Exempting Whole Health Well-Being Services From Copayment

DEPARTMENT OF VETERANS AFFAIRS <CFR>38 CFR Part 17</CFR> <RIN>RIN 2900-AS23</RIN> <SUBJECT>Exempting Whole Health Well-Being Services From Copayment</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 revise its medical regulations to exempt Whole Health well-being services from the copayment requirements for inpatient hospital care and outpatient medical care. These Whole Health well-being services, which consist of Whole Health education and skill-building programs and complementary and integrative health well-being services, are provided to Veterans within the VA Whole Health System of Care to improve Veterans' overall health and well-being. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> Comments must be received on or before March 4, 2025. </EFFDATE> <HD SOURCE="HED">ADDRESSES:</HD> Comments may be submitted through <E T="03">www.regulations.gov.</E> Except as provided herein, 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">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; however, we will post 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-AS23. <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Kavitha Reddy, Associate Director, Employee Whole Health, Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, 314-312-8126. (This is not a toll-free number.) </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <HD SOURCE="HD1">Authority</HD> Section 1710 of title 38 United States Code (U.S.C.) requires VA to furnish hospital care and medical services that VA determines to be needed for eligible Veterans. Section 1701(6) defines medical services as examination, treatment, and rehabilitative services, as well as other specifically listed services. VA implemented the statutory requirements through 38 Code of Federal Regulations (CFR) 17.38, frequently referred to as the Medical Benefits Package. Under section 1710(g)(1), VA may not furnish medical services to certain Veterans unless the Veteran agrees to pay “the applicable amount or amounts established by the Secretary [of VA] by regulation.” VA has interpreted section 1710(g)(1) to mean that VA may establish in regulation the amount of a copayment, even if that amount is zero, meaning that VA effectively has the authority to exempt certain care from copayment requirements. VA has set forth copayment requirements for inpatient hospital care, outpatient medical care, and urgent care in 38 CFR 17.108. Generally, 38 CFR 17.108 sets forth requirements regarding copayments for inpatient hospital care and outpatient medical care provided to Veterans by VA. 38 CFR 17.108(b) and (c). Services not subject to copayments are listed in 38 CFR 17.108(e). VA has long acknowledged that copayments can deter Veterans from obtaining certain services and be a barrier to participation in a program promoted by VA. Therefore, to encourage Veterans to become more actively involved in their medical care, thereby improving health care outcomes and, in turn, lowering overall health care costs, VA has exempted certain services from the copayment requirements. There are currently multiple copayment exemptions listed in § 17.108(e) such as weight management counseling and publicly announced VA public health initiatives (for example, health fairs) or outpatient visits solely consisting of preventative screening and immunizations to encourage such behavior. In this rulemaking, VA proposes to add an additional copayment exemption for Whole Health well-being services to encourage Veterans to be more actively involved in their health care and further use these important services. <HD SOURCE="HD1">Whole Health Well-Being Services and the Whole Health System of Care</HD> Whole Health well-being services, which are services that focus on the overall well-being of the Veteran independent of treatment for a specific medical condition or diagnosis, are an important aspect of the Whole Health System of Care. The Whole Health System of Care is care that supports the Veteran's health and well-being in line with what matters most to the Veteran. The Whole Health System of Care engages and empowers Veterans to prioritize a healthy lifestyle—including mental, emotional, functional, spiritual, social, and community aspects—equipping them to take charge of their health and well-being by addressing lifestyle and environmental root causes of chronic disease. This approach has improved Veterans' perceptions of health care, increased their engagement in health care and self-care, and improved their life's meaning and purpose. One component of the Whole Health System of Care focuses on the overall well-being of the Veteran that is independent of treatment of a specific medical condition or diagnosis to equip each Veteran to better manage their own health. The well-being component includes various services that are centered around what matters most to the Veteran and their health and well-being goals. Whole Health well-being services are provided to Veterans alongside conventional health care to promote, preserve, and restore health. All Whole Health well-being services provided by VA are in line with accepted standards of medical practice, serve to increase Veterans' access to care, and currently are authorized and provided to Veterans as part of the medical benefits package under 38 CFR 17.38. Whole Health well-being services include Whole Health education and skill-building programs and complementary and integrative health well-being services, both of which are discussed in further detail herein. VA determined it is necessary to exempt these Whole Health well-being services from copayment to remove a barrier that may discourage Veterans from proactively engaging in the Whole Health System of Care and to further encourage Veterans to better manage their health and improve their overall well-being. Whole Health well-being services do not generally require the expertise of a licensed clinical provider or specialty care provider as these approaches are not used for treatment of a specific condition or diagnosis but rather to support health and overall well-being. A Veteran's participation in Whole Health well-being services can initiate a cascade of health benefits that result from a Veteran's conscious, committed participation in promoting, restoring, and preserving the Veteran's own health. Exempting Whole Health well-being services would encourage Veterans to proactively take advantage of well-being services to improve their overall well-being. <HD SOURCE="HD1">Copayment Exemption for Whole Health Well-Being Services</HD> In this rulemaking, we propose to amend 38 CFR 17.108 by adding new paragraph (e)(20) to exempt Whole Health well-being services from copayment requirements. New paragraph (e)(20) of section 17.108 would provide that “the following Whole Health well-being services” would be exempt from copayment requirements. As mentioned previously, Whole Health well-being services consist of Whole Health education and skill-building programs as well as complementary and integrative health well-being services. Proposed paragraphs (e)(20)(i) and (ii) would then describe these two categories of well-being services that would be exempt from copayment. In addition, we would make two minor technical edits to maintain proper punctuation throughout the list of copayment exempt services in § 17.108(e). We would remove “and” at the end of current paragraph (17); we would remove the period at the end of paragraph (18) and in its place insert a semicolon; and we would remove the period at the end of paragraph (19) and in its place insert a semicolon followed by “and.” These changes would ensure that new paragraph (20) would properly complete the list of currently exempt services in § 17.108(e). <HD SOURCE="HD1">Whole Health Education and Skill-Building Programs</HD> Proposed § 17.108(e)(20)(i) would describe “Whole Health education and skill-building programs.” Whole Health education and skill-building programs would be defined as the services that educate, instruct, and empower Veterans to understand and implement the principles and practices of Whole Health. VA would use this definition for Whole Health education and skill-building programs because it would succinctly describe this category of Whole Health-focused programs and would be consistent with how Whole Health education and skill-building programs are provided to Veterans within VA. Whole Health education and skill-building programs have a Whole Health-focused curriculum, contribute to the overall well-being of the Veteran, and may be offered individually or in a group setting. Whole Health education and skill-building programs generally address Whole Health ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 23k characters. Full document text is stored and available for version comparison. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━