Federal Register / Vol. 87, No. 105 / Wednesday, June 1, 2022 / Rules and Regulations 33021 

anchoring within the safety zone is 

prohibited unless authorized by the 

Captain of the Port Duluth or their 

designated on-scene representative. 

DATES: The regulations in 33 CFR 

165.943(a)(5) will be enforced from 9:30 

p.m. through 11:00 p.m. on July 4, 2022. 

FOR FURTHER INFORMATION CONTACT: If 

you have questions about this notice of 

enforcement, call or email LT Joe 

McGinnis, U.S. Coast Guard; telephone 

218–725–3818, email DuluthWWM@

uscg.mil. 

SUPPLEMENTARY INFORMATION: The Coast 

Guard will enforce the safety zone in 33 

CFR 165.943(a)(5) on all waters of 

Duluth Harbor bounded by the arc of a 

circle with a 1120-foot radius from the 

fireworks launch site with its center in 

position 46°46′14′′ N, 092°06′16′′ W 

from 9:30 p.m. through 11:00 p.m. on 

July 4, 2022. This action is necessary to 

protect participants and spectators 

during the Duluth Fourth Fest 

Fireworks. Entry into, transiting, or 

anchoring within the safety zone is 

prohibited unless authorized by the 

Captain of the Port Duluth or their 

designated on-scene representative. 

This notice of enforcement is issued 

under authority of 33 CFR 165.943 and 

5 U.S.C. 552 (a). In addition to this 

publication in the Federal Register, the 

Coast Guard will provide the maritime 

community with advance notification of 

the enforcement of this safety zone via 

Broadcast Notice to Mariners. The 

Captain of the Port Duluth or their onscene representative may be contacted 

via VHF Channel 16. 

Dated: May 25, 2022. 

F.M. Smith, 

Captain of the Port Duluth, CDR, U.S. Coast 

Guard. 

[FR Doc. 2022–11711 Filed 5–31–22; 8:45 am] 

BILLING CODE 9110–04–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 17 

RIN 2900–AQ65 

Transplant Procedures With Live 

Donors and Related Care and Services 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) adopts as final, with 

changes, a proposed rule amending its 

medical regulations to implement 

legislation providing it stand-alone 

authority to provide procedures to 

remove a solid organ or bone marrow 

from a live donor for transplantation 

into a veteran and to furnish the live 

donor care or services before and after 

the procedure required in connection 

with the veteran’s transplantation 

procedure. This rulemaking implements 

the mandates of section 153 of the VA 

MISSION Act of 2018. 

DATES: This rule is effective July 1, 

2022. 

FOR FURTHER INFORMATION CONTACT: 

Mani Murugavel, DNP, NE–BC, CSSGB, 

RN, National Director, Clinical Services, 

National Surgery Office (11SURG), 

Veterans Health Administration, 810 

Vermont Avenue NW, Washington, DC 

20420, (202) 461–7130. (This is not a 

toll-free number.) 

SUPPLEMENTARY INFORMATION: In a 

document published in the Federal 

Register (FR) on March 24, 2021, (86 FR 

15628), VA proposed to amend its 

medical regulations to implement its 

authority to provide procedures to 

remove a solid organ or bone marrow 

from a live donor for transplantation 

into a veteran and to furnish the live 

donor care or services before and after 

the procedure. VA provided a 60-day 

comment period, which ended on May 

24, 2021. Six comments were received. 

Comments 

The six comments were generally 

supportive of the proposed rule, and we 

thank the commenters for their 

comments. Of those six comments, four 

included substantive feedback, which is 

discussed below. 

One commenter opined that live 

donors should be further compensated. 

This commenter suggested VA cover 

additional expenses that are deemed 

necessary and for which live donors 

submit documentation, as there are 

‘‘other factors such as emotional effects 

that donors sometime[s] experience’’ 

due to the transplant procedure. 

However, this commenter did not 

specify the types of additional expenses 

VA should cover. 

As explained in the proposed rule, 

VA will cover for the live donor hospital 

care and medical services prior to the 

surgical removal of the solid organ, part 

of a solid organ, or bone marrow; the 

surgical procedure to remove a solid 

organ, part of a solid organ, or bone 

marrow, and related care; and follow-up 

care which varies based on the type of 

donation. Additionally, VA will cover 

travel costs, including temporary 

lodging as VA determines to be needed. 

While VA acknowledges that live 

donors may incur additional expenses, 

VA believes the services and expenses 

covered under this rulemaking are 

reasonable under section 1788 of title 

38, United States (U.S.C.), are consistent 

with how VA has administered the 

transplant program to date, and 

recognize the sacrifices that live donors 

make. While VA understands the 

commenter’s support and rationale for 

expanding upon the additional expenses 

covered by VA, VA is not making any 

changes based on this comment. 

To the extent that this commenter 

further suggested that live donors 

should be compensated for their 

donation, by law, VA may not 

knowingly acquire, receive, or otherwise 

transfer any human organ for valuable 

consideration for use in human 

transplantation if the transfer affects 

interstate commerce. 42 U.S.C. 274e(a). 

For purposes of this statute, the term 

‘‘valuable consideration’’ ‘‘does not 

include the reasonable payments 

associated with the removal, 

transportation, implantation, 

processing, preservation, quality 

control, and storage of a human organ or 

the expenses of travel, housing, and lost 

wages incurred by the donor of a human 

organ in connection with the donation 

of the organ.’’ Section 274e(c)(2). 

Although this prohibition does not 

apply to a ‘‘human organ paired 

donation,’’ (see last sentence of section 

274e(a)), that is not to say that 

compensation is available in these 

cases, because the term ‘‘human organ 

paired donation,’’ as defined in section 

274e(c)(4), clearly bars valuable 

consideration from being provided for 

the organ in subparagraph (c)(4)(F). 

Thus, furnishing compensation for a 

human organ is legally barred. In 

addition, a host of ethical questions are 

raised by such a proposal. Transplant 

programs participating in the Organ 

Procurement Transplantation Network 

(OPTN) are authorized, however, to 

provide reimbursement for incidental 

non-medical expenses of donors. See 42 

U.S.C. 274f, as implemented by § 121.14 

of title 42, Code of Federal Regulations 

(CFR). This authority is discretionary, 

and while VA voluntarily participates 

and complies with OPTN requirements 

and is an OPTN-designated transplant 

program, VA will cover only the nonmedical costs we have identified, as 

these types of non-medical costs are 

directly integral to the donor’s 

transplant episode. In addition, this 

aligns with how very limited nonmedical care benefits, or financial 

incentives, exist for other VA 

beneficiaries. Nonetheless, VA will 

undertake additional review and 

analysis to determine whether nonmedical expenses other than those 

already covered under this rulemaking 

should be covered to encourage greater 


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donor participation. If VA determines 

additional non-medical expenses such 

as incidental non-medical costs 

described in 42 CFR 121.14 should also 

be covered, it will propose to do so in 

a separate future rulemaking. 

VA therefore makes no changes based 

on this comment. 

Another commenter stated that it was 

unclear whether the definition of kidney 

paired donation, in 38 CFR 17.395(b), 

included living donor chains, and 

suggested VA modify this definition to 

explicitly cover living donor chains. As 

explained in OPTN policies, a living (or 

live) donor chain is an approach in 

which a live donor without an intended 

recipient donates an organ, which is 

matched with a recipient. See OPTN, 

Policy 1: Administrations Rules and 

Definitions, and Policy 13: Kidney 

Paired Donation. U.S. Department of 

Health and Human Services, Health 

Resources and Services Administration. 

Retrieved from: https://www.hhs.gov/ 

guidance/sites/default/files/hhsguidance-documents/optn_policies.pdf 

(Accessed: 25 October 2021). That 

recipient’s prospective live donor then 

donates an organ that can be matched 

with another recipient. Id. A chain of 

donations then occurs that allows for 

the donation and receipt of compatible 

organs. Id. Currently, live donor chains 

are widely used for the donation and 

receipt of kidneys. 

The definition of kidney paired 

donation in § 17.395(b) is consistent 

with OPTN’s definition of kidney paired 

donation. However, it does not 

specifically address live donor chains 

nor does it prohibit live donor chains. 

For the purposes of this rulemaking, VA 

clarifies that live donor chains are 

permitted, and interpreted to be 

included, under VA’s definition of 

kidney paired donation. Based on this 

comment, VA is adding a note to the 

definition of kidney paired donation to 

state that for purposes of this section, 

kidney paired donation includes live 

donor chains. VA is also adding a 

definition for live donor chain to mean 

a set of kidney paired donation matches 

that begins with a donation of a kidney 

from a live donor without an intended 

recipient. Such live donor donates a 

kidney for transplantation into the 

intended recipient of a prospective live 

donor. The prospective live donor then 

donates a kidney for transplantation 

into a recipient other than the intended 

recipient. A chain continues to allow 

donation and receipt of compatible 

kidneys. VA makes no further changes 

based on this comment. 

One commenter suggested that VA 

revise its rule to specify that VA bone 

marrow programs follow standards of 

care and patient safety issued by the 

nation’s bone marrow registry, as they 

opined that it is critical VA and non-VA 

bone marrow programs align. This 

commenter noted that National Marrow 

Donor Program (NMDP) network 

members are held to standards of care 

and safety for bone marrow transplant 

similar to OPTN members. 

As an initial matter, NMDP manages 

a bone marrow registry in which donors 

unrelated to the transplant recipient can 

voluntarily register to donate their bone 

marrow (including stem cells). These 

donations are then stored and managed 

by NMDP. While medical hospitals and 

facilities can become NMDP-contracted 

bone marrow donor centers, which are 

subject to NMDP Donor Center 

participation standards, VA does not 

have any such bone marrow donor 

centers as part of its bone marrow 

transplantation program. Instead, VA 

contracts with NMDP to obtain bone 

marrow for transplantation when a bone 

marrow match is identified (through 

NMDP’s registry) for a veteran recipient. 

VA also may obtain bone marrow 

directly from live donors who are 

identified by VA as a match for the 

veteran recipient. 

To the extent that this commenter is 

suggesting VA revise the rule to specify 

that VA’s bone marrow program follows 

standards of care and patient safety 

issued by NMDP for live donors of bone 

marrow, NMDP maintains standards for 

bone marrow donor centers, specifically 

related to the bone marrow donor. 

Because VA does not operate NMDPcontracted bone marrow donor centers, 

related NMDP standards do not apply to 

VA. When VA procures bone marrow 

including stem cells from NMDP for 

transplantation into a veteran recipient, 

VA does not directly interact with the 

bone marrow donor and thus any 

standards about donor care would be 

inapplicable, particularly as VA would 

not know the identity of the live donor. 

Therefore, NDMP donor center 

participation standards do not apply to 

VA’s bone marrow transplantation 

program because VA does not operate 

such donor centers. As noted earlier, VA 

may obtain bone marrow directly from 

live donors (for example, family 

members of the veteran) who are 

identified by VA as a match for the 

veteran recipient; however, such 

donations do not fall under NMDP 

standards for donor centers. VA believes 

the current language in the regulation 

regarding care for bone marrow donors 

is sufficient, particularly as it is 

consistent with VA current policy and 

practices. VA does not make any 

changes to the regulation based on this 

comment. 

NMDP also maintains standards, 

including data reporting, relating to the 

unrelated allogeneic bone marrow 

transplant procedure. VA voluntarily 

complies with such standards. To the 

extent that this commenter is suggesting 

VA revise the rule to specify that VA’s 

bone marrow program follows standards 

of care and patient safety issued by 

NMDP for transplant recipients, VA 

considers this outside the scope of the 

rulemaking as this relates to transplant 

recipients, not live donors. VA makes 

no changes to the regulation based on 

this comment. 

That same commenter also suggested 

the rule be revised to specify that data 

reporting requirements for bone marrow 

transplant be submitted to the Stem Cell 

Therapeutic Outcomes Database 

(SCTOD), as that ‘‘database allows 

analysis of program use, center-specific 

outcomes, size of donor registry and 

cord blood inventory, and patient access 

to hematopoietic cell transplantations, 

and per the Stem Cell Therapeutic and 

Research Act of 2005, VA would share 

outcomes data with the SCTOD.’’ 

VA voluntarily complies with the 

Foundation for the Accreditation of 

Cellular Therapy (FACT) standards for 

direct allogeneic live donor care and 

data reporting requirements. These 

include submission of direct allogeneic 

stem cell transplant data to the SCTOD. 

However, VA considers this part of the 

comment beyond the scope of the 

rulemaking as these reporting 

requirements for bone marrow 

transplant mainly concern the 

engraftment and recipient, and not the 

live donor, and this comment does not 

pertain to the care and services available 

to live donors under VA’s transplant 

program. VA believes that this is more 

appropriate for internal VA policy than 

regulation since it concerns internal VA 

requirements. To the extent that this 

commenter is suggesting non-VA 

providers performing bone marrow 

transplants under VA’s transplant 

program comply with these same data 

reporting requirements, this is beyond 

the scope of this rulemaking and would 

be more appropriate for inclusion in 

agreements VA enters into with these 

non-VA providers. VA is making no 

changes based on this comment. 

One commenter stated that OPTN 

requires that transplant programs only 

use living donor organs recovered from 

OPTN approved living donor recovery 

hospitals and noted that when VA 

enters into agreements with non-VA 

facilities for organ transplants, it should 

ensure that these non-VA facilities are 

approved for recovery of organs from 

living donors if the recovery will occur 

in such facilities. This commenter 


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suggested VA consider clarifying in the 

final rule the minimum requirements for 

these non-VA facilities that recover 

organs from living donors. Relatedly, 

this commenter recommended the rule 

be ‘‘explicit about requirements for 

outcomes reporting, compliance 

monitoring, and other considerations 

between bone marrow and solid organ 

transplant, given their distinct 

contractual relationships with the 

federal government.’’ 

With regards to the comment that VA 

should ensure that non-VA facilities 

with which VA enters into agreements 

for bone marrow or solid organ 

transplants are approved by OPTN, VA 

considers this part of the comment 

beyond the scope of the rulemaking 

since it does not pertain to the care and 

services available to live donors under 

VA’s transplant program. The 

qualifications that VA requires non-VA 

facilities providing such services to 

possess is a separate matter that will be 

addressed by VA in the context of its 

acquisitions. 

In the agreements VA would enter 

into with non-VA facilities for organ 

transplants, VA would ensure that the 

appropriate requirements, such as those 

requirements for outcomes reporting, 

compliance monitoring, and other 

requirements or considerations, are 

included in such agreements. This 

information is commonly set forth in 

agreements rather than regulations, 

especially to permit flexibility, as 

requirements are subject to change. 

Additionally, the purpose of this 

rulemaking is to regulate the care and 

services available to living donors 

before and after the procedure required 

in connection with a veteran’s 

transplantation procedure; not to 

regulate the requirements for reporting, 

monitoring, or other similar 

requirements with which non-VA 

providers must comply. 

VA is making no changes based on 

this comment. 

Technical Changes Not Based on 

Comments 

VA makes two technical changes not 

based on comments. Both technical 

changes are made to 38 CFR 17.395(g), 

which states the limitations on VA 

obligations in kidney paired donations. 

The first change is to replace the term, 

care, with the term, hospital care, in the 

introductory paragraph of § 17.395(g). 

The second change is to replace the 

term, services, with the term, medical 

services, in the introductory paragraph 

of § 17.395(g). These technical changes 

clarify the specific type of care and 

services referenced in § 17.395(g) and 

are consistent with how these terms are 

used in paragraph (c) of § 17.395. These 

technical changes will also avoid 

potential confusion with the terms, nonhospital care and non-medical services, 

which appear in paragraph (d) of 

§ 17.395. 

Based on the rationale set forth in the 

proposed rule and in this final rule, VA 

is adopting the proposed rule with 

changes as noted. 

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. The Office of 

Information and Regulatory Affairs 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. 

Regulatory Flexibility Act 

The Secretary hereby certifies that 

this final 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). VA has determined 

that this rule will not have a significant 

impact on a substantial number of small 

entities because the final rule does not 

directly regulate or impose costs on 

small entities and any effects would be 

indirect. 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 

one year. This final rule will have no 

such effect on State, local, and tribal 

governments, or on the private sector. 

Paperwork Reduction Act 

This final rule contains no provisions 

constituting a collection of information 

under the Paperwork Reduction Act of 

1995 (44 U.S.C. 3501–3521). 

Assistance Listing 

The Assistance Listing numbers and 

titles for the programs affected by this 

document are 64.009, Veterans Medical 

Care Benefits; 64.029, Purchased Care 

Program; 64.047, VHA Primary Care; 

64.042, 64. 045, VHA Ancillary 

Outpatient Services; 64.042, VHA 

Inpatient Surgery; 64.040, VHA 

Inpatient Medicine; 64.041,VHA 

Outpatient Specialty Care; 64.035, 

Veterans Transportation Program. 

Congressional Review Act 

Pursuant to Subtitle E of the Small 

Business Regulatory Enforcement 

Fairness Act of 1996 (known as the 

Congressional Review Act) (5 U.S.C. 801 

et seq.), the Office of Information and 

Regulatory Affairs designated this rule 

as not a major rule, as defined by 5 

U.S.C. 804(2). 

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 March 7, 2022, 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. 

Consuela Benjamin, 

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 amends 38 CFR part 17 as set 

forth below: 

PART 17—MEDICAL 

■ 1. The general authority citation for 

part 17 continues and an authority 


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citation for § 17.395 is added in 

numerical order to read as follows: 

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

specific sections. 

* * * * * 

Section 17.395 is also issued under 38 

U.S.C. 1788. 

■ 2. Add an undesignated center 

heading and § 17.395 to read as follows: 

Hospital Care, Medical Services, and 

Other Services for Live Donors 

§ 17.395 Transplant procedures with live 

donors, and related services. 

(a) Scope. This section provides for 

medical and non-medical care and 

services of persons who volunteer to 

donate a solid organ, part of a solid 

organ, or bone marrow for 

transplantation into an eligible veteran 

transplant candidate, irrespective of a 

donor’s eligibility to receive VA health 

care for any reason other than to donate 

a solid organ, part of a solid organ, or 

bone marrow. It prescribes the type, 

timing, and duration of hospital care 

and medical services VA provides, 

including medical care or services 

purchased by agreement from a non-VA 

facility. It also provides for non-medical 

care and services essential to the 

prospective live donor’s or live donor’s 

participation and for VA reimbursement 

for that care and services. The section 

does not provide for eligible veteran 

transplant candidates’ VA medical 

benefits. 

(b) Definitions. For purposes of this 

section: 

Initial prospective live donor means 

an intended recipient’s prospective live 

donor who volunteers to donate a 

kidney to a recipient other than the 

intended recipient through kidney 

paired donation. 

Intended recipient means the 

transplant candidate who VA identifies 

to receive a live donor’s solid organ, 

part of a solid organ, or bone marrow. 

Kidney paired donation means one 

prospective live donor’s voluntary 

donation of a kidney for transplantation 

into a recipient other than an intended 

recipient, paired with the 

transplantation into the intended 

recipient of a compatible kidney from a 

different live donor. Note: For purposes 

of this section, kidney paired donation 

includes live donor chains. 

Live donor means an individual who 

is: 

(i) Medically suitable for donation; 

(ii) Is a compatible match to an 

identified veteran transplant candidate; 

and 

(iii) Has provided informed consent to 

undergo elective removal of one solid 

organ, part of a solid organ, or of bone 

marrow. 

Live donor chain means a set of 

kidney paired donation matches that 

begins with a donation of a kidney from 

a live donor without an intended 

recipient. Such live donor donates a 

kidney for transplantation into the 

intended recipient of a prospective live 

donor. The prospective live donor then 

donates a kidney for transplantation 

into a recipient other than the intended 

recipient. A chain continues to allow 

donation and receipt of compatible 

kidneys. 

Live Donor Follow-Up Means 

(i) For live donors of a solid organ or 

part of a solid organ, the collection of 

clinically relevant post-donation live 

donor data and the provision of 

recommended clinical laboratory tests 

and evaluations consistent with Organ 

Procurement and Transplantation 

Network policy, and the provision of 

direct medical care required to address 

reasonably foreseeable donor health 

complications resulting directly from 

the donation procedure. 

(ii) For live donors of bone marrow, 

the provision of direct medical care 

required to address reasonably 

foreseeable donor health complications 

resulting directly from the donation 

procedure. 

Prospective live donor means a person 

who has volunteered to donate a solid 

organ, part of a solid organ, or bone 

marrow to an intended recipient, and 

who has agreed to participate in any 

activity VA deems necessary to carry 

out the intended recipient’s transplant 

procedure. 

Transplant candidate means an 

enrolled veteran or a veteran otherwise 

eligible for VA’s medical benefits 

package who VA determines has a 

medical need for a solid organ, part of 

a solid organ, or bone marrow 

transplant. 

Transplant recipient means a 

transplant candidate who has 

undergone transplantation and received 

a solid organ, part of a solid organ, or 

bone marrow from a live donor. 

(c) Hospital care and medical 

services. To obtain a solid organ, part of 

a solid organ, or bone marrow for a VA 

transplant candidate, VA may provide 

the following hospital care and medical 

services to a prospective live donor or 

live donor: 

(1) Before removal of a solid organ, 

part of a solid organ, or bone marrow, 

VA will provide examinations, tests, 

and studies necessary to qualify a 

prospective live donor to donate a solid 

organ, part of a solid organ, or bone 

marrow. 

(2) During removal of a solid organ, 

part of a solid organ, or bone marrow, 

VA will provide the surgical procedure 

to remove a solid organ, part of a solid 

organ, or bone marrow from the living 

donor whose solid organ, part of a solid 

organ, or bone marrow will be 

transplanted into an intended recipient. 

(3) After removal of a solid organ or 

part of a solid organ, VA will provide 

all hospital care, medical services, and 

other services which are necessary and 

appropriate to live donor follow-up as 

defined in paragraph (b) of this section 

for a period not less than that which the 

Organ Procurement and Transplantation 

Network prescribes or recommends or 

for a period of 2 years, whichever is 

greater. 

(4) After bone marrow removal, VA 

will provide direct medical care 

required to address reasonably 

foreseeable live donor health 

complications resulting directly from 

the bone marrow donation procedure for 

a period not greater than 2 years. 

(5) A prospective live donor who is 

also a veteran enrolled in VA’s health 

care system may receive care and 

services authorized in paragraphs (c)(1) 

and (2) only under this section. A live 

donor who is also a veteran enrolled in 

VA’s health care system may opt to 

receive the care and services authorized 

under paragraph (c)(3) or (4) under 

either the medical benefits package 

codified at § 17.38 or under this section, 

but not both at the same time. 

(d) Non-hospital care and nonmedical services. If VA determines the 

prospective live donor’s or the live 

donor’s presence or proximity is 

necessary, VA will reimburse the travel 

costs of the prospective live donor or 

live donor, including one needed 

attendant or support person, at the rates 

provided in § 70.30 of this chapter, 

without the deductibles required by 

§ 70.31 of this chapter, for: 

(1) Travel between the prospective 

live donor’s or live donor’s residence 

and the site of hospital care or medical 

services authorized in paragraph (c) of 

this section; and 

(2) Temporary lodging: 

(i) While the live donor is 

hospitalized for the organ removal 

procedure; or 

(ii) While the prospective live donor’s 

or live donor’s participation in the live 

donor program requires the prospective 

live donor’s or live donor’s presence 

away from home at least overnight and 

the prospective live donor’s or live 

donor’s presence or proximity is 

determined necessary by VA. 

(e) Use of non-VA facilities and nonVA service providers. (1) If and only if 

VA and a non-VA facility or non-VA 


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service provider have an agreement 

governed by 38 U.S.C. 8153 or any other 

applicable authority in title 38, United 

States Code, a non-VA facility may 

provide— 

(i) A surgical procedure and care and 

services described in paragraph (c) of 

this section; or 

(ii) Non-hospital care or non-medical 

services described and otherwise 

reimbursable under paragraph (d) of this 

section. 

(2) The prospective live donor or live 

donor is eligible for hospital care and 

medical services, or travel services, at a 

non-VA facility solely for the procedure, 

care, and services described in 

paragraphs (c) and (d) of this section as 

governed by an agreement described in 

paragraph (e)(1) of this section. 

(f) Participation terminated without 

completion of the intended recipient’s 

transplantation procedure. (1) VA will 

provide the prospective live donor or 

live donor the care and services 

described in this section for any VAauthorized participation in the intended 

recipient’s organ or bone marrow 

transplantation process even if the 

transplantation procedure for which the 

prospective live donor or live donor 

volunteered to donate a solid organ, part 

of a solid organ, or bone marrow is not 

completed. 

(2) A prospective live donor or a live 

donor may withdraw his or her 

informed consent at any time and for 

any reason. In the case of revocation of 

consent, VA will pay all the costs 

authorized under this section for the 

prospective live donor or live donor up 

until when the donor revokes consent 

and ends his or her participation. 

(g) Limitation on VA obligation in 

kidney paired donations. In kidney 

paired donations, VA’s obligation to 

provide any procedure, hospital care, or 

medical services under this section 

extends: 

(1) To the initial prospective live 

donor who elects to participate in a 

kidney paired donation matching 

program, but only for the examinations, 

tests, and studies described in 

paragraph (c)(1) of this section for a 

prospective live donor before kidney 

removal. 

(2) To the live donor whose kidney 

the intended recipient will receive or 

has received but only for the services 

described in paragraphs (c)(2) and (3) of 

this section. 

[FR Doc. 2022–10764 Filed 5–31–22; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 79 

RIN 2900–AR33 

Legal Services for Homeless Veterans 

and Veterans At-Risk for 

Homelessness Grant Program 

AGENCY: Department of Veterans Affairs. 

ACTION: Interim final rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) issues this rule to 

implement a new authority requiring 

VA to award grants to eligible entities 

that will provide certain legal services 

for homeless veterans and veterans at 

risk for homelessness. This new grant 

program is within the continuum of 

VA’s homeless services programs. This 

rulemaking specifies grant eligibility 

criteria, application requirements, 

scoring criteria, constraints on the 

allocation and use of the funds, and 

other requirements necessary to 

implement this grant program. 

DATES:

Effective date: This interim final rule 

is effective July 1, 2022. 

Comment date: Comments must be 

received on or before August 1, 2022. 

ADDRESSES: Comments must be 

submitted through 

www.Regulations.gov. Comments 

received will be available at 

regulations.gov for public viewing, 

inspection or copies. Comments 

received will be available at 

regulations.gov for public viewing, 

inspection or copies. 

FOR FURTHER INFORMATION CONTACT: 

Madolyn Gingell, National Coordinator, 

Legal Services for Veterans, Veterans 

Justice Programs, Clinical Services, 

Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Ave. NW, Washington, DC 

20420, (239) 223–4681. (This is not a 

toll-free telephone number.) 

SUPPLEMENTARY INFORMATION: 

Background on Governing Statute and 

Public Input 

On January 5, 2021, the Johnny 

Isakson and David P. Roe, M.D. Veterans 

Health Care and Benefits Improvement 

Act of 2020, Public Law 116–315 (the 

Act) was enacted in law to improve the 

lives of veterans during the COVID–19 

pandemic and beyond. Several sections, 

including section 4202, of the Act were 

created to better serve veterans who are 

struggling with homelessness or housing 

insecurity. Id. Section 4202 of the Act, 

codified at section 2022A of title 38, 

United States Code (U.S.C.), directs the 

Secretary of Veterans Affairs (Secretary) 

to award grants to eligible entities to 

provide legal services to homeless 

veterans and veterans at risk for 

homelessness. 

The Act requires that VA, in 

establishing criteria and requirements 

for grants under section 4202 of the Act, 

consult with organizations that have 

experience in providing services to 

homeless veterans. Therefore, in March 

2021, we solicited feedback from 

selected veteran service organizations, 

Equal Justice Works (EJW), and other 

legal services organizations with 

experience in providing services to 

homeless veterans via email. VA 

requested information in five areas: (1) 

Criteria and requirements necessary to 

carry out this grant program in rural 

communities, on trust lands, or in 

territories and possessions of the United 

States; (2) types of legal services VA 

should consider authorizing as part of 

this grant program; (3) evaluation 

criteria VA should consider using to 

assess the operational effectiveness and 

cost effectiveness of this grant program; 

(4) general criteria and requirements 

that VA should have for this grant 

program; and (5) criteria that VA require 

for eligible entities to receive grants 

under this grant program. We received 

input from 13 organizations. The 

majority of the comments centered on: 

(1) Definitions that should be included 

in the regulation (§ 79.5) and/or Notice 

of Funding Opportunity (NOFO); (2) the 

types of legal services that should be 

provided to eligible veterans to include 

an expanded view of issues impacting 

the veteran population that may not be 

seen as directly tied to housing 

instability, such as consumer debt 

issues and income support services 

(§ 79.20); (3) scoring criteria 

considerations, which focused on an 

applicant’s connections to a community, 

ability to work with other organizations, 

and cultural competence with the 

affected population being served 

(§ 79.35); and (4) metrics the legal 

services programs could use for VA to 

determine their cost and operational 

effectiveness. The feedback received is 

publicly available online at 

www.regulations.gov. 

Part 79, of Title 38, Code of Federal 

Regulations 

Through this interim final rule, VA 

establishes and implements, in new part 

79 of title 38, Code of Federal 

Regulations (CFR), the Legal Services for 

Homeless Veterans and Veterans AtRisk for Homelessness Grant Program 

(hereinafter referred to as the ‘‘Grant 

Program’’). Establishment of this new 

part ensures organization and clarity for 


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