements and ensuring that 

non-VA providers fulfill the appropriate 

training requirements prior to 

furnishing mental health care that VA 

obtains through VCAs in clinical areas 

for which VA has special expertise, 

including PTSD and TBI. Training 

requirements for mental health 

providers furnishing care and services 

pursuant to VCAs may need to be 

changed over time, potentially quickly 

in certain instances, for reasons 

including developments in clinical 

practice or new legal requirements with 

which VA must comply. So, 

establishing training requirements in the 

terms of VCAs, rather than in the 

certification process set forth in the final 

rule resulting from this rulemaking, will 

ensure VA retains the flexibility to more 

quickly and efficiently adjust those 

training requirements as appropriate 

based on evolving circumstances and 

requirements. For the foregoing reasons, 

we do not adopt the commenter’s 

recommendation to add a training 

requirement to the certification process 

set forth in § 17.4110 of the interim final 

rule. 

The same commenter also provided 

recommendations regarding the 

authority set forth in § 17.4020(d) of the 

interim final rule, which authorizes VA 

to establish payment rates exceeding the 

applicable Medicare-based limitations 

in § 17.4120(a)–(b) when VA determines 

that it is not practicable to limit 

payment to those rates. Specifically, the 

commenter recommended that the 

authority to make the determinations 

referenced in § 17.4120(d) should be 

delegated to officials at individual VHA 

medical facilities and should not be 

subject to an overly burdensome 

justification and approval process. In 

response, VA notes that although the 

authority to generate determinations 

referenced in § 17.4120(d) of the interim 

final rule is delegated to officials at 

individual VHA medical facilities, that 

authority is circumscribed by a 

requirement that each such 

determination must be approved by 

VHA’s national Office of Community 

Care. This centralized oversight by the 

Office of Community Care is intended to 

enhance the effectiveness and integrity 

of VA’s use of VCAs, as well as the 

entire VCCP, by bringing that office’s 

resources, data, and enterprise-wide 

view of VCAs and the VCCP to bear in 

a manner that will promote consistency 

and quality in how VA interprets and 

applies the impracticability standard in 

§ 17.4120(d) of the interim final rule and 

that will ensure VA is appropriately 

assessing and accounting for the 

potential impacts, if any, of such 

determinations on the VCCP more 

broadly. Consequently, VA does not 

make any changes to the interim final 

rule based on these comments. 

The same commenter also indicated 

that the non-VA entities and providers 

furnishing care pursuant to VCAs need 

to be adequately compensated on a 

timely basis for their services. In 

response, we note that VA agrees with 

this comment and will work to ensure 

timely payments for care and services 

obtained pursuant to VCAs, as required 

by 38 U.S.C. 1703D. All VCAs contain 

payment terms that require VA to make 

payment in accordance with the 

timeframes required by statute, so it 

would serve no relevant purpose to add 

those same payment timeliness 

requirements to this final rule. 

Consequently, we do not make any 

changes to the interim final rule based 

on this comment. 

The same commenter also asserted 

that VA must develop and partner with 

a network of dedicated providers and 

that service-disabled veteran owned 

small businesses (SDVOSB), veteran 

owned small businesses (VOSB), and 

prior VA clinicians should be given 

priority. The comment indicated that 

the reasons for recommending that VA 

prioritize utilization of SDVOSBs and 

VOSBs include that veterans (which we 

presume refers to the veteran owners of 

those businesses) have shared military 

experience that improves the efficacy of 

counseling services provided to fellow 

veterans and that such veteran owners 

are highly motivated, dedicated, and 

willing to make sacrifices to help their 

fellow veterans. As it pertains to the 

subject matter of this rulemaking, VCAs, 

we interpret this comment 

recommending that VA give ‘‘priority’’ 

to SDVOSBs, VOSBs, and prior VA 

clinicians to mean that when VA is 

obtaining needed hospital care, medical 

services, or extended care services for a 

veteran through a VCA, in accordance 

with the legal criteria for doing so,4 two 

or more VCAs are feasibly available for 

that purpose, and one or more of those 

feasibly available VCAs was entered 

into with an entity that’s an SDVOSB or 

a VOSB or with a provider that’s a prior 


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50860 Federal Register / Vol. 86, No. 174 / Monday, September 13, 2021 / Rules and Regulations 

5See 38 U.S.C. 1703(g)(2) (‘‘[VA] shall not 

prioritize providers in a tier over providers in any 

other tier in a manner that limits the choice of a 

covered veteran in selecting a health care provider 

specified in subsection (c) for receipt of hospital 

care, medical services, or extended care services 

under [the VCCP]’’); 38 CFR 17.4030 (‘‘[a] covered 

veteran may specify a particular eligible entity or 

provider’’). 

VA clinician, that VA should 

automatically obtain the needed care or 

services through one of the VCAs 

entered into with the entities and 

providers in those classes in lieu of 

using any other VCAs that are feasibly 

available. In response, we note that 

when the needed care or services at 

issue are being obtained through the 

VCCP, the veteran is legally permitted to 

select the eligible entity or provider 

from which the veteran receives such 

care or services.5 So, implementing the 

commenter’s recommendation would 

not be legally feasible in that context if 

the veteran opts to select the eligible 

entity or provider. Moreover, if and 

when VA finds itself in the position of 

selecting from among multiple VCAs 

that are feasibly available for purposes 

of obtaining needed care or services, 

VA’s determination of the appropriate 

VCA to utilize will be driven by clinical 

considerations, including those bearing 

on ensuring VA obtains timely and 

quality care and services most 

appropriate to the specific needs of the 

beneficiary. In some instances, the 

involvement of veterans or prior VA 

clinicians in the delivery of care and 

services by certain entities and 

providers could prove relevant to such 

individualized and clinically driven 

determinations. However, selecting the 

VCA that VA will use based upon 

whether the VCA was entered into with 

an SDVOSB, a VOSB, or a prior VA 

clinician, rather than based upon a 

holistic and individualized assessment 

of all relevant clinical considerations, 

including those bearing on ensuring VA 

obtains timely and quality care and 

services most appropriate to the specific 

needs of the veteran, could result in 

adverse consequences, including worse 

health outcomes, for the veteran. 

Consequently, we decline to adopt such 

an approach, and, for the foregoing 

reasons, we make no changes to the 

interim final rule based on this 

comment. 

Administrative Procedure Act 

VA has considered all relevant input 

and information contained in the 

comments submitted in response to the 

interim final rule (84 FR 21668) and, for 

the reasons set forth in the foregoing 

responses to those comments, has 

concluded that no changes to the 

interim final rule are warranted. 

Accordingly, based upon the authorities 

and reasons set forth in the interim final 

rule (84 FR 21668), as supplemented by 

the additional reasons provided in this 

document in response to comments 

received, VA is adopting the provisions 

of the interim final rule as a final rule 

with no substantive changes. 

Paperwork Reduction Act 

The Paperwork Reduction Act of 1995 

(44 U.S.C. 3507) requires that VA 

consider the impact of paperwork and 

other information collection burdens 

imposed on the public. Except for 

emergency approvals under 44 U.S.C. 

3507(j), 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. The interim final rule included 

provisions constituting new collections 

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) (the 

provisions in the interim final rule are 

§§ 17.4110, 17.4130, and 17.4135). 

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

VA submitted a copy of the interim final 

rule to OMB for review, and VA 

requested that OMB approve the 

collections of information on an 

emergency basis. VA did not receive any 

comments on the collections of 

information contained in the interim 

final rule. OMB approved the 

collections of information under control 

number 2900–0872. 

Regulatory Flexibility Act 

The Secretary hereby certifies that 

this rule will not have a significant 

economic impact on a substantial 

number of small entities as they are 

defined in the Regulatory Flexibility 

Act, 5 U.S.C. 601–612. 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. 

Executive Orders 12866 and 13563 

Executive Orders 12866 and 13563 

direct agencies to assess the costs and 

benefits of available regulatory 

alternatives and, when regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, and other advantages; 

distributive impacts; and equity). 

Executive Order 13563 (Improving 

Regulation and Regulatory Review) 

emphasizes the importance of 

quantifying both costs and benefits, 

reducing costs, harmonizing rules, and 

promoting flexibility. OMB’s Office of 

Information and Regulatory Affairs 

(OIRA) has determined that this rule is 

not a significant regulatory action under 

Executive Order 12866. The Regulatory 

Impact Analysis associated with this 

rulemaking can be found as a 

supporting document at 

www.regulations.gov. 

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 

one year. This final rule will have no 

such effect on State, local, and tribal 

governments, or on the private sector. 

Congressional Review Act 

Pursuant to the Congressional Review 

Act (5 U.S.C. 801 et seq.), OIRA 

designated this rule as not a major rule, 

as defined by 5 U.S.C. 804(2). 

Catalog of Federal Domestic Assistance 

The Catalog of Federal Domestic 

Assistance numbers and titles for the 

programs affected by this document are 

as follows: 64.009, Veterans Medical 

Care Benefits; and 64.018, Sharing 

Specialized Medical Resources. 

List of Subjects in 38 CFR Part 17 

Administrative practice and 

procedure, Alcohol abuse, Alcoholism, 

Claims, Day care, Dental health, Drug 

abuse, Foreign relations, Government 

contracts, Grant programs—health, 

Grant programs—veterans, Health care, 

Health facilities, Health professions, 

Health records, Homeless, Medical and 

dental schools, Medical devices, 

Medical research, Mental health 

programs, Nursing homes, Philippines, 

Reporting and recordkeeping 

requirements, Scholarships and 

fellowships, Travel and transportation 

expenses, Veterans. 

Signing Authority 

Denis McDonough, Secretary of 

Veterans Affairs, approved this 

document on July 27, 2021, and 

authorized the undersigned to sign and 

submit the document to the Office of the 

Federal Register for publication 


lotter on DSK11XQN23PROD with RULES1
Federal Register / Vol. 86, No. 174 / Monday, September 13, 2021 / Rules and Regulations 50861 

electronically as an official document of 

the Department of Veterans Affairs. 

Michael P. Shores, 

Director, Office of Regulation Policy & 

Management, Office of General Counsel, 

Department of Veterans Affairs. 

Accordingly, the interim final rule 

amending 38 CFR part 17, which was 

published at 84 FR 21668 on May 14, 

2019, is adopted as final with the 

following technical amendments: 

PART 17—MEDICAL 

■ 1. The general authority citation for 

part 17 continues to read as follows: 

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

specific sections 

* * * * * 

§ § 17.4110, 17.4130, and 17.4135 

[Amended] 

■ 2. In §§ 17.4110, 17.4130, and 

17.4135, remove the OMB statement 

‘‘(The information collection 

requirements have been submitted to 

the Office of Management and Budget 

(OMB) and are pending OMB 

approval.)’’ and add in its place ‘‘(Office 

of Management and Budget approved 

the collection of information under 

control number 2900–0872.)’’. 

[FR Doc. 2021–19470 Filed 9–10–21; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 622 

[Docket No. 121004515–3608–02; RTID 

0648–XB398] 

Fisheries of the Caribbean, Gulf of 

Mexico, and South Atlantic; 2021 

Commercial Closure for South Atlantic 

Red Snapper 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Temporary rule; closure. 

SUMMARY: NMFS implements an 

accountability measure for red snapper 

in the exclusive economic zone (EEZ) of 

the South Atlantic. NMFS projects 

commercial landings of red snapper 

have reached the commercial annual 

catch limit (ACL) for the 2021 fishing 

year. Therefore, NMFS is closing the 

commercial sector for red snapper in the 

South Atlantic EEZ. This closure is 

necessary to protect the red snapper 

resource. 

DATES: This temporary rule is effective 

from 12:01 a.m., eastern time, on 

September 14, 2021, through December 

31, 2021. 

FOR FURTHER INFORMATION CONTACT: 

Mary Vara, NMFS Southeast Regional 

Office, telephone: 727–824–5305, email: 

mary.vara@noaa.gov. 

SUPPLEMENTARY INFORMATION: The 

snapper-grouper fishery of the South 

Atlantic includes red snapper and is 

managed under the Fishery 

Management Plan for the SnapperGrouper Fishery of the South Atlantic 

Region (FMP). The FMP was prepared 

by the South Atlantic Fishery 

Management Council and is 

implemented by NMFS under the 

authority of the Magnuson-Stevens 

Fishery Conservation and Management 

Act (Magnuson-Stevens Act) by 

regulations at 50 CFR part 622. 

The commercial ACL for red snapper 

in the South Atlantic is 124,815 lb 

(56,615 kg), round weight, as specified 

in 50 CFR 622.193(y)(1). 

Under 50 CFR 622.193(y)(1), NMFS is 

required to close the commercial sector 

for red snapper when the commercial 

ACL is reached, or is projected to be 

reached, by filing a notification to that 

effect with the Office of the Federal 

Register. NMFS has determined that the 

commercial ACL for South Atlantic red 

snapper will be reached by September 

14, 2021. Accordingly, the commercial 

sector for South Atlantic red snapper is 

closed effective at 12:01 a.m., eastern 

time, on September 14, 2021. For the 

2022 fishing year, unless otherwise 

specified, the commercial season will 

begin on the second Monday in July (50 

CFR 622.183(b)(5)(i)). 

The operator of a vessel with a valid 

commercial vessel permit for South 

Atlantic snapper-grouper having red 

snapper on board must have landed and 

bartered, traded, or sold such red 

snapper prior to 12:01 a.m., eastern 

time, on September 14, 2021. Because 

the recreational sector closed on July 12, 

2021 (86 FR 30393, June 8, 2021), after 

the commercial sector closure that is 

effective on September 14, 2021, all 

harvest and possession of red snapper in 

or from the South Atlantic EEZ is 

prohibited for the remainder of the 2021 

fishing year. 

On and after the effective date of the 

closure notification, all sale or purchase 

of red snapper is prohibited. This 

prohibition on the harvest, possession, 

sale or purchase applies in the South 

Atlantic on a vessel for which a valid 

Federal commercial or charter vessel/ 

headboat permit for South Atlantic 

snapper-grouper has been issued, 

regardless if such species were 

harvested or possessed in state or 

Federal waters (50 CFR 622.193(y)(1) 

and 622.181(c)(2)). 

Classification 

NMFS issues this action pursuant to 

section 305(d) of the Magnuson-Stevens 

Act. This action is required by 50 CFR 

622.193(y)(1), which was issued 

pursuant to section 304(b) of the 

Magnuson-Stevens Act, and is exempt 

from review under Executive Order 

12866. 

Pursuant to 5 U.S.C. 553(b)(B), the 

NMFS Assistant Administrator (AA) 

finds good cause to waive prior notice 

and an opportunity for public comment 

on this action, as notice and comment 

are unnecessary and contrary to the 

public interest. Such procedures are 

unnecessary because the rule that 

established the commercial season, 

ACL, and accountability measure for red 

snapper has already been subject to 

notice and comment, and all that 

remains is to notify the public of the 

closure. Such procedures are contrary to 

the public interest because of the need 

to immediately implement this action to 

protect red snapper because the capacity 

of the fishing fleet allows for rapid 

harvest of the commercial ACL. Prior 

notice and opportunity for public 

comment would require time and could 

potentially result in a harvest well in 

excess of the established commercial 

ACL. 

For the aforementioned reasons, the 

AA also finds good cause to waive the 

30-day delay in the effectiveness of this 

action under 5 U.S.C. 553(d)(3). 

Authority: 16 U.S.C. 1801 et seq. 

Dated: September 8, 2021. 

Jennifer M. Wallace, 

Acting Director, Office of Sustainable 

Fisheries, National Marine Fisheries Service. 

[FR Doc. 2021–19687 Filed 9–9–21; 8:45 am] 

BILLING CODE 3510–22–P 


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