[Federal Register Volume 79, Number 229 (Friday, November 28, 2014)]
[Rules and Regulations]
[Pages 70938-70940]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-27231]



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Vol. 79

Friday,

No. 229

November 28, 2014

Part II





Department of Veterans Affairs





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38 CFR Part 17





Exempting Mental Health Peer Support Services From Copayments; Direct 
Final Rule; Proposed Rule

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

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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.

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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 hand-delivery 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-for-profit 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 Sec.  
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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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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    For the reasons set out in the preamble, VA amends 38 CFR part 17 
as follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 continues to read as follows:

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

0
2. Amend Sec.  17.108 by:
0
a. In paragraph (e)(4), removing ``.'' and adding in its place ``;''.
0
b. In paragraph (e)(14), removing ``and'' immediately after ``;''.
0
c. In paragraph (e)(15), removing ``.'' and adding in its place ``;''.
0
d. In paragraph (e)(16), removing ``.'' and adding in its place ``; 
and''.
0
e. Adding a new paragraph (e)(17) to read as follows:


Sec.  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