Department of Veterans Affairs: Veterans Community Care Program


June 19, 2019

The Honorable Johnny Isaacson
The Honorable Jon Tester
Ranking Member
veterans committee
United States Senate

The Honorable Mark Takano
The Honorable Phil Roe, MD
Ranking Member
veterans committee
House of Representatives

Matter: Department of Veterans Affairs: Veterans Community Care Program

Pursuant to Section 801(a)(2)(A) of Title 5 of the United States Code, this is our report on a major rule promulgated by the Department of Veterans Affairs (VA) titled “Veterans Community Care Program” ( RIN: 2900 -AQ46). We received the rule on June 6, 2019. It was published in the Federal Register as final rule on June 5, 2019. 84 Fed. Reg. 26278. The effective date of the rule is June 6, 2019.

The final rule governs how covered veterans receive necessary hospital care, medical services, and extended care services from non-VA entities or providers in the community. The rule is intended to implement a provision of the VA MISSION Law of 2018, Public Law 115-182, as amended. 38 USC § 1703. Specifically, this rule implements the Veterans Community Care Program to provide required care and services to covered veterans through eligible entities and providers.

The Congressional Review Act (CRA) requires 60 days for the effective date of a major rule from the date of publication in the Federal Register or receipt of the rule by Congress, whichever is later. 5 USC § 801(a)(3)(A). The final rule was published in the Federal Register on June 5, 2019 and received on June 6, 2019. The rule has a declared effective date of June 6, 2019. Therefore, the final rule does not have the required 60-day deadline in its effective date. vigor. However, the 60-day delay from the effective date may be waived if an agency finds for cause that such delay is impractical, unnecessary, or contrary to the public interest, and the agency incorporates the findings and a brief statement of these in the issued rule. 5 USC § 808(2). VA concluded that there were good reasons to make the rule effective on June 6, 2019. Specifically, VA concluded that it would be contrary to the public interest to delay the effective date of this rule, because any delay in the implementation of the rule would have serious consequences. detrimental effect on the health care of veterans.

Attached is our assessment of VA’s compliance with the procedural steps required by Title 5 Section 801(a)(1)(B)(i) through (iv) with respect to the rule. If you have any questions about this report or would like to contact GAO officials responsible for the valuation work relating to the subject matter of the rule, please contact Janet Temko-Blinder, Assistant General Counsel, at (202) 512-7104 .


Shirley A.Jones

Associate Legal Director


cc: Luvenia Potts
Rules Development Coordinator
Office of Regulatory Policy and Management
Department of Veterans Affairs






(RIN: 2900-AQ46)

(i) Cost-benefit analysis

The Department of Veterans Affairs (VA) has projected the estimated total budget impact (transfers and costs) of this final rule to be $346.3 million in fiscal year 2019 and $17.9 billion over a period 5 years old. VA estimated transfers at $15.6 billion over 5 years and costs at $2.2 billion over 5 years. These transfer impacts are from the federal government to eligible veterans. Cost impacts are administrative costs, claims costs and other non-vendor payment costs.

According to VA, this rule will have the benefit of strengthening access to VA health care overall by increasing veterans’ choices for their health care and complementing the increasingly timely and high-quality care provided. by VA medical facilities. VA said veterans will continue to have the option of choosing to receive care at a VA medical facility or a community provider. Additionally, according to VA, expanding access will allow veterans to receive care in the community through a network of providers when VA does not provide required care or services, wait times are not consistent with VA access standards, the service line does not meet VA quality standards, or the referring clinician determines that it is in the veteran’s best medical interest to receive care or services in the community. Additionally, as described by VA, veterans will be able to access community care where the veteran was eligible to receive care under certain grandfathered provisions or VA does not operate a full-service medical facility in the state. in which the veteran resides.

VA has determined that the net costs of this final rule will be $2.2 million over a 5-year period (fiscal years 2019 to 2023) and $429 million per year on a rolling basis discounted at 7% from to the year 2016, on a perpetual time horizon.

(ii) Agency Actions Regarding the Regulatory Flexibility Act (RFA), 5 USC §§ 603-605, 607 and 609

VA has certified that this final rule will not have a significant economic impact on a substantial number of small entities as defined in the statute.

(iii) Agency Actions Regarding Sections 202-205 of the Unfunded Warrants Reform Act of 1995, 2 USC §§ 1532-1535

VA has determined that this final rule will not result in expenditures by state, local, and tribal governments, as a whole, or by the private sector, of $100 million or more (adjusted annually for inflation) during of a year.

(iv) Other relevant information or requirements under laws and decrees

Administrative Procedure Act, 5 USC §§ 551and following.

On February 22, 2019, VA released a proposed rule. 84 Fed. Reg. 5629. VA received 1,297 unique comments and responded to comments in the final rule. Additionally, VA has found good cause under the law to publish this rule with an effective date that is less than 30 days from the date of publication. Specifically, VA concluded that it would be contrary to the public interest to delay the effective date of this rule, as any delay in implementing the rule would have a serious adverse impact on health care. veterans.

Red Tape Reduction Act (PRA), 44 USC §§ 3501-3520

VA has determined that this final rule will modify the information gathering requirements currently approved under Office of Management and Budget (OMB) control number 2900-0823 and will impose new information gathering requirements and burden. VA stated that OMB’s Notice of Approval for this information gathering will be published in the Federal Register.

Legal authorization of the rule

VA has promulgated this Final Rule pursuant to Sections 101(28), 501, 513, 1701, 1703, 1703B, 1703C, 1710, 1710B, 1712, 1720D, 1722A, 1725A, 1728, 1730A, and 3104 of Title 38, United Code States.

Executive Order No. 12,866 (Planning and Regulatory Review)

VA has considered the economic, interagency, fiscal, legal and policy implications of this final rule and determined that it is economically significant under the order.

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