DEPARTMENT OF VETERANS AFFAIRS (VA)

Statement of Regulatory Priorities

The Department of Veterans Affairs (VA) administers benefit programs that recognize the important public obligations to those who served this Nation. VA's regulatory responsibility is almost solely confined to carrying out mandates of the laws enacted by Congress relating to programs for veterans and their families. VA's major regulatory objective is to implement these laws with fairness, justice, and efficiency.

Most of the regulations issued by VA involve at least one of three VA components: The Veterans Benefits Administration, the Veterans Health Administration, and the National Cemetery Administration. The primary mission of the Veterans Benefits Administration is to provide high-quality and timely nonmedical benefits to eligible veterans and their dependents. The primary mission of the Veterans Health Administration is to provide high-quality health care on a timely basis to eligible veterans through its system of medical centers, nursing homes, domiciliaries, and outpatient medical and dental facilities. The primary mission of the National Cemetery Administration is to bury eligible veterans, members of the Reserve components, and their dependents in VA National Cemeteries and to maintain those cemeteries as national shrines in perpetuity as a final tribute of a grateful Nation to commemorate their service and sacrifice to our Nation.

VA Regulatory Priorities

VA's most important significant regulatory actions are identified and discussed in the following chart. These actions are identified as helping to implement VA's policies and priorities, and embody the core of VA's regulatory priorities.

RIN	Title	Summary of Rulemaking
2900-AP66	Diseases Associated With Exposure to Contaminated Water at Camp Lejeune	The Department of Veterans Affairs (VA) proposed to amend its adjudication regulations relating to presumptive service connection to add certain diseases associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune (Camp Lejeune), North Carolina, from August 1, 1953 to December 31, 1987. The chemical compounds involved have been associated by various scientific organizations with the development of certain diseases. The effect of this rule would be to establish that veterans, former reservists, and former National Guard members, who served at Camp Lejeune during this period, and who have been diagnosed with any of nine associated diseases, are presumed to have a service-connected disability for purposes of entitlement to VA benefits. In addition, VA proposed establishing a presumption that these individuals were disabled during the relevant period of service, thus establishing active military service for benefit purposes. Under this presumption, affected former reservists and National Guard members would have veteran status for purposes of entitlement to some VA benefits. The proposal would implement a decision by the Secretary of Veterans Affairs that service connection on a presumptive basis is warranted for claimants who served at Camp Lejeune and later develop certain diseases. VA plans to finalize this proposal after considering public comments.
2900-AP54	VA Homeless Providers Grant and Per Diem Program	The Department of Veterans Affairs (VA) is proposing to amend its regulations concerning the VA Homeless Providers Grant and Per Diem Program (GPD). These amendments would provide GPD with increased flexibility to (1) respond to the changing needs of homeless veterans; (2) repurpose existing and future funds more efficiently; and (3) allow grant providers the ability to add, modify, or eliminate components of funded programs. We are proposing these amendments to better serve our homeless veteran population and the grantees who serve them.
2900-AO53	Fiduciary Activities	VA proposed to amend its fiduciary program regulations, which govern the oversight of beneficiaries who, because of injury, disease, the infirmities of advanced age, or minority, are unable to manage their VA benefits and the appointment and oversight of fiduciaries for these vulnerable beneficiaries. The proposed amendments would update and reorganize regulations consistent with current law, VA policies and procedures, and VA's reorganization of its fiduciary activities. They would also clarify the rights of beneficiaries in the program and the roles of VA and fiduciaries in ensuring that VA benefits are managed in the best interest of beneficiaries and their dependents.
2900-AP72	Veterans Employment Pay for Success Program	The Department of Veterans Affairs (VA) established a grant program (Veterans Employment Pay for Success (VEPFS)) under the authority of 38 U.S.C. 3119 to award grants to eligible entities to fund projects that are successful in accomplishing employment rehabilitation for Veterans with service-connected disabilities. VA will award grants on the basis of an eligible entity's proposed use of a Pay for Success (PFS) strategy to achieve goals. This interim final rule established regulations for awarding a VEPFS grant, including the general process for awarding the grant, criteria and parameters for evaluating grant applications, priorities related to the award of a grant, and general requirements and guidance for administering a VEPFS grant program.
2900-AP35	Tiered Pharmacy Copayments for Medications	The Department of Veterans Affairs (VA) proposes to amend its regulations concerning copayments charged to certain veterans for medication required on an outpatient basis to treat nonservice-connected conditions. This rulemaking would establish three classes of medications for copayment purposes, identified as Tier 1, Tier 2, and Tier 3. These tiers would distinguish in part based on whether the medications are available from multiple sources or a single source, with some exceptions. Copayment amounts would be fixed, and would be dependent upon the class of medication. For most veterans these copayment amounts would result in lower out-of-pocket costs, thereby encouraging greater adherence to prescribed medications and reducing the risk of fragmented care that results when veterans use multiple pharmacies to fill their prescriptions.
2900-AP57	Repayment by VA of Educational Loans for Certain Psychiatrists (Clay Hunt Act)	The Department of Veterans Affairs (VA) has added to its medical regulations a program for the repayment of educational loans for certain psychiatrists who agree to a period of obligated service with VA. This program is intended to increase the pool of qualified VA psychiatrists and increase veterans' access to mental health care.
2900-AO88	Per Diem Paid to States for Care of Eligible Veterans in State Homes	The Department of Veterans Affairs (VA) proposed to reorganize, update (based on revisions to statutory authority), and clarify its regulations that govern paying per diem to State homes providing nursing home and adult day health care to eligible veterans. The reorganization will improve consistency and clarity throughout these State home programs. We believe that these proposed regulations will clarify current law and policy, which should improve and simplify the payment of per diem to State homes, and encourage participation in these programs. VA plans to finalize this proposal after considering public comments.
2900-AP60	Expanded Access to Non-VA Care Through the Veterans Choice Program (VCP)	The Department of Veterans Affairs (VA) revised its medical regulations that implement section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (hereafter referred to as "the Choice Act"), which requires VA to establish a program to furnish hospital care and medical services through eligible non-VA health care providers to eligible veterans who either cannot be seen within the wait-time goals of the Veterans Health Administration (VHA) or who qualify based on their place of residence (hereafter referred to as "the Veterans Choice Program" or "the Program"). These regulatory revisions are required by the most recent amendments to the Choice Act made by the Construction Authorization and Choice Improvement Act of 2014, and by the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015. The Construction Authorization and Choice Improvement Act of 2014 amended the Choice Act to define additional criteria that VA may use to determine that a veteran's travel to a VA medical facility is an "unusual or excessive burden," and the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 amended the Choice Act to cover all veterans enrolled in the VA health care system, remove the 60-day limit on an episode of care, modify the wait-time and 40-mile distance eligibility criteria, and expand provider eligibility based on criteria as determined by VA.
2900-AP44	Advanced Practice Registered Nurses	The Department of Veterans Affairs (VA) proposed to amend its medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment. This rulemaking would increase veterans' access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians. This rule would permit VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA. VA will finalize its proposal after considering public comments.

Retrospective Review of Existing Regulations

Consistent with guidance from section 6 of Executive Order 13563, VA identifies rules that are to be ''modified, streamlined, expanded, or repealed so as to make the agency's regulatory program more effective or less burdensome in achieving the regulatory objectives." In addition, consistent with Executive Order 13610, initiatives that are discussed in those plans are identified below.

RIN	Title	Significantly Reduce Burdens on Small Businesses	Summary of Rulemaking
Multiple RINs	Revise and Streamline VA Acquisition Regulation to Adhere to Federal Acquisition	No	VA is proposing to amend VA Acquisition Regulation (VAAR) as part of a project to update the VAAR. Under this initiative all parts of the regulation are being reviewed and updated in phased increments to incorporate any new regulations or policies and to remove any procedural guidance that is internal to VA. This project aims to streamline the VAAR to implement and supplement the Federal Acquisition Regulation (FAR) only when required, and to eliminate internal agency guidance in keeping with the FAR principles concerning agency acquisition regulations.
2900-AO53	Fiduciary Activities	No	VA proposes to amend its fiduciary program regulations, which govern the oversight of beneficiaries who, because of injury, disease, the infirmities of advanced age, or minority, are unable to manage their VA benefits, and the appointment and oversight of fiduciaries for these vulnerable beneficiaries. The proposed amendments would update and reorganize regulations consistent with current law, VA policies and procedures, and VA's reorganization of its fiduciary activities. They would also clarify the rights of beneficiaries in the program and the roles of VA and fiduciaries in ensuring that VA benefits are managed in the best interest of beneficiaries and their dependents.
Multiple RINs	VA Schedule for Rating Disabilities (With Specific Body System)	No	VA is updating its Schedule for Rating Disabilities (VASRD, or Rating Schedule) to better reflect modern medicine. The VASRD, which is part 4 of title 38, Code of Federal Regulations, governs how claims processors evaluate the severity of disabilities. While VA has routinely updated parts of the VASRD, this proposal is the first time VA is working to update the entire VASRD since 1945. In 2009, a formal project management plan was created to outline how to update the VASRD. A working group of specialized physicians (VA and non-VA), stakeholders, and claims processors reviews each of the 15 body systems and provides analysis to assist VA in developing updates. The public has 60 days to provide VA with comments. VA will introduce the proposed updates to the VASRD incrementally and is committed to an update of the entire VASRD.