70938 Federal Register / Vol. 79, No. 229 / Friday, November 28, 2014 / Rules and Regulations 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 17 

RIN 2900–AP11 

Exempting Mental Health Peer Support 

Services From Copayments 

AGENCY: Department of Veterans Affairs. 

ACTION: Direct final rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) is taking final action to 

amend its regulation that sets forth the 

VA services that are not subject to 

copayment requirements for inpatient 

hospital care or outpatient medical care. 

Specifically, the regulation is amended 

to exempt mental health peer support 

services from having any required 

copayment. This removes a barrier that 

may have previously discouraged 

veterans from choosing to use mental 

health peer support services as a viable 

care option. VA believes that mental 

health peer support services are a 

valuable resource for veterans with 

mental health conditions and wants to 

ensure that veterans take full advantage 

of all resources available to them. 

DATES: This final rule is effective 

January 27, 2015, without further notice, 

unless VA receives an adverse comment 

by January 27, 2015. 

ADDRESSES: Written comments may be 

submitted through 

www.Regulations.gov; by mail or handdelivery to the Director, Regulation 

Policy and Management (02REG), 

Department of Veterans Affairs, 810 

Vermont Ave. NW., Room 1068, 

Washington, DC 20420; or by fax to 

(202) 273–9026. Comments should 

indicate that they are submitted in 

response to ‘‘RIN 2900–AP11— 

Exempting Mental Health Peer Support 

Services From Copayments.’’ 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 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 comment period, comments may be 

viewed online through the Federal 

Docket Management System (FDMS) at 

www.Regulations.gov. 

FOR FURTHER INFORMATION CONTACT: 

Kristin J. Cunningham, Director 

Business Policy, Chief Business Office 

(10NB6), Veterans Health 

Administration, Department of Veterans 

Affairs, 810 Vermont Ave. NW., 

Washington, DC 20420; (202) 382–2508. 

(This is not a toll-free number.) 

SUPPLEMENTARY INFORMATION: Peer 

support services are provided as part of 

the medical care available to veterans 

under 38 U.S.C. 1710, specifically as 

part of mental health care services. 

Under 38 U.S.C. 7401 and 7402, VA has 

the authority to appoint peer specialists. 

A peer specialist is a veteran ‘‘who has 

recovered or is recovering from a mental 

health condition’’ and is certified to 

provide peer support services. 38 U.S.C. 

7402(b)(13). This certification may be 

obtained from a VA approved not-forprofit entity or a State approved process. 

These specialists are appointed by VA 

to provide veteran support services by 

relating to the veterans through their 

own personal experiences in recovering 

from mental illness. VA uses peer 

support services to help veterans with 

mental illness to successfully engage in 

their treatment through sharing 

experiences, encouragement, and 

instilling a sense of hope and skill 

building to promote recovery. Section 4 

of Executive Order 13625, dated August 

31, 2012, ordered VA to expand mental 

health staffing by hiring and training 

800 peer-to-peer counselors to 

‘‘empower veterans to support other 

veterans and help meet mental health 

care needs.’’ 77 FR 54784, Sept. 5, 2012. 

VA is now exempting mental health 

peer support services from the 

copayment requirement set forth in 38 

CFR 17.108. Prior to this rulemaking, 

veterans, unless otherwise exempt, had 

been required to pay a copayment of 

fifteen dollars for mental health peer 

support services. Under 38 U.S.C. 

1710(g)(1), VA may not furnish medical 

services to certain veterans unless the 

veteran agrees to pay ‘‘the applicable 

amount or amounts established by the 

Secretary by regulation.’’ VA has 

interpreted section 1710(g)(1) to mean 

that VA has the discretion to establish 

the applicable copayment amount in 

regulation, even if such amount is zero. 

Generally, VA calculates the amount of 

a copayment based on the type of 

medical care provided and the resources 

needed to provide such care. In 

addition, VA may exempt certain care 

from copayment requirements in an 

effort to make health care more 

accessible to veterans, or to encourage 

veterans to become more actively 

involved in their medical care, and 

thereby improve health care outcomes 

(which, in turn, lowers overall health 

care costs). VA is making mental health 

peer support services exempt from 

copayments in order to make such 

services more accessible to veterans and 

encourage veterans’ use of such 

services. Veterans value the dynamic of 

peer support services because they can 

relate to other veterans through shared 

experiences, but because, prior to this 

rulemaking, such services were subject 

to copayments, they might have been 

less attractive to veterans who could 

benefit from them. VA is making peer 

support services exempt from 

copayments by amending 38 CFR 17.108 

to add a new paragraph (e)(17) to 

include mental health peer support 

services as services that are exempt from 

copayment requirements. The removal 

of the copayment will eliminate a 

potential barrier that could discourage 

veterans from using mental health peer 

support services as part of their mental 

health care. We are also making minor 

technical corrections to § 17.108(e). 

Administrative Procedure Act 

VA believes this regulatory 

amendment is non-controversial and 

anticipates that this rule will not result 

in any significant adverse comment, and 

therefore is issuing it as a direct final 

rule. Previous actions of this nature, 

which remove restrictions on VA 

medical benefits to improve health 

outcomes, have not been controversial 

and have not resulted in significant 

adverse comments. However, in this 

Federal Register publication, we are 

publishing a separate, substantially 

identical proposed rule document that 

will serve as a proposal for the 

provisions in this direct final rule if 

significant adverse comments are filed. 

See RIN 2900–AP10. 

For purposes of the direct final 

rulemaking, a significant adverse 

comment is one that explains why the 

rule would be inappropriate, including 

challenges to the rule’s underlying 

premise or approach, or why it would 

be ineffective or unacceptable without a 

change. In determining whether an 

adverse comment is significant and 

warrants withdrawing a direct final rule, 

we will consider whether the comment 

raises an issue serious enough to 

warrant a substantive response in a 

notice-and-comment process in 

accordance with section 553 of the 

Administrative Procedure Act (5 U.S.C. 

553). Comments that are frivolous, 

insubstantial, or outside the scope of the 

rule will not be considered adverse 

under this procedure. For example, a 

comment recommending an additional 

change to the rule will not be 

considered a significant comment 

unless the comment states why the rule 

would be ineffective or unacceptable 

without the additional change. 

Under direct final rule procedures, if 

no significant adverse comment is 

received within the comment period, 

the rule will become effective on the 

date specified above. After the close of 


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Federal Register / Vol. 79, No. 229 / Friday, November 28, 2014 / Rules and Regulations 70939 

the comment period, VA will publish a 

document in the Federal Register 

indicating that no significant adverse 

comment was received and confirming 

the date on which the final rule will 

become effective. VA will also publish 

a document in the Federal Register 

withdrawing the proposed rule. 

However, if any significant adverse 

comment is received, VA will publish in 

the Federal Register a document 

acknowledging receipt of a significant 

adverse comment and withdrawing this 

direct final rule. In the event this direct 

final rule is withdrawn because of 

receipt of any significant adverse 

comment, VA can proceed with the 

proposed rulemaking by addressing the 

comments received and publishing a 

final rule. Any comments received in 

response to this direct final rule will be 

treated as comments regarding the 

proposed rule. Likewise, any significant 

adverse comment received in response 

to the proposed rule will be considered 

as a comment regarding this direct final 

rule. VA will consider such comments 

in developing a subsequent final rule. 

Effect of Rulemaking 

Title 38 of the Code of Federal 

Regulations, as revised by this 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 final rule contains no provisions 

constituting a collection of information 

under the Paperwork Reduction Act of 

1995 (44 U.S.C. 3501–3521). 

Regulatory Flexibility Act 

The Secretary hereby certifies that 

this final rule will not have a significant 

economic impact on a substantial 

number of small entities as they are 

defined in the Regulatory Flexibility 

Act, 5 U.S.C. 601–612. This final rule 

directly affects only individuals and 

will not directly affect small entities. 

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. 

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 final rule have been 

examined, and it has been determined 

not to be a significant regulatory action 

under Executive Order 12866. VA’s 

impact analysis can be found as a 

supporting document at http://

www.regulations.gov, usually within 48 

hours after the rulemaking document is 

published. Additionally, a copy of the 

rulemaking and its 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. 

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 final rule will have no such 

effect on State, local, and tribal 

governments, or on the private sector. 

Catalog of Federal Domestic Assistance 

The Catalog of Federal Domestic 

Assistance numbers and titles for the 

programs affected by this document are 

64.008, Veterans Domiciliary Care; 

64.009, Veterans Medical Care Benefits; 

64.010, Veterans Nursing Home Care; 

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 31, 2014, for 

publication. 

List of Subjects in 38 CFR Part 17 

Administrative practice and 

procedure, Alcohol abuse, Alcoholism, 

Claims, Drug abuse, Foreign relations, 

Government contracts, Grant 

programs—health, Grant programs— 

veterans, Health care, Health facilities, 

Health professions, Health records, 

Homeless, Medical and dental schools, 

Medical devices, Medical research, 

Mental health programs, Nursing 

homes, Philippines, Reporting and 

recordkeeping requirements, 

Scholarships and fellowships, Travel 

and transportation expenses, Veterans. 

Dated: November 13, 2014. 

William F. Russo, 

Acting Director, Office of Regulation Policy 

& Management, Office of the General Counsel, 

U.S. Department of Veterans Affairs. 


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70940 Federal Register / Vol. 79, No. 229 / Friday, November 28, 2014 / Rules and Regulations 

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. In paragraph (e)(4), removing ‘‘.’’ 

and adding in its place ‘‘;’’. 

■ b. In paragraph (e)(14), removing 

‘‘and’’ immediately after ‘‘;’’. 

■ c. In paragraph (e)(15), removing ‘‘.’’ 

and adding in its place ‘‘;’’. 

■ d. In paragraph (e)(16), removing ‘‘.’’ 

and adding in its place ‘‘; and’’. 

■ e. Adding a new paragraph (e)(17) to 

read as follows: 

§ 17.108 Copayments for inpatient hospital 

care and outpatient medical care. 

* * * * * 

(e) * * * 

(17) Mental health peer support 

services. 

* * * * * 

[FR Doc. 2014–27231 Filed 11–26–14; 8:45 am] 

BILLING CODE 8320–01–P 


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