Federal Register / Vol. 79, No. 214 / Wednesday, November 5, 2014 / Rules and Regulations 65571 

TABLE 3—HOLDING SCENARIO—MANEUVERS—Continued 

Configuration CG Trim speed Maneuver 

Landing flaps, gear down Optional (aft range) ....... VREF (Minimum AFM speed) ........... • Level, 40° banked turn, 

• Bank-to-bank rapid roll, 30°–30°, 

• Speed-brake extension, retraction (if approved), 

• Deceleration to alpha-max (1 knot/second deceleration rate, wings level, power off). 

TABLE 4—APPROACH/LANDING SCENARIO—MANEUVERS

Test 

condition 

Ice accretion 

thickness (*) Configuration CG Trim speed Maneuver 

First 13 mm (0.5 

inch).

Flaps up, gear up .. Optional (aft range) Holding ................... No specific test. 

1 ................. Additional 6.3 mm 

(0.25 in) (19 mm 

(0.75 in) total).

First intermediate 

flaps, gear up.

Optional (aft range) Minimum AFM 

speed.

• Level 40° banked turn, 

• Bank-to-bank rapid roll, 30°–30°, 

• Speed brake extension and retraction 

(if approved), 

• 1kt/s Level deceleration until the deceleration is stopped due to alphafloor triggering. 

2 ................. Additional 6.3 mm 

(0.25 in) (25 mm 

(1.00 in) total).

First intermediate 

flaps, gear up (as 

applicable).

Optional (aft range) Minimum AFM 

speed.

• Bank-to-bank rapid roll, 30°–30°, 

• Speed brake extension and retraction 

(if approved), 

• 1kt/s Level deceleration until the deceleration is stopped due to alphafloor triggering. 

3 ................. Additional 6.3 mm 

(0.25 in) (31 mm 

(1.25 in) total).

Landing flaps, gear 

down).

Optional (aft range) VREF (Minimum 

AFM speed).

• Bank-to-bank rapid roll, 30°–30°, 

• Speed brake extension and retraction 

(if approved), 

• Bank to 40° 

• Deceleration to alpha-max. 

(*) The indicated thickness is that obtained on the parts of the unprotected airfoil with the highest collection efficiency. 

8. In lieu of AC 25–25, 3. v., Failure 

conditions, § 25.1309, the following guidance 

is made for (2)(d): 

(2) Acceptable Test Program 

(d) In the configurations listed below, trim 

the airplane at the minimum AFM speed. 

Decrease speed to the minimum steady 

achievable speed, plus 1 second and 

demonstrate prompt recovery using the same 

recovery maneuver as for the noncontaminated airplane. It is acceptable for 

stall warning to be provided by a different 

means (for example, by the behavior of the 

airplane) for failure cases not considered 

probable. 

1 High lift devices retracted configuration: 

Straight/Power Off. 

2 Landing configuration: Straight/Power 

Off. 

Issued in Renton, Washington. 

Michael Kaszycki, 

Acting Manager, Transport Airplane 

Directorate, Aircraft Certification Service. 

[FR Doc. 2014–26289 Filed 11–4–14; 8:45 am] 

BILLING CODE 4910–13–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 17 

RIN 2900–AP24 

Expanded Access to Non-VA Care 

Through the Veterans Choice Program 

AGENCY: Department of Veterans Affairs. 

ACTION: Interim final rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) amends its medical 

regulations concerning its authority for 

eligible veterans to receive care from 

non-VA entities and providers. The 

Veterans Access, Choice, and 

Accountability Act of 2014 directs VA 

to establish a program to furnish 

hospital care and medical services 

through non-VA health care providers to 

veterans who either cannot be seen 

within the wait-time goals of the 

Veterans Health Administration or who 

qualify based on their place of residence 

(hereafter referred to as the Veterans 

Choice Program, or the ‘‘Program’’). The 

law also requires VA to publish an 

interim final rule establishing this 

program. This interim final rule defines 

the parameters of the Veterans Choice 

Program, and clarifies aspects affecting 

veterans and the non-VA providers who 

will furnish hospital care and medical 

services through the Veterans Choice 

Program. 

DATES: Effective Date: This rule is 

effective on November 5, 2014. 

Comment date: Comments must be 

received on or before March 5, 2015. 

ADDRESSES: Written comments may be 

submitted by email through http:// 

www.regulations.gov; by mail or handdelivery to Director, Regulation Policy 

and Management (02REG), Department 

of Veterans Affairs, 810 Vermont 

Avenue NW., Room 1068, Washington, 

DC 20420; or by fax to (202) 273–9026. 

(This is not a toll-free number.) 

Comments should indicate that they are 

submitted in response to ‘‘RIN 2900– 

AP24, Expanded Access to Non-VA Care 

through the Veterans Choice Program.’’ 

Copies of comments received will be 

available for public inspection in the 

Office of Regulation Policy and 

Management, Room 1068, between the 

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

Monday through Friday (except 

holidays). Please call (202) 461–4902 for 

an appointment. (This is not a toll-free 

number.) In addition, during the 


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comment period, comments may be 

viewed online through the Federal 

Docket Management System (FDMS) at 

http://www.regulations.gov. 

FOR FURTHER INFORMATION CONTACT: 

Kristin Cunningham, Director, Business 

Policy, Chief Business Office (10NB), 

Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue NW., Washington, DC 

20420, (202) 382–2508. (This is not a 

toll-free number.) 

SUPPLEMENTARY INFORMATION: 

Executive Summary: Purpose of This 

Regulatory Action: We are creating new 

regulations to define and authorize the 

Veterans Choice Program required by 

section 101 of the Veterans Access, 

Choice, and Accountability Act of 2014, 

as modified by the Department of 

Veterans Affairs Expiring Authorities 

Act of 2014. Specifically, under this 

Program, eligible veterans may elect to 

receive hospital care and medical 

services from eligible non-VA entities 

and providers. The Program does not 

modify VA’s previously existing 

authorities to furnish care through nonVA providers, but instead enhances 

VA’s options to furnish care that is 

timely and available in veterans’ 

communities. 

Summary of the Major Provisions of 

this Regulatory Action: This interim 

final rule— 

• Modifies VA’s existing copayment 

regulations to clarify that a copayment 

of $0 is owed at the time of service for 

eligible veterans receiving care or 

services through the Program. VA will 

determine the copayment amount after 

the provider bills VA for the cost of 

furnished care, and veterans may be 

liable for some or all of the copayment 

amount at that time. Copayment rates 

will not exceed those currently 

established in regulation. 

• Establishes the scope of the 

Program, including the types of care and 

services that are covered. By law, the 

Program is authorized to run until 

August 7, 2017, or until the Veterans 

Choice Fund established by the Act is 

exhausted. 

• Defines key terms used throughout 

the regulation. These terms include 

episode of care, which is limited to 60 

days but includes follow-up 

appointments and ancillary and 

specialty services; health-care plan, 

which includes any insurance plan or 

contract or agreement other than 

Medicare, Medicaid, or TRICARE; 

residence, which is a legal residence or 

personal domicile; VA medical facility, 

which includes VA hospitals, 

community-based outpatient clinics, 

and VA health care centers; and the 

wait-time goals of the Veterans Health 

Administration, which are to furnish 

care within 30 days of either the date 

that an appointment is deemed 

clinically appropriate by a VA health 

care provider, or if no such clinical 

determination has been made, the date 

a veteran prefers to be seen. 

• Defines eligibility criteria for 

veterans to participate in the Program. 

In general, veterans must have been 

enrolled in the VA health care system 

on or before August 1, 2014, or must be 

within 5 years of post-combat 

separation. Veterans must also either be 

unable to schedule an appointment 

within the wait-time goals of the 

Veterans Health Administration or 

qualify based on their place of 

residence. Veterans may qualify based 

on their place of residence if they live 

more than 40 miles from the closest VA 

medical facility; if they reside in a state 

without a VA medical facility that 

provides hospital care, emergency 

medical services, and surgical care rated 

by the Secretary as having a surgical 

complexity of standard, and they reside 

more than 20 miles from a medical 

facility that offers these services in 

another state; or, with certain 

exceptions, if they reside 40 miles or 

less from a VA medical facility and 

must travel by air, boat, or ferry, or face 

an unusual or excessive burden in 

traveling to a VA medical facility 

because of geographical challenges. 

• Explains the process for authorizing 

non-VA care under the Program. Eligible 

veterans may elect to receive VA or nonVA care. If they elect to receive non-VA 

care, they may select the provider who 

will furnish their care, if that provider 

is eligible. 

• Describes the effect of the Program 

on other benefits and services available 

to veterans. In general, the Program does 

not affect a veteran’s eligibility for 

hospital care or medical services under 

the medical benefits package. VA will 

pay for and fill prescriptions written by 

non-VA providers under the Program to 

the extent such prescriptions are 

covered by the VA medical benefits 

package. VA will reimburse veterans’ 

copayments or cost-shares required by 

their other health-care plan to the extent 

authorized by law, and VA will 

calculate veterans’ VA copayments as 

described above. VA will also reimburse 

veterans for travel to receive care under 

the Program if the veteran is otherwise 

eligible to participate in VA’s 

beneficiary travel program. 

• Identifies the start date for eligible 

veterans under the Program. VA is 

phasing in implementation of the 

Program to ensure it has the necessary 

resources in place to furnish hospital 

care and medical services to eligible 

veterans. 

• Defines eligibility criteria for nonVA health care entities and providers to 

participate in the Program. Eligible nonVA entities and providers must enter 

into an agreement with VA to furnish 

care, and must be participating in the 

Medicare program, be a Federallyqualified health center, or be a part of 

the Department of Defense or the Indian 

Health Service. Non-VA entities or 

providers must be accessible to the 

veteran, meaning they must be able to 

provide timely care, must have the 

necessary qualifications to furnish the 

care, and must be within a reasonable 

distance of the veteran’s residence. 

Eligible non-VA entities and providers 

must maintain at least the same or 

similar credentials and licenses as VA 

providers, and must submit information 

verifying compliance with this 

requirement annually. 

• Establishes payment rates and 

methodologies for reimbursing 

participating non-VA health care 

entities and providers furnishing care 

and services through the Program. 

Except for in highly rural areas, VA may 

not pay an eligible entity or provider 

more than the applicable Medicare rate 

under Title XVIII of the Social Security 

Act for hospital care or medical services 

furnished under the Program. When 

there are no Medicare rates available, 

VA will follow its usual methodology 

for calculating payments to the extent 

such methodology is consistent with the 

Act. VA is a secondary payer for care 

furnished for a nonservice-connected 

disability if the veteran has another 

health-care plan. VA will only pay for 

authorized care where an actual 

encounter with a health care provider 

occurs. Veterans must seek 

authorization from VA before receiving 

care. 

• Establishes a claims processing 

system to receive requests for payment 

and to provide accurate and timely 

payments for claims received under the 

Program. This system will be managed 

by the Veterans Health Administration’s 

Chief Business Office. 

Costs and Benefits: As further detailed 

in the Regulatory Impact Analysis, 

which can be found as a supporting 

document at http://www.regulations.gov 

and is available on VA’s Web site at 

http://www.va.gov/orpm/, by following 

the link for ‘‘VA Regulations Published 

From FY 2004 Through Fiscal Year to 

Date,’’ the interim final rule will affect 

eligible veterans and eligible non-VA 

health care entities and providers. 

Eligible veterans may elect to receive, at 

VA expense, care from a non-VA 

provider of their choice that is eligible 


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and accessible to them. These providers 

generally will either be able to provide 

care sooner than VA could or are 

located closer to the eligible veteran’s 

residence than a VA medical facility. 

The Program is authorized to run for 3 

years, or until resources appropriated in 

the Veterans Choice Fund are 

exhausted, and is intended as a shortterm solution to expand access to care 

while VA enhances its capacity to 

furnish care in a timely and accessible 

manner. Participating eligible non-VA 

health care entities and providers will 

receive payment for furnishing 

authorized hospital care and medical 

services to eligible veterans under the 

Program. 

General Discussion: On August 7, 

2014, the President signed into law the 

Veterans Access, Choice, and 

Accountability Act of 2014 (‘‘the Act,’’ 

Public Law 113–146, 128 Stat. 1754). 

Further technical revisions to the Act 

were made on September 26, 2014, 

when the President signed into law the 

Department of Veterans Affairs Expiring 

Authorities Act of 2014 (Pub. L. 113– 

175, 128 Stat. 1901, 1906). Section 101 

of the Act creates the Veterans Choice 

Program (‘‘the Program’’). Section 101 

requires the Secretary to furnish 

hospital care and medical services to 

certain eligible veterans through 

agreements with identified eligible 

entities or providers. Sec. 101(a)(1)(A), 

Public Law 113–146, 128 Stat. 1754. 

Delivery of such care through non-VA 

health care providers will be at the 

election of eligible veterans. This 

interim final rulemaking primarily 

restates these mandates and 

prescriptions in a regulatory framework, 

and provides guidance where Congress’ 

instructions were not clearly executable 

on the face of the law. Congress directed 

VA to publish interim final regulations 

concerning this program within 90 days 

of enactment. Sec. 101(n), Public Law 

113–146, 128 Stat. 1754. This 

rulemaking complies with that mandate. 

Nothing in this rulemaking modifies 

VA’s existing authority to furnish nonVA care, such as under 38 U.S.C. 1703, 

1725, 1728, 8111, or 8153. The 

requirements of those statutes and their 

implementing regulations continue to 

apply, and VA will use those authorities 

when appropriate. Any veteran 

currently receiving non-VA care who is 

eligible for the Program will be provided 

the opportunity to elect to participate in 

the Program or to continue being 

provided care under VA’s other 

authorities. As discussed below, there 

are some differences between the 

Program and other non-VA care. 

VA is making changes to several other 

regulations as part of this rulemaking. 

Specifically, VA is amending 38 CFR 

17.108, 17.110, and 17.111 concerning 

copayment responsibilities for hospital 

care and medical services. Section 101(j) 

of the Act requires an eligible veteran to 

pay a copayment at the time of the 

appointment to the non-VA provider if 

such veteran would be required to pay 

a copayment for the receipt of hospital 

care or medical services at a VA medical 

facility. Under current practice, when 

veterans receive non-VA care, VA 

copayment obligations are not 

calculated until the end of the billing 

process. Consistent with this practice, 

VA is exercising its authority to 

establish copayment rates under 38 

U.S.C. 1710(f) to revise its copayment 

regulations at §§ 17.108, 17.110, and 

17.111 to state that veterans who receive 

hospital care and medical services 

under the Program are subject to a VA 

copayment of $0 at the time of service, 

and that their copayment liability will 

be determined after the authorized care 

is furnished, but will be no greater than 

the amounts already specified in 

§§ 17.108, 17.110, or 17.111. 

Currently, no veterans are charged a 

VA copayment at the time of their 

appointment. This is true whether such 

care is furnished by a VA or non-VA 

provider. Under current practice, if a 

veteran has other health insurance, any 

payment by the other health insurance 

is first applied against the veteran’s VA 

copayment liability, and if the third 

party payment is equal to or greater than 

the veteran’s copayment liability, the 

veteran owes no VA copayment. Even if 

a veteran does not have other health 

insurance, VA does not bill the veteran 

for the applicable copayment until after 

the appointment. This VA practice has 

been followed for years but has never 

been prescribed in regulation. 

For many veterans with other healthcare plans, the experience under the 

Program will be the same as they would 

experience receiving non-VA care under 

another authority. Payments made by 

the veteran’s health-care plan are 

generally enough to extinguish the VA 

copayment liability in full, and to the 

extent this happens under the Program, 

these veterans would owe no VA 

copayment. If the other health-care plan 

does not pay enough to cover the 

amount of the VA copayment, the 

veteran will be liable for the balance. 

VA is making changes to §§ 17.108, 

17.110, and 17.111 to make the veteran’s 

experience under the Program more like 

the veteran’s experience in VA facilities 

and under other non-VA care authorities 

described above. Specifically, VA is 

establishing the copayment amount 

under these authorities at $0 at the time 

of service and, consistent with 

§§ 17.108, 17.110, and 17.111, as 

amended, VA will notify non-VA 

providers that the VA copayment 

amount required at the time of service 

is $0. This ensures that VA’s 

implementation of section 101(j), which 

states that non-VA entities and 

providers will collect at the time of 

furnishing care or services any 

copayment that would be required for 

the receipt of the care or services at a 

medical facility of the Department, is 

consistent with VA practice under 

existing non-VA care authorities and 

addresses a number of practical 

challenges, as described below. 

While VA will authorize care in 

advance of an appointment, VA may not 

be able to determine the veteran’s 

copayment liability until after VA 

receives a report of what specific 

services were furnished by the non-VA 

provider. For care provided by VA, 

there are specific copayment rates for 

different types of appointments. 

However, this coding practice is not 

necessarily consistent with the practices 

used by other health care providers. 

Thus, VA cannot accurately assess a 

veteran’s potential copayment liability 

before care is actually furnished by the 

non-VA provider. When VA has 

received a report of what services were 

provided, it can then determine the 

proper copayment amounts for those 

services in accordance with §§ 17.108, 

17.110, and 17.111. Establishing the 

copayment amount at $0 at the time of 

services will ensure that VA is 

consistently determining the copayment 

responsibilities for eligible veterans. 

This is also consistent with section 

101(j)(1) of the Act, which provides that 

the Secretary must require a copayment 

from eligible veterans ‘‘only if such 

eligible veteran would be required to 

pay a copayment for the receipt of such 

care or services at a medical facility of 

the Department.’’ These changes to 

§§ 17.108, 17.110, and 17.111 will 

ensure that veterans are only liable for 

copayments they would have paid if the 

care or services had been provided in a 

VA facility or under the standard nonVA care program. We believe it is better 

to ensure that veterans are liable only 

for an appropriate copayment amount 

that is determined after the appointment 

than to institute a blanket requirement 

at the point of service that may result in 

either additional billing to the veteran 

or reimbursement to the veteran. 

Billing the veteran at the end of the 

billing process is also consistent with 

VA’s practice under existing non-VA 

care authorities. The difficulty in 

determining the appropriate copayment 

is present in the standard non-VA care 

program, but is not an issue because 


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when VA uses its existing authorities to 

pay for non-VA care, VA is the primary 

payer and can determine liabilities after 

the care is furnished. Thus, VA has 

resolved this issue through the standard 

non-VA care program administratively 

by calculating the copayment at the end 

of the billing process. This is a more 

efficient mechanism than assigning a 

copayment upfront that could be wrong 

and later determining that either 

reimbursement or further collections are 

needed. 

VA is modifying § 17.108(b)(1) to note 

that copayments will be determined as 

set forth in paragraphs (b)(2), (b)(3), and 

a new (b)(4) of that section. The new 

paragraph (b)(4) provides that under the 

Program, the copayment amount is $0 at 

the time of service, and that the 

copayment liability will be determined 

at the end of the billing process. VA is 

revising § 17.108(c)(1) to include an 

exception as set forth in a new (c)(4) of 

that section. VA is also making a minor 

technical adjustment to paragraphs 

(b)(1) and (c)(1) to include care pursuant 

to a contract, provider agreement, or 

sharing agreement consistent with the 

authorized forms of agreement under 

the Act. The new paragraph (c)(4) 

includes the same language as the new 

paragraph (b)(4). VA also is modifying 

§§ 17.110(b) and 17.111(b) in a similar 

way. The changes to § 17.110 provide 

that veterans will owe a copayment of 

$0 at the time they fill a prescription, 

and the changes to § 17.111 read the 

same as those in § 17.108. VA notes that 

under the Program, only services that 

are considered hospital care and 

medical services may be furnished. 

Section 17.111 authorizes both 

institutional and non-institutional care, 

but only non-institutional care is 

considered part of hospital care or 

medical services under § 17.38(a)(1)(xi). 

Section 17.1500 Purpose and Scope 

Section 17.1500 states the purpose 

and scope of the Program authorized by 

section 101 of the Act. The Program is 

funded with $10 billion in appropriated 

resources in the Veterans Choice Fund 

through section 802 of the Act. The 

Program is authorized to continue until 

the date the Veterans Choice Fund is 

exhausted or until August 7, 2017, 

whichever occurs first. Sec. 101(p), 

Public Law 113–146, 128 Stat. 1754. 

Section 17.1500(a) cites to the Act but 

does not identify specifically the 

alternate termination events specified in 

the Act. When one of those events 

occurs, VA will no longer have 

authority to operate this Program. 

Absent further amendments to the Act, 

the Program will end upon the 

occurrence of one of these events, at 

which time VA will issue a direct final 

rule to remove this regulation from the 

Code of Federal Regulations. 

Section 17.1500(b) defines the scope 

of the Program as authorizing non-VA 

hospital care and medical services to 

eligible veterans through agreements 

with eligible entities or providers. This 

is consistent with section 101(a)(1)(A) of 

the Act. Eligible veterans are described 

in § 17.1510, and eligible entities or 

providers are described in § 17.1530. 

The Act authorizes VA to provide 

hospital care and medical services to 

eligible veterans. VA has defined the 

terms hospital care and medical services 

through regulation at § 17.38, which 

establishes the medical benefits 

package. Any care that is covered by the 

medical benefits package, including 

prescriptions such as prescription 

medications or prosthetic devices, may 

be furnished through the Program, but 

any services for which there are specific 

eligibility criteria that must be met to 

receive these services (such as dental 

care) are still subject to those eligibility 

standards. 

Section 17.1505 Definitions 

Section 17.1505 defines key terms for 

the Program. 

The term ‘‘appointment’’ is defined in 

these regulations as an authorized and 

scheduled encounter with a health care 

provider for the delivery of hospital care 

or medical services. The definition 

excludes unscheduled visits and 

emergency room visits because they are 

not scheduled encounters and cannot be 

authorized in advance. The purpose of 

the Program is to offer veterans the 

option to receive non-VA care if they 

cannot obtain a scheduled visit from a 

VA provider in a timely or 

geographically convenient manner. 

There is no indication in the law that it 

was intended to authorize unscheduled 

non-VA care. Emergency care would, 

however, continue to be reimbursed by 

VA consistent with 38 CFR 17.120–132 

and 17.1000–1008. In short, if a veteran 

visits a non-VA health care provider 

without seeking authorization from VA 

to schedule such an appointment, VA 

cannot use Program funds to pay for the 

services delivered and cannot provide 

reimbursement after the fact. 

‘‘Attempt to schedule’’ is defined as 

contact with a VA scheduler or VA 

health care provider in which a stated 

request for an appointment is made. The 

contact must be with a VA employee 

who is responsible for scheduling 

appointments or with a VA health care 

provider. This limitation will ensure 

that an attempt to schedule only occurs 

when an individual contacts someone 

who has the capacity to actually 

schedule an appointment or, in the case 

of a VA health care provider, ensure that 

a scheduler is made aware of the need 

for an appointment. There must also be 

a statement by the veteran that he or she 

is requesting an appointment. If a 

veteran does not request an 

appointment, he or she would not have 

attempted to schedule an appointment. 

While VA will apply this standard 

liberally, a veteran must indicate a 

desire to be seen by a VA health care 

provider. The requirement of an attempt 

to schedule an appointment is 

established under section 101(b)(2)(A) 

of the Act as a prerequisite for certain 

veteran eligibility under the Program; 

that section states that veterans are 

eligible under this Program if they 

attempt or have attempted to schedule 

an appointment with VA but were 

unable to do so within the wait-time 

goals of the Veterans Health 

Administration. 

The term ‘‘episode of care’’ is defined 

to mean a necessary course of treatment, 

including follow-up appointments and 

ancillary and specialty services, that 

lasts no longer than 60 days from the 

date of the first appointment with a nonVA health care provider under the 

Program. Section 101(h) of the Act states 

that VA must ensure that an eligible 

veteran receives hospital care or 

medical services, including follow up 

care, ‘‘for a period not exceeding 60 

days.’’ If an eligible veteran requires 

care beyond 60 days, and either the 

veteran continues to qualify for the 

Program based on residence or if VA 

cannot schedule an appointment with 

the veteran within the wait-time goals of 

the Veterans Health Administration, we 

will contact the veteran before the 60 

days have expired to determine if the 

veteran would like to continue receiving 

care from the non-VA health care 

provider. If the veteran does, VA will 

issue a new authorization for up to 

another 60 days. 

A ‘‘health-care plan’’ has the same 

definition as provided in section 

101(e)(4) of the Act. The Act defines a 

health-care plan as an insurance policy 

or contract, medical or hospital service 

agreement not administered by VA, 

under which health services for 

individuals are provided, or the 

expenses of such services are paid, 

except that it does not include any such 

policy, contract, agreement, or similar 

arrangement under the Medicare or 

Medicaid programs or TRICARE. 

A ‘‘residence’’ is defined as a legal 

residence or personal domicile. A 

residence cannot be a post office box or 

non-residential point of delivery, 

because the address of the place a 

veteran resides is used to determine 


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eligibility under §§ 17.1510(b)(2)–(4). 

Sections 101(b)(2)(B)–(D) of the Act 

define eligibility based upon travel 

distance between a person’s residence 

and a VA medical facility, and the 

regulatory definition recognizes that a 

post office box or other non-residential 

point of delivery could not be used to 

assess that eligibility criterion. 

However, we have added that a 

residence may be ‘‘seasonal,’’ and 

consequently, a veteran may maintain 

more than one residence, but only one 

residence at a time. Therefore, if a 

veteran lives in more than one location 

during a year, the veteran’s residence is 

the residence or domicile where the 

person is staying at the time the veteran 

wants to receive hospital care or 

medical services through the Program. 

For example, if a veteran lived in New 

Hampshire during the summer months 

but in Florida during the winter months, 

and the veteran was seeking care in 

January, the veteran’s residence in 

Florida would be used as the basis for 

determining his or her eligibility. 

Allowing for seasonal or multiple 

residences recognizes Congressional 

intent to reach, through the Program, 

those veterans who have geographical 

challenges in reaching a VA medical 

facility, without authorizing the use of 

Program funds for individuals who in 

fact are living near a VA medical facility 

at the time that they need an 

appointment. Homeless veterans 

currently provide an address to VA that 

is recorded in the Veterans Health 

Information Systems and Technology 

Architecture (VistA); this address is 

used for other VHA benefits and may be 

applied to veterans seeking to 

participate in the Program as well. For 

example, any homeless veteran who is 

residing in a place supported by a 

Department of Housing and Urban 

Development (HUD)-VA Supportive 

Housing (VASH) voucher can list that 

address, and any veteran using one of 

our community-based programs like the 

Homeless Grant and Per Diem or Health 

Care for Homeless Veterans programs 

can supply the address of the service 

provider. 

The term ‘‘schedule’’ is defined to 

mean identifying and confirming a date, 

time, location, and entity or health care 

provider for an appointment, as the term 

appointment has been previously 

defined. 

A ‘‘VA medical facility’’ is defined as 

a VA hospital, a VA community-based 

outpatient clinic (CBOC), or a VA health 

care center. We have included these 

types of VA facilities because they 

provide medical care or hospital 

services that may be provided as part of 

the Program. This is consistent with the 

phrase ‘‘medical facility of the 

Department,’’ as used in the Act in 

section 101(b)(2)(B) and elsewhere. Vet 

Centers, or Readjustment Counseling 

Service Centers, are not considered a 

VA medical facility because they do not 

furnish hospital care or medical 

services. 

The term ‘‘wait-time goals of the 

Veterans Health Administration’’ is 

defined to mean, unless changed by 

further notice in the Federal Register, a 

date that is not more than 30 days from 

either the date that an appointment is 

deemed clinically appropriate by a VA 

health care provider, or if no such 

clinical determination has been made, 

the date a veteran prefers to be seen by 

a health care provider capable of 

furnishing the hospital care or medical 

services required by the veteran. In the 

event a VA health care provider 

identifies a time range when care must 

be provided (e.g., within the next 2 

months), VA will use the last clinically 

appropriate date for determining 

whether or not such care is timely. 

Section 101(s)(1) of the Act defines the 

wait-time goals of the Veterans Health 

Administration as being ‘‘not more than 

30 days from the date on which a 

veteran requests an appointment for 

hospital care or medical services from 

[VA].’’ However, section 101(s)(2) 

authorizes VA to identify a different 

wait-time goal by submitting a report to 

Congress within 60 days of the 

enactment of the Act, and publishing 

that goal in the Federal Register and on 

a public Web site. On October 3, 2014, 

VA exercised this option and submitted 

a report to Congress; on October 17, 

2014, VA published in the Federal 

Register, and posted notice on its Web 

site that it is adopting the definition 

contained in this regulation. 79 FR 

65219. This definition ensures that 

clinical considerations and the 

preferences of the veteran are taken into 

account. In some cases, the date that a 

veteran prefers to be seen for an 

appointment may be the date on which 

the veteran contacts VA for an 

appointment. In other situations, 

though, the date the veteran prefers to 

receive hospital care or medical services 

may not be for some time, such as if the 

veteran is traveling, or if the veteran 

would prefer to delay care. Defining 

‘‘wait-time goals of the Veterans Health 

Administration’’ to include a 

determination that an appointment is 

clinically appropriate acknowledges the 

primary reason for the appointment—to 

provide clinically appropriate care. For 

example, a VA health care provider may 

determine that a veteran needs to be 

seen, but that such a visit would not be 

clinically useful until a certain time has 

passed (e.g., 2 months from the current 

appointment). This is a common 

scenario in the delivery of health care 

across the industry. In such a scenario, 

the wait-time goals of the Veterans 

Health Administration will be within 30 

days of the date identified by a VA 

health care provider as clinically 

appropriate, even if the veteran requests 

to schedule the appointment 

immediately. In the event a VA health 

care provider identifies a time range 

when care must be provided (e.g., 

within the next 2 months), VA will use 

the last clinically appropriate date for 

determining whether or not such care is 

timely. For example, if a provider 

determines that a Veteran should be 

seen in October, VA will use October 31 

as the clinically appropriate date. If no 

such clinical determination has been 

made, utilizing the preferred date of an 

appointment, rather than the date the 

veteran contacted VA, better reflects 

veterans’ preferences for when they 

want to receive care. A veteran can 

specify any date, including the date the 

veteran contacts VA, as the preferred 

date for an appointment. The 30-day 

period established by this standard 

would begin on that preferred date. 

VA believes that it may be necessary 

to make further revisions to its 

standards for the Program in the future. 

Specific metrics may evolve over time, 

and the prescribed methods of 

measurement today may not provide a 

full picture of veterans’ experience in 

accessing health care in the future. VA 

has contracted with the Institute of 

Medicine to independently identify 

metrics that may be the basis for further 

changes to this standard. VA will 

carefully evaluate any recommendations 

from the Institute of Medicine or other 

sources and determine the most 

appropriate means of addressing or 

changing the standard, if warranted. 

Any such changes to the goals will be 

communicated through a report to 

Congress, an update to VA’s Web site, 

and a publication in the Federal 

Register. 

Section 17.1510 Eligible Veterans 

VA will determine a veteran’s 

eligibility to elect to receive non-VA 

care through the Program using a twostep process, consistent with the Act’s 

structure and the requirements in 

section 101(b). 

First, the veteran must have enrolled 

in the VA health care system under 38 

CFR 17.36 on or before August 1, 2014, 

or the veteran must be eligible for 

hospital care and medical services 

under 38 U.S.C. 1710(e)(1)(D) and be a 

veteran described in 38 U.S.C. 


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1710(e)(3). These requirements are 

consistent with the standards 

established in sections 101(b)(1)(A)–(B) 

of the Act, and are included in 

§§ 17.1510(a)(1)–(2). If a veteran meets 

either of these requirements, the veteran 

then must also meet a criterion 

described in § 17.1510(b), and must 

provide the information required by 

§ 17.1510(d). 

Under § 17.1510(b)(1), a veteran is 

eligible if the veteran attempts, or has 

attempted, to schedule an appointment 

with a VA health care provider, but VA 

has been unable to schedule an 

appointment for the veteran within the 

wait-time goals of the Veterans Health 

Administration. As these terms are 

defined, this would mean that VA is 

unable to identify a particular date, 

time, location, and entity or health care 

provider within 30 days of the date that 

the appointment was deemed clinically 

necessary by a VA health care provider, 

or, if no such clinical determination has 

been made, the date that a veteran 

prefers to be seen by a health care 

provider capable of furnishing the 

hospital care or medical services 

required by the veteran. This is 

consistent with the requirements in the 

Act at section 101(b)(2)(A). 

Under § 17.1510(b)(2), a veteran is 

eligible if the veteran resides more than 

40 miles from the VA medical facility 

that is closest to the veteran’s residence. 

This standard considers the distance 

between a veteran’s residence, as 

defined in § 17.1505, and any VA 

medical facility, even if that facility 

cannot provide the care that the veteran 

requires. For example, if a veteran needs 

cardiac care and lives 10 miles from a 

VA community-based outpatient clinic 

(CBOC) that only offers primary care 

and mental health care, but 50 miles 

from a VA medical facility that offers 

cardiac care, the veteran would not be 

eligible based on his or her proximity to 

the CBOC. This interpretation is 

consistent with the plain language of the 

Act, which refers only to ‘‘the medical 

facility of the Department that is closest 

to the residence of the veteran,’’ without 

allowing VA to consider whether the 

facility can actually provide the care 

needed by the veteran. Sec. 101(b)(2)(B), 

Public Law 113–146, 128 Stat. 1754. 

Additionally, the Conference Report 

accompanying the legislation states that 

veterans are eligible if they live ‘‘within 

40 miles of a medical facility,’’ again 

without regard to such facility’s ability 

to provide the required care. H.R. Rpt. 

113–564, p. 55. The use of the general 

article ‘‘a’’ demonstrates that Congress 

intended for this to refer to any facility, 

rather than to a specific facility. Nothing 

in the Act modifies or precludes VA 

from using its existing statutory 

authorities to furnish non-VA care, such 

as under 38 U.S.C. 1703, 1725, 1728, 

8111, or 8153. Those statutes and their 

implementing regulations continue to 

apply, and VA will use those authorities 

as appropriate to ensure that veterans 

are able to access care. 

Under § 17.1510(b)(3), a veteran is 

eligible if the veteran’s residence is in 

a state without a full-service (meaning 

that it provides, on its own and not 

through a joint venture, hospital care, 

emergency medical services, and 

surgical care having a surgical 

complexity of standard) VA medical 

facility and the veteran lives more than 

20 miles from such a facility. This 

language is consistent with the 

requirements in section 101(b)(2)(C) of 

the Act. As of the publication of this 

rule, veterans in three states would 

qualify under this standard: Alaska, 

Hawaii, and New Hampshire. No 

veteran residing in Alaska or Hawaii 

lives within 20 miles of a full-service 

VA medical facility in another state, but 

some veterans residing in New 

Hampshire do live within 20 miles of a 

full-service VA medical facility that is 

located in a bordering state. We note 

that this specific, special eligibility for 

veterans in states without full-service 

VA medical facilities further supports 

our view that the Act requires VA to 

find veterans ineligible who live within 

40 miles of a VA medical facility, even 

if such facility cannot provide the 

specific care required. When read as a 

whole, the Act specifically addresses 

the ability of a facility to provide care 

only in section 101(b)(2)(C). We believe 

that, in addition to the arguments 

presented earlier in this rulemaking, the 

legislative specificity in section 

101(b)(2)(C) underscores the absence of 

reference to this issue in section 

101(b)(2)(B) of the Act. 

As noted previously when discussing 

the definition of residence, a veteran’s 

residence may change throughout the 

year but the veteran’s residence at the 

time he or she wants to schedule an 

appointment will determine his or her 

eligibility under this paragraph. In the 

prior example we presented, a veteran 

who resides in New Hampshire in the 

summer and in Florida in the winter 

may be eligible under this paragraph 

during the summer months, but not 

during the winter. 

We also note that the term ‘‘surgical 

complexity of standard,’’ used in 

§ 17.1510(b)(3)(i) and section 

101(b)(2)(C)(i)(III) of the Act, is a term 

of art coined by VA to describe the 

operative complexity of each VA 

medical facility with an inpatient 

surgical program. The designation of a 

VA medical facility’s surgical 

complexity as ‘‘standard’’ is used by VA 

to establish infrastructure requirements 

and compliance with VA quality 

standards. A ‘‘standard’’ designation 

refers to a VA facility that has the 

appropriate infrastructure to provide at 

least the most basic forms of surgical 

care. VA has published a list of VA 

medical facilities complying with at 

least a standard level of surgical care on 

the following Web site: www.va.gov/ 

health/surgery. VA will post notice on 

this Web site of any changes to this list 

of facilities. 

Finally, under paragraph (b)(4) of this 

section, a veteran who resides in a 

location other than one in Guam, 

American Samoa, or the Republic of the 

Philippines that is 40 miles or less from 

a VA medical facility can be eligible 

under two scenarios. First, if the veteran 

must travel by air, boat, or ferry to reach 

such a VA medical facility, the veteran 

is eligible for non-VA care under the 

Program. This is consistent with the text 

in sections 101(b)(2)(D)(i) and (ii)(I) of 

the Act. Second, veterans who reside 40 

miles or less from a VA medical facility 

are eligible if they face an unusual or 

excessive burden in accessing such a 

facility due to geographical challenges. 

Sec. 101(b)(2)(D)(ii)(II), Public Law 113– 

146, 128 Stat. 1754. VA has interpreted 

this standard through regulation so that 

if the veteran’s travel to the nearest VA 

medical facility is impeded by the 

presence of a body of water (including 

moving and still water) or a geologic 

formation that cannot be crossed by 

road, the veteran is eligible for non-VA 

care under the Program. VA believes 

that the emphasis on a geographical 

challenge as referring only to naturally 

occurring permanent or semi-permanent 

conditions is consistent with the plain 

meaning of the Act. While VA is able to 

take into account other factors, such as 

traffic or weather conditions or the 

veteran’s health, when making 

determinations regarding beneficiary 

travel benefits provided under 38 CFR 

part 70, the Act does not provide us the 

authority to apply these or similar 

factors in operating the Program because 

it specifically limits eligibility to 

geographical challenges without 

allowing for environmental or 

circumstantial challenges. 

Under paragraph (c) of this section, a 

veteran who changes his or her 

residence and is participating in the 

Choice Program must update VA about 

the change within 60 days. A veteran’s 

residence may be the basis for his or her 

eligibility for the Program under 

paragraphs (b)(2)–(b)(4) of this section, 

so it is essential that VA have current 

and accurate information to make an 


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eligibility determination. Veterans who 

are eligible based on being unable to be 

seen within the wait-time goals of the 

Veterans Health Administration must 

also provide this information so VA can 

determine if they would become eligible 

based on residence. It is also important 

that VA have accurate information about 

a veteran’s residence to ensure we can 

contact a veteran regarding any issues 

and for billing purposes. We believe that 

60 days is an appropriate period of time, 

as it will allow veterans sufficient 

opportunity to submit this information 

while ensuring that VA has the ability 

to make accurate determinations about 

eligibility for the Program. 

In addition to meeting the eligibility 

criteria under paragraphs (a) and (b) of 

this section, a veteran must also provide 

to VA information about any health-care 

plan under which the veteran is 

covered. Section 17.1510(d) requires 

that a veteran provide this information 

to be able to receive authorized non-VA 

care through the Program. This is 

consistent with the requirement in the 

Act in section 101(e)(1), which states 

that before a veteran can receive 

hospital care or medical services under 

the Program, the veteran must provide 

information about other health 

insurance. Section 17.1510(d) requires a 

veteran to submit information and 

updated information to VA within 60 

days if the veteran changes health-care 

plans. We believe that 60 days is an 

appropriate period of time, as it will 

allow veterans sufficient time to submit 

this information while ensuring that VA 

has the ability to provide accurate 

information to eligible entities and 

providers under the Program. 

Under § 17.1510(e), VA will calculate 

distance between a veteran’s residence 

and the nearest VA medical facility 

using a straight-line distance, rather 

than the driving distance. The 

Conference Report accompanying the 

final bill provides strong support for 

this interpretation, as it states, ‘‘In 

calculating the distance from a nearest 

VA medical facility, it is the Conferees’ 

expectation that VA will use geodesic 

distance, or the shortest distance 

between two points.’’ H.R. Rpt. 113– 

564, p. 55. The shortest distance 

between two points is a straight line, so 

a veteran who is outside of a 40 mile 

radius of a VA medical facility would be 

eligible under this provision. VA 

understands that actual travel distances 

may be longer than 40 miles for some 

veterans who reside within the 40 mile 

radius based on the layout of roads or 

other factors, and to the extent that such 

travel is due to geographic challenges, 

these veterans may be eligible for the 

Program under § 17.1510(b)(4). These 

veterans may also be eligible to receive 

non-VA care under another authority. 

Section 17.1515 Authorizing Non-VA 

Care 

Section 17.1515 describes the process 

and requirements for authorizing nonVA care under this Program. 

Paragraph (a) states that eligible 

veterans may choose between 

scheduling an appointment with a VA 

health care provider, being placed on an 

electronic waiting list for a VA 

appointment, or receiving authorized 

non-VA hospital care or medical 

services from an eligible entity or 

provider. Section 101(c) of the Act 

provides that eligible veterans can make 

an election to have the Secretary 

schedule an appointment for the veteran 

with a VA health care provider, place 

him or her on an electronic waiting list, 

or authorize non-VA care. If a veteran 

elects to receive VA care and VA is able 

to schedule an appointment for the 

veteran, even if such an appointment is 

outside of the wait-time goals of the 

Veterans Health Administration or is at 

a facility more than 40 miles from the 

veteran’s residence, we will do so. 

Otherwise, we will place a veteran who 

elects to receive VA care on an 

electronic waiting list. We will continue 

to track and report the average length of 

time an individual must wait for an 

appointment, disaggregated by medical 

facility and type of care or services 

needed. We will provide this facilitylevel information at the time the veteran 

makes his or her choice so the veteran 

can make an informed election about 

whether to receive hospital care or 

medical services from a VA or non-VA 

health care provider. Sections 

101(c)(1)(A) and (c)(2) require VA to 

schedule an appointment for a veteran 

or place the veteran on an electronic 

waiting list, which must be available to 

determine the place of an eligible 

veteran on the waiting list and to 

determine the average length of time an 

individual spends on a waiting list, 

disaggregated by medical facility and 

type of care or services needed. The Act 

clearly specifies that this information 

must be provided ‘‘for purposes of 

allowing such eligible veteran to make 

an informed election.’’ Sec. 101(c)(2)(B), 

Public Law 113–146, 128 Stat. 1754. 

Additionally, if the veteran elects to 

receive care from a non-VA health care 

provider, VA will notify the veteran by 

the most effective means available, as 

identified by the veteran, of the scope of 

the authorization for care, thereby 

complying with the requirements of 

section 101(c)(1)(B)(ii). 

Section 17.1515(b) states that eligible 

veterans may specify a particular nonVA entity or health care provider from 

whom they wish to receive care, if the 

entity or health care provider is eligible 

under § 17.1530. Section 101(a)(2) of the 

Act establishes that veterans who are 

eligible for the Program based upon the 

wait-time standard have the right to 

select the specific health care provider 

they wish to see, so long as the provider 

is eligible under the Act and under 

§ 17.1530. The Act does not address 

whether or not veterans who are eligible 

based upon residence may select a 

particular non-VA provider. VA is 

filling this gap in the law by providing 

these veterans the same opportunity to 

select a particular provider as veterans 

eligible based upon the wait-time 

standard. Eligible veterans may 

nevertheless choose not to make such a 

selection, and in such a situation, those 

veterans will be referred to an eligible 

entity or provider identified by VA. 

Section 17.1520 Effect on Other 

Provisions 

Section 17.1520 addresses the effect 

of the Program on other provisions and 

programs administered by VA. 

Paragraph (a) of this section provides 

that, generally, eligibility under the 

Program does not affect a veteran’s 

eligibility for hospital care or medical 

services under the medical benefits 

package or other benefits addressed in 

part 17. If particular services, such as 

health care for newborns of veterans 

under 38 CFR 17.38(a)(xiv) and dental 

benefits under §§ 17.160–17.169, have 

unique eligibility standards, only 

veterans who are eligible under 

§ 17.1510 and meet the eligibility 

standards for those services can elect to 

receive non-VA care for them. Nothing 

in the Act or these regulations waives 

the eligibility requirements established 

in other statutes or regulations. 

The regulation also provides that 

notwithstanding any other provision of 

this part, VA will cover prescription 

medications and other prescriptions 

made while furnishing hospital care or 

medical services through the Program. 

This is consistent with section 

101(a)(1)(A) of the Act, which requires 

VA to furnish medical services to 

eligible veterans under the Program, and 

with 38 U.S.C. 1710. VA fills emergency 

prescriptions written by non-VA health 

care providers, but does not normally 

fill prescriptions written by non-VA 

providers when veterans receive 

authorized non-VA care. However, we 

interpret the requirement in section 101 

to furnish hospital care and medical 

services to include these benefits. The 

terms ‘‘hospital care’’ and ‘‘medical 

services’’ are defined through the 

medical benefits package at 38 CFR 


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17.38, which specifically includes 

prescription drugs, including over-thecounter drugs and medical and surgical 

supplies available under the VA 

national formulary system. 38 CFR 

17.38(a)(1)(iii). Veterans receiving care 

under the Program are eligible because 

they either could not be seen within the 

wait-time goals of the Veterans Health 

Administration or because of their place 

of residence. Typically, VA requires 

veterans to visit a VA medical facility so 

one of our providers can establish that 

the prescription is medically needed 

and appropriate for the patient. 

Imposing such a requirement on 

veterans eligible under the Program 

would not make sense because their 

eligibility is predicated on either being 

unable to be seen within a timely 

manner or because of difficulties they 

face in traveling to a VA medical 

facility. We believe this decision is 

consistent with section 101(r) of the Act, 

which states that nothing in section 101 

shall be construed to alter the process 

for filling and paying for prescription 

medications. This regulation does not 

alter how prescriptions are filled or 

purchased. VA will pay for 

prescriptions, including prescription 

drugs, over-the-counter drugs, and 

medical and surgical supplies 

prescribed by eligible entities and 

providers under the Program. However, 

VA will only pay for those items that are 

on the VA National Formulary, in 

accordance with § 17.38(a)(1)(iii), and 

eligible veterans will be charged a VA 

copayment, if applicable, as with all 

other care and services offered under 

the Program. If prosthetics are 

prescribed as part of the care that is 

provided under the Program, VA will 

pay for these items as well. 

Section 17.1520(b) states that VA will 

be liable for any deductibles, costshares, or copayments required by the 

health-care plan of an eligible veteran 

participating in the Program and owed 

to the non-VA provider, to the extent 

that such reimbursement does not result 

in expenditures by VA for the furnished 

care or services that exceed the rates 

determined under § 17.1535. Currently, 

non-VA providers who accept VA 

payments for hospital care or medical 

services must accept VA payment as 

payment in full and cannot assess any 

additional charges. 38 CFR 17.55 and 

17.56. By contrast, VA is a secondary 

payer under the Program for care and 

services related to a nonserviceconnected disability. Under section 

101(e)(3)(B)(ii) of the Act, VA is 

authorized to pay the cost of care or 

services that is not covered by a 

veteran’s health-care plan, except that 

VA’s payment may not exceed the rate 

established under § 17.1535. We 

interpret section 101(e)(3)(B)(ii) to 

authorize VA to cover the balance due 

the non-VA provider after any payment 

by the veteran’s health-care plan and 

any payment made by the veteran, and 

to be liable for any copayments, costshares, or deductibles required of the 

veteran by the other health-care plan, up 

to the amount established under 

§ 17.1535. 

Under the Program, the non-VA 

provider is responsible for first billing 

the veteran’s other health-care plan, if 

the care provided under the Program is 

related to a nonservice-connected 

disability. Any payment made by a 

health-care plan to the non-VA provider 

reduces the amount owed by VA as the 

secondary payer. If the balance due to 

the non-VA provider, after any payment 

by the veteran’s health-care plan and 

any payment by the veteran, is less than 

the rate established under § 17.1535, VA 

will, consistent with its authority in 

section 101(e)(3)(B)(ii), cover the 

veteran’s copayments, cost-shares, or 

deductibles required by the health-care 

plan. If the veteran paid any such costs 

to the non-VA provider, VA will 

reimburse the veteran for the paid costs. 

To the extent the amount contributed 

by the health-care plan would cover the 

veteran’s VA copayment obligation, VA 

will apply that amount to reduce the 

veteran’s VA copayment obligation as 

determined under §§ 17.108, 17.110, 

and 17.111. In some instances, though, 

veterans will still owe a VA copayment. 

As is currently the case, to the extent 

the veteran qualifies for a hardship 

exemption or a waiver of that debt 

under §§ 17.104 or 17.105, the veteran 

may seek such relief. VA is establishing 

a hotline, 1–866–606–8198, that 

veterans and health care providers can 

call with questions about payments and 

liabilities. 

Paragraph (c) of this section addresses 

the beneficiary travel program 

administered under 38 CFR part 70. 

This paragraph provides that veterans 

who are eligible for beneficiary travel 

under part 70 will be reimbursed for 

travel to and from the location of the 

eligible entity or provider who furnishes 

hospital care or medical services for an 

authorized appointment under the 

Program, even if there is another nonVA health care provider that is closer. 

Current regulations governing the 

beneficiary travel program at 38 CFR 

70.30(b)(2) provide that VA will pay 

mileage reimbursement for travel 

between a beneficiary’s residence and 

the closest non-VA health care provider 

that could furnish such care. For 

veterans who have the right to select a 

provider of their own choice under 

§ 17.1515(b), they may select a provider 

who is slightly farther away from their 

residence than another non-VA provider 

who could furnish the same care. For 

veterans who elect non-VA care, VA 

may schedule an appointment with an 

eligible non-VA entity or provider that 

is farther away because that non-VA 

provider can see the veteran sooner. We 

believe that it is fair and consistent to 

provide mileage reimbursement in these 

instances. VA has authority under 38 

U.S.C. 111(b)(2) to define the parameters 

under which it will reimburse eligible 

veterans for travel expenses, and VA is 

exercising that authority here to help 

veterans who obtain non-VA care 

through the Program access non-VA 

health care entities and providers. 

Hence, § 17.1520(c) waives the 

requirements of 38 CFR 70.30(b)(2) for 

purposes of the Program. 

Section 17.1525 Start Date for Eligible 

Veterans 

Section 17.1525 defines when eligible 

veterans may begin receiving hospital 

care and medical services through the 

Program. VA is phasing in 

implementation of the Program for 

different categories of eligible veterans 

to ensure that VA has the resources in 

place to support care for these veterans. 

Paragraph (a) of this section identifies 

the start date for eligible veterans based 

on which criterion in § 17.1510(b) they 

meet. In paragraph (a)(1) of this section, 

veterans who are eligible based on their 

place of residence under 17.1510(b)(2) 

through (b)(4) will be able to start 

receiving hospital care and medical 

services on the date of publication of 

this rule. We are starting with this 

population because it is more easily 

identified and less subject to change 

over time than those who are eligible 

based on being unable to be seen within 

the wait-time goals of the Veterans 

Health Administration. Veterans eligible 

under 17.1510(b)(1) will be able to start 

receiving hospital care and medical 

services no later than December 5, 2014. 

Paragraph (b) of this section states that 

notwithstanding the dates identified in 

paragraph (a), VA may publish a Notice 

in the Federal Register informing the 

public that veterans may receive care 

sooner. This will ensure VA has 

flexibility so that if we determine we 

have the necessary resources in place to 

furnish care, we can begin doing so 

without further delay. 

Section 17.1530 Eligible Entities and 

Providers 

Section 17.1530 defines requirements 

for non-VA entities and health care 

providers to be eligible to be reimbursed 


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for furnishing hospital care and medical 

services to eligible veterans under the 

Program. Paragraph (a) of this section 

provides that an entity or provider must 

be accessible to the veteran and be one 

of the four entities specified in section 

101(a)(1)(B) of the Act. These include 

any health care provider that is 

participating in the Medicare program 

under title XVIII of the Social Security 

Act (42 U.S.C. 1395 et seq.), including 

any physician furnishing services under 

such program; any Federally-qualified 

health center (as defined in section 

1905(l)(2)(B) of the Social Security Act 

(42 U.S.C. 1396d(l)(2)(B)); the 

Department of Defense; or the Indian 

Health Service. Outpatient health 

programs or facilities operated by a tribe 

or tribal organization under the Indian 

Self-Determination and Education 

Assistance Act or by an urban Indian 

organization receiving funds under title 

V of the Indian Health Care 

Improvement Act are defined as 

Federally-qualified health centers in 

section 1905(l)(2)(B) of the Social 

Security Act and would be eligible 

providers under section 101(a)(1)(B). 

Additionally, the entity or provider 

must not be a part of, or an employee 

of, VA, or if the provider is an employee 

of VA, he or she cannot be acting within 

the scope of such employment while 

providing hospital care or medical 

services through the Program. Many of 

VA’s health care providers are also 

appointed to other institutions, so if 

these health care providers are 

furnishing care under this Program, they 

must be doing so on non-Department 

time and using non-VA resources. The 

Act specifically envisions that care 

under the Program is provided by nonVA resources, as demonstrated by 

section 101(a)(3) of the Act, which 

requires VA to coordinate through the 

Non-VA Care Coordination Program the 

furnishing of care and services under 

this Program. Furthermore, non-VA care 

is a general term applied throughout VA 

to refer to any care furnished by a nonVA entity or health care provider under 

any authority or agreement. The title of 

section 101 of the Act, ‘‘Expanded 

availability of hospital care and medical 

services for veterans through use of 

agreements with non-Department of 

Veterans Affairs entities,’’ also clearly 

demonstrates Congress’s intent that any 

entity or provider that is a VA resource 

should not be eligible to participate in 

the Program. 

Under § 17.1530(b), an entity or 

provider must enter into an agreement 

with VA to provide non-VA hospital 

care or medical services under the 

Program. This requirement is consistent 

with section 101(a)(1)(A) of the Act. 

This section of the Act also authorizes 

VA to use agreements reached before the 

enactment of the Act, so long as such 

agreement is with an eligible entity or 

provider as defined in section 

101(a)(1)(B) of the Act. Agreements may 

be formed by contract, 

intergovernmental agreement, or a 

provider agreement, consistent with 

section 101(d)(1)(B) of the Act. Each 

form of agreement must be executed by 

a duly authorized Department official to 

ensure that Federal resources are being 

committed by a person with the 

authority to do so. As an operational 

matter, VA will, to the maximum extent 

practicable and consistent with the 

requirements of section 101, use 

existing sharing agreements, existing 

contracts, and other processes available 

at VA medical facilities prior to using 

provider agreements under this section. 

This is consistent with the requirements 

of section 101(d)(1)(A), as modified by 

section 409 of Public Law 113–175. 

Paragraph (c) of § 17.1530 defines 

whether an entity or provider is 

accessible to a veteran. Under section 

101(a)(2) of the Act, a veteran who is 

eligible for the Program based on being 

unable to schedule an appointment 

within the wait-time goals of the 

Veterans Health Administration can 

only select an entity or provider that is 

accessible to the veteran. The broad 

intent of the Act is to ensure that 

veterans are able to be seen quickly and 

close to their home. The Act did not 

contemplate, for example, that a veteran 

living in New York would have his or 

her care in California and travel paid for 

by VA. Under the Act, this accessibility 

requirement technically only applies to 

veterans who are eligible based on being 

unable to be seen within the wait-time 

goals of the Veterans Health 

Administration. However, we believe 

the same standard should apply when 

any eligible veteran elects to receive 

non-VA care under the Program because 

it would be unfair to impose an 

accessibility requirement to limit the 

non-VA entities and providers available 

to some veterans but not others. Also, in 

those situations when a veteran does not 

select a provider, it would be 

inconsistent with the purpose of the Act 

if VA were able to select a non-VA 

provider who was inaccessible to 

veterans whose basis for eligibility is 

their residence. The factors identified in 

§ 17.1530(c)(1)–(3) are intended to 

ensure that, as often as possible, 

veterans are able to access the care they 

need from an entity or provider that can 

see them quickly and that is at least as 

close as the nearest VA medical facility. 

VA will consider several factors when 

determining whether an entity or 

provider is accessible. Under 

§ 17.1530(c)(1), VA will consider the 

length of time an eligible veteran would 

have to wait to receive hospital care or 

medical services. One of the principal 

issues the Act was intended to address 

was extended wait times for hospital 

care and medical services in VA 

facilities. Senate Veterans’ Affairs 

Committee Chairman Sanders explained 

the purpose of the Program shortly 

before the Senate passed an early 

version of this bill by saying, ‘‘this 

legislation says to veterans that if there 

are long wait times, if they cannot get 

into a facility in a reasonable time, they 

can go out outside of . . . VA.’’ See 160 

Cong. Rec. S3591 (June 11, 2014). By 

considering the length of time a veteran 

would have to wait to receive hospital 

care or medical services from a non-VA 

entity or provider, VA can ensure that 

veterans receive care as quickly as 

possible. If a veteran selects a provider 

who cannot see the veteran for several 

months, VA would probably determine 

that provider was inaccessible. 

Alternatively, under this standard, there 

may be several eligible entities or 

providers who could provide care more 

quickly than VA could, and in such a 

situation, in those instances when an 

eligible veteran does not specify a 

particular eligible entity or provider, VA 

could select the eligible entity or 

provider that is able to schedule the 

earliest appointment for the eligible 

veteran. 

Under § 17.1530(c)(2), VA will 

consider the qualifications of the entity 

or provider to furnish the hospital care 

or medical services the veteran requires. 

If an entity or provider does not have 

the expertise or equipment necessary to 

provide the required care or services, 

the needed care is not accessible from 

that provider, and VA will not authorize 

a patient to receive hospital care or 

medical services from that entity or 

provider. This will ensure that veterans 

have access to, and can receive, the care 

they need and that appropriated 

resources are spent only for services that 

actually can be delivered. 

Under § 17.1530(c)(3), VA will 

consider the distance between the 

eligible veteran’s residence and the 

entity or provider. Three of the four 

bases for eligibility under the Program 

focus on the residence of the veteran, 

and therefore we believe that travel 

distance was a clear concern and focus 

of the Act. If a veteran has to travel long 

distances to receive care, then these 

non-VA providers may be no more 

accessible than a VA medical facility 

that is more than 40 miles away from 

the veteran’s residence. 


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VA will consider these factors 

together. Sometimes, there may be 

several eligible entities or providers that 

could deliver care close to the veteran’s 

residence, and in such a scenario, 

distance likely will not matter. In other 

situations, there may only be one 

provider near the veteran’s residence, 

but this provider either has extended 

wait times or lacks the expertise or 

equipment to provide the necessary 

care. VA will need to balance these 

competing interests and the preference 

of the veteran to determine whether or 

not an entity or provider is accessible. 

We will also make accessibility 

determinations on a case-by-case basis, 

considering each veteran’s specific 

needs and ability to travel, as well as 

changes in the status of a non-VA entity 

or provider. For example, VA might find 

a health care provider inaccessible to a 

veteran in one month because the 

provider cannot see new patients in a 

timely manner or because the provider 

lacks the qualifications to treat a 

particular condition. But the following 

month, VA might find that same health 

care provider accessible to the same 

veteran because the provider’s wait time 

has decreased or the provider has 

gained expertise through a newly hired 

health care provider. 

Under § 17.1530(d), a non-VA 

provider must maintain at least the 

same or similar credentials and licenses 

as required by VA of its own providers. 

This requirement is codified in section 

101(i)(1) of the Act, which also provides 

further support for the qualification 

standard in paragraph (c)(2) of this 

section. The agreement VA reaches with 

the non-VA entity or provider will 

clarify the requirement referenced in 

§ 17.1530(d). These requirements will be 

the same or similar to the requirements 

included in VA policy and are also 

available through Veterans Health 

Administration (VHA) Handbook 

1100.19 and VHA Directive 2012–030, 

available online at: http://www.va.gov/

vhapublications/. Non-VA health care 

entities or providers must submit 

verification of this information to VA at 

least once per 12-month period to 

continue to remain eligible under this 

Program. This requirement is consistent 

with section 101(i)(2) of the Act. 

For purposes of the Program, 

qualifications of non-VA providers will 

be set forth in the terms of the 

agreement with VA, but, in accordance 

with the Act, those terms must specify 

requirements that are ‘‘at least the same 

or similar credentials and licenses’’ as 

those required of VA providers. Sec. 

101(i)(1), Public Law 113–146, 128 Stat. 

1754. We also note that to the extent 

there may be concerns about the 

qualifications of a particular provider, 

section 101(a)(1)(B) of the Act requires 

that eligible entities and providers of 

non-VA care must either be Federal 

providers themselves (the Department of 

Defense or the Indian Health Service), a 

Federally-qualified health center, or be 

a participating provider in the Medicare 

program. Accordingly, these non-VA 

entities and providers have already met 

quality standards established in Federal 

law. 

Entities are not required by the Act to 

maintain the same or similar credentials 

and licenses as VA providers because 

entities are not direct health care 

providers. Any entities that are eligible 

to provide care through the Program 

must ensure that any of their providers 

furnishing care and services through the 

Program meet these standards. If an 

eligible entity has more than one 

provider furnishing hospital care or 

medical services under this Program, 

the entity may submit the information 

required by paragraph (d) of this section 

on behalf of its providers. This will 

reduce the administrative 

responsibilities of each provider and VA 

by allowing for a consolidated 

submission of information. 

Although not addressed in the 

regulation, eligible entities and 

providers furnishing hospital care and 

medical services to eligible veterans 

through the Program, to the extent 

possible, should submit medical records 

back to VA in an electronic format. This 

will ensure that the veteran’s medical 

record is as complete as possible to 

provide quality care in a timely manner. 

The agreements VA reaches with 

eligible entities and providers will 

clarify this requirement. 

Section 17.1535 Payment Rates and 

Methodologies 

Section 17.1535 addresses payment 

rates and payment methodologies. 

Section 17.1535(a) addresses payment 

rates. This paragraph states that rates 

will be negotiated and set forth in an 

agreement between VA and an eligible 

entity or provider. This is consistent 

with sections 101(d)(1)(A) and (d)(2)(A) 

of the Act. 

Section 17.1535(a)(1) establishes the 

default payment rule that 

reimbursement rates under the Program 

will not exceed the applicable Medicare 

rate under Title XVIII of the Social 

Security Act. This limitation is 

established in section 101(d)(2)(B)(i) of 

the Act. 

Section 17.1535(a)(2) states that VA 

may pay a rate higher than the default 

Medicare rate to an eligible entity or 

provider in a highly rural area, so long 

as such rate is still determined by VA 

to be fair and reasonable. A highly rural 

area is an area located in a county that 

has fewer than seven individuals 

residing in that county per square mile. 

This limited exception to the default 

Medicare rate is specifically 

contemplated, and narrowly 

circumscribed, by section 

101(d)(2)(B)(ii) of the Act. The 

limitation that such rate be determined 

by VA to be fair and reasonable is 

necessary to ensure that VA is 

committing and using budgetary 

resources appropriately. 

Section 17.1535(a)(3) addresses 

situations where there is no Medicare 

rate. As cited above, section 101(d)(2)(B) 

of the Act establishes that, except in 

highly rural areas, VA must pay the 

Medicare rate. However, there are 

certain types of care, such as obstetrics/ 

gynecological and dental care, that are 

authorized by the VA medical benefits 

package in 38 CFR 17.38 but for which 

Medicare does not have established 

rates. The Act does not address the 

appropriate rate in such a situation. 

Because Congress did not address what 

rate can be paid when Medicare rates do 

not exist, we must fill the gap left by the 

law. See Chevron U.S.A., Inc. v NRDC, 

467 U.S. 837, 842–843 (1984). 

Under § 17.1535(a)(3), VA follows the 

process and methodology outlined in 

specified paragraphs of 38 CFR 17.55 

and 17.56, to the extent these 

paragraphs are consistent with the 

requirements of section 101 of the Act, 

when there are no available rates as 

described in § 17.1535(a)(1). Sections 

17.55 and 17.56 establish rates for 

payment for care provided to veterans 

by non-VA providers under different 

authorities than the Act. Paragraphs (g) 

and (k) of § 17.55 conflict with the Act 

and therefore are not applicable to 

payments made under the Program and 

would not be followed. Section 17.55(g), 

for example, states that payment by VA 

is payment in full, and the health care 

provider or agent may not impose any 

additional charge on a veteran or his or 

her health care insurer for any inpatient 

services for which payment is made by 

VA. This is inconsistent with sections 

101(e) and 101(j) of the Act, which, as 

discussed above, specifically require 

billing to a health-care plan and 

copayments by a veteran for services 

rendered. Section 17.55(k) states that 

VA will not pay more than the amount 

determined under paragraphs (a)–(j) of 

§ 17.55 or the negotiated amount, but 

§ 17.1535(a) already establishes a rate 

ceiling for payments made under the 

Program. Sections 17.55(j) and 17.56(b) 

address payment for care furnished in 

Alaska, but section 101 of the Act does 

not permit us to follow these rates. If the 


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Act is further modified by Congress to 

provide flexibility to pay different rates, 

VA will comply with the new statutory 

requirements and will follow any 

methodologies in §§ 17.55 and 17.56 

that are consistent with those 

requirements. 

Section 17.1535(b) details payment 

responsibilities. Section 17.1535(b)(1) 

concerns payments for care related to a 

nonservice-connected disability. VA 

defines a nonservice-connected 

disability consistent with 38 CFR 3.1(l). 

This longstanding VA definition is 

consistent with section 101(e)(3)(C) of 

the Act, as well as the use of that term 

in other VA programs. We believe that 

using this definition will result in the 

same outcomes as the definition 

presented in the Act and is more 

familiar to the VA staff who will be 

administering the Program. VA has 

defined the term ‘‘nonserviceconnected’’ at 38 CFR 3.1(l) to refer to 

a disability that was not incurred or 

aggravated in line of duty in the active 

military, naval, or air service. The 

Veterans Benefits Administration (VBA) 

is responsible for making 

determinations about whether a specific 

disability is service connected or not, 

and any disability that VBA has not 

identified as service connected is 

considered nonservice connected. 

When a veteran is seeking care for a 

nonservice-connected disability through 

the Program, the health-care plan of the 

eligible veteran, if one exists, is 

primarily responsible for paying the 

eligible entity or provider for authorized 

hospital care or medical services that 

are furnished to an eligible veteran. This 

is consistent with the requirements of 

section 101(e)(3)(A) of the Act. The 

health-care plan is only responsible to 

the extent the care or services are 

covered by the health-care plan; this is 

again consistent with the language of 

section 101(e)(3)(A) of the Act. VA will 

be responsible for promptly paying only 

the amount that is not covered by the 

health-care plan, except VA cannot pay 

more than the rate determined under 

§ 17.1535(a). 

Section 101(e)(3)(B) of the Act defines 

when VA is secondarily responsible for 

care. The Act states that the eligible 

entity or provider is responsible for 

seeking reimbursement for the cost of 

furnishing hospital care or medical 

services from the health-care plan of the 

veteran, if applicable, and VA is 

responsible for only paying for the VAauthorized service to the extent not 

covered by such health-care plan. Under 

section 101(d)(2)(C) of the Act, an 

eligible entity or provider cannot collect 

more than the negotiated rate for the 

furnishing of care or services. If a 

veteran is required to make a VA 

copayment under section 101(j) of the 

Act and § 17.1520(b) of this regulation, 

the copayment will be applied to the 

rate established by § 17.1535(a). This 

will, in turn, reduce VA’s ultimate 

liability. 

Paragraph (b)(2) of this section 

provides that if hospital care or medical 

services are being furnished for a 

service-connected disability or pursuant 

to 38 U.S.C. 1710(e), 1720D, or 1720E, 

VA is solely responsible for paying the 

eligible entity or provider for such 

hospital care or medical services. VA 

has defined the term ‘‘serviceconnected’’ at 38 CFR 3.1(k) to mean, 

with respect to a disability, that such 

disability was incurred or aggravated in 

line of duty in the active military, naval, 

or air service. VA only has authority to 

recover or collect reasonable charges 

from a health-care plan when the care 

is being furnished for a nonserviceconnected disability, so VA cannot 

collect such charges when serviceconnected care is involved. 38 U.S.C. 

1729. The Act is silent in terms of 

collecting payment for serviceconnected care, so VA believes its 

existing authorities should apply here. 

The three additional authorities cited, 

38 U.S.C. 1710(e), 1720D, and 1720E, 

are what VA refers to as special 

authorities, which require VA to furnish 

care based on certain conditions or 

exposures associated with military 

service. Excluding hospital care and 

medical services furnished under these 

authorities from liability by health-care 

plans is consistent with VA’s past 

practice and with the intent and 

language of section 101(e)(3) of the Act. 

VA is developing a separate rulemaking 

that would specifically restrict the 

ability of VA to collect charges from 

health-care plans for care provided 

under these special authorities. Both 

that proposed rulemaking and this 

rulemaking are consistent with current 

practice. 

Paragraph (c) of this section states that 

VA will only pay for hospital care or 

medical services authorized by VA. 

Accordingly, if in the course of 

providing authorized care or services 

under the Program, the eligible entity or 

provider determines that additional 

hospital care or medical services are 

necessary beyond what VA has 

authorized, the eligible entity or 

provider must contact VA for 

authorization prior to furnishing such 

care or services, in order for such care 

and services to be paid for by VA under 

the Program. Section 101(h) of the Act 

requires that, at the election of the 

veteran, VA must ensure that a veteran 

receives such hospital care or medical 

services through the completion of the 

episode of care, including all specialty 

and ancillary services deemed necessary 

as part of the recommended treatment. 

We believe that the language ‘‘deemed 

necessary’’ authorizes VA to make such 

determinations. This belief is supported 

by the Conference Report of the final 

bill, which stated, ‘‘When coordinating 

care for eligible veterans through the 

Non-VA Care Coordination program, the 

Department should attempt to ensure 

when an appointment is authorized, the 

eligible veteran receives care within an 

appropriate time period, as defined by 

medical necessity as determined by the 

referring physician, or a mandatory time 

period established by the Secretary 

when the request for care is not initiated 

by a physician.’’ H.R. Rpt. 113–564, p. 

55, (emphasis added). In this context, 

the referring physician would be a VA 

health care provider. Furthermore, for 

non-VA care authorized under other 

statutes, VA must periodically review 

the necessity for continuing such care. 

38 U.S.C. 1703(b). We interpret the 

language in section 101(h) of the Act to 

impose a similar obligation to ensure 

that VA has not entered into an openended commitment. VA will craft 

authorizations for non-VA care to 

ensure that veterans can receive the 

episode of care they need, including 

specialty and ancillary service, from 

eligible entities and providers. While 

some episodes of care may only involve 

a single visit, such as a specific 

procedure or test, others may involve 

multiple visits. VA will authorize only 

the care that it deems necessary as part 

of the treatment plan; if a non-VA health 

care provider believes that additional 

services are needed beyond 60 days or 

outside the scope of the initial course of 

treatment that was authorized, the 

health care provider must contact VA 

prior to administering such care to 

ensure that this care is authorized and 

therefore will be paid for by VA. These 

provisions are included so that veterans 

are not subjected to unapproved 

procedures and tests, and so that 

appropriated resources are not used for 

unapproved care or services. 

Also, there must be an actual 

encounter with a health care provider, 

who is either an employee of an entity 

in an agreement with VA or who is 

furnishing care through an agreement 

the health care provider has entered into 

with VA, and such encounter must 

occur after an election is made by an 

eligible veteran. The encounter may be 

virtual through use of telehealth or other 

technologies, but the health care 

provider must furnish hospital care or 

medical services during the 


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appointment. This will ensure that VA 

only pays for hospital care or medical 

services that were actually furnished, 

and is consistent with the Act’s 

requirement in section 101(m) that the 

Department does not pay for care or 

services that were not furnished to an 

eligible veteran. 

Section 17.1540 Claims Processing 

System 

Section 17.1540 provides general 

requirements for a VA claims processing 

system. This is required by section 

101(k) of the Act. Paragraph (a) of this 

section establishes the claims 

processing system within the Chief 

Business Office of the Veterans Health 

Administration. This is required by 

section 101(k)(3) of the Act. The system 

will process and pay bills or claims for 

authorized hospital care and medical 

services furnished to veterans through 

the Program, as required by section 

101(k)(1). 

Paragraph (b) of this section 

establishes responsibility for overseeing 

the system with the Chief Business 

Office of the Veterans Health 

Administration. Section 101(k)(3) 

requires this assignment of authority. 

Paragraph (c) of this section states that 

the system will receive requests for 

payment from eligible entities and 

providers for hospital care or medical 

services furnished to eligible veteran, 

and that the system will provide 

accurate and timely payments for claims 

received under the Program. This is 

required by section 101(k) and section 

105 of the Act. 

Administrative Procedure Act 

The Secretary of Veterans Affairs 

finds that there is good cause under 5 

U.S.C. 553(b)(B) and (d)(3) to dispense 

with the opportunity for advance notice 

and opportunity for public comment 

and good cause to publish this rule with 

an immediate effective date. Section 

101(n) of the Act requires publication of 

an interim final rule no later than 

November 5, 2014, the date that is 90 

days after the date of the enactment of 

the law. We interpret this mandate to 

mean that, as a matter of law, it is 

impracticable and contrary to law and 

the public interest to delay this rule for 

the purpose of soliciting advance public 

comment or to have a delayed effective 

date. 

VA is making the rule effective for 

certain veterans prior to the usual 30 

day delay for an interim final rule to 

allow VA to begin furnishing hospital 

care and medical services immediately 

to certain eligible veterans. Delaying 

implementation could result in delayed 

health care for these veterans, which 

could have unpredictable negative 

health effects. 

For the above reasons, the Secretary 

issues this rule as an interim final rule. 

However, VA will consider and address 

comments that are received within 120 

days of the date this interim final rule 

is published in the Federal Register. 

Effect of Rulemaking 

Title 38 of the Code of Federal 

Regulations, as revised by this interim 

final rulemaking, represents VA’s 

implementation of its legal authority on 

this subject. Other than future 

amendments to this regulation or 

governing statutes, no contrary guidance 

or procedures are authorized. All 

existing or subsequent VA guidance 

must be read to conform with this 

rulemaking if possible or, if not 

possible, such guidance is superseded 

by this rulemaking. 

Paperwork Reduction Act 

This interim final rule includes a 

collection of information under the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 3501–3521) that requires 

approval by the Office of Management 

and Budget (OMB). Accordingly, under 

44 U.S.C. 3507(d), VA has submitted a 

copy of this rulemaking to OMB for 

review. 

OMB assigns a control number for 

each collection of information it 

approves. VA may not conduct or 

sponsor, and a person is not required to 

respond to, a collection of information 

unless it displays a currently valid OMB 

control number. Sections 17.1510(d), 

17.1515, and 17.1530 contain a 

collection of information under the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 3501–3521). If OMB does not 

approve the collection of information as 

requested, VA will immediately remove 

the provisions containing a collection of 

information or take such other action as 

is directed by OMB. 

Comments on the collection of 

information contained in this interim 

final rule should be submitted to the 

Office of Management and Budget, 

Attention: Desk Officer for the 

Department of Veterans Affairs, Office 

of Information and Regulatory Affairs, 

Washington, DC 20503, with copies sent 

by mail or hand delivery to the Director, 

Regulation Policy and Management 

(02REG), Department of Veterans 

Affairs, 810 Vermont Avenue NW., 

Room 1068, Washington, DC 20420; fax 

to (202) 273–9026; or through 

www.Regulations.gov. Comments 

should indicate that they are submitted 

in response to ‘‘RIN 2900–AP24— 

Expanded Access to Non-VA Care 

through the Veterans Choice Program.’’ 

A comment to OMB is best assured of 

having its full effect if OMB receives it 

within 30 days of publication. This does 

not affect the deadline for the public to 

comment on the rule. 

VA considers comments by the public 

on proposed collections of information 

in— 

• Evaluating whether the proposed 

collections of information are necessary 

for the proper performance of the 

functions of VA, including whether the 

information will have practical utility; 

• Evaluating the accuracy of VA’s 

estimate of the burden of the proposed 

collections of information, including the 

validity of the methodology and 

assumptions used; 

• Enhancing the quality, usefulness, 

and clarity of the information to be 

collected; and 

• Minimizing the burden of the 

collections of information on those who 

are to respond, including through the 

use of appropriate automated, 

electronic, mechanical, or other 

technological collection techniques or 

other forms of information technology, 

e.g., permitting electronic submission of 

responses. 

The amendments to title 38 CFR part 

17 contain collections of information 

under the Paperwork Reduction Act of 

1995 for which we are requesting 

approval by OMB. These collections of 

information are described immediately 

following this paragraph, under their 

respective titles. 

Title: Election to Receive Authorized 

Non-VA Care and Selection of Provider 

for the Veterans Choice Program. 

Summary of collection of information: 

Section 17.1515 requires eligible 

veterans to notify VA whether the 

veteran elects to receive authorized nonVA care through the Veterans Choice 

Program, be placed on an electronic 

waiting list, or be scheduled for an 

appointment with a VA health care 

provider. Section 17.1515(b)(1) also 

allows eligible veterans to specify a 

particular non-VA entity or health care 

provider, if that entity or provider meets 

certain requirements. 

Description of the need for 

information and proposed use of 

information: The information is 

required by the Act. Section 101(c) of 

Public Law 113–146 requires an eligible 

veteran to make an election to receive 

authorized non-VA care through the 

Veterans Choice Program, be placed on 

an electronic waiting list, or be 

scheduled for an appointment with a 

VA health care provider. Section 

101(a)(2) authorizes certain eligible 

veterans to select a non-VA health care 

provider, and through regulation at 

§ 17.1515(b), all eligible veterans may 


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select a non-VA health care provider 

that is eligible under § 17.1530. This 

information is necessary because VA 

must know what the veteran’s choice is 

and whom the veteran would like to see 

for an appointment. 

Description of likely respondents: 

Eligible veterans seeking authorization 

to receive non-VA care through the 

Veterans Choice Program. 

Estimated number of respondents per 

year: 440,794 eligible persons. 

Estimated frequency of responses per 

year: 12.64 times per year. 

Estimated average burden per 

response: 2 minutes. 

Estimated total annual reporting and 

recordkeeping burden: 185,721 hours. 

Title: Health-Care Plan Information 

for the Veterans Choice Program. 

Summary of collection of information: 

Section 17.1510(d) requires eligible 

veterans to submit to VA information 

about their health-care plan to 

participate in the Veterans Choice 

Program. 

Description of the need for 

information and proposed use of 

information: The information is 

required by the Act. Section 101(e)(1) of 

Public Law 113–146 requires an eligible 

veteran to provide to the Secretary 

information on any health-care plan 

under which the eligible veteran is 

covered. This information is necessary 

because the veteran’s other health-care 

plan is primarily responsible for paying 

for hospital care or medical services 

furnished through the Veterans Choice 

Program for a nonservice-connected 

disability. 

Description of likely respondents: 

Eligible veterans seeking authorization 

to receive non-VA care through the 

Veterans Choice Program. 

Estimated number of respondents per 

year: 440,794 eligible persons. 

Estimated frequency of responses per 

year: 1.2 times per year. 

Estimated average burden per 

response: 10 minutes. 

Estimated total annual reporting and 

recordkeeping burden: 88,159 hours. 

Title: Submission of Medical Record 

Information under the Veterans Choice 

Program. 

Summary of collection of information: 

Participating eligible entities and 

providers are required to submit a copy 

of any medical record related to hospital 

care or medical services furnished 

under this Program to an eligible 

veteran. 

Description of the need for 

information and proposed use of 

information: The information is 

required by the Act. Section 101(l) of 

Public Law 113–146, as amended by 

section 409 of Public Law 113–175, 

requires VA to ensure that any health 

care provider that furnishes care or 

services under the Program to an 

eligible veteran submits to VA a copy of 

any medical record related to the care or 

services that were provided. This is 

necessary to ensure continuity of care 

for the health and well-being of the 

veteran. 

Description of likely respondents: 

Eligible entities and health care 

providers furnishing hospital care or 

medical services to eligible veterans 

through the Veterans Choice Program. 

Estimated number of respondents per 

year: 187,000 eligible persons. 

Estimated frequency of responses per 

year: 29.80 times per year. 

Estimated average burden per 

response: 5 minutes. 

Estimated total annual reporting and 

recordkeeping burden: 464,428 hours. 

Title: Submission of Information on 

Credentials and Licenses by Eligible 

Entities or Providers. 

Summary of collection of information: 

Section 17.1530 requires eligible entities 

and providers to submit verification that 

the entity or provider maintains at least 

the same or similar credentials and 

licenses as those required of VA’s health 

care providers, as determined by the 

Secretary. 

Description of the need for 

information and proposed use of 

information: The information is 

required by the Act. Section 101(i) of 

Public Law 113–146 requires non-VA 

entities or providers to maintain the 

same or similar credentials and licenses 

as those required of health care 

providers of the Department, as 

determined by the Secretary, and to 

submit not less than once per year 

verification of such licenses and 

credentials maintained by the health 

care provider. Under the interim final 

rule, an eligible entity may submit this 

information on behalf of its providers. 

This information is necessary to ensure 

that non-VA entities and providers who 

are furnishing hospital care and medical 

services to eligible veterans are meeting 

the same quality standards as VA health 

care providers. 

Description of likely respondents: 

Eligible entities or providers furnishing 

hospital care and medical services 

through the Veterans Choice Program. 

Estimated number of respondents per 

year: 187,000 eligible persons. 

Estimated frequency of responses per 

year: 1 time per year. 

Estimated average burden per 

response: 5 minutes. 

Estimated total annual reporting and 

recordkeeping burden: 15,583 hours. 

VA is also developing a survey to 

understand veteran satisfaction with 

receipt of care under the Veterans 

Choice Program. The information is 

required by the Act. Section 101(q)(2)(D) 

of Public Law 113–146 requires VA to 

report to Congress the results of a survey 

of eligible veterans who have received 

care or services under this Program on 

the satisfaction of such eligible veterans 

with the care or services they received. 

This information is necessary because 

VA must report this information to 

Congress, and this feedback will help 

VA better understand whether veterans 

like the Program. A separate notice will 

be published in the Federal Register 

providing more information about the 

planned veteran satisfaction survey. 

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. Executive Order 

12866 (Regulatory Planning and 

Review) defines a ‘‘significant 

regulatory action,’’ requiring review by 

the Office of Management and Budget 

(OMB), unless OMB waives such 

review, as ‘‘any 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, or State, local, 

or tribal governments or communities; 

(2) Create a serious inconsistency or 

otherwise interfere with an action taken 

or planned 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 this Executive 

Order.’’ 

The economic, interagency, 

budgetary, legal, and policy 

implications of this regulatory action 

have been examined, and it has been 

determined that this is an economically 

significant regulatory action under 

Executive Order 12866. VA’s regulatory 

impact analysis can be found as a 

supporting document at http://


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www.regulations.gov, usually within 48 

hours after the rulemaking document is 

published. Additionally, a copy of the 

rulemaking and its regulatory impact 

analysis are available on VA’s Web site 

at http://www.va.gov/orpm/, by 

following the link for ‘‘VA Regulations 

Published From FY 2004 Through Fiscal 

Year to Date.’’ 

Congressional Review Act 

This regulatory action is a major rule 

under the Congressional Review Act, 5 

U.S.C. 801–08, because it may result in 

an annual effect on the economy of $100 

million or more. Although this 

regulatory action constitutes a major 

rule within the meaning of the 

Congressional Review Act, 5 U.S.C. 

804(2), it is not subject to the 60-day 

delay in effective date applicable to 

major rules under 5 U.S.C. 801(a)(3) 

because the Secretary finds that good 

cause exists under 5 U.S.C. 808(2) to 

make this regulatory action effective on 

the date of publication, consistent with 

the reasons given for the publication of 

this interim final rule. Congress directed 

VA to publish an interim final rule 

within 90 days of the date of enactment 

of the law, and further delay in 

expanding access to non-VA care for 

eligible veterans could result in the 

deterioration of their health. 

Accordingly, the Secretary finds that 

additional advance notice and public 

procedure thereon are impractical, 

unnecessary, and contrary to the public 

interest. In accordance with 5 U.S.C. 

801(a)(1), VA will submit to the 

Comptroller General and to Congress a 

copy of this regulatory action and VA’s 

Regulatory Impact Analysis. 

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 

1 year. This interim final rule will have 

no such effect on State, local, and tribal 

governments, or on the private sector. 

Regulatory Flexibility Act 

The Secretary hereby certifies that 

this interim 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. This 

interim final rule will not have a 

significant economic impact on 

participating eligible entities and 

providers who enter into agreements 

with VA. To the extent there is any such 

impact, it will result in increased 

business and revenue for them. We also 

do not believe there will be a significant 

economic impact on insurance 

companies, as claims will only be 

submitted for care that will otherwise 

have been received whether such care 

was authorized under this Program or 

not. Therefore, pursuant to 5 U.S.C. 

605(b), this rulemaking is exempt from 

the initial and final regulatory flexibility 

analysis requirements of 5 U.S.C. 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 

as follows: 64.007, Blind Rehabilitation 

Centers; 64.008, Veterans Domiciliary 

Care; 64.009, Veterans Medical Care 

Benefits; 64.010, Veterans Nursing 

Home Care; 64.011, Veterans Dental 

Care; 64.012, Veterans Prescription 

Service; 64.013, Veterans Prosthetic 

Appliances; 64.014, Veterans State 

Domiciliary Care; 64.015, Veterans State 

Nursing Home Care; 64.016, Veterans 

State Hospital Care; 64.018, Sharing 

Specialized Medical Resources; 64.019, 

Veterans Rehabilitation Alcohol and 

Drug Dependence; 64.022, Veterans 

Home Based Primary Care; and 64.024, 

VA Homeless Providers Grant and Per 

Diem Program. 

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. Jose 

D. Riojas, Chief of Staff, Department of 

Veterans Affairs, approved this 

document on October 30, 2014, for 

publication. 

List of Subjects in 38 CFR Part 17 

Administrative practice and 

procedure, Alcohol abuse, Alcoholism, 

Claims, Day care, Dental health, Drug 

abuse, Government contracts, Grant 

programs—health, Grant programs— 

veterans, Health care, Health facilities, 

Health professions, Health records, 

Homeless, Mental health programs, 

Nursing homes, Reporting and 

recordkeeping requirements, Travel and 

transportation expenses, Veterans. 

Dated: October 31, 2014. 

William F. Russo, 

Acting Director, Office of Regulation Policy 

& Management, Office of the General Counsel, 

U.S. Department of Veterans Affairs. 

For the reasons set out in the 

preamble, VA amends 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, and as noted in 

specific sections. 

■ 2. Amend § 17.108 by: 

■ a. Revising paragraph (b)(1). 

■ b. Adding paragraph (b)(4). 

■ c. Revising paragraph (c)(1). 

■ d. Adding paragraph (c)(4). 

■ e. Revising the authority citation at 

the end of the section. 

The revisions and additions read as 

follows: 

§ 17.108 Copayments for inpatient hospital 

care and outpatient medical care. 

* * * * * 

(b) Copayments for inpatient hospital 

care. (1) Except as provided in 

paragraphs (d) or (e) of this section, a 

veteran, as a condition of receiving 

inpatient hospital care provided by VA 

(provided either directly by VA or 

obtained by VA by contract, provider 

agreement, or sharing agreement), must 

agree to pay VA (and is obligated to pay 

VA) the applicable copayment, as set 

forth in paragraph (b)(2), (b)(3), or (b)(4) 

of this section. 

* * * * * 

(4) For inpatient hospital care 

furnished through the Veterans Choice 

Program under § 17.1500 through 

17.1540, the copayment amount at the 

time of furnishing such care or services 

by a non-VA entity or provider is $0. VA 

will determine and assess the veteran’s 

copayment amount at the end of the 

billing process, but at no time will a 

veteran’s copayment be more than the 

amount identified in paragraphs (b)(2) 

or (b)(3) of this section. 

* * * * * 

(c) Copayments for outpatient medical 

care. (1) Except as provided in 

paragraphs (d), (e), or (f) of this section, 

a veteran, as a condition for receiving 

outpatient medical care provided by VA 

(provided either directly by VA or 

obtained by VA by contract, provider 

agreement, or sharing agreement), must 

agree to pay VA (and is obligated to pay 

VA) a copayment as set forth in 

paragraph (c)(2) or (c)(4) of this section. 

* * * * * 

(4) For outpatient medical care 

furnished through the Veterans Choice 


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Program under § 17.1500 through 

17.1540, the copayment amount at the 

time of furnishing such care or services 

by a non-VA entity or provider is $0. VA 

will determine and assess the veteran’s 

copayment amount at the end of the 

billing process, but at no time will a 

veteran’s copayment be more than the 

amount identified in paragraph (c)(2) of 

this section. 

* * * * * 

(Authority: 38 U.S.C. 501, 1710, 1730A, Sec. 

101, Pub. L. 113–146, 128 Stat. 1754) 

■ 3. Amend § 17.110 by: 

■ a. Adding paragraph (b)(4). 

■ b. Revising the authority citation at 

the end of the section. 

The revisions read as follows: 

§ 17.110 Copayments for medications. 

* * * * * 

(b) * * * 

(4) For medications furnished through 

the Veterans Choice Program under 

§ 17.1500 through 17.1540, the 

copayment amount at the time the 

veteran fills the prescription is $0. VA 

will determine and assess the veteran’s 

copayment amount at the end of the 

billing process, but at no time will a 

veteran’s copayment be more than the 

amount identified in paragraphs (b)(1)(i) 

through (b)(1)(iii) of this section. 

* * * * * 

(Authority: 38 U.S.C. 501, 1710, 1720D, 

1722A, 1730A, Sec. 101, Pub. L. 113–146, 

128 Stat. 1754) 

■ 4. Amend § 17.111 by: 

■ a. Adding paragraph (b)(3). 

■ b. Revising the authority citation at 

the end of the section. 

The addition and revision read as 

follows: 

§ 17.111 Copayments for extended care 

services. 

* * * * * 

(b) * * * 

(3) For hospital care and medical 

services considered non-institutional 

care furnished through the Veterans 

Choice Program under § 17.1500 

through 17.1540, the copayment amount 

at the time of furnishing such care or 

services by a non-VA entity or provider 

is $0. VA will determine and assess the 

veteran’s copayment amount at the end 

of the billing process, but at no time will 

a veteran’s copayment be more than the 

amount identified in paragraphs (b)(1) 

or (b)(2) of this section. 

* * * * * 

(Authority: 38 U.S.C. 101(28), 501, 1701(7), 

1710, 1710B, 1720B, 1720D, 1722A, Sec. 101, 

Pub. L. 113–146, 128 Stat. 1754) 

■ 5. Add an undesignated center 

heading and §§ 17.1500 through 17.1540 

to read as follows: 

Expanded Access to Non-VA Care 

Through the Veterans Choice Program 

Sec. 

17.1500 Purpose and scope. 

17.1505 Definitions. 

17.1510 Eligible veterans. 

17.1515 Authorizing non-VA care. 

17.1520 Effect on other provisions. 

17.1525 Start date for eligible veterans. 

17.1530 Eligible entities and providers. 

17.1535 Payment rates and methodologies. 

17.1540 Claims processing system. 

Expanded Access to Non-VA Care 

Through the Veterans Choice Program 

§ 17.1500 Purpose and scope. 

(a) Purpose. Sections 17.1500 through 

17.1540 implement the Veterans Choice 

Program, authorized by section 101 of 

the Veterans Access, Choice, and 

Accountability Act of 2014. 

(b) Scope. The Veterans Choice 

Program authorizes VA to furnish 

hospital care and medical services to 

eligible veterans, as defined in 

§ 17.1510, through agreements with 

eligible entities or providers, as defined 

in § 17.1530. 

(Authority: Sec. 101, Pub. L. 113–146, 128 

Stat. 1754) 

§ 17.1505 Definitions. 

For purposes of the Veterans Choice 

Program under §§ 17.1500 through 

17.1540: 

Appointment means an authorized 

and scheduled encounter with a health 

care provider for the delivery of hospital 

care or medical services. A visit to an 

emergency room or an unscheduled 

visit to a clinic is not an appointment. 

Attempt to schedule means contact 

with a VA scheduler or VA health care 

provider in which a stated request by 

the veteran for an appointment is made. 

Episode of care means a necessary 

course of treatment, including follow-up 

appointments and ancillary and 

specialty services, which lasts no longer 

than 60 days from the date of the first 

appointment with a non-VA health care 

provider. 

Health-care plan means an insurance 

policy or contract, medical or hospital 

service agreement, membership or 

subscription contract, or similar 

arrangement not administered by the 

Secretary of Veterans Affairs, under 

which health services for individuals 

are provided or the expenses of such 

services are paid; and does not include 

any such policy, contract, agreement, or 

similar arrangement pursuant to title 

XVIII or XIX of the Social Security Act 

(42 U.S.C. 1395 et seq.) or chapter 55 of 

title 10, United States Code. 

Residence means a legal residence or 

personal domicile, even if such 

residence is seasonal. A person may 

maintain more than one residence but 

may only have one residence at a time. 

If a veteran lives in more than one 

location during a year, the veteran’s 

residence is the residence or domicile 

where the person is staying at the time 

the veteran wants to receive hospital 

care or medical services through the 

Program. A post office box or other nonresidential point of delivery does not 

constitute a residence. 

Schedule means identifying and 

confirming a date, time, location, and 

entity or health care provider for an 

appointment. 

VA medical facility means a VA 

hospital, a VA community-based 

outpatient clinic, or a VA health care 

center. A Vet Center, or Readjustment 

Counseling Service Center, is not a VA 

medical facility. 

Wait-time goals of the Veterans 

Health Administration means, unless 

changed by further notice in the Federal 

Register, a date not more than 30 days 

from either: 

(1) The date that an appointment is 

deemed clinically appropriate by a VA 

health care provider. In the event a VA 

health care provider identifies a time 

range when care must be provided (e.g., 

within the next 2 months), VA will use 

the last clinically appropriate date for 

determining whether or not such care is 

timely. 

(2) Or, if no such clinical 

determination has been made, the date 

that a veteran prefers to be seen for 

hospital care or medical services. 

(Authority: Sec. 101, Pub. L. 113–146, 128 

Stat. 1754) 

§ 17.1510 Eligible veterans. 

A veteran must meet the eligibility 

criteria under both paragraphs (a) and 

(b) of this section to be eligible for care 

through the Veterans Choice Program. A 

veteran must also provide the 

information required by paragraphs (c) 

and (d) of this section. 

(a) A veteran must: 

(1) Be enrolled in the VA health care 

system under § 17.36 on or before 

August 1, 2014; or 

(2) Be eligible for hospital care and 

medical services under 38 U.S.C. 

1710(e)(1)(D) and be a veteran described 

in 38 U.S.C. 1710(e)(3). 

(b) A veteran must also meet at least 

one of the following criteria: 

(1) The veteran attempts, or has 

attempted, to schedule an appointment 

with a VA health care provider, but VA 

is unable to schedule an appointment 

for the veteran within the wait-time 

goals of the Veterans Health 

Administration. 

(2) The veteran’s residence is more 

than 40 miles from the VA medical 


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facility that is closest to the veteran’s 

residence. 

(3) The veteran’s residence is both: 

(i) In a state without a VA medical 

facility that provides hospital care, 

emergency medical services, and 

surgical care having a surgical 

complexity of standard (VA maintains a 

Web site with a list of the facilities that 

have been designated with at least a 

surgical complexity of standard. That 

Web site can be accessed here: 

www.va.gov/health/surgery); and 

(ii) More than 20 miles from a medical 

facility described in paragraph (b)(3)(i) 

of this section. 

(4) The veteran’s residence is in a 

location, other than one in Guam, 

American Samoa, or the Republic of the 

Philippines, which is 40 miles or less 

from a VA medical facility and the 

veteran: 

(i) Must travel by air, boat, or ferry to 

reach such a VA medical facility; or 

(ii) Faces an unusual or excessive 

burden in traveling to such a VA 

medical facility based on the presence 

of a body of water (including moving 

water and still water) or a geologic 

formation that cannot be crossed by 

road. 

(c) If the veteran changes his or her 

residence, the veteran must update VA 

about the change within 60 days. 

(d) A veteran must provide to VA 

information on any health-care plan 

under which the veteran is covered 

prior to obtaining authorization for care 

under the Veterans Choice Program. If 

the veteran changes health-care plans, 

the veteran must update VA about the 

change within 60 days. 

(e) For purposes of calculating the 

distance between a veteran’s residence 

and the nearest VA medical facility 

under this section (except for purposes 

of calculating a driving route under 

paragraph (b)(4)(ii) of this section), VA 

will use the straight-line distance 

between the nearest VA medical facility 

and a veteran’s residence. 

(Authority: Sec. 101, Pub. L. 113–146, 128 

Stat. 1754) 

(The information collection requirements 

have been submitted to the Office of 

Management and Budget and are pending 

OMB approval.) 

§ 17.1515 Authorizing non-VA care. 

(a) Electing non-VA care. A veteran 

eligible for the Veterans Choice Program 

under § 17.1510 may choose to schedule 

an appointment with a VA health care 

provider, be placed on an electronic 

waiting list for VA care, or have VA 

authorize the veteran to receive an 

episode of care for hospital care or 

medical services under 38 CFR 17.38 

from an eligible entity or provider. 

(b) Selecting a non-VA provider. An 

eligible veteran may specify a particular 

non-VA entity or health care provider, 

if that entity or health care provider 

meets the requirements of § 17.1530. If 

an eligible veteran does not specify a 

particular eligible entity or provider, VA 

will refer the veteran to a specific 

eligible entity or provider. 

(Authority: Sec. 101, Pub. L. 113–146, 128 

Stat. 1754) 

(The information collection requirements 

have been submitted to the Office of 

Management and Budget and are pending 

OMB approval.) 

§ 17.1520 Effect on other provisions. 

(a) General. In general, eligibility 

under the Veterans Choice Program does 

not affect a veteran’s eligibility for 

hospital care or medical services under 

the medical benefits package, as defined 

in § 17.38, or other benefits addressed in 

this part. Notwithstanding any other 

provision of this part, VA will pay for 

and fill prescriptions written by eligible 

providers under § 17.1530 for eligible 

veterans under § 17.1510, including 

prescriptions for drugs, including overthe-counter drugs and medical and 

surgical supplies available under the VA 

national formulary system. 

(b) Copayments. VA will be liable for 

any deductibles, cost-shares, or 

copayments required by an eligible 

veteran’s health-care plan for hospital 

care and medical services furnished 

under this Program, to the extent that 

such reimbursement does not result in 

expenditures by VA for the furnished 

care or services in excess of the rate 

established under § 17.1535. Veterans 

are also liable for a VA copayment for 

care furnished under this Program, as 

required by §§ 17.108(b)(4), 17.108(c)(4), 

17.110(b)(4), and 17.111(b)(3). 

(c) Beneficiary travel. For veterans 

who are eligible for beneficiary travel 

benefits under part 70 of this chapter, 

VA will provide beneficiary travel 

benefits for travel to and from the 

location of the eligible entity or provider 

who furnishes hospital care or medical 

services for an authorized appointment 

under the Veterans Choice Program 

without regard to the limitations in 

§ 70.30(b)(2) of this chapter. 

(Authority: 38 U.S.C. 111; Sec. 101, Pub. L. 

113–146, 128 Stat. 1754) 

§ 17.1525 Start date for eligible veterans. 

(a) VA will begin furnishing hospital 

care and medical services under the 

Program authorized by 38 CFR 17.1500 

through 17.1540 as follows: 

(1) Beginning November 5, 2014, to 

Veterans eligible under § 17.1510(b)(2), 

(b)(3), or (b)(4). 

(2) Beginning no later than December 

5, 2014, to Veterans eligible under 

§ 17.1510(b)(1). 

(b) If the start date will be earlier than 

the date identified in paragraph (a)(2) of 

this section, the Secretary will notify the 

public of the start date by publishing a 

Notice in the Federal Register. 

(Authority: Sec. 101, Pub. L. 113–146, 128 

Stat. 1754) 

§ 17.1530 Eligible entities and providers. 

(a) General. An entity or provider is 

eligible to deliver care under the 

Veterans Choice Program if, in 

accordance with paragraph (c) of this 

section, it is accessible to the veteran 

and is an entity or provider identified in 

section 101(a)(1)(B) of the Veterans 

Access, Choice, and Accountability Act 

of 2014 and is either: 

(1) Not a part of, or an employee of, 

VA; or 

(2) If the provider is an employee of 

VA, is not acting within the scope of 

such employment while providing 

hospital care or medical services 

through the Veterans Choice Program. 

(b) Agreement. An entity or provider 

must enter into an agreement with VA 

to provide non-VA hospital care or 

medical services to eligible veterans 

through one of the following types of 

agreements: contracts, 

intergovernmental agreements, or 

provider agreements. Each form of 

agreement must be executed by a duly 

authorized Department official. 

(c) Accessibility. An entity or provider 

may only furnish hospital care or 

medical services to an eligible veteran if 

the entity or provider is accessible to the 

eligible veteran. VA will determine 

accessibility by considering the 

following factors: 

(1) The length of time the eligible 

veteran would have to wait to receive 

hospital care or medical services from 

the entity or provider; 

(2) The qualifications of the entity or 

provider to furnish the hospital care or 

medical services to the eligible veteran; 

and 

(3) The distance between the eligible 

veteran’s residence and the entity or 

provider. 

(d) Requirements for health care 

providers. To be eligible to furnish care 

or services under the Veterans Choice 

Program, a health care provider must 

maintain at least the same or similar 

credentials and licenses as those 

required of VA’s health care providers, 

as determined by the Secretary. The 

agreement reached under paragraph (b) 

of this section will clarify these 

requirements. Eligible health care 

providers must submit verification of 

such licenses and credentials 


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maintained by the provider to VA at 

least once per 12-month period. Any 

entities that are eligible to provide care 

through the Program must ensure that 

any of their providers furnishing care 

and services through the Program meet 

these standards. An eligible entity may 

submit this information on behalf of its 

providers. 

(Authority: Sec. 101, Pub. L. 113–146, 128 

Stat. 1754) 

(The information collection requirements 

have been submitted to the Office of 

Management and Budget and are pending 

OMB approval.) 

§ 17.1535 Payment rates and 

methodologies. 

(a) Payment rates. Payment rates will 

be negotiated and set forth in an 

agreement between the Secretary and an 

eligible entity or provider. 

(1) Except as otherwise provided in 

this section, payment rates may not 

exceed the rates paid by the United 

States to a provider of services (as 

defined in section 1861(u) of the Social 

Security Act (42 U.S.C. 1395x(u)) or a 

supplier (as defined in section 1861(d) 

of such Act (42 U.S.C. 1395x(d)) under 

the Medicare program under title XVIII 

of the Social Security Act (42 U.S.C. 

1395 et seq.) for the same care or 

services. These rates are known as the 

‘‘Medicare Fee Schedule’’ for VA 

purposes. 

(2) For eligible entities or providers in 

highly rural areas, the Secretary may 

enter into an agreement that includes a 

rate greater than the rate defined 

paragraph (a)(1) of this section for 

hospital care or medical services, so 

long as such rate is still determined by 

VA to be fair and reasonable. The term 

‘‘highly rural area’’ means an area 

located in a county that has fewer than 

seven individuals residing in that 

county per square mile. 

(3) When there are no available rates 

as described in paragraph (a)(1) of this 

section, the Secretary shall, to the extent 

consistent with the Veterans Access, 

Choice, and Accountability Act of 2014, 

follow the process and methodology 

outlined in §§ 17.55 and 17.56 and pay 

the resulting rate. 

(b) Payment responsibilities. 

Responsibility for payments will be as 

follows. 

(1) For a nonservice-connected 

disability, as that term is defined at 

§ 3.1(l) of this chapter, a health-care 

plan of an eligible veteran is primarily 

responsible, to the extent such care or 

services is covered by the health-care 

plan, for paying the eligible entity or 

provider for such hospital care or 

medical services as are authorized 

under §§ 17.1500 through 17.1540 and 

furnished to an eligible veteran. VA 

shall be responsible for promptly paying 

only for costs of the VA-authorized 

service not covered by such health-care 

plan, including a payment made by the 

veteran, except that such payment may 

not exceed the rate determined for such 

care or services pursuant to paragraph 

(a) of this section. 

(2) For hospital care or medical 

services furnished for a serviceconnected disability, as that term is 

defined at § 3.1(k) of this chapter, or 

pursuant to 38 U.S.C. 1710(e), 1720D, or 

1720E, VA is solely responsible for 

paying the eligible entity or provider for 

such hospital care or medical services as 

are authorized under §§ 17.1500 through 

17.1540 and furnished to an eligible 

veteran. 

(c) Authorized care. VA will only pay 

for an episode of care for hospital care 

or medical services authorized by VA. 

The eligible entity or provider must 

contact VA to receive authorization 

prior to providing any hospital care or 

medical services the eligible non-VA 

entity or provider believes are necessary 

that are not identified in the 

authorization VA submits to the eligible 

entity or provider. VA will only pay for 

the hospital care or medical services 

that are furnished by an eligible entity 

or provider. There must be an actual 

encounter with a health care provider, 

who is either an employee of an entity 

in an agreement with VA or who is 

furnishing care through an agreement 

the health care provider has entered into 

with VA, and such encounter must 

occur after an election is made by an 

eligible veteran. 

(Authority: Secs. 101, 105, Pub. L. 113–146, 

128 Stat. 1754) 

§ 17.1540 Claims processing system. 

(a) There is established within the 

Chief Business Office of the Veterans 

Health Administration a nationwide 

claims processing system for processing 

and paying bills or claims for authorized 

hospital care and medical services 

furnished to eligible veterans under 

§§ 17.1500 through 17.1540. 

(b) The Chief Business Office is 

responsible for overseeing the 

implementation and maintenance of 

such system. 

(c) The claims processing system will 

receive requests for payment from 

eligible entities and providers for 

hospital care or medical services 

furnished to eligible veterans. The 

claims processing system will provide 

accurate, timely payments for claims 

received in accordance with §§ 17.1500 

through 17.1540. 

(Authority: Secs. 101, 105, Pub. L. 113–146, 

128 Stat. 1754) 

[FR Doc. 2014–26316 Filed 11–4–14; 8:45 am] 

BILLING CODE 8320–01–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[EPA–R01–OAR–2014–0243; A–1–FRL– 

9918–00–Region 1] 

Approval and Promulgation of Air 

Quality Implementation Plans; Maine; 

Volatile Organic Compound 

Regulations 

AGENCY: Environmental Protection 

Agency. 

ACTION: Final rule. 

SUMMARY: The Environmental Protection 

Agency (EPA) is approving four State 

Implementation Plan (SIP) revisions 

submitted by the State of Maine. These 

revisions establish Reasonably Available 

Control Technology (RACT) for two 

categories of volatile organic compound 

(VOC) sources and revise two existing 

VOC RACT regulations previously 

approved into Maine’s SIP. The 

intended effect of this action is to 

approve these requirements into the 

Maine SIP. This action is being taken 

under the Clean Air Act (CAA). 

DATES: This rule is effective on 

December 5, 2014. 

ADDRESSES: EPA has established a 

docket for this action under Docket 

Identification No. EPA–R01–OAR– 

2014–0243. All documents in the docket 

are listed on the www.regulations.gov 

Web site. Although listed in the index, 

some information is not publicly 

available, i.e., CBI or other information 

whose disclosure is restricted by statute. 

Certain other material, such as 

copyrighted material, is not placed on 

the Internet and will be publicly 

available only in hard copy form. 

Publicly available docket materials are 

available either electronically through 

www.regulations.gov or in hard copy at 

the U.S. Environmental Protection 

Agency, EPA New England Regional 

Office, Office of Ecosystem Protection, 

Air Quality Planning Unit, 5 Post Office 

Square—Suite 100, Boston, MA. EPA 

requests that if at all possible, you 

contact the contact listed in the FOR

FURTHER INFORMATION CONTACT section to 

schedule your inspection. The Regional 

Office’s official hours of business are 

Monday through Friday, 8:30 a.m. to 

4:30 p.m., excluding legal holidays. 

Copies of the documents relevant to 

this action are also available for public 


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