Has Anyone Seen This?

[cowgirl]

Okay, I cant figure it out if its going to be worthwhile or how it goes. How do I get travel 'reimbursement' from the VA? thanks. cg

The VA takes $6 for first 3(round trip) visits each month. After that, nothing is taken from travel for rest of that month. For C & P or AO Exam there is no deductible. Been getting same travel for more than 30 years.

Don

[Dale Jr. 8]

CG,

You are entitled to travel pay if you are 30% or more. If you are less that 30% then you are only entitled to travel for treatment for an SC condition. In your case since you have 60% you are entitled to travel each time you go to the VAMC. You have to go to the pay window and give them your ID card and they will print out a paper and you sign it and take it to another window to get your money. In my VAMC at Fayetteville NC the travel window is next to the pharmacy. You get 11 cents a mile currently. There is a deductible of $3.00 each way. I live 100 miles away so I get $22 minus the $3.00 each way which equals $6.00 and the total for me is $22 minus $6 which equals $16. I have never had enough appts to not have to pay the deductible. One month I had 3 appts so I had to still pay the deductible. Travel is always worth while. It usually covers my gas up and back. If they up it to 28 cents they I will feel like I won the lottery. They will probably up the deductible to go along with the mileage change. DJ 8

[Speaking Out]

I just got this from Military.com

Senators Ask for Travel Pay Increase

Week of January 28, 2008

Seven U.S. senators are asking the Department of Veterans Affairs to increase the amount it pays disabled veterans who travel to Veterans Administration hospitals to receive care. Sen. Mike Enzi, R-Wyo., announced the effort to get an increase of 17.5 cents per mile in the reimbursement rate. The current travel reimbursement rate for veterans was set in 1977, when gas averaged between 60 cents per gallon.

I haven't found out when a decision might be made.

[Wings]

[Federal Register: July 23, 2007 (Volume 72, Number 140)]

[Proposed Rules]

[Page 40096-40105]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr23jy07-15]

=======================================================================

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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Parts 17 and 70

RIN 2900-AM02

Beneficiary Travel Under 38 U.S.C. 111 Within the United States

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY: This document proposes to amend the beneficiary travel

regulations of the Department of Veterans Affairs (VA) that provide a

mechanism for payment of travel expenses within the United States under

38 U.S.C. 111 to help veterans and other persons obtain care and

services from VA's Veterans Health Administration (VHA). We propose to

revise the regulations to more fully implement the statutory provisions

governing such payments.

DATES: Comments must be received by VA on or before September 21, 2007.

ADDRESSES: Written comments may be submitted through http://www.regulations.gov

; by mail or hand-delivery to the Director,

Regulations Management (00REG), Department of Veterans Affairs, 810

Vermont Avenue, NW., Room 1068, Washington, DC 20420 or by fax to (202)

273-9026. Comments should indicate that they are submitted in response

to ``RIN 2900-AM02--Beneficiary Travel Under 38 U.S.C. 111 Within the

United States.'' Copies of comments received will be available for

public inspection in the Office of Regulation Policy and Management,

Room 1063B, between the hours of 8 a.m. and 4:30 p.m., Monday through

Friday (except holidays). Please call (202) 273-9515 for an

appointment. (This is not a toll-free number.) In addition, during the

comment period, comments may be viewed online through the Federal

Docket Management System (FDMS) at http://www.regulations.gov. See the

Paperwork Reduction Act heading under the SUPPLEMENTARY INFORMATION

section of this preamble regarding submission of comments on the

information collection provisions.

FOR FURTHER INFORMATION CONTACT: Tony Guagliardo, Chief Business

Office, Veterans Health Administration, Department of Veterans Affairs,

810 Vermont Avenue, NW., Washington, DC 20420; (202) 254-0406. (This is

not a toll-free number.)

SUPPLEMENTARY INFORMATION: We propose to revise the beneficiary travel

regulations captioned ``Transportation of Claimants and

Beneficiaries.'' These regulations provide a mechanism for payment of

travel expenses within the United States under 38 U.S.C. 111 to help

veterans and other persons obtain care and services from VHA. The

current regulations are set forth at 38 CFR 17.143 through 17.145. We

propose to transfer the current regulations to a new 38 CFR part 70 and

to make changes as discussed below.

The current regulations at Sec. 17.143(b) through (e) contain

provisions listing the eligibility criteria for paying beneficiary

travel expenses under 38 U.S.C. 111, for charging a statutory

deductible, and for paying beneficiary travel expenses based upon a

finding that an individual is unable to defray the expenses of travel.

Except for changes discussed below, the substance of these provisions

is included in proposed Sec. Sec. 70.4, 70.10, 70.20, and 70.31.

The current regulations at Sec. 17.143(f), (g), (h), and (k) refer

to types of activities for which beneficiary travel may be paid. We

propose to remove these provisions for reasons set forth below in the

discussion regarding the Medical Benefits Package under the heading

``Sec. 70.10--Eligible persons.''

The current regulations at Sec. 17.143(i), (j), (l), and (m)

concern special requirements for payment. Except for changes discussed

below, the substance of these provisions is included in proposed Sec.

70.30.

The current regulation at Sec. 17.143(n) concerns the provision of

VA beneficiary travel to beneficiaries of other Federal agencies and

allied beneficiaries as defined by 38 U.S.C.109. Proposed Sec. 70.10

provides eligibility for such beneficiaries subject to reimbursement

agreement with the appropriate agency or government and is essentially

unchanged from the previous regulation.

Current Sec. 17.144 concerns the application of the deductible

requirement, which we propose to amend and move to new Sec. 70.31.

Current Sec. 17.144 also sets forth payment principles concerning

travel costs, which we propose to amend and move to new Sec. 70.30.

Current Sec. 17.145 contains provisions regarding general prior

approval for beneficiary travel. In a document published in the Federal

Register on October 21, 1991 (56 FR 52,426), we deleted the main

provisions requiring a general prior approval for beneficiary travel.

We intended to remove all of the provisions concerning general prior

approval for beneficiary travel, but inadvertently failed to remove

Sec. 17.145. Accordingly, we propose to remove this section.

Purpose and Scope--Sec. 70.1

Section 70.1 would explain the purpose and scope of the VA's

beneficiary travel regulations consistent with the current regulations.

The provisions of this section would not constitute a substantive

change.

Definitions--Sec. 70.2

Proposed Sec. 70.2 would establish definitions of ``attendant,''

``beneficiary,'' ``claimant,'' ``clinician,'' ``emergency treatment,''

``irregular discharge,'' ``special mode of transportation,'' ``United

States,'' ``VHA,'' ``VA,'' ``VA authorized health care facility,'' and

``VA facility.'' While used in prior regulations the terms

``attendant,'' ``beneficiary,'' and ``irregular discharge'' have not

been previously defined. This led to occasional confusion by veterans,

the public, and VA field stations when processing claims for

beneficiary travel payments. Therefore, for purposes of clarification,

we propose to define these terms in the new part 70.

Currently, 38 CFR 17.143©(2)(i) requires a ``physician'' to make

medical determinations regarding the need for a special mode of

transportation. We deleted the requirement that a physician make the

determination. We would expect a clinician to be the decisionmaker.

However, by not specifying in the regulation that a physician will be

the decisionmaker will ensure that the claimant has a meaningful right

of appeal via the VA clinical appeals process should he or she disagree

with the decision of the clinician.

The definition of ``United States'' is consistent with the

definition of ``State'' in 38 U.S.C. 101(20). The term ``claimant'' is

the same as that established in 38 CFR 17.123.

We propose to define ``VA authorized health care facility'' and

``VA facility'' for clarification purposes due to occasional confusion

on the part of veterans, the public, and VA staff.

The definition of ``special mode of transportation'' has been

changed in the proposed rule to clarify the status of privately-owned

vehicles (POV) that have been modified to transport wheelchairs or

disabled individuals. The intent of ``special mode of transportation''

within the context of 38 U.S.C. 111 is to provide payment for

beneficiary travel in commercially operated vehicles. Therefore, we

propose that for the purposes of this rule that a POV is not to be

considered a ``special mode of transportation.''

Existing regulations do not define the term ``emergency

treatment.'' However, the proposed rule would define that term because

it is one of the factors that VHA considers when authorizing and

providing payment for travel by special mode of transportation. We

propose to define ``emergency treatment'' to mean ``treatment for a

condition of such a nature that a prudent layperson would have

reasonably expected that delay in seeking immediate medical attention

would have been hazardous to life or health (this standard would be met

if there were an emergency medical condition manifesting itself by

acute symptoms of sufficient severity (including severe pain) that a

prudent layperson who possesses an average knowledge of health and

medicine could reasonably expect the absence of immediate medical

attention to result in placing the health of the individual in serious

jeopardy, serious impairment to bodily functions, or serious

dysfunction of any bodily organ or part).'' This definition provides a

workable, common-sense standard for determining when emergency

treatment would occur for purposes of determinations under proposed

Sec. Sec. 70.4 (Criteria for approvals), 70.20 (Application), and

70.32 (Reimbursement or prior payment). Also, this definition is

consistent with the standard in 38 CFR 17.1002 for determining when

emergency treatment would occur under the regulations concerning

payment for emergency transportation of veterans for non-service-

connected conditions in non-VA facilities.

Determination of Secretary--Sec. 70.3

Proposed Sec. 70.3 is new. It would implement 38 U.S.C. 111, which

authorizes the Secretary to make beneficiary travel payments in any

fiscal year if he determines that VA has available funding.

Criteria for Approvals--Sec. 70.4

Although it is apparent from the current regulations at 38 CFR

17.143 and 17.144 that a beneficiary must meet certain requirements to

obtain payment for beneficiary travel (e.g., must be within an eligible

category, and must obtain prior approval for a special mode of

transportation in non-emergency situations), the current regulations do

not set forth all of the applicable criteria for approving or

disapproving payments under current VA practice. Proposed Sec. 70.4

provides a full list of the approval criteria that VA would apply to

claims for beneficiary travel, including the individuals who would be

eligible for benefits, application procedures, payment criteria for

travel without prior VA authorization, and criteria for approval

of travel in a special mode

of transportation. VA has determined that these criteria would permit

VA to distribute available travel funds to beneficiaries under the

discretionary authority in 38 U.S.C. 111 while maintaining high

standards for delivery of VA's health care benefits. Also, for purposes

of fairness, the proposed rule would allow payment for travel when the

failure to obtain scheduled care or services was due to actions such as

a last minute clinic cancellation by VA officials or persons acting on

behalf of VA. Applicants would be required to satisfy all of the

criteria to receive payments.

Proposed Sec. 70.4(b) provides that when payment for beneficiary

travel is requested after the provision of care or services and the

travel did not include a special mode of transportation, VA would

approve round-trip payment under this part only if the travel was in

connection with care or services that were scheduled with VHA prior to

arrival at the facility where the care or services were to be obtained,

or for emergency treatment. Also, proposed Sec. 70.4© provides that

when payment for beneficiary travel is requested for travel for care or

services that were not scheduled with VHA prior to arrival at the

facility and the travel did not include a special mode of

transportation, VA would not approve round-trip payment. However, if

care or services actually are provided during such unscheduled visits,

VA would approve payment for the return trip.

Proposed Sec. 70.4(b) and © would help ensure that beneficiary

travel is covered only when necessary for the provision of care or

services and not merely to obtain cash for other reasons. It would also

help ensure that beneficiaries have the means to return home after

receiving nonscheduled care or services.

Proposed Sec. 70.4(d) restates a requirement in current 38 CFR

17.143©(2)(iii) for prior approval of travel by a special mode of

transportation. Proposed paragraph (d) also restates a provision in

current Sec. 17.143©(2)(i).

Eligible Persons--Sec. 70.10

The proposed rule at Sec. 70.10 designates as eligible persons all

of those categories of persons specifically mentioned in VA statutes as

persons for which payment for beneficiary travel may be made by VHA

under 38 U.S.C. 111. These are the same persons eligible for

beneficiary travel payments under the current program, with one

exception. The current regulations include individuals eligible for

payment of travel under the Civilian Health and Medical Program of the

Department of Veterans Affairs (CHAMPVA), which provides care or

services for certain spouses or children of veterans or persons who

died in the line of duty. We propose to remove CHAMPVA beneficiaries

getting their care through VA facilities from the list of persons

eligible for beneficiary travel payments because there exists no

statutory authority to provide them these benefits. Although 38 U.S.C.

1781 provides that these beneficiaries shall be eligible for the same

medical services as a veteran, a veteran must still meet the additional

eligibility criteria set forth in section 111 to receive beneficiary

travel benefits. That is, not all veterans are eligible for beneficiary

travel benefits under section 111. Thus a CHAMPVA beneficiary receiving

care through VA facilities would similarly have to meet the additional

eligibility criteria of section 111, which they do not. VA is

requesting comments on this change.

Under 38 U.S.C. 111, certain veterans are eligible for beneficiary

travel payments for ``examination, treatment, or care.'' The proposed

rule at Sec. 70.10(b), provides that ``examination, treatment, or

care'' means all of the care provided under the Medical Benefits

Package in 38 CFR 17.38. This definition would replace current 38 CFR

17.143, which limits beneficiary travel payments to certain types of

activities (hospital admissions, hospital readmissions, preparatory and

post hospital care, hospital discharges, and outpatient services). We

propose to clearly state in broader language that beneficiary travel

payments are available for all of the care services provided under the

Medical Benefits Package. The current regulations and the proposed rule

both allow for payment related to the use of a special mode of

transportation if an individual is unable to defray the expense.

Therefore, the definition of ``unable to defray'' in proposed Sec.

70.10© is the same as in current 38 CFR 17.143(e). This definition is

for the purposes of this proposed rule only and does not apply to any

other regulations promulgated by VA.

We note that the provisions of current Sec. 17.143(d) refer to 38

U.S.C. 1701(6)(B) and 38 U.S.C. 1713. These statutes are not included

as authorities in the proposed rule because Public Law 107-135

redesignated the authorities as 38 U.S.C. 1782 and 1783. These

provisions concern limited eligibility for beneficiary travel payments

for individuals with specified relationships to certain veterans.

Application--Sec. 70.20

The provisions of proposed Sec. 70.20 are new, except as discussed

below. The new provisions are consistent with current VA policy and

practice at VA health care facilities.

Current Sec. 17.144(d) provides, ``Transportation will not be

authorized for the cost of the travel in excess of the actual expense

incurred by any person as certified by that person in writing.'' In

contrast, the proposed rule at Sec. 70.20(a) generally provides that a

claimant may apply for beneficiary travel payments orally or in writing

but must provide to VA the receipt for each expense other than for

mileage. The proposed rule will reduce the burden on claimants while

ensuring that VA obtains the necessary information for making

beneficiary travel determinations. Veterans usually request payment of

beneficiary travel before they leave the VA facility. There is no need

to obtain a certification or written request since VA can independently

determine the length of travel and the receipts would establish travel

expenditures other than mileage.

For beneficiary travel that does not include a special mode of

transportation, proposed Sec. 70.20(b) provides that a claimant must

apply for payment of beneficiary travel within 30 days after the travel

is completed. In the usual case, it is not administratively feasible

for VA to grant approval prior to travel. Further, the proposed

provisions requiring that a claimant must apply for payment of

beneficiary travel within 30 days after the travel is completed would

provide sufficient time for applicants to apply and would assist VA in

monitoring the expenditure of beneficiary travel funds.

For beneficiary travel that includes a special mode of

transportation, proposed Sec. 70.20©, with one exception, provides

that a claimant must apply for payment of beneficiary travel and obtain

approval from VA prior to the travel. Under the exception, if the

travel included a special mode of transportation and the claimant

without prior approval applied for payment of the beneficiary travel

within 30 days after the travel is completed, the application would be

considered timely submitted if the travel by special mode of

transportation was for emergency treatment. This is consistent with the

time period for submitting applications discussed above, limits VA's

payments to actual reimbursements, and otherwise implements specific

requirements of 38 U.S.C. 111(b)(3)(A) regarding prior approval.

Proposed Sec. 70.20(d) provides a new requirement that a claimant

must apply for and receive approval prior to incurring expenses for

meals and/or lodging. Current 38 CFR 17.143(l) authorizes payments for

meals and lodging but does not require that the claimant obtain prior

VA approval. The prior approval provisions would provide VA with the

opportunity to explore reasonable options and minimize costs.

The proposed rule at Sec. 70.20(e) provides that if VA determines

that additional information is needed to make a determination, VA would

notify the claimant in writing of the deficiency and request the needed

additional information. Section 70.20(e) further provides that if the

claimant has not responded to the request within 30 days, VA may decide

the claim prior to the expiration of the 1-year submission period

required by 38 U.S.C. 5103(b)(1) based on all the information contained

in the file, including any information it has obtained on behalf of the

claimant. If VA does so, however, and the claimant subsequently

provides the information within 1 year of the date of the request, VA

must readjudicate the claim. This would help ensure the timely

resolution of matters while meeting the statutory requirements.

Proposed Sec. 70.20(f) provides that if a claimant becomes

eligible for beneficiary travel benefits after the travel takes place,

the beneficiary may apply for such benefits within 30 days of the date

when he or she became eligible. This would help ensure that persons

would not be barred from beneficiary travel in those cases when they

could not have known they were eligible for such benefit at the time of

travel.

To ensure that beneficiaries meet the application deadline, the

proposed rule at Sec. 70.20(g) provides that the date of an

application for beneficiary travel is the postmark date, if mailed; or

the date of submission if hand delivered, provided by electronic means,

or provided orally.

Where To Apply--Sec. 70.21

The proposed rule at Sec. 70.21 provides that claimants must apply

for travel benefits at the Chief Business Office or with the designated

official at the VA health care facility responsible for the care being

provided and for which travel is required. While this has been general

field policy, previous regulations have not designated an office or

official for receipt of beneficiary travel claims. Designation of an

office or official to receive claims will help ensure that requests for

travel benefits are appropriately routed and timely processed.

Payment Principles--Sec. 70.30

Under proposed Sec. 70.30(a), the Secretary, subject to the

deductibles required under Sec. 70.31, would pay for beneficiary

travel as explained below.

Under 38 U.S.C. 111, VA has discretion to establish payment

principles based on the number of miles traveled and/or based on actual

necessary expenses. Pursuant to that discretion, VA currently pays a

per-mile allowance for travel by POV and pays the actual cost of travel

by common carrier and for other necessary expenses attendant to travel,

subject to specified limitations. However, current regulations do not

specifically state that reimbursement will be based upon mileage

(except as noted). Therefore, proposed paragraph (a) includes

provisions stating that the Secretary would establish and pay a per-

mile rate for use of a POV or the actual cost for use of the most

economical common carrier (bus, train, taxi, airplane, etc.), for

travel to and from VA authorized health care and for travel by a POV

for a compensation and pension examination that is solely ``for the

convenience of the Government'' (e.g., repeat a laboratory test, redo a

poor quality x-ray). The proposed rule would establish when and how the

Secretary would determine whether the mileage rate should be changed.

The payment principles are based on the Secretary's determination under

Sec. 70.3 to allocate available funds for VA health care programs, and

are intended to provide a reasonable and uniform amount of

reimbursement consistent with the administration of VA's overall health

care program.

Proposed Sec. 70.30(a)(1)(ii) and (iii) limiting payment for the

use of a POV and payment for the use of a common carrier are based on

statutory limitations at 38 U.S.C. 111(g)(2)(B) and replace 38 CFR

17.144©.

Proposed Sec. 70.30(a)(2) includes provisions stating that VA

would pay the actual cost of ferry fares, bridge tolls, road tolls,

tunnel tolls and would pay the actual cost of a special mode of

transportation. This implements provisions in 38 U.S.C. 111(a) and

(b)(3)(A).

Proposed Sec. 70.30(a)(3) includes provisions stating that VA

would pay the actual cost for meals, lodging, or both, when VA

determines that an overnight stay is required, not to exceed 50 percent

of the amount allowed for government employees under 5 U.S.C. 5702. The

section also identifies four factors as examples of those VA will

consider in determining whether an overnight stay is necessary. Paying

for the cost of meals only when there is an overnight stay is a

reasonable cost-control measure. Current regulations do not specify a

maximum for payment of meals and lodging. This proposed payment

principle is based on VA's concern about the adequate funding and

administration of all VA health care programs; in view of the overall

cost of administrating these programs, it is intended to provide a

reasonable and uniform amount of payment.

The proposed rule at Sec. 70.30(b) would place limits on

beneficiary travel payments as explained below.

Current 38 CFR 17.143(j)(1) provides that VA will pay expenses for

return transportation to ``the point from which the beneficiary

traveled to receive care, or any other place if there is no additional

cost.'' Proposed paragraphs (b)(1) and (2), except as discussed below,

would clarify that payment is limited to travel from the beneficiary's

residence to the nearest facility (VA facility or non-VA facility if VA

determines that it is necessary to obtain the care or services at a

non-VA facility) where the care or services could be provided and from

such VA facility to the beneficiary's residence. This clarification is

necessary to ensure that beneficiaries do not report longer distances

than they actually traveled to obtain higher payments. Further, the

exceptions set forth below explain those circumstances when it appears

appropriate to pay benefits from points other than the beneficiary's

residence.

If the beneficiary is not staying at his or her residence, proposed

Sec. 70.30(b)(3) would permit payment for travel from or to a place

where the beneficiary is residing but this payment may not exceed the

amount that would be payable for travel from the beneficiary's

residence. This provision clarifies current 38 CFR 17.143(j)(1).

Current Sec. 17.143(j)(3) provides, ``Transportation may be

furnished to a point other than that from which a patient had proceeded

to a hospital upon a showing of bona fide change of address to the

patient's residence during the period of hospital care.'' VA intended

that this provision would allow for payment for an individual's return

trip to a different location in the same area, not to a distant place.

Proposed Sec. 70.30(b)(4) would permit payment for the return trip

travel to the new residence in a distant place, except that payment may

not exceed the amount that would be allowed from the facility nearest

to the new residence where the care or services could have been

provided. For example, if during a

period of care or services in Baltimore, a beneficiary changed his or

her address from Baltimore to Detroit, payment for the return trip

would be limited to that allowed for traveling to the new residence

from the nearest facility to the new residence in Detroit where the

care or services could have been provided.

Proposed Sec. 70.30(b)(5), which would allow payment for certain

travel for beneficiaries, in substance, restates the current provisions

in 38 CFR 17.143(j)(2).

Proposed Sec. 70.30(b)(6) provides that payment may be made for

travel from a non-VA health care facility where the beneficiary is

receiving care or services to the nearest VA facility where the

appropriate care or services could be provided. This new provision

would clarify that VA may pay for travel to a VA facility from another

medical facility, not just from the veteran's residence.

Proposed Sec. 70.30(b)(7) provides that payment would not be made

for return travel for a patient receiving an irregular discharge. This,

in substance restates most of current 38 CFR 17.143(j)(4). However, the

revised version does not include a provision in the current regulation

that allows payment when the patient receiving an irregular discharge

is unable to defray the expense of the return travel. That provision

was deleted because payment in such cases inappropriately encourages

the unacceptable behavior of leaving the facility on an irregular

discharge.

Proposed Sec. 70.30(b)(8) provides that on a case-by-case basis,

payment for travel may be paid for any distance if it is financially

favorable to the government. This new provision would provide VA with

flexibility to, for example, pay for travel to a more distant nursing

home when admission to that nursing home is a prerequisite to qualify

for community assistance that would more than offset the additional

travel payment.

Proposed Sec. 70.30© provides that payment for travel of an

attendant would be calculated on the same basis as for the beneficiary

except that duplicate payment for costs would not be allowed. For

example, if a beneficiary and an attendant travel in the same

automobile, the travel would be limited to only one mileage payment.

This new provision would clarify and implement the provisions of 38

U.S.C. 111(e) regarding payment of beneficiary travel for an attendant.

Proposed Sec. 70.30(f) provides that the Secretary shall conduct

periodic investigations in consultation with the Administrator of the

General Services Administration in order to determine whether

reimbursement rates noted in Sec. 70.30(a) should change. While always

required by statute this would be an addition to current beneficiary

travel regulations.

Although VA policy is generally to provide payments for beneficiary

travel consistent with statutory authority and availability of funds,

there are some situations where such payments are not medically

feasible. Accordingly, under proposed Sec. 70.30(e), VA would not pay

beneficiary travel if paying a travel allowance would be

counterproductive to prescribed therapy, and the determination is

recorded in the person's VA medical records, and the chief of the care

service endorses the determination in the medical records. These

provisions reflect the policy of withholding payment for beneficiary

travel when such payment could be detrimental to a beneficiary's

treatment.

Deductibles--Sec. 70.31

Paragraph (a) of proposed Sec. 70.31 provides that the VA shall

deduct an amount established by the Secretary (currently $3 or the

total amount of travel if it is less than $3) for each one-way trip

from the amount otherwise payable for such one-way trip, except that VA

shall not make any more deductions in a calendar month after the

completion of six one-way trips for which deductions were made in such

calendar month. In addition, whenever the Secretary makes adjustments

to the mileage reimbursement rates as noted in Sec. 70.30(a)(1)(iv),

the deductible amount will be adjusted proportionately.

Proposed Sec. 70.31 implements 38 U.S.C. 111©(1), (2) and (5),

which require VA to deduct $3 from the amount otherwise payable for

each one-way trip with a calendar monthly cap of $18 (but limiting

these $3 deductions to six one-way trips), and to adjust

proportionately the amounts whenever there is a change to the mileage

rates. However, since the deductible amount and monthly cap could

change, these proposed regulations do not limit those rates to those

currently established. In addition, we do not interpret 38 U.S.C.

111© as requiring VA to deduct more than the cost of a one-way trip

if the reimbursement would be less than the deductible. Therefore, in a

given calendar month, we would pay beneficiary travel without a

deductible for trips seven, eight, nine, and so on, even if the total

deductible amount for the first six trips were less than the monthly

cap in effect at time of travel.

Section 111©(4) further provides that the VA may waive the

deductible when imposition of the deductible would cause severe

financial hardship. Under the current regulations, the test for

``severe financial hardship'' is essentially the same as ``unable to

defray,'' which is used for determinations regarding basic eligibility

for beneficiary travel. However, we do not believe that Congress

intended the terms ``unable to defray'' and ``severe financial

hardship'' to have the same meaning. The term ``severe financial

hardship'' would seem to require that a beneficiary have less financial

ability than would be the maximum allowed for basic eligibility for

beneficiary travel. Accordingly, we propose that an individual with

``severe financial hardship'' is one who has no more than 90 percent of

the maximum income allowed for meeting the ``unable to defray''

standard.

Reimbursement or Prior Payment--Sec. 70.32

Proposed Sec. 70.32(a) provides that payment would be made on a

reimbursement basis after the travel has occurred with the following

two statutory exceptions.

Upon completion of examination, treatment, or care, 38 U.S.C.

111(d) specifically allows payment to be made before the return travel

has occurred. This helps provide the beneficiary with resources for

return travel. This exception is included in proposed Sec.

70.32(a)(1).

With respect to a special mode of travel, 38 U.S.C. 111(b)(3)(B)

authorizes VA to provide payment for beneficiary travel to the provider

of the transportation before determining eligibility of such person for

payment if VA determines that providing payment is in the best interest

of furnishing care and services. This exception is included in proposed

Sec. 70.32(a)(2). We would interpret ``is in the best interest of

furnishing care and services'' to mean ``that the travel is for

emergency treatment and VA determines that the beneficiary is eligible

for payment for the travel.'' In non-emergency situations, we would

have time to determine eligibility before travel. Further, the proposed

provisions are designed to help ensure that individuals likely to be

subsequently found eligible are not initially denied travel by special

mode of transportation.

Proposed Sec. 70.32(b) provides that payment would be made to the

beneficiary, except that VA may make a beneficiary travel payment to a

person or organization other than the beneficiary upon satisfactory

evidence that the person or organization actually provided or paid for

the travel. This is for the convenience of the veteran or the

person or organization that provided or paid for the travel.

Administrative Procedures--Sec. 70.40

Proposed Sec. 70.40 incorporates reconsideration and appeal rights

as established by 38 CFR 17.133 and 38 CFR parts 19 and 20. These

rights will be utilized when an adverse decision is made regarding

beneficiary travel benefits. This is an established procedure, which we

intend to clarify in this proposed rule.

Recovery of Payments--Sec. 70.41

For informational purposes, the proposed rule at Sec. 70.41 makes

reference to applicable VA provisions governing recovery of payments.

False Statements--Sec. 70.42

For informational purposes, the proposed rule at Sec. 70.42

advises that a person who makes a false statement for the purpose of

obtaining payments for beneficiary travel would be subject to

prosecution under applicable laws, including 18 U.S.C. 1001.

Reduced Fare Requests--Sec. 70.50

Proposed Sec. 70.50 restates statutory provisions authorizing VA

to make forms available to veterans and their authorized attendants for

use in requesting a reduced fare from transportation providers when

they are traveling at their own expense in relation to VA or VA-

authorized health care. Whether to grant a reduced fare is determined

by the transportation provider.

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 Executive

Order classifies a ``significant regulatory action,'' requiring review

by the Office of Management and Budget (OMB) unless OMB waives such

review, as any 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, or State, local, or tribal governments or

communities; (2) create a serious inconsistency or otherwise interfere

with an action taken or planned 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 proposed rule have been examined and it has been

determined to be a significant regulatory action under the Executive

Order because it is likely to result in a rule that may raise novel

legal or policy issues arising out of legal mandates, the President's

priorities, or the principles set forth in the Executive Order and/or

materially alter the budgetary impact of entitlements, grants, user

fees, or loan programs or the rights and obligations of recipients

thereof.

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 expenditure by

State, local, and tribal governments, in the aggregate, or by the

private sector, of $100 million or more (adjusted annually for

inflation) in any given year. This proposed rule would have no such

effect on State, local, and tribal governments, or on the private

sector.

Paperwork Reduction Act

The proposed rule includes provisions constituting collections of

information under the Paperwork Reduction Act (44 U.S.C. 3501-3521)

(``Act'') that would need approval by the Office of Management and

Budget (OMB). Accordingly, under section 3507(d) of the Act, VA has

submitted a copy of this rulemaking action to OMB for review.

OMB assigns a control number for each collection of information it

approves. VA may not conduct or sponsor, and a person is not required

to respond to, a collection of information unless it displays a

currently valid OMB control number.

Comments on the collections of information should be submitted to

the Office of Management and Budget, Attention: Desk Officer for the

Department of Veterans Affairs, Office of Information and Regulatory

Affairs, Washington, DC 20503, with copies mailed or hand-delivered to:

Director, Regulations Management (00REG), Room 1068, 810 Vermont Ave.,

NW., Washington, DC 20420; or faxed to (202) 273-9026; or e-mailed to

http://www.regulations.gov. Comments should indicate that they are

submitted in response to ``RIN 2900-AM02.''

Title: VHA Beneficiary Travel Program Under 38 U.S.C. 111.

Summary of collection of information: The proposed rule at Sec.

70.20 requires that certain information is required by VA to determine

payment of VHA beneficiary travel under 38 U.S.C. 111. In most cases,

this information is electronically available due to previous

submissions by the claimant for other VHA benefits or through other VA

data sources and no further information is required for VA to determine

eligibility and payment amount for VHA beneficiary travel. However, in

those cases where a claimant requests reimbursement for the cost of

ferry fares, bridge tolls, road tolls, or tunnel tolls in accordance

with Sec. 70.30(a)(2), such information is not available and receipt

for those expenses must be collected from the claimant.

Description of the need for information and proposed use of

information: This information is needed to determine eligibility for

payment of beneficiary travel.

Description of likely respondents: Beneficiaries and attendants

requesting payment for beneficiary travel.

Estimated number of respondents per year: 23,835.

Estimated frequency of responses per year: 3 per individual (total

of 68,505).

Estimated average burden per response: 3 minutes.

Estimated total annual reporting and recordkeeping burden: 3,425

hours.

The Department considers comments by the public on proposed

collections of information in:

Evaluating whether the proposed collections of information

are necessary for the proper performance of the functions of the

Department, including whether the information will have practical

utility;

Evaluating the accuracy of the Department's estimate of

the burden of the proposed collections of information, including the

validity of the methodology and assumptions used;

Enhancing the quality, usefulness, and clarity of the

information to be collected; and

Minimizing the burden of the collections of information on

those who are to respond, including responses through the use of

appropriate automated, electronic, mechanical, or other technological

collection techniques or other forms of information technology, e.g.,

permitting electronic submission of responses.

OMB is required to make a decision concerning the collections of

information contained in this proposed

rule between 30 and 60 days after publication of this document in the

Federal Register. Therefore, a comment to OMB is best assured of having

its full effect if OMB receives it within 30 days of publication. This

does not affect the deadline for the public to comment on the proposed

rule.

Regulatory Flexibility Act

VA hereby certifies that the provisions of the proposed rule will

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. 601-602. This proposed rule primarily affects individuals and

any effects on small businesses would be inconsequential. Therefore,

pursuant to 5 U.S.C. 605(b), this final rule is exempt from the initial

and final regulatory flexibility analysis requirement of sections 603

and 604.

Catalog of Federal Domestic Assistance

The Catalog of Federal Domestic Assistance program numbers and

titles are 64.007, Blind Rehabilitation Centers; 64.009, Veterans

Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.011,

Veterans Dental Care; 64.013, Veterans Prosthetic Appliances; 64.018,

Sharing Specialized Medical Resources; 64.019, Veterans Rehabilitation

Alcohol and Drug Dependence; and 64.022, Veterans Home Based Primary

Care.

List of Subjects in 38 CFR Parts 17 and 70

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 record-keeping requirements, Scholarships and fellowships, Travel

and transportation expenses, Veterans.

Approved: March 26, 2007.

Gordon H. Mansfield,

Deputy Secretary of Veterans Affairs.

Editorial Note: This document was received at the Office of the

Federal Register on July 17, 2007.

For the reasons set forth in the preamble, the Department of

Veterans Affairs proposes to amend 38 CFR Chapter I as follows:

PART 17--MEDICAL

1. The authority citation continues to read as follows:

Authority: 38 U.S.C. 501, 1721, and as stated in specific

sections.

2. In Sec. 17.38, revise paragraph (a)(1)(xii) to read as follows:

Sec. 17.38 Medical benefits package.

(a) * * *

(1) * * *

(xii) Payment of beneficiary travel as authorized under 38 CFR part

70.

* * * * *

Sec. Sec. 17.143 through 17.145 [Removed]

3. Remove Sec. Sec. 17.143 through 17.145 and the undesignated

center heading ``TRANSPORTATION OF CLAIMANTS AND BENEFICIARIES''.

4. Add a new part 70 to read as follows:

PART 70--VHA BENEFICIARY TRAVEL UNDER 38 U.S.C. 111

Sec.

70.1 Purpose and scope.

70.2 Definitions.

70.3 Determination of Secretary.

70.4 Criteria for approvals.

70.10 Eligible persons.

70.20 Application.

70.21 Where to apply.

70.30 Payment principles.

70.31 Deductibles.

70.32 Reimbursement or prior payment.

70.40 Administrative procedures.

70.41 Recovery of payments.

70.42 False statements.

70.50 Reduced fare requests.

Authority: 38 U.S.C. 101, 111, 501, 1701, 1714, 1720, 1728,

1782, 1783, E.O. 11302.

Sec. 70.1 Purpose and scope.

(a) This part provides a mechanism under 38 U.S.C. 111 for the

Veterans Health Administration (VHA) to make payments for travel

expenses incurred in the United States to help veterans and other

persons obtain care or services from VHA.

(b) This part does not cover payment for emergency transportation

of veterans for non-service-connected conditions in non-VA facilities

when the payment for transportation is covered by Sec. Sec. 17.1000

through 17.1008 of this chapter, as authorized by 38 U.S.C. 1725.

(Authority: 38 U.S.C. 101, 111, 501, 1701, 1714, 1720, 1728, 1782,

1783, E.O. 11302)

Sec. 70.2 Definitions.

For purposes of this part:

Attendant means an individual traveling with a beneficiary who is

eligible for beneficiary travel and requires the aid and/or physical

assistance of another person.

Beneficiary means a person determined eligible for VHA benefits.

Claimant means a veteran who received services (or his/her

guardian) or the hospital, clinic, or community resource that provided

the services, or the person other than the veteran who paid for the

services.

Clinician means a Physician, Physician Assistant (PA), Nurse

Practitioner (NP), Psychologist, or other independent licensed

practitioner.

Emergency treatment means treatment for a condition of such a

nature that a prudent layperson would have reasonably expected that

delay in seeking immediate medical attention would have been hazardous

to life or health (this standard would be met if there were an

emergency medical condition manifesting itself by acute symptoms of

sufficient severity (including severe pain) that a prudent layperson

who possesses an average knowledge of health and medicine could

reasonably expect the absence of immediate medical attention to result

in placing the health of the individual in serious jeopardy, serious

impairment to bodily functions, or serious dysfunction of any bodily

organ or part).

Irregular discharge means the release of a competent patient from a

VA or VA authorized hospital, nursing home, or domiciliary care due to:

refusal, neglect or obstruction of examination or treatment; leaving

without the approval of the treating health care clinician; or

disorderly conduct and discharge is the appropriate disciplinary

action.

Special mode of transportation means an ambulance, ambulette, air

ambulance, wheelchair van, or other modes of transportation specially

designed to transport disabled persons (this would not include a mode

of transportation not specifically designed to transport disabled

persons, such as a bus, subway, taxi, train, or airplane). A modified,

privately owned vehicle, with special adaptive equipment and/or capable

of transporting disabled persons is not a special mode of

transportation for the purposes of this rule.

United States means each of the several States, Territories, and

possessions of the United States, the District of Columbia, and the

Commonwealth of Puerto Rico.

VA means the Department of Veterans Affairs.

VA authorized health care facility means a non-VA health care

facility where VA has approved care for an eligible beneficiary at VA

expense.

VA facility means VA Medical Center (VAMC), VA Outpatient Clinic

(OPC), or VA Community Based Outpatient Clinic (CBOC).

VHA means the Veterans Health Administration, a principal unit

within VA.

(Authority: 38 U.S.C. 101, 111, 501, 1701, 1714, 1720, 1728, 1782,

1783, E.O. 11302)

[[Page 40103]]

Sec. 70.3 Determination of Secretary.

For each fiscal year, the Secretary of Veterans Affairs will

determine whether funds are available for paying expenses of VHA

beneficiary travel under 38 U.S.C. 111. If the Secretary determines

that funds are available for such purpose, VA will make payment for

expenses of such travel in accordance with the provisions of this part.

(Authority: 38 U.S.C. 101, 111, 501, 1701, 1714, 1720, 1728, 1782,

1783, E.O. 11302)

Sec. 70.4 Criteria for approvals.

(a) VA will approve payment for beneficiary travel under this part

if:

(1) The travel was made to obtain care or services for a person who

is eligible for beneficiary travel payments under Sec. 70.10,

(2) The travel was in connection with care or services for which

such person was eligible under the laws administered by VA,

(3) Application was made in accordance with Sec. 70.20,

(4) All of the requirements of this part for payment are met, and

(5) Any failure to obtain the care or services was due to actions

by officials of VA or persons acting on behalf of VA.

(b) When a claimant requests payment for beneficiary travel after

the provision of care or services and the travel did not include a

special mode of transportation, VA will approve round-trip payment

under this part only if the travel was:

(1) In connection with care or services that were scheduled with

VHA prior to arrival at the VHA-designated facility, or

(2) For emergency treatment.

© When a claimant requests payment for beneficiary travel for

care or services that were not scheduled with VHA prior to arrival at

the facility and were not emergency treatment and the travel did not

include a special mode of transportation, VA will not approve round-

trip payment under this part but will approve payment for the return

trip if VHA actually provided care or services.

(d) Except as provided in Sec. 70.32 concerning reimbursement or

prior payment, when payment for beneficiary travel is requested for

travel that includes a special mode of transportation, VA will approve

payment under this part if:

(1) The travel is medically required,

(2) The beneficiary is unable to defray the cost of such

transportation, and

(3) VHA approved the travel prior to travel in the special mode of

transportation or the travel was undertaken in connection with a

medical emergency.

(Authority: 38 U.S.C. 101, 111, 501, 1701, 1714, 1720, 1728, 1782,

1783, E.O. 11302)

Sec. 70.10 Eligible persons.

(a) The following listed persons are eligible for beneficiary

travel payments under this part:

(1) A veteran who travels to or from a VA facility or VA authorized

health care facility in connection with treatment or care for a

service-connected disability (regardless of percent of disability).

(2) A veteran with a service-connected disability rated at 30

percent or more who travels to or from a VA facility or VA authorized

health care facility for examination, treatment, or care for any

condition.

(3) A veteran who travels to a VA facility or VA authorized health

care facility for a scheduled compensation and pension examination.

(4) A veteran receiving pension under 38 U.S.C. 1521, who travels

to or from a VA facility or VA authorized health care facility for

examination, treatment, or care.

(5) A veteran whose annual income (as determined under 38 U.S.C.

1503) does not exceed the maximum annual rate of pension that the

veteran would receive under 38 U.S.C. 1521 (as adjusted under 38 U.S.C.

5312) if the veteran was eligible for pension and who travels to or

from a VA facility or VA authorized health care facility for

examination, treatment, or care.

(6) A veteran who travels to or from a VA facility or VA authorized

health care facility for examination, treatment, or care, and who is

unable to defray the expenses of that travel as defined in paragraph

© of this section.

(7) A member of a veteran's immediate family, a veteran's legal

guardian, or a person in whose household the veteran certifies an

intention to live, if such person is traveling for consultation,

professional counseling, training, or mental health services concerning

a veteran who is receiving care for a service-connected disability; or

a member of a veteran's immediate family, if such person is traveling

for bereavement counseling relating to the death of such veteran in the

active military, naval, or air service in the line of duty and under

circumstances not due to the veteran's own misconduct.

(8) An attendant other than a VA employee, who is accompanying and

assisting a beneficiary eligible for beneficiary travel payments under

this section, when such beneficiary is medically determined to require

the presence of the attendant because of a physical or mental

condition.

(9) Beneficiaries of other Federal agencies, incident to medical

services rendered upon requests of those agencies, subject to

reimbursement agreement by those agencies.

(10) Allied beneficiaries as defined by 38 U.S.C. 109 subject to

reimbursement agreement by the government concerned.

(b) For purposes of this section, the term ``examination,

treatment, or care'' means the care services provided under the Medical

Benefits Package in Sec. 17.38 of this chapter.

© For purposes of this section, a beneficiary shall be considered

unable to defray the expenses of travel if the beneficiary:

(1) Has an income for the year (as defined under 38 U.S.C. 1503)

immediately preceding the application for beneficiary travel that does

not exceed the maximum annual rate of pension that the beneficiary

would receive under 38 U.S.C. 1521 (as adjusted under 38 U.S.C. 5312)

if the beneficiary were eligible for pension during that year; or

(2) Is able to demonstrate that due to circumstances such as loss

of employment, or incurrence of a disability, his or her income in the

year of travel will not exceed the maximum annual rate of pension that

the beneficiary would receive under 38 U.S.C. 1521 (as adjusted under

38 U.S.C. 5312) if the beneficiary were eligible for pension; or

(3) Has a service-connected disability rated at least 30 percent;

or

(4) Is traveling in connection with treatment of a service-

connected disability.

(Authority: 38 U.S.C. 101, 111, 501, 1701, 1714, 1720, 1728, 1782,

1783, E.O. 11302)

Sec. 70.20 Application.

(a) A claimant may apply for beneficiary travel orally or in

writing but must provide VA the receipt for each expense other than for

mileage.

(b) A claimant must apply for payment of beneficiary travel within

30 calendar days after completing beneficiary travel that does not

include a special mode of transportation.

© For beneficiary travel that includes a special mode of

transportation, a claimant must apply for payment of beneficiary travel

and obtain approval from VA prior to the travel; however, if the travel

included a special mode of transportation and the claimant without

prior approval applies for payment of the beneficiary travel within 30

calendar days after the travel is completed, the application will be

considered timely submitted if the travel was for emergency treatment.

[[Page 40104]]

(d) Notwithstanding other provisions of this section, for travel

that includes meals and/or lodging, a claimant must apply for and

receive approval prior to obtaining the meals and/or lodging.

(e) If VA determines that additional information is needed to make

a determination concerning an application under this part, VA will

notify the claimant in writing of the deficiency and request additional

information. If the claimant has not responded to the request within 30

days, VA may decide the claim prior to the expiration of the 1-year

submission period required by 38 U.S.C. 5103(b)(1) based on all the

information contained in the file, including any information it has

obtained on behalf of the claimant. If VA does so, however, and the

claimant subsequently provides the information within 1 year of the

date of the request, VA must readjudicate the claim.

(f) Notwithstanding other provisions of this section, if a person

becomes eligible for payment of beneficiary travel after the travel

takes place, payment may be made if the person applies for travel

benefits within 30 days of the date when the person became eligible for

travel benefits.

(g) The date of an application for beneficiary travel is the

postmark date, if mailed; or the date of submission if hand delivered,

provided by electronic means, or provided orally.

(Authority: 38 U.S.C. 101, 111, 501, 1701, 1714, 1720, 1728, 1782,

1783, E.O. 11302)

Sec. 70.21 Where to apply.

Claimants for beneficiary travel must submit the information

required in Sec. 70.20 to the Chief of the Business Office or other

designee at the VA medical facility responsible for the medical care or

services being provided and for which travel is required.

(Authority: 38 U.S.C. 101, 111, 501, 1701, 1714, 1720, 1728, 1782,

1783, E.O. 11302)

Sec. 70.30 Payment principles.

(a) Subject to the other provisions of this section and subject to

the deductibles required under Sec. 70.31, VA will pay the following

for beneficiary travel by an eligible beneficiary when travel expenses

are actually incurred:

(1) The per mile rate established by the Secretary for the period

of travel for use of privately owned vehicle or the actual cost for use

of the most economical common carrier (bus, train, taxi, airplane,

etc.), for travel to and from VA or VA authorized health care subject

to the following:

(i) Travel by a privately-owned vehicle for a compensation and

pension examination that is solely for the convenience of the

Government (e.g., repeat a laboratory test, redo a poor quality x-ray)

may have a different per mile rate if deemed appropriate by the

Secretary.

(ii) Per mile payment for use of privately-owned vehicle may not

exceed the cost of such travel by public transportation (even if it is

for the convenience of the government) unless determined to be

medically necessary.

(iii) Payment for a common carrier may not exceed the amount

allowed for a privately-owned vehicle unless travel by a privately-

owned vehicle is not reasonably accessible or is determined to be

medically necessary.

(iv) As required by law, each time the Federal government makes a

change in mileage rates payable under 5 U.S.C. 5702 and 5704

[Maurice]

Hello How much will they paid me for a 35 round trip to the VAMC.? I'm 60% DAV

[evandc]

With $6 deductable, you would owe them $2.15, Just some more VA Math.

Don