Quiero saber acerca de...

50860

Federal Register / Vol. 86, No. 174 / Monday, September 13, 2021 / Rules and Regulations
VA clinician, that VA should automatically obtain the needed care or services through one of the VCAs entered into with the entities and providers in those classes in lieu of using any other VCAs that are feasibly available. In response, we note that when the needed care or services at issue are being obtained through the VCCP, the veteran is legally permitted to select the eligible entity or provider from which the veteran receives such care or services.5 So, implementing the commenters recommendation would not be legally feasible in that context if the veteran opts to select the eligible entity or provider. Moreover, if and when VA finds itself in the position of selecting from among multiple VCAs that are feasibly available for purposes of obtaining needed care or services, VAs determination of the appropriate VCA to utilize will be driven by clinical considerations, including those bearing on ensuring VA obtains timely and quality care and services most appropriate to the specific needs of the beneficiary. In some instances, the involvement of veterans or prior VA
clinicians in the delivery of care and services by certain entities and providers could prove relevant to such individualized and clinically driven determinations. However, selecting the VCA that VA will use based upon whether the VCA was entered into with an SDVOSB, a VOSB, or a prior VA
clinician, rather than based upon a holistic and individualized assessment of all relevant clinical considerations, including those bearing on ensuring VA
obtains timely and quality care and services most appropriate to the specific needs of the veteran, could result in adverse consequences, including worse health outcomes, for the veteran.
Consequently, we decline to adopt such an approach, and, for the foregoing reasons, we make no changes to the interim final rule based on this comment.

interim final rule are warranted.
Accordingly, based upon the authorities and reasons set forth in the interim final rule 84 FR 21668, as supplemented by the additional reasons provided in this document in response to comments received, VA is adopting the provisions of the interim final rule as a final rule with no substantive changes.

Administrative Procedure Act
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
lotter on DSK11XQN23PROD with RULES1

VA has considered all relevant input and information contained in the comments submitted in response to the interim final rule 84 FR 21668 and, for the reasons set forth in the foregoing responses to those comments, has concluded that no changes to the 5 See 38 U.S.C. 1703g2 VA shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection c for receipt of hospital care, medical services, or extended care services under the VCCP; 38 CFR 17.4030 a covered veteran may specify a particular eligible entity or provider.

VerDate Sep<11>2014

16:20 Sep 10, 2021

Jkt 253001

Paperwork Reduction Act The Paperwork Reduction Act of 1995
44 U.S.C. 3507 requires that VA
consider the impact of paperwork and other information collection burdens imposed on the public. Except for emergency approvals under 44 U.S.C.
3507j, 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. The interim final rule included provisions constituting new collections of information under the Paperwork Reduction Act of 1995 44 U.S.C. 3501
3521 that require approval by the Office of Management and Budget OMB the provisions in the interim final rule are 17.4110, 17.4130, and 17.4135.
Accordingly, under 44 U.S.C. 3507d, VA submitted a copy of the interim final rule to OMB for review, and VA
requested that OMB approve the collections of information on an emergency basis. VA did not receive any comments on the collections of information contained in the interim final rule. OMB approved the collections of information under control number 29000872.
Regulatory Flexibility Act The Secretary hereby certifies that this 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. 601612. Therefore, pursuant to 5 U.S.C. 605b, the initial and final regulatory flexibility analysis requirements of 5 U.S.C. 603 and 604 do not apply.

PO 00000

Frm 00024

Fmt 4700

Sfmt 4700

promoting flexibility. OMBs Office of Information and Regulatory Affairs OIRA has determined that this rule is not a significant regulatory action under Executive Order 12866. The Regulatory Impact Analysis associated with this rulemaking can be found as a supporting document at www.regulations.gov.
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 one year. This final rule will have no such effect on State, local, and tribal governments, or on the private sector.
Congressional Review Act Pursuant to the Congressional Review Act 5 U.S.C. 801 et seq., OIRA
designated this rule as not a major rule, as defined by 5 U.S.C. 8042.
Catalog of Federal Domestic Assistance The Catalog of Federal Domestic Assistance numbers and titles for the programs affected by this document are as follows: 64.009, Veterans Medical Care Benefits; and 64.018, Sharing Specialized Medical Resources.
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Foreign relations, Government contracts, Grant programshealth, Grant programsveterans, 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.
Signing Authority Denis McDonough, Secretary of Veterans Affairs, approved this document on July 27, 2021, and authorized the undersigned to sign and submit the document to the Office of the Federal Register for publication
E:FRFM13SER1.SGM

13SER1