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Federal Register / Vol. 86, No. 194 / Tuesday, October 12, 2021 / Rules and Regulations
states that one of the eligibility requirements is that the individual has received a certificate, associate degree, baccalaureate degree, masters degree, or postbaccalaureate training in a science relating to health care. We agree with the commenter in that the statutory requirement in section 246 would prevent PAs that graduate from an ARC
PA program and pass the National Commission on Certification of Physician Assistants NCCPA, from participating in the EACFMAF because the PA does not have health science undergraduate degree. The legislative history of the EACFMAF shows that this program, including its eligibility requirements, is based on an earlier house bill H.R. 3794, 114th Congress, Grow Our Own Directive: Physician Assistant Employment and Education Act of 2016. The House Subcommittee on Health held a hearing on several bills, including H.R. 3794 on April 20, 2016, and the bill was referred to the full House after markup. House Report 114710 September 6, 2016. While there are minor differences between H.R. 3794 and enacted section 246 of the Consolidated Appropriations Act, 2018, the eligibility requirements remained unchanged. VA does not have the authority to change eligibility requirements for this pilot program absent a change in the law.
However, VA notes that if the veteran otherwise meets one of the other two eligibility criteria, such veteran may be eligible to participate in the EACFMAF:
That the veteran has medical or military health experience gained while serving as a member of the Armed Forces, or has participated in the delivery of health care services or related medical services, including participation in military training relating to the identification, evaluation, treatment, and prevention of disease and disorders. VA has other scholarship programs for participants to receive financial assistance for their health care education, including as a PA, such as the Health Professional Scholarship Program, found at 38 CFR
17.60017.612. Individuals who do not meet the eligibility criteria for the EACFMAF, may apply for these other scholarship programs if they otherwise meet the eligibility criteria for such scholarship programs. However, these other programs and their eligibility criteria are beyond the scope of the proposed rule. We are not making any changes based on these comments.
School and Individual requirements.
Another commenter was in favor of the rule, but requested that the requirement in proposed 17.536b1 be amended to include students who are enrolled or accepted for enrollment in an accredited
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school located in a State as part-time students. The commenter indicated that veterans could have families and other job requirements that would limit their ability to attend school as a full-time student. The commenter added that if VA allowed participants of the EACFMAF to be enrolled part-time and provide a longer time frame to complete their degree, more veterans would have the opportunity to apply for the scholarship and complete their degree.
VA understands that some students may not be able to attend school on a full-time basis. Proposed 17.536b1
states that to be eligible for the EACFMAF, an applicant must be unconditionally accepted for enrollment or be enrolled as a full-time student in an accredited school located in a State.
These school requirements are in alignment with similar VA scholarship programs. See 38 CFR 17.602. Allowing enrollment on a less than full-time basis will not meet the needs of the EACFMAF, which is a pilot program that will expire unless renewed in five years. As such, we proposed only to provide financial assistance for one to three years under proposed 17.536b and we do not believe that education to become a PA or related professional can be completed on a less than full-time basis prior to the pilot expiring. We are not making any changes based on this comment.
17.537 Award Procedures Priority. A commenter was in favor of the proposed rule, but requested that proposed 17.537a3 be removed because it unfairly favors States that already have adequate PA populations in urban areas and consequently draws viable candidates away from rural locations where their services and expertise are more acutely needed. The commenter also stated that 17.537a3 goes against the agencys core values of commitment and advocacy by giving priority to eligible individuals who agree to be employed as physician assistants in a VA medical facility that is in a State with a per capita population of veterans of more than five percent. The commenter stated that while VA has the best intentions, the proposed section fails to consider that PA shortages prevalently continue predominantly along an urban-rural dichotomy, and that over 84 percent of PAs already provide services in an urban market. The commenter indicated that dedicating future PAs to the States with the largest per capita of veterans in the U.S., such as California, Texas, and Florida, all of which boast large urban populations, therefore ignores the larger problem that veterans in rural areas are
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in need of more support. The commenter recommends that VA
remove 17.537a3 because the previous subsection already achieves VAs goal of providing more support to medically underserved facilities without providing an unnecessary limitation.
VA agrees that PAs are needed to serve in medically underserved populations. However, we do not agree that 17.537a3 provides an unnecessary limitation or that it unfairly favors States that already have adequate PA populations in urban areas. Read in its entirety, proposed 17.537a3
priority is not limited to the sole factor of veteran population. Rather, it states that VA will give priority to eligible individuals who agree to be employed as physician assistants in a VA medical facility that: 1 Is located in a community that is designated as a medically underserved population as defined by 42 U.S.C. 254bb3A; 2
Is designated by VA as a medically underserved facility; and 3 Is in a State with a per capita population of veterans of more than five percent, according to the National Center for Veterans Analysis and Statistics and the United States Census Bureau. Proposed 17.537a3 is also a requirement established under section 246d2 of the Consolidated Appropriations Act, 2018, which is meant to allow VA to provide health care to a State with a per capita population of veterans of more than five percent, but is not meant to be exclusive of an urban population. All other conditions in 17.537a must also be met, which includes medically underserved communities and VA
medical facilities. VA intends to utilize the EACFMAF to expand health care services in VA medical facilities where recruitment and retention of PAs is difficult due to the location of the VA
medical facility. In addition, establishing the five percent requirement allows VA to serve a larger number of veterans in communities that would otherwise benefit from increased health care professionals. We are not making any changes based on this comment.
17.538
Service
Agreement and Obligated
Obligated serviceGeneral. A
commenter stated that if there was not an employment vacancy for a PA at a VA medical facility that is located in the vicinity of the participants residence within 90 days after the date that the participant completes their education, then the 90 day requirement should be extended to 180 days for such individual.

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