[Federal Register Volume 86, Number 20 (Tuesday, February 2, 2021)]
[Notices]
[Pages 7921-7923]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-02138]
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DEPARTMENT OF VETERANS AFFAIRS
Draft Criteria for Section 203 of the VA MISSION Act of 2018
AGENCY: Department of Veterans Affairs.
ACTION: Notice and request for comment.
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SUMMARY: The Secretary of Department of Veterans Affairs (VA) is
responsible for establishing a procedure for making recommendations in
reviewing assets and infrastructure. This notice provides the selection
criteria to guide this process in order to meet this this
responsibility.
ADDRESSES: Written comments may be submitted through
www.regulations.gov. Comments should indicate that they are submitted
in response to ``Notice of Intent and request for comments.'' During
the comment period, comments may also be viewed online through the
Federal Docket Management System at www.regulations.gov.
DATES: Comments must be received on or before May 1, 2021.
FOR FURTHER INFORMATION CONTACT: Valerie Mattison Brown, Chief
Strategy Officer, Veterans Health Administration, Department of
Veterans Affairs, 810 Vermont Avenue NW, Washington DC 20420, (202)
461-7100 or VAMissionActSection203@va.gov.
SUPPLEMENTARY INFORMATION: Section 1703C of 38 U.S.C., as added by
Section 203 of the John S. McCain III, Daniel K. Akaka, and Samuel R.
Johnson VA Maintaining Internal Systems and Strengthening Integrated
Outside Networks (MISSION) Act of 2018 requires VA to establish
criteria to be used in assessing and making recommendations regarding
the modernization or realignment of facilities of the Veterans Health
Administration (VHA) under the subtitle Selection Criteria. In 2019,
VHA began working with various stakeholders and experts to identify
factors to be considered in developing the criteria. VHA solicited
feedback from Veterans Service Organizations, Veteran Engagement Boards
and a wide range of interdisciplinary VA leaders. Six criteria and
associated sub-criteria were developed through these robust
engagements. VHA proposes to use these criteria to evaluate potential
market opportunities for submission to the Asset and Infrastructure
Review Commission.
Foreword
VA is honored to deliver excellent health care for the more than 9
million Veterans who entrust us with their care and is proud to serve
as the backstop to the Nation's health care system. VA was in the midst
of a tremendous transformation before the COVID-19 pandemic, working to
empower Veterans with more excellent choices while modernizing our
systems to enable an optimal experience of care and services. As the
impacts of this unprecedented public health challenge have moved across
the Nation and the globe, we have continued to demonstrate the strength
of our nationwide, integrated system, positioning VA at the leading
edge of U.S. health care on behalf of those we serve. We have employed
each of our four missions--health care, education, research and
emergency response--to lead the Nation forward beside our interagency
and strategic partners. Each of these missions will be a vital element
of the next step in our transformation journey: Designing the future of
VA around the Veterans we serve.
VA works each day to serve and honor America's Veterans and seeks
to ensure each individual Veteran feels they are cared for uniquely,
wherever they are and however they need. As Veteran needs, preferences
and demographics shift over the coming decades, decisions about health
care delivery and infrastructure need to be made by the Secretary to
ensure Veterans can continue to access a sustainable, flexible and
high-quality health care system well into the future. In line with our
missions, VA proposes the following set of criteria for making
decisions on health care improvement, as required by Section 203 of the
MISSION Act of 2018. The criteria are designed to keep Veterans' needs
at the center of the decision-making process,
[[Page 7922]]
assuring that each Veteran can receive the care they have earned and
deserve.
Criteria
VA is conducting Market Assessments to design high-performing
networks of care to provide high quality, readily accessible cost-
effective care through VHA, Federal partners, academic affiliates and
other private sector providers. This design provides VA with the
ability to plan for the continuing evolution of Veteran health care,
incorporating major trends and events in the national and global health
ecosystem (e.g., the COVID-19 pandemic and telehealth). Each assessment
will create opportunities to position the VA health care system to
increase health equity, enhance Veteran experience, account for social
determinants and serve as the coordinator of health care provided by
VA. Through thoughtful and constructive engagements with internal and
external stakeholders, the following criteria were developed for the
evaluation of VHA realignment and modernization opportunities.
The Secretary will use the criteria to make recommendations to the
Asset and Infrastructure Review (AIR) Commission, established by the
MISSION Act for the modernization and realignment of VHA facilities and
to improve Veteran access to high-quality health care across the
country. Recommendations submitted to the AIR Commission will focus on
creating Veteran-centric outcomes that retain or improve health care
services for Veterans through the most equitable modalities and through
services and locations that most benefit those we serve. The
recommendations will then go through the AIR Commission review process
as outlined in the MISSION Act.
Each criterion begins with a commitment statement, outlining VA's
philosophy and commitment to current and future Veterans, followed by
the criterion statement, sub-criteria and explanatory statement:
Veterans' Need for Care & Services (Demand)
Commitment Statement: VA is committed to providing Veterans the
full range of care and services needed and desired throughout their
lifetimes, to include preventive, acute and chronic care. These
services will be carefully balanced to meet Veterans' needs and
preferences. We intend to ensure Veterans receive the personalized care
they have earned. We will do this by matching the services and support
they may need with our ability to provide those services in a timely
manner, through VA's direct care system, through our Community Care
Network and through government, academic and strategic partners.
Demand Criterion: The recommendation aligns VA's high performing
network resources to effectively meet the future health care demand of
the Veteran enrollee population.
Demand Sub-Criteria:
The recommendation:
[cir] Aligns the quality and delivery of care and services with
projected Veteran demand across demographics and geography;
[cir] Retains or improves VA's ability to meet projected demand;
[cir] Considers health equity (i.e., demographics);
[cir] Reflects consideration of factors underpinning observed
utilization patterns (e.g., rurality and other social determinants of
health); and
[cir] Incorporates trends in the evolution of U.S. health care.
When applying the `demand' criterion, VA will consider how a
recommendation will impact VA's ability to meet the needs of Veterans
in the future. VA will consider what Veterans may need through
understanding the services that Veterans have accessed in the past and
are projected to need and prefer in the future. VA will also consider
how and where Veterans wish to receive services, including in
ambulatory settings, hospitals, in the community, through telehealth,
and through innovative models and modalities.
Accessibility of Care for Veterans (Access)
Commitment Statement: We intend to provide Veterans with an
accessible, whole health experience, with services thoughtfully
designed to meet their needs. We will do this by making the services
and support Veterans need accessible through locations, models and
modalities that most benefit them and match their needs and
preferences.
Access Criterion: The recommendation maintains or improves Veteran
access to care.
Access Sub-Criteria:
The recommendation:
[cir] Aligns VA points of care and services with projected Veteran
need across demographics and geography;
[cir] Retains or improves Veterans' ability to access VA care;
[cir] Ensures Veterans are provided a range of health care options
and the opportunity to choose care they trust, based on their
preferences, throughout their lifetime;
[cir] Enables VA to serve as the coordinator of each Veteran's
health care whether provided within or beyond VA;
[cir] Considers health equity (i.e., demographics);
[cir] Reflects consideration of factors underpinning observed
access patterns (e.g., rurality and other social determinants of
health); and
[cir] Incorporates trends in the evolution of U.S. health care.
When applying the `access' criterion, VA will consider how a
recommendation will impact the convenience of care provided to Veterans
in the future. Key components of access include the time it takes to
receive care and the barriers and accelerators to receiving care, such
as distance or availability of technology.
Impact on Mission
Commitment Statement: VA is committed to delivering best-in-class
care throughout Veterans' lifetimes. This means positioning the VA
health care system at the leading edge of the health care industry in
education, research and national emergency preparedness.
Impact on Mission Criterion: The recommendation provides for VA's
second, third and fourth statutory missions of education, research and
emergency preparedness.
Impact on Mission Sub-Criteria:
The recommendation:
[cir] Aligns resources to VA's education, research and emergency
preparedness missions across demographics and geography;
[cir] Education: Maintains or augments VA's ability to execute its
education mission;
[cir] Research: Maintains or augments VA's ability to execute its
research mission;
[cir] Emergency Preparedness: Maintains or augments VA's ability to
execute its emergency preparedness mission;
[cir] Considers health equity (i.e., demographics);
[cir] Reflects consideration of factors underpinning observed
mission impacts of education, research and emergency preparedness
efforts (e.g., rurality and other social determinants of health; and
[cir] Incorporates trends in the evolution of U.S. health care.
The `impact on mission' criterion allows VA to consider how a
recommendation will impact our ability to execute our statutory
missions of education, research and emergency preparedness in support
of Veterans and the nation.
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Providing the Highest Quality Whole Health Care (Quality)
Commitment Statement: VA is committed to providing Veterans with a
high-quality, whole health care system that delivers an excellent
experience of care and optimal health outcomes. VA will deliver the
same high quality, evidence-based standards of care regardless of
where, or by which modality, their care is received.
Quality Criterion: The recommendation considers the quality and
delivery of health care services available to Veterans, including the
experience, safety and appropriateness of care.
Quality Sub-Criteria:
The recommendation:
[cir] Ensures the highest possible quality of care across
demographics and geography;
[cir] Promotes recruitment of top clinical and non-clinical talent;
[cir] Maintains or enhances Veteran experience;
[cir] Considers health equity (i.e., demographics);
[cir] Reflects consideration of factors underpinning observed
quality patterns (e.g., rurality and other social determinants of
health); and
[cir] Incorporates trends in the evolution of U.S. health care.
When applying the `quality' criterion, VA will consider how a
recommendation will impact the quality of care for Veterans. Quality in
health care is measured through metrics and ratings assessed by federal
and commercial health care entities. VA will consider the care needs
and preferences of Veterans in order to provide optimal experience,
safety, and outcomes.
Effective Use of Resources for Veteran Care (Cost Effectiveness)
Commitment Statement: VA is committed to optimizing our health care
system through the effective use and sharing of resources, including
staffing, space, infrastructure and funding, with the goal of providing
Veterans with the best health care and outcomes. We will actively and
mindfully manage our resources, allowing us to provide services and
support that effectively match Veterans' needs and preferences while
putting their health and empowerment at the center of system design.
Cost Effectiveness Criterion: The recommendation provides a cost-
effective means by which to provide Veterans with modern health care.
Cost Effectiveness Sub-Criteria:
The recommendation:
[cir] Reflects stewardship of taxpayer dollars by optimizing
investments and resources for Veterans;
[cir] Recognizes potential savings or efficiencies that may free
resources for more impactful investment for Veterans;
[cir] Considers the value of Veteran and employee experience,
innovation, and other intangible elements of value;
[cir] Considers health equity (i.e., demographics);
[cir] Reflects consideration of factors underpinning observed cost
patterns (e.g., rurality and other social determinants of health); and
[cir] Incorporates trends in the evolution of U.S. health care.
When applying the `cost effectiveness' criterion, VA will consider
whether a recommendation optimizes funding for Veteran care.
Ensuring a Safe Environment of Care (Sustainability)
Commitment Statement: VA is committed to providing Veterans a safe
and welcoming environment of care. Our goal is for Veterans to feel
safe physically, mentally, socially and emotionally when in our care.
We commit to providing standard and complementary types of care for our
unique Veteran population in an equitable and inclusive environment. We
will do this by ensuring points of care are modern and inviting, with
an expert workforce and care options designed to meet them where they
are in their health journey.
Sustainability Criterion: The recommendation creates a sustainable
health care delivery system for Veterans.
Sustainability Sub-Criteria:
The recommendation:
[cir] Aligns investment in care and services with Veteran need
across demographics and geography;
[cir] Reflects stewardship of taxpayer dollars by creating a
sustainable infrastructure system for Veterans;
[cir] Enables recruitment and retention of top clinical and non-
clinical talent;
[cir] Considers health equity (i.e., demographics);
[cir] Reflects consideration of factors underpinning observed
access patterns (e.g., rurality and other social determinants of
health); and
[cir] Incorporates trends in the evolution of U.S. health care.
When applying the `sustainability' criterion, VA will consider how
a recommendation impacts our ability to offer Veterans a welcoming and
safe care environment that meets modern health care standards and
ensures sustainability for future generations of Veterans.
Signing Authority
Dat P. Tran, Acting Secretary of Veterans Affairs, approved this
document on January 26, 2021, 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.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
the Secretary, Department of Veterans Affairs.
[FR Doc. 2021-02138 Filed 2-1-21; 8:45 am]
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