Updates to Waiver of Charges for Copayments

DEPARTMENT OF VETERANS AFFAIRS <CFR>38 CFR Part 17</CFR> <RIN>RIN 2900-AS25</RIN> <SUBJECT>Updates to Waiver of Charges for Copayments</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Department of Veterans Affairs. <HD SOURCE="HED">ACTION:</HD> Proposed rule. <SUM> <HD SOURCE="HED">SUMMARY:</HD> The Department of Veterans Affairs (VA) proposes to amend its medical regulations to allow VA to initiate a waiver request for debt accumulated from health care copayments on behalf of veterans in certain circumstances and to remove the requirement that veterans submit VA Form 5655 when seeking a waiver of copayment debt. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> Comments must be received on or before February 18, 2025. </EFFDATE> <HD SOURCE="HED">ADDRESSES:</HD> Comments must be submitted through <E T="03">www.regulations.gov.</E> Except as provided below, comments received before the close of the comment period will be available at <E T="03">www.regulations.gov</E> for public viewing, inspection, or copying, including any personally identifiable or confidential business information that is included in a comment. We post the comments received before the close of the comment period on <E T="03">www.regulations.gov</E> as soon as possible after they have been received. VA will not post public comments on <E T="03">www.regulations.gov</E> that make threats to individuals or institutions or suggest that the commenter will take actions to harm an individual. VA encourages individuals not to submit duplicative comments. We will post acceptable comments from multiple unique commenters even if the content is identical or nearly identical to other comments. Any public comment received after the comment period's closing date is considered late and will not be considered in the final rulemaking. In accordance with the Providing Accountability Through Transparency Act of 2023, a plain language summary (not more than 100 words in length) of this proposed rule is available at <E T="03">www.regulations.gov,</E> under RIN 2900-AS25. <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Andrew Patrick, Executive Director, Revenue Operations, Office of Finance, (104RO), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Ave. NW, Washington DC 20420, (202) 809-3030. (This is not a toll-free telephone number.) </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <HD SOURCE="HD1">Authority and Background</HD> Section 1710 of title 38, United States Code (U.S.C.) requires VA to furnish hospital care and medical services, and authorizes VA to provide nursing home care, that VA determines to be needed for eligible veterans. Section 1710 authorizes VA to provide such care only when the veteran agrees to pay the applicable copayment. 38 U.S.C. 1710(f)(1) and (g)(1). Additionally, section 1722A establishes that VA must require a copayment from certain veterans for medications. VA has set forth copayment requirements for inpatient hospital care and outpatient medical care in § 17.108 of title 38, Code of Federal Regulations (CFR), copayment requirements for medication in § 17.110, copayments for extended care services in § 17.111, and copayments for urgent care at § 17.4600. These types of medical copayments are generally referred to as “copayments” throughout this rulemaking. Under 31 U.S.C. 3711(a)(1), Federal agencies are required to “try to collect a claim of the United States Government for money or property arising out of the activities of, or referred to, the agency,” which means that VA must attempt to collect amounts owed by veterans to VA, including debts arising from copayments. However, VA is authorized to waive recovery of payments or overpayments of benefits, including copayments, when recovery would be against equity and good conscience and an application for relief is made within 180 days from the date of notification of the indebtedness by VA. 38 U.S.C. 5302(a)(1). VA has regulated the waiver of debts arising from medical copayments in 38 CFR 17.105(c). VA has also regulated the process for waiver applications in 38 CFR 1.963(b), the process to request a hearing in § 1.966(a), and the application of the “equity and good conscience” standard in §§ 1.965 and 1.966(a). Explained in more detail below, VA proposes to amend § 17.105(c) to: remove the requirement to submit a particular form when requesting a waiver of charges for copayments; add the ability for VA to initiate waiver requests on behalf of veterans; update VA staff position titles; and clarify the applicability of other regulations related to appeals of VA decisions on the waiver of copayments. These changes would provide clarity within the regulation, be consistent with the statutory authority for collection of copayments and waiver of copayments, reflect the current position title used by VA, and update cross-references to other regulatory sections. We note at the outset that current § 17.105(c) references only claimants, not veterans. In the proposed changes to § 17.105(c) discussed below, we would include references to both claimants and veterans. We would maintain the existing references to claimants when discussing the process for anyone other than VA to initiate a waiver request for charges of copayments, and we would use the word veteran when discussing the process whereby VA would initiate a request for waiver on behalf of a veteran. <HD SOURCE="HD1">Changes to 38 CFR 17.105(c)</HD> In this rulemaking we propose to amend 38 CFR 17.105(c) related to waivers for copayments. We would first restructure current § 17.105(c) by breaking the single paragraph into proposed subparagraphs (c)(1) through (5), which would retain the majority of the language in current paragraph (c), but the further subparagraphs would make the proposed substantive and technical changes clearer. The first sentence of current § 17.105(c) introduces the process for requesting a waiver of charges for copayments and states that “[if] the debt represents charges for outpatient medical care, inpatient hospital care, medication or extended care services copayments made under §§ 17.108, 17.110, 17.111, or 17.4600, the claimant must request a waiver by submitting VA Form 5655 (Financial Status Report) to the Consolidated Patient Account Center (CPAC) Chief Financial Officer.” We would retain this sentence as a standalone proposed § 17.105(c), with the following revisions. We would first add the phrase “urgent care” to the list of debts from charges for care authorized to be waived. Current § 17.105(c) does not include the phrase urgent care but does include reference to § 17.4600, which addresses copayments for urgent care. Therefore, to ensure a complete and parallel listing of all applicable care types, we would add the phrase “urgent care” to qualify § 17.4600. We would then add language in proposed § 17.105(c) to establish that VA may initiate a waiver request in addition to a “claimant.” This change would be necessary because VA recognizes that situations may arise where it would be more equitable and efficient for VA staff to initiate waiver requests on behalf of veterans. We would not propose to list specific situations in which VA may initiate a waiver, so that VA may retain greater flexibility in assessing what we believe would be novel circumstances. However, one example for when VA might initiate a waiver request would be in cases of VA error, particularly when large groups of veterans are impacted by the same VA error or errors. Proposed § 17.105(c) would remove the requirement in current § 17.105(c) that claimants must submit VA Form 5655 to request a waiver of charges of copayments. VA Form 5655 is a two-page form that requires each claimant provide detailed information regarding monthly expenses, debts, and other financial information. VA now finds that this level of specificity can be burdensome to the claimant and is often more information than VA requires to make a waiver determination. VA would still regulate other criteria for submission of waiver requests, but the requirement would be moved to proposed § 17.105(c)(1). Lastly, proposed § 17.105(c) would move the requirement that the form be sent to the Chief Financial Officer to § 17.105(c)(1)(ii), and in that provision, change the position title from “Chief Financial Officer” to “Chief Fiscal Officer” to reflect the current position title. This is merely a technical change and would not change the process to submit a waiver or to whom the request is submitted. For the reasons stated above, proposed § 17.105(c) would read: “ <E T="03">Of charges for copayments.</E> If the debt represents charges for outpatient medical care, inpatient hospital care, medication, extended care services, or urgent care copayments made under §§ 17.108, 17.110, 17.111, or 17.4600, either a claimant or VA may initiate a waiver request.” Proposed § 17.105(c)(1) would establish requirements for claimants to submit requests for waiver of charges of copayments. Proposed paragraph (c)(1) would establish introductory language to state “[i]f the claimant requests a waiver, the claimant must:” where proposed subparagraphs (c)(1)(i)-(iv) would establish the specific criteria for a waiver request. The criteria in proposed paragraphs (c)(1)(i), (ii), and (iv) would remain the same as those listed in current § 17.105(c), with the exceptions of the requirement to submit VA Form 5655 and changing the title of the CPAC Chief Financial Officer to the Chief Fiscal Officer. Proposed § 17.105(c)(1)(i) would establish that claimants must make the request within the time period provided in § 1.963(b) of this chapter. This is identical to the submission timeframe in current § 17.105(c) as VA finds it is still sufficient for purposes of waiver requests for copayments. Proposed § 17.105(c)(1)(ii) would establish that claim ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 22k characters. Full document text is stored and available for version comparison. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━