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The Department of Veterans Affairs proposes to revise its medical regulations to establish a new pilot program on graduate medical education and residency, as required by section 403 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.

Statement of Need:

This rulemaking is needed to implement section 403 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 (hereafter referred to as the MISSION Act).  Section 403 of the MISSION Act requires the Department of Veterans Affairs (VA) create a pilot program  to establish additional medical residency positions authorized under section 301(b)(2) of Public Law 113-146 (note to section 7302 of title 38 United States Code (U.S.C.)) at certain covered facilities, to include non-VA facilities.  Prior to section 403 of the MISSION Act, VA’s authority in 38 U.S.C. 7302 permitted VA to establish medical residency programs in VA facilities and ensure that such programs have a sufficient number of residents, where VA’s graduate medical education (GME) programming was limited to funding resident salaries and benefits only if such residents were in VA facilities, caring for Veterans, and supervised by VA staff, with some additional support to the affiliated educational institutions for educational costs.  

Summary of the Legal Basis:

Section 403 of the MISSION Act expanded on this authority by creating a pilot to allow VA to fund residents regardless of whether they are in VA facilities, and to pay for certain costs of new residency programs that might also not be in VA facilities. 

Alternatives:

VA analyzed whether this pilot program could be implemented without regulations, because the administration of resident stipends and benefits, as well as the reimbursement of certain costs of new residency programs, would be controlled by contracts or agreements outside of regulations.  However, regulations were thought necessary to: better characterize selection criteria for the covered facilities in which residents will be placed, and to establish priority placement at certain covered facilities as required by section 403; establish criteria for defining new residency programs; qualify the resident activities that would be reimbursable; and qualify the reimbursable costs for new residency programs if VA places a resident in a new residency program.  Regulations were also thought necessary to clarify that this pilot program, unlike many other VA pilot programs, is not a grant program or a cooperative agreement program through which entities may apply to be considered for resident funding or reimbursement of new residency program costs. 

Anticipated Costs and Benefits:

Increasing the number of residents and residency programs in underserved regions may improve the number of physicians practicing there after residency training and also will increase access to healthcare for veterans and possibly non-Veterans residing in those regions.

VA estimates that costs of this program will be $4,160,259 in FY22 and 13,691,052 over a 5-year period. Transfers will be zero in FY22 and $25,687,106 over a 5-year period. Combined, this results in a budget impact of $4,160,259 in FY 22 and $39,378,158 over a 5-year window.

Risks:

None.