Federal Register / Vol. 79, No. 229 / Friday, November 28, 2014 / Proposed Rules 70941 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 17 

RIN 2900–AP10 

Exempting Mental Health Peer Support 

Services From Copayments 

AGENCY: Department of Veterans Affairs. 

ACTION: Proposed rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) is proposing 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 would be amended to 

exempt mental health peer support 

services from having any required 

copayment. This would remove 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: Written comments must be 

received on or before 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–AP10— 

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 now proposes to exempt mental 

health peer support services from the 

copayment requirement set forth in 38 

CFR 17.108. Unless otherwise exempt, 

Veterans are currently 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 proposes to make 

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 

such services are currently subject to 

copayments, they may be less attractive 

to veterans who could benefit from 

them. VA proposes to make 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 would eliminate a 

potential barrier that could discourage 

veterans from using mental health peer 

support services as part of their mental 

health care. We would also make minor 

technical corrections to § 17.108(e). 

Administrative Procedure Act 

Concurrent with this proposed rule, 

we also are publishing a separate, 

substantively identical direct final rule 

in this Federal Register. See RIN 2900– 

AP11. The simultaneous publication of 

these documents will speed notice and 

comment rulemaking under section 553 

of the Administrative Procedure Act (5 

U.S.C. 553) should we have to withdraw 

the direct final rule due to receipt of 

significant adverse comments. 

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 

change. If significant adverse comments 

are received, VA will publish a 

document acknowledging receipt of 

significant adverse comments in the 

Federal Register and withdrawing the 

direct final rule. 

Under direct final rule procedures, 

unless significant adverse comments are 

received within the comment period, 

the regulation will become effective on 

the date specified in RIN 2900–AP11. 

After the close of the comment period, 

VA will publish a document in the 

Federal Register indicating that no 

adverse comments were received and 

confirming the date on which the final 

rule will become effective. VA will also 

publish a document withdrawing this 

proposed rule. 

In the event the direct final rule is 

withdrawn because of significant 

adverse comments, VA can proceed 

with the rulemaking by addressing the 

comments received and publishing a 

final rule. The comment period for the 

proposed rule runs concurrently with 

that of the direct final rule. Any 

comment received under the direct final 

rule will be treated as a comment 

regarding the proposed rule. VA will 

consider such comment in developing a 

subsequent final rule. Likewise, 

significant adverse comments submitted 

to the proposed rule will be considered 


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70942 Federal Register / Vol. 79, No. 229 / Friday, November 28, 2014 / Proposed Rules 

as comments regarding the direct final 

rule. 

Effect of Rulemaking 

The Code of Federal Regulations, as 

proposed to be revised by this proposed 

rulemaking, would represent the 

exclusive legal authority on this subject. 

No contrary rules or procedures would 

be authorized. All VA guidance would 

be read to conform with this rulemaking 

if possible or, if not possible, such 

guidance would be superseded by this 

rulemaking. 

Paperwork Reduction Act 

This proposed 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 proposed rule would not have a 

significant economic impact on a 

substantial number of small entities as 

they are defined in the Regulatory 

Flexibility Act, 5 U.S.C. 601–612. This 

proposed rule would directly affect only 

individuals and would not directly 

affect any 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 proposed 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 proposed rule would 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. 

For the reasons set out in the 

preamble, VA proposes to amend 38 

CFR part 17 as follows: 

PART 17—MEDICAL 

■ 1. The authority citation for part 17 

continues to read as follows: 

Authority: 38 U.S.C. 501, 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. 2014–27230 Filed 11–26–14; 8:45 am] 

BILLING CODE 8320–01–P 


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