Emergent Suicide Care rule (2023)
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The Emergent Suicide Care rule is a significant rule issued by the U.S. Department of Veterans Affairs (VA) effective March 20, 2023, that required the VA to reimburse or pay for emergent suicide care for certain veterans. This rule was in accordance with the Veterans Comprehensive Prevention, Access to Care, and Treatment Act of 2020.[1]
Timeline
The following timeline details key rulemaking activity:
- March 20, 2023: The comment period closed.[1]
- January 17, 2023: The VA issued the interim final rule and it took effect. The VA also opened the comment period.[1]
Background
The VA enacted the Emergent Suicide Care rule without notice of the proposed rulemaking, per the Administrative Procedure Act that says "when an agency for good cause finds... that notice and public procedure thereon are impracticable, unnecessary, or contrary to the public interest,” they are not required to issue notice of a proposed rule. The VA, citing the National Health and Resilience in Veterans Study, concluded that the COVID-19 pandemic has increased suicidal risk factors for veterans; the number of calls to the Veterans Crisis Line increased by 22% between 2019 and 2022. The VA said it was against public interest to wait to enact this rule, which aimed to alleviate financial burdens from veterans facing psychological distress and to encourage veterans to seek help by eliminating a financial barrier.[1]
Summary of the rule
The following is a summary of the rule from the rule's entry in the Federal Register:
| “ | The Department of Veterans Affairs (VA) amends its medical regulations to implement section 201 of the Veterans Comprehensive Prevention, Access to Care, and Treatment Act of 2020, which directs VA to furnish, reimburse, and pay for emergent suicide care for certain individuals, to include the provision of emergency transportation necessary for such care.[1][2] | ” |
Summary of provisions
The following is a summary of the provisions from the rule's entry in the Federal Register:[1]
| “ | Emergent Suicide Care
§ 17.1200 Purpose and scope. (a) Purpose. Sections 17.1200 through 17.1230 implement VA's authority under 38 U.S.C. 1720J to provide emergent suicide care. (b) Scope. If an individual is eligible under § 17.1210, VA will provide emergent suicide care under §§ 17.1200 through 17.1230 and not under other regulations in title 38 CFR through which emergent or other care could be provided. Eligibility under § 17.1210, however, does not affect eligibility for other care under chapter 17 of title 38, U.S.C. § 17.1205 Definitions. For purposes of sections §§ 17.1200 through 17.1230: Acute suicidal crisis means an individual was determined to be at imminent risk of self-harm by a trained crisis responder or health care provider. Crisis residential care means emergent suicide care provided in a residential facility other than a hospital (that is not a personal residence) that provides 24-hour medical supervision. Crisis stabilization care means, with respect to an individual in acute suicidal crisis, care that ensures, to the extent practicable, immediate safety and reduces: the severity of distress; the need for urgent care; or the likelihood that the severity of distress or need for urgent care will increase during the transfer of that individual from a facility at which the individual has received care for that acute suicidal crisis. Emergent suicide care means crisis stabilization care provided to an individual eligible under § 17.1210 pursuant to a recommendation from the Veterans Crisis Line or when such individual has presented at a VA or non-VA facility in an acute suicidal crisis. Health care provider means a VA or non-VA provider who is licensed to practice health care by a State and who is performing within the scope of their practice as defined by a State or VA practice standard. Health-plan contract has the same meaning as that term is defined in 38 U.S.C. 1725(f)(2). Inpatient care means care received by an individual during their admission to a hospital. Non-VA facility means a facility that meets the definition in 38 U.S.C. 1701(4). Outpatient care means care received by an individual that is not described within the definition of “inpatient care” under this section to include telehealth, and without the provision of room or board. Provide, provided, or provision means furnished directly by VA, paid for by VA, or reimbursed by VA. Trained crisis responder means an individual who responds to emergency situations in the ordinary course of their employment and therefore can be presumed to possess adequate training in crisis intervention. VA facility means a facility that meets the definition in 38 U.S.C. 1701(3). Veterans Crisis Line means the hotline under 38 U.S.C. 1720F(h). § 17.1210 Eligibility. (a) An individual is eligible for emergent suicide care if they were determined to be in acute suicidal crisis and are either of the following: (1) A veteran as that term is defined in 38 U.S.C. 101; or (2) An individual described in 38 U.S.C. 1720I(b). (b) VA may initiate provision of emergent suicide care for an individual in acute suicidal crisis prior to that individual's status under paragraphs (a)(1) or (2) of this section being confirmed. If VA is unable to confirm an individual's status under paragraph (a)(1) or (2) of this section, VA shall bill that individual for the emergent suicide care provided consistent with 38 CFR 17.102(a) and (b)(1). § 17.1215 Periods of emergent suicide care. (a) Unless extended under paragraph (b) of this section, emergent suicide care will be provided to an individual eligible under § 17.1210 from the date acute suicidal crisis is determined to exist: (1) Through inpatient care or crisis residential care, as long as the care continues to be clinically necessary, but not to exceed 30 calendar days; or (2) If care under paragraph (a)(1) of this section is unavailable, or if such care is not clinically appropriate, through outpatient care, as long as the care continues to be clinically necessary, but not to exceed 90 calendar days. (b) VA may extend a period under paragraph (a) of this section if such period is ending and VA determines that an individual continues to require care to address the effects of the acute suicidal crisis. § 17.1220 Provision of emergent suicide care. (a) Emergent suicide care will be provided to individuals eligible under § 17.1210 only if it is determined by a health care provider to be clinically necessary and in accord with generally accepted standards of medical practice. (b) Prescription drugs, biologicals, and medical devices that may be provided during a period of emergent suicide care under § 17.1215 must be approved by the Food and Drug Administration, unless the treating VA facility or non-VA facility is conducting formal clinical trials under an Investigational Device Exemption or an Investigational New Drug application, or the drugs, biologicals, or medical devices are prescribed under a compassionate use exemption. § 17.1225 Payment or reimbursement for emergent suicide care. (a) VA will not charge individuals eligible under § 17.1210 who receive care under § 17.1215 any costs for such care. (1) For care furnished in a VA facility, VA will not charge any copayment or other costs that would otherwise be applicable under 38 CFR chapter 17. (2) For care furnished in a non-VA facility, VA will either: (i) Pay for the care furnished, subject to paragraphs (b) through (d) of this section; or (ii) Reimburse an individual eligible under § 17.1210 for the costs incurred by the individual for the care received, subject to paragraph (e) of this section. (b) The amounts paid by VA for care furnished under paragraph (a)(2)(i) of this section will: (1) Be established pursuant to contracts, or agreements, or (2) If there is no amount determinable under paragraph (b)(1) of this section, VA will pay the following amounts: (i) For care furnished in Alaska for which a VA Alaska Fee Schedule (see 38 CFR 17.56(b)) code and amount exists: The lesser of billed charges or the VA Alaska Fee Schedule amount. The VA Alaska Fee Schedule only applies to physician and non-physician professional services. The schedule uses the Health Insurance Portability and Accountability Act mandated national standard coding sets. (ii) For care not within the scope of paragraph (b)(2)(i) of this section, and for which an applicable Medicare fee schedule or prospective payment system amount exists for the period in which the service was provided (without any changes based on the subsequent development of information under Medicare authorities) (hereafter “Medicare rate”): The lesser of billed charges or the applicable Medicare rate. (iii) For care not within the scope of paragraph (b)(2)(i) of this section, furnished by a facility currently designated as a Critical Access Hospital (CAH) by CMS, and for which a specific amount is determinable under the following methodology: The lesser of billed charges or the applicable CAH rate verified by VA. Data requested by VA to support the applicable CAH rate shall be provided upon request. Billed charges are not relevant for purposes of determining whether a specific amount is determinable under the above methodology. (iv) For care not within the scope of paragraphs (b)(2)(i) through (iii) of this section and for which there exists a VA Fee Schedule amount for the period in which the service was performed: The lesser of billed charges or the VA Fee Schedule amount for the period in which the service was performed, as posted on VA.gov. (v) For care not within the scope of paragraphs (b)(2)(i) through (iv) of this section: Billed charges. (c) Payment by VA under paragraph (a)(2)(i) of this section shall, unless rejected and refunded within 30 calendar days of receipt, extinguish all liability on the part of the individual who received care. Neither the absence of a contract or agreement between the Secretary and the provider nor any provision of a contact, agreement, or assignment to the contrary shall operate to modify, limit, or negate this requirement. (d) To obtain payment under paragraph (a)(2)(i) of this section, a health care provider or non-VA facility must: (1) If the care was provided pursuant to a contract, follow all applicable provisions and instructions in such contract to receive payment. (2) If the care was not provided pursuant to a contract with VA, submit to VA a standard billing form and other information as required no later than 180 calendar days from the date services were furnished. Submission instructions, to include required forms and other information, can be found at www.va.gov. (e) To obtain reimbursement under paragraph (a)(2)(ii) of this section, an individual eligible under § 17.1210 must submit to VA a standard billing form and other information as required no later than 180 calendar days from the date the individual paid for emergent suicide care. Submission instructions, to include required forms and other information, can be found at www.va.gov. (f) VA may recover costs of care it has paid or reimbursed under paragraphs (a)(2)(i) and (ii) of this section, other than for such care for a service-connected disability, if the individual who received the care is entitled to the care (or payment of the care) under a health plan contract. Such recovery procedures will generally comply with 38 CFR 17.100-17.106. § 17.1230 Payment or reimbursement of emergency transportation. (a) VA will pay or reimburse for the costs of emergency transportation (i.e., ambulance or air ambulance) to a VA facility or non-VA facility for the provision of emergent suicide care to an eligible individual under § 17.1210. (1) For claims submitted by providers of emergency transportation, rates of payment for emergency transportation under paragraph (a) of this section will be calculated as they are under 38 CFR 17.1005(a)(1) through (3). For purposes of this section, the term “emergency treatment” in § 17.1005(a) should be read to mean “emergency transportation.” (2) For claims submitted by an individual eligible under § 17.1210, VA will reimburse for emergency transportation under paragraph (a) of this section the costs such individual incurred for the emergency transportation. (b) To obtain payment for emergency transportation furnished under paragraph (a) of this section, the provider of such transportation must submit to VA a standard billing form and other information as required no later than 180 calendar days from the date transportation was furnished. Submission instructions, to include required forms and other information, can be found at www.va.gov. (c) To obtain reimbursement for emergency transportation under paragraph (a) of this section, an individual eligible under § 17.1210 must submit to VA a standard billing form and other information as required no later than 180 calendar days from the date the individual paid for such transportation. Submission instructions, to include required forms and other information, can be found at www.va.gov. (d) Payment by VA under paragraph (a) of this section shall, unless rejected and refunded within 30 calendar days of receipt, extinguish all liability on the part of the individual who received care. No provision of a contact, agreement, or assignment to the contrary shall operate to modify, limit, or negate this requirement.[2] |
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Significant impact
- See also: Significant regulatory action
Executive Order 12866, issued by President Bill Clinton (D) in 1993, directed the Office of Management and Budget (OMB) to determine which agency rules qualify as significant rules and thus are subject to OMB review.
Significant rules have had or might have a large impact on the economy, environment, public health, or state or local governments. These actions may also conflict with other rules or presidential priorities. Executive Order 12866 further defined an economically significant rule as a significant rule with an associated economic impact of $100 million or more. Executive Order 14094, issued by President Joe Biden (D) on April 6, 2023, made changes to Executive Order 12866, including referring to economically significant rules as section 3(f)(1) significant rules and raising the monetary threshold for economic significance to $200 million or more.[1]
The text of the Emergent Suicide Care rule states that OMB deemed this rule significant, but not economically significant:
| “ | The Office of Information and Regulatory Affairs has determined that this rule is a significant regulatory action under Executive Order 12866.[2] | ” |
Text of the rule
The full text of the rule is available below:[1]>
See also
External links
Footnotes
