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The Department of Veterans Affairs (VA) amends its medical regulations to implement its authority to furnish necessary care to covered individuals through certain non-contractual agreements. Section 102 of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Network Act of 2018 authorizes VA to enter into these agreements to furnish required care and services when such care and services are not feasibly available to certain individuals through a VA facility, a contract, or a sharing agreement. This interim final rule establishes the parameters of those agreements, to include: defining the eligibility of providers to furnish such care or services; establishing a methodology by which rates will be calculated for payment of care or services under an agreement; and establishing a process for the submission of claims for payment of care or services provided under an agreement.