Voglio sapere a riguardo di…

Federal Register / Vol. 86, No. 194 / Tuesday, October 12, 2021 / Rules and Regulations We stated in proposed 17.538b1
that the obligated service would begin on the date on which the eligible individual begins full-time permanent employment with VA as a clinical practice employee as a physician assistant, but no later than 90 days after the date that the eligible individual completes a masters degree in physician assistant studies or similar masters degree or the date the eligible individual becomes licensed in a State and certified as required by the Secretary, whichever is later. VA has been successful in placing participants of similar scholarship programs into full-time VA employment within an even shorter 60-day time frame. See 38
CFR 17.607b. In addition, the participant must be willing to relocate to another geographic location to carry out their service obligation. We are not making any changes based on this comment.
A commenter stated that the fulltime service requirement to begin within 90
days after completion of the PA degree assumes that VA will have full time permanent positions available. The commenter suggested that the requirement should be that an individual will undertake at least 50
percent time employment on a fulltime or temporary basis, in order to give the maximum flexibility to both the individual and the VA. The commenter added that VA hospitals may have limited hiring ability and may not wish to hire full time permanent employees, but could still benefit from having more physician assistants.
VA currently has PA vacancies nationwide, especially in VA medical facility located in communities that are designated as medically underserved under 42 U.S.C. 245bb3A and those VA medical facilities that VA has determined as medically underserved.
In addition, VA anticipates the need for PAs will remain, particularly in the medically underserved areas. Under proposed 17.538a3 a participant agrees to be employed as a full-time clinical practice employee in VA as a physician assistant for a period of obligated service for one calendar year for each school year or part thereof for which the EACFMAF was awarded, but for no less than three years. The fulltime employment requirement is also similar to other VA scholarship programs. Reducing the service to anything other than full time would defeat the purpose of the EACFMAF.
We are not making any changes based on this comment.
One commenter stated that 17.538b1 does not provide enough flexibility to account for unforeseeable
VerDate Sep<11>2014

15:55 Oct 08, 2021

Jkt 256001

delays in attaining certification as it does not account for possible extenuating circumstances outside of an individuals control. The commenter added that the COVID19 pandemic has clearly demonstrated that unforeseen events can arise, which can delay intended plans indefinitely, and that there is arguably a lack of compassion in a provision that can cause an individual to be in breach of their contract when they are not at fault because of major outside influences.
The commenter suggests that VA
consider extending the length of time before an individual is in breach to one year and revise the consequence of failing to acquire licensure or certification due to unforeseen circumstances by placing the participant under review, subject to breach if the failure was due to the individuals actions.
We stated in the proposed rule that section 246 of the Consolidated Appropriations Act, 2018 does not establish a time frame for when an eligible individual will repay the amount of damages when such eligible individual breaches their terms of agreement, and that proposed 17.539b would mirror the repayment period language from similar scholarship programs. See 38 U.S.C.
7617c2 and 38 CFR 17.610c. We stated in part in proposed 17.538b1
that VA will actively assist and monitor eligible individuals to ensure State licenses and certificates are obtained in a minimal amount of time following graduation. We also stated that if an eligible individual fails to obtain his or her degree, or fails to become licensed in a State or become certified no later than 180 days after receiving the degree, the eligible individual is considered to be in breach of the acceptance agreement. Participants of similar VA
scholarship programs have been successfully able to obtain the required certification within the 180-day time frame, and we believe that will be the case in EACFMAF as well. However, we are aware that there may be instances where the participant of the EACFMAF
may not be able to obtain their certification due to unforeseen circumstances such as the COVID19
National Emergency. VAs engagement in assisting and monitoring the eligible individuals obtain their State license and certificates will alert VA of any potential unforeseen circumstance. VA
will examine these unforeseen circumstances as they arise on a case by case basis and may provide general guidance to all participants if the unforeseen circumstance affects all
PO 00000

Frm 00005

Fmt 4700

Sfmt 4700

56649

participants. We are not making any changes based on this comment.
Location and position of obligated service. One commenter was in favor of the rule, but stated that more clarity is needed regarding exactly which VA
medical facilities are considered to be given preference under the criteria set forth in the rule. The commenter added that the proposed regulation text is vague and subject to changes based on classification of various sites, for which the criteria is unclear.
We agree with the commenter in that the proposed rule did not specify how VA would alert potential participants of VA locations that have vacancies. We, therefore, revise 17.538b2 as proposed to state that VA will publish a list of VA medical facilities where the participants may perform their period of obligated service in a notice in the Federal Register on a yearly basis.
Participants of the EACFMAF may select their preference for service from this list to serve the period of obligated service, however, VA reserves the right to make the final decision on location.
By providing this list of vacancies, prospective participants will know prior to applying for the program the VA
medical facilities that will have vacancies in which the participants of the EACFMAF may perform their period of obligated service.
Several commenters stated that students receiving EACFMAF should, at the very least, have relocation costs reimbursed if their assigned facility is outside the area of their current residence or have the participant agree before their service begins where their term is to be served, and commit via contract. These commenters asserted that these changes would reduce financial hardship for students with families with already limited resources and lessen the burden of a mandated move.
We stated in the proposed rule that VA reserves the right to make final decisions on the location and position of the obligated service. We also stated that an eligible individual who receives an EACFMAF must be willing to relocate to another geographic location to carry out their service obligation.
This language is consistent with similar scholarship programs. See 38 CFR
17.607d. We appreciate that relocation expenses can be burdensome to some applicants. However, paying relocation expenses to a participant of the EACFMAF would reduce the amount of funds available for the program. In addition, Public Law 115141 section 246 does not give VA specific authority to pay relocation expenses. We are not
E:FRFM12OCR1.SGM

12OCR1