[Federal Register Volume 75, Number 91 (Wednesday, May 12, 2010)]
[Proposed Rules]
[Pages 26683-26685]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-11177]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AN41


Hospital and Outpatient Care for Veterans Released From 
Incarceration to Transitional Housing

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its 
regulations to authorize VA to provide hospital and outpatient care to 
a veteran in a program that provides transitional housing upon release 
from incarceration in a prison or jail. The proposed rule would permit 
VA to work with these veterans while they are in these programs with 
the goal of continuing to work with them after their release. This 
would assist in preventing homelessness in this population of veterans.

DATES: Comments must be received on or before July 12, 2010.

ADDRESSES: Written comments may be submitted through http://www.Regulations.gov/; by mail or hand-delivery to the Director, 
Regulations Management (02REG), 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 ``RIN 2900-AN41 Hospital and Outpatient Care for Veterans 
Released from Incarceration to Transitional Housing.'' Copies of 
comments received will be available for public inspection in the Office 
of Regulation Policy and Management, Room 1063B, between the hours of 8 
a.m. and 4:30 p.m., Monday through Friday (except holidays). Please 
call (202) 461-4902 for an appointment. In addition, during the comment 
period, comments may be viewed online through the Federal Docket 
Management System (FDMS) at http://www.Regulations.gov/.

FOR FURTHER INFORMATION CONTACT: James McGuire, Program Manager, 
Healthcare for Re-entry Veterans, Veterans Health Administration, 
Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 
20420, (202) 461-1591. (This is not a toll free number.)

SUPPLEMENTARY INFORMATION: Section 1710(h) of title 38, United States 
Code, states that VA is not required ``to furnish care to a veteran to 
whom another agency of Federal, State, or local government has a duty 
to provide care in an institution of such government.'' The 
implementing regulation for section 1710(h) is 38 CFR 17.38(c)(5). 
Generally, Sec.  17.38(c)(5) bars VA from providing ``[h]ospital and 
outpatient care for a veteran who is either a patient or inmate in an 
institution of another government agency if that agency has a duty to 
give the care or services.'' Typically, government agencies have a duty 
to provide medical care to inmates who have been released from 
incarceration in a prison or jail to a temporary housing program (such 
as a community residential re-entry center or halfway house).
    This duty may exist even though the responsible government agency 
expects

[[Page 26684]]

residents in these programs to arrange for their own medical care. 
Irrespective of whether a duty exists, however, VA wants to be able to 
provide hospital and outpatient care to eligible veterans in these 
programs. Under Sec.  17.38(c)(5), VA cannot provide care to veterans 
in these programs if the other government agency has a duty to provide 
the care unless that agency is willing to pay VA for the care by 
contract. Accordingly, we propose to amend Sec.  17.38 to establish 
that the exclusion in paragraph (c)(5) does not apply to any veteran 
who is released from incarceration to a transitional housing program. 
This amendment is necessary to authorize VA hospital and outpatient 
care for these veterans who often require additional assistance in 
successfully transitioning from incarceration. This amendment would not 
be contrary to section 1710(h) because that provision only states that 
VA is not required to provide care to these veterans; it does not 
prohibit VA from providing care to them.
    VA wants to provide care to these veterans because VA has found 
that upon release from jail or prison these veterans are particularly 
at risk of not receiving adequate care and in many cases become 
homeless after their release from transitional housing programs. Under 
38 U.S.C. 2022(a), VA is charged with reaching out ``to veterans at 
risk of homelessness, including particularly veterans who are being 
discharged or released from institutions after * * * imprisonment.'' 
Outreach workers for the Veterans Health Administration report that 
veterans with acute or chronic medical or psychiatric problems treated 
while incarcerated often have difficulty obtaining similar treatment 
during a transitional period. In particular, if mental health issues 
are not addressed during the transitional period, upon release, many of 
these veterans are rendered incapable of finding or maintaining 
appropriate housing.
    In addition to being an important component of VA's duty to attempt 
to prevent veterans from becoming homeless, establishing that the 
exclusion in 38 CFR 17.38(c)(5) does not apply to veterans who are 
residents in transitional housing programs offers potentially 
significant public benefits and will further other VA policies. For 
example, section 20 of VHA Handbook 1160.01 specifically requires VA to 
``engage with veterans being released from prison in need of care.'' 
VHA Handbook 1160.01, section 20(a)(2). As significant numbers of 
veterans in these programs have difficulty obtaining medical treatment 
comparable to the treatment they received in prison, some begin to 
believe the only way they can obtain treatment is to violate the terms 
of their release and return to prison. A 2008 Urban Institute study of 
a large re-entry population cohort, found healthcare played a key role 
in the first months of community readjustment and reduced recidivism. 
Mallik-Kane, K, and Visher, C.A., Health and prisoner re-entry: How 
physical, mental, and substance abuse conditions shape the process of 
re-integration. Urban Institute Justice Policy Center: Washington, DC 
(2008). In particular, the study noted that access to medications for 
chronic health and mental health conditions is a low-cost powerful tool 
in preventing recidivism.
    For the foregoing reasons, VA proposes to amend 38 CFR 17.38 to 
revise the exclusion in the VA medical benefits package for a veteran 
who is a patient or inmate in an institution of another government 
agency so that the exclusion does not apply to a veteran who is a 
resident of a transitional housing program. For purposes of this 
proposed rule, a ``transitional housing program,'' would include 
community residential re-entry centers, halfway houses, and similar 
residential facilities.

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 an 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 given year. This proposed rule would have no such 
effect on State, local and tribal governments, on the private sector.

Executive Order 12866

    Executive Order 12866 directs agencies to assess all 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, 
and other advantages; distributive impacts; and equity). The Order 
classifies a ``significant regulatory action,'' requiring review by the 
Office of Management and Budget (OMB), as a regulatory action that is 
likely to result in a rule that may: (1) Have an annual effect on the 
economy of $100 million or more, or adversely affect in a material way 
the economy, a sector of the economy, productivity, competition, jobs, 
the environment, public health or safety, State, local, or tribal 
governments or communities; (2) create a serious inconsistency or 
otherwise interfere with an action planned or taken by another agency; 
(3) materially alter the budgetary impact of entitlements, grants, user 
fees or loan programs or the rights and obligations of recipients 
thereof; or (4) raise novel legal or policy issues arising out of legal 
mandates, the President's priorities, or the principles set forth in 
the Executive Order.
    The economic, interagency, budgetary, legal, and policy 
implications of this proposed rule have been examined, and it has been 
determined not to be a significant regulatory action under Executive 
Order 12866.

Paperwork Reduction Act

    The proposed rule does not contain any collections of information 
under the Paperwork Reduction Act (44 U.S.C. 3501-3520).

Regulatory Flexibility Act

    The Secretary hereby certifies that this proposed rule would 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. This proposed rule would only affect individuals, not 
small entities. Therefore, pursuant to 5 U.S.C. 605(b), this proposed 
rule is exempt from the initial and final regulatory flexibility 
analysis requirements of sections 603 and 604.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance numbers and titles for 
the programs affected by this document are 64.009, Veterans Medical 
Care Benefits; 64.011, Veterans Dental Care; 64.012, Veterans 
Prescription Service; 64.013, Veterans Prosthetic Appliances; 64.019, 
Veterans Rehabilitation Alcohol and Drug Dependence; and 64.022, 
Veterans Home Based Primary Care.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. John R. 
Gingrich, Chief of Staff, Department of Veterans Affairs, approved this 
document on May 3, 2010, for publication.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug

[[Page 26685]]

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.

    Dated: May 6, 2010.
Robert C. McFetridge,
Director, Regulation Policy and Management, Office of the General 
Counsel.

    For the reasons stated in the preamble, VA proposes to amend 38 CFR 
part 17 as follows:

PART 17--MEDICAL

    1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501, 1721, and as noted in specific 
sections.

    2. Amend Sec.  17.38 by revising paragraph (c)(5) to read as 
follows:


Sec.  17.38  Medical benefits package.

* * * * *
    (c) * * *
    (5) Hospital and outpatient care for a veteran who is either a 
patient or inmate in an institution of another government agency if 
that agency has a duty to give the care or services. This exclusion 
does not apply to veterans who are released from incarceration in a 
prison or jail into a temporary housing program (such as a community 
residential re-entry center or halfway house).
* * * * *
[FR Doc. 2010-11177 Filed 5-11-10; 8:45 am]
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