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Federal Register / Vol. 86, No. 174 / Monday, September 13, 2021 / Rules and Regulations
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referenced in this comment has been completed, the commenters concern that providers might be hesitant to enter into VCAs until the completion of that rulemaking process is no longer applicable.
In its fourth and final comment, the same commenter stated that it wants to ensure that services covered under VA
contracts will continue to be covered under VCAs. While the intended meaning of this comment is unclear to us, we note that, in accordance with the statutory authority for VCAs and the interim final rule, VA can use VCAs to obtain hospital care as defined in 38
U.S.C. 17015, medical services as defined 38 U.S.C. 17016, and extended care services defined as the services described in 38 U.S.C.
1710Ba.3 We also note that the circumstances when VA is legally authorized to use VCAs to obtain hospital care, medical services, or extended care services are specified in 38 U.S.C. 1703Aa and in 17.4115a of the interim final rule. Consequently, we do not make any changes to the interim final rule based on this comment.
One commenter that represents a membership consisting of hearing health care professionals, including licensed hearing aid specialists, offered several comments in response to the interim final rule. Some of those comments pertain to matters that are outside the scope of this rulemaking and which do not implicate any considerations that would necessitate or merit any changes to the interim final rule. For example, the commenter urged VA to develop and implement the qualifications, which VA is authorized to prescribe pursuant to 38 U.S.C.
7402b14, for hearing aid specialists appointed to positions in VHA in accordance with 38 U.S.C. 7401. The commenter also urged VA to include hearing aid specialists appointed pursuant to 38 U.S.C. 7401 in the audiology teams that operate in VHA
facilities. The government personnel matters raised in these comments, including whether and when VA
develops qualifications for hearing aid specialists appointed to positions in VHA, and how VA utilizes any such specialists in VHA facilities, are outside the scope of this rulemaking and 3 See 38 U.S.C. 1703Aa1A authorizing VA to use VCAs to obtain hospital care, a medical service, or an extended care service in certain circumstances; 38 U.S.C. 170156 defining the terms hospital care and medical services for purposes of 38 U.S.C. chapter 17, which includes section 1703A; 38 CFR 17.4100 defining the terms hospital care, medical services, and extended care services for purposes of sections 17.4100
17.4135.

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implicate no issues bearing on the contents of the interim final rule.
The same commenter also urged VA
to prioritize delivery of hearing-related health care services to veterans, both in VHA facilities and through the Community Care Program, a phrase that we interpret to be a reference to the Veterans Community Care Program VCCP established by section 101 of the MISSION Act codified as amended at 38 U.S.C. 1703. The matters raised in this comment, including whether and to what extent VA can and does prioritize the provision of certain types of hospital care, medical services, and extended care services in VHA facilities or through the VCCP, are matters outside the scope of this rulemaking. Moreover, to the extent the commenter is concerned about VA electing to adopt regulatory parameters that restrict VAs ability to provide hearing-related health care services through VCAs, we note that the interim final rule contains no such elective restrictions. The interim final rule authorizes VA to use VCAs to obtain any of the types of hospital care, medical services, and extended care services permitted by the underlying statutory authority, 38 U.S.C. 1703A.
The commenter also recommended that VA use licensed hearing aid specialists and audiologists to provide hearing aid evaluations, hearing aid fittings, and related services when veterans are receiving such services through the Community Care Program, a phrase that, as previously noted, we interpret to be a reference to the VCCP. The matters raised in this comment, including whether and to what extent certain specific types of providers furnish the care and services that VA obtains for covered veterans through the VCCP, are matters outside the scope of this rulemaking. Moreover, to the extent the commenter is concerned about VA electing to adopt regulatory parameters that restrict VAs ability to use VCAs to obtain care and services furnished by licensed hearing aid specialists and audiologists, we note that the interim final rule contains no such elective restrictions. For example, the certification process set forth in 17.4110 of the interim final rule contains no requirements or approval criteria that would fundamentally preclude VA from granting certification to licensed hearing aid specialists and audiologists or that are any more restrictive with regard to those types of providers than they are for any other type of provider or entity seeking certification.
In addition to providing the general comments described above, the same commenter also suggested two changes
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to the text of the interim final rule. First, the commenter suggested that VA
replace the term medical in 17.4110b1i with the term health care so that the licensure documentation requirement in that subparagraph encompasses health care professionals other than physicians. In response, we clarify that the requirement in that subparagraph to provide documentation of applicable medical licenses does not preclude health care professionals other than physicians from applying for and receiving certification under 17.4110.
If the applicant does not possess a medical license, then there are no applicable medical licenses of which the applicant must submit documentation under that subparagraph. Moreover, we also note that under 17.4110b1ii, VA can require applicants to submit documentation of relevant licenses other than medical licenses.
Consequently, because the result apparently sought by the commenter VAs certification process accommodating the submission of documentation of licenses from health care professionals other than physiciansis already provided for in the existing language of the interim final rule, VA does not adopt the change recommended in this comment. The commenter also indicated that the payment rate parameters set forth in 17.4120ab of the interim final rule, which are expressly tied to Medicare payment models, should be revised to allow for the establishment of fee schedules for services that are not within the scope of those Medicarerelated parameters, such as hearing tests for the provision of hearing aids and related hearing aid services. In response, VA notes that the payment rate parameters set forth in 17.4120 of the interim final rule already permit the very result that the commenter is seeking. Under 17.4120, the rates paid by VA for hospital care, medical services, or extended care services furnished pursuant to a VCA are the rates set forth in the price terms of that specific VCA, and, when the Medicarerelated parameters set forth in 17.4120ab do not apply to the care or services at issue, VA is permitted to establish the payment rates for such care or services based on a fee schedule or some other formulation that is unrelated to Medicare payment rates and methodologies. Given that the result sought by the commenter is already permitted under the existing language of the interim final rule, VA makes no changes based on this comment.

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