[Federal Register Volume 76, Number 41 (Wednesday, March 2, 2011)]
[Rules and Regulations]
[Pages 11338-11339]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-4686]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AN41
Hospital and Outpatient Care for Veterans Released From
Incarceration to Transitional Housing
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: This document affirms as final a proposed rule that amends the
Department of Veterans Affairs (VA) medical regulations to authorize VA
to provide hospital and outpatient care to a veteran in a program that
provides temporary housing upon release from incarceration in a prison
or jail. The final rule permits VA to work with these veterans while
they are in these programs with the goal of continuing to work with
them after their release, which will assist in preventing homelessness
in this population of veterans.
DATES: This final rule is effective April 1, 2011.
FOR FURTHER INFORMATION CONTACT: James McGuire, Program Manager,
Healthcare for Re-entry Veterans, Veterans Health Administration,
Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC
20420, (202) 461-1591. (This is not a toll free number.)
SUPPLEMENTARY INFORMATION: Under 38 U.S.C. 1710(h), VA is not required
``to furnish care to a veteran to whom another agency of Federal,
State, or local government has a duty under law to provide care in an
institution of such government.'' VA implemented this statute in 38 CFR
17.38(c)(5). Generally, Sec. 17.38(c)(5) bars VA from providing
``[h]ospital and outpatient care for a veteran who is either a patient
or inmate in an institution of another government agency if that agency
has a duty to give the care or services.'' Typically, government
agencies have a duty to provide medical care to inmates who have been
released from incarceration in a prison or jail to a temporary housing
program (such as a community residential re-entry center or halfway
house).
This duty may exist even though the responsible government agency
expects residents in these programs to arrange for their own medical
care. Irrespective of whether a duty exists, however, VA wants to be
able to provide hospital and outpatient care to eligible veterans in
these programs. Under Sec. 17.38(c)(5), VA cannot provide care to
veterans in these programs if the other government agency has a duty to
provide the care unless that agency is willing to pay VA for the care
by contract.
In a proposed rule published May 12, 2010, we proposed to amend
Sec. 17.38 to establish that the exclusion in paragraph (c)(5) does
not apply to any veteran who is released from incarceration to a
temporary housing program. We explained that this amendment is
necessary to authorize VA hospital and outpatient care for these
veterans who often require additional assistance in successfully
transitioning from incarceration.
VA wants to provide care to these veterans because VA has found
that upon release from jail or prison these veterans are particularly
at risk of not receiving adequate medical care, and in many cases
become homeless, as a result of not receiving such care, after their
release from temporary housing programs. Under 38 U.S.C. 2022(a), VA is
charged with reaching out ``to veterans at risk of homelessness,
including particularly veterans who are being discharged or released
from institutions after * * * imprisonment.'' Outreach workers for the
Veterans Health Administration report that veterans with acute or
chronic medical or psychiatric problems who are treated while
incarcerated, often have difficulty obtaining similar treatment during
a transitional period. In particular, if mental health issues are not
addressed during the transitional period, upon release, many of these
veterans are rendered incapable of finding or maintaining appropriate
housing.
In addition to being an important component of VA's duty to attempt
to prevent veterans from becoming homeless, establishing that the
exclusion in 38 CFR 17.38(c)(5) does not apply to veterans who are
residents in temporary housing programs offers potentially significant
public benefits and will further the success of other VA policies. For
example, section 20 of VHA Handbook 1160.01 specifically requires VA to
``engage with veterans being released from prison in need of care.''
VHA Handbook 1160.01, section 20(a)(2). As significant numbers of
veterans in these programs have difficulty obtaining medical treatment
comparable to the treatment they received in prison, some begin to
believe the only way they can obtain treatment is to violate the terms
of their release and return to prison. A 2008 Urban Institute study of
a large re-entry population cohort, found health care played a key role
in the first months of community re-adjustment and reduced recidivism.
Mallik-Kane, K, and Visher, C.A., Health and prisoner re-entry: How
physical, mental, and substance abuse conditions shape the process of
re-integration. Urban Institute Justice Policy Center: Washington, DC
(2008). In particular, the study noted that access to medications for
chronic health and mental health conditions is a low-cost powerful tool
in preventing recidivism.
We received three comments on the proposed rule. All of the
comments support the substance of the proposed rule. One commenter
recommended that VA add a number of services to its medical benefits
package, and made strategic recommendations for VA housing programs.
This rulemaking simply removes a bar that prevented veterans, who are
released from incarceration into temporary housing, from receiving
outpatient and hospital care under the medical benefits package.
Because the commenter suggested that additional services be added to
this package, we do not believe that these comments are within the
scope of this rulemaking. However, to the extent that the commenter
seeks to connect veterans to needed care and support services, we note
that VA currently provides a number of programs that provide housing
and other support services to veterans. Nothing prevents formerly
incarcerated veterans from taking advantage of any of the programs for
which they qualify.
For the foregoing reasons, VA amends 38 CFR 17.38 to revise the
exclusion in the VA medical benefits package for a veteran who is a
patient or inmate in an institution of another government agency so
that the exclusion does not apply to a veteran who is a resident of a
temporary housing program. For purposes of this rule, a ``temporary
housing program,'' includes community residential re-entry centers,
halfway houses, and similar residential facilities.
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.
1532, that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in an expenditure by
state, local and tribal governments, in the aggregate, or by the
private sector, of $100 million or more
[[Page 11339]]
(adjusted annually for inflation) in any given year. This rule has no
such effect on state, local and tribal governments, or on the private
sector.
Executive Order 12866
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives, and when regulation is
necessary to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety,
and other advantages; distributive impacts; and equity). The Order
classifies a ``significant regulatory action,'' requiring review by the
Office of Management and Budget (OMB), as a regulatory action that is
likely to result in a rule that may: (1) Have an annual effect on the
economy of $100 million or more, or adversely affect in a material way
the economy, a sector of the economy, productivity, competition, jobs,
the environment, public health or safety, state, local, or tribal
governments or communities; (2) create a serious inconsistency or
otherwise interfere with an action planned or taken by another agency;
(3) materially alter the budgetary impact of entitlements, grants, user
fees or loan programs or the rights and obligations of recipients
thereof; or (4) raise novel legal or policy issues arising out of legal
mandates, the President's priorities, or the principles set forth in
the Executive Order.
The economic, interagency, budgetary, legal, and policy
implications of this rule have been examined, and it has been
determined not to be a significant regulatory action under Executive
Order 12866.
Paperwork Reduction Act
This rule does not contain any collections of information under the
Paperwork Reduction Act (44 U.S.C. 3501-3520).
Regulatory Flexibility Act
The Secretary hereby certifies that this rule does not have a
significant economic impact on a substantial number of small entities
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. This rule only affects individuals, not small entities. Therefore,
pursuant to 5 U.S.C. 605(b), this rule is exempt from the initial and
final regulatory flexibility analysis requirements of sections 603 and
604.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic Assistance numbers and titles for
the programs affected by this document are 64.009, Veterans Medical
Care Benefits; 64.011, Veterans Dental Care; 64.012, Veterans
Prescription Service; 64.013, Veterans Prosthetic Appliances; 64.019,
Veterans Rehabilitation Alcohol and Drug Dependence; and 64.022,
Veterans Home Based Primary Care.
Signing Authority
The Secretary of Veterans Affairs, or designee, approved this
document and authorized the undersigned to sign and submit the document
to the Office of the Federal Register for publication electronically as
an official document of the Department of Veterans Affairs. John R,
Gingrich, Chief of Staff, approved this document on February 24, 2011
for publication.
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug abuse, Foreign relations,
Government contracts, Grant programs--health, Grant programs--veterans,
Health care, Health facilities, Health professions, Health records,
Homeless, Medical and dental schools, Medical devices, Medical
research, Mental health programs, Nursing homes, Philippines, Reporting
and recordkeeping requirements, Scholarships and fellowships, Travel
and transportation expenses, Veterans.
Dated: February 25, 2011.
William F. Russo,
Director, Regulations Management, Department of Veterans Affairs.
For the reasons stated in the preamble, VA amends 38 CFR part 17 as
follows:
PART 17--MEDICAL
0
1. The authority citation for part 17 continues to read as follows:
Authority: 38 U.S.C. 501, and as noted in specific sections.
0
2. Revise Sec. 17.38(c)(5) to read as follows:
Sec. 17.38 Medical benefits package.
* * * * *
(c) * * *
(5) Hospital and outpatient care for a veteran who is either a
patient or inmate in an institution of another government agency if
that agency has a duty to give the care or services. This exclusion
does not apply to veterans who are released from incarceration in a
prison or jail into a temporary housing program (such as a community
residential re-entry center or halfway house).
* * * * *
[FR Doc. 2011-4686 Filed 3-1-11; 8:45 am]
BILLING CODE 8320-01-P