VA Health Professional Scholarship Program

<RULE> DEPARTMENT OF VETERANS AFFAIRS <CFR>38 CFR Part 17</CFR> <RIN>RIN 2900-AR98</RIN> <SUBJECT>VA Health Professional Scholarship Program</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Department of Veterans Affairs. <HD SOURCE="HED">ACTION:</HD> Final rule. <SUM> <HD SOURCE="HED">SUMMARY:</HD> The Department of Veterans Affairs (VA) adopts as final, without changes, a proposed rule to amend its regulations that govern the VA Health Professional Scholarship Program (HPSP) by implementing the mandates of the Consolidated Appropriations Act, which would expand the number of scholarships available to those who are pursuing degrees or training in occupations providing care within mental health programs. This rule also adopts as final technical corrections under the Paperwork Reduction Act section to correct an approved Office of Management and Budget (OMB) control number. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> This rule is effective July 18, 2024. </EFFDATE> <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Nicole Nedd, Director, Scholarships and Clinical Education, Workforce Management and Consulting Office, 810 Vermont Ave. NW, Washington, DC 20420. ((504) 881-4036). (This is not a toll-free telephone number.) </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> In a document published in the <E T="04">Federal Register</E> (FR) on August 14, 2023, VA proposed to revise its VA Health Professional Scholarship Program (HPSP) regulations. The purpose of the HPSP is to award scholarships to students pursuing a course of study leading to a degree in certain health care occupations, listed in 38 U.S.C. 7401(1) and (3). See § 17.600. The HPSP allows VA to provide scholarship awards to facilitate recruitment and retention of employees in several hard-to-fill health care occupations. Id. In the proposed rule we stated that we would amend the HPSP to reflect statutory changes made by section 104(a) of Division V of the Consolidated Appropriations Act (the Act), Public Law 117-328, which expanded HPSP by requiring VA to specifically award scholarships to applicants pursuing degrees or training in mental health disciplines, including advanced practice nursing (with a focus on mental health or substance use disorder), psychology, and social work. Section 104(a) of the Act also required that VA provide no fewer than an additional 50 awards (as compared to academic year 2021, which provided 33 awards) to such applicants per academic year starting in academic year 2022. 88 FR 54972. The rule also proposed to make a technical edit to the HPSP regulations to correct an approved Office of Management and Budget (OMB) control number. Id. VA provided a 60-day comment period, which ended on October 13, 2023. VA received 13 comments on the proposed rule. One comment supported the proposed rule and will not be further addressed in this final rule. The remaining comments are summarized and addressed in the discussion below. <HD SOURCE="HD1">Public Comments</HD> <HD SOURCE="HD2">Physician Assistants</HD> VA received 11 comments regarding physician assistants (PAs). The comments suggested or supported the inclusion of PAs as mental health care professionals eligible to receive scholarships under proposed § 17.603(b)(2). For instance, a commenter suggested that generally PAs should receive scholarships under proposed § 17.603(b)(2) and another stated that PAs are a core mental health profession. VA does not make any changes based on these comments. PAs are eligible to apply for and receive HPSP scholarships for mental health disciplines under proposed § 17.603(b)(2). Consistent with section 104(a) of Division V of the Act, VA proposed to revise § 17.603(b)(2) to expand HPSP to applicants who are pursuing degrees or training in mental health disciplines, including advanced practice nursing (with a focus on mental health or substance use disorder), psychology, and social work. As noted in the proposed rule, this is not an exhaustive list and merely mirrors section 104(a) of Division V of the Act. 88 FR 54974. VA acknowledges that PAs' training includes core mental health training and mandatory psychiatry clinical rotations, and they may provide mental health care. Thus, PAs are eligible to apply for and may receive HPSP scholarships for mental health disciplines under proposed § 17.603(b)(2) once this rule is final and effective. Other commenters suggested that PAs be listed in proposed § 17.603(b)(2) as a mental health profession eligible for a HPSP scholarship pursuant to the Act. Relatedly, one commenter stated that VA should provide an exhaustive list of health care professions that may be awarded the HPSP scholarship under proposed § 17.603(b)(2). We do not make changes to the rule based on these comments. As VA explained in the proposed rule, the list of mental health disciplines in proposed § 17.603(b)(2) is not an exhaustive list, as there are other mental health disciplines not included in the Act. (See 88 FR 54974). Other mental health disciplines may include licensed professional mental health counselor, marriage and family therapist, and rehabilitation counseling. The list in proposed § 17.603(b)(2) was merely meant to mirror the statutory language and is not exclusionary of other mental health care professions. VA determined that it should maintain a non-exhaustive list in the regulation to permit flexibility so that new mental health professions can be included without the need to amend the regulations. Therefore, other occupations not listed in proposed § 17.603(b)(2) that may provide clinical care in mental health programs may, and are encouraged to, apply for and receive HPSP scholarships. One commenter recommended that VA expand HPSP scholarships to mandate inclusion for PAs. We are not making any changes based on this comment. To the extent that the commenter is suggesting that VA mandate that PAs be prioritized over other potential applicants, VA cannot mandate that PAs be selected over other health care professions. Under 38 U.S.C. 7612(D), VA may provide scholarships with a preference for applicants who are veterans. VA does not have any other preferential statutory authority. The awarding of HPSP scholarships is based on VA recruitment needs. As previously stated in this rulemaking, an HPSP scholarship will be awarded only when necessary to assist VA in alleviating shortages or anticipated shortages of personnel in the health professions. One commenter raised concerns that the HPSP website indicates that existing HPSP scholarships are limited to only those PAs with veteran status. VA is not making any changes to the rule based on this comment. VA acknowledges that its HPSP website previously indicated that the PA scholarship is only open to those that have veteran status. VA has since updated its HPSP website to ensure it clearly explains that all PA students are allowed to apply for an HPSP scholarship, but that a preference may be given to veterans, consistent with § 17.605. While the eligibility criteria for HPSP does not require that applicants have any military experience (see § 17.602), if there are a larger number of equally qualified applicants than there are awards to be made, VA will first select veterans, then use a random method as the basis for further selection. See § 17.605(a). This provision applies to all health care professions eligible for HPSP scholarships, not just PAs. <HD SOURCE="HD2">Awarding HPSP Scholarships in Academic Year 2023</HD> One commenter encouraged VA to issue the 50 additional awards in the 2023 academic year, as increasing access to mental health care is critical. Consistent with section 104(a) of Division V of the Act, VA proposed to provide no fewer than an additional 50 awards (as compared to academic year 2021) to applicants who are pursuing degrees or training in mental health disciplines per academic year starting in academic year 2022. See proposed § 17.603(b)(2) and 88 FR 54973. However, VA will not be able to implement this regulation until this final rule is published and effective, which will be after the start of the 2023 academic year. VA notes that under the current regulations, VA is authorized to provide HPSP scholarships to disciplines that provide clinical care within mental health programs and in academic year 2023, VA offered 87 scholarships for professions providing clinical care within mental health programs, which is more than the required 83 scholarships for mental health professions as required under the Act. VA is not making any changes based on this comment. <HD SOURCE="HD2">Chaplains</HD> While not entirely clear, one commenter appeared to request chaplains be eligible for HPSP scholarships since they should be considered mental health professionals who are eligible under the changes VA proposed to make to § 17.603(b)(2) in the proposed rule. VA is not making changes based on this comment. VA considers chaplains to be an integral part of the veteran's mental health and individuals who are pursuing a degree that leads to placement as a chaplain may be eligible to receive HPSP scholarships under §§ 17.603(b)(2) and (3) as revised and made final in this rule. However, in order to be eligible under § 17.603(b)(2) the criteria in § 17.603(b)(1) still needs to be met, which provides that an HPSP scholarship will be awarded only when necessary to assist VA in alleviating shortages or anticipated shortages of personnel in the health professions stated in paragraph (b) of this section. These occupations are identified in OIG's Determination of Veterans Health Administration's Severe Occupational Staffing Shortages Fiscal Year 2023. However, the OIG's report did not list the chaplain occupation as one of the severe shortage occupations within VA. Therefore, VA cannot award HPSP scholarships to individuals who are pursuing a degree leading to a posit ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 18k characters. Full document text is stored and available for version comparison. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━