Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program

CourtVeterans Affairs Department
Citation87 FR 13806
Published date10 March 2022
Record Number2022-04477
Federal Register, Volume 87 Issue 47 (Thursday, March 10, 2022)
[Federal Register Volume 87, Number 47 (Thursday, March 10, 2022)]
                [Rules and Regulations]
                [Pages 13806-13844]
                From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
                [FR Doc No: 2022-04477]
                [[Page 13805]]
                Vol. 87
                Thursday,
                No. 47
                March 10, 2022
                Part IIDepartment of Veterans Affairs-----------------------------------------------------------------------38 CFR Part 78Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program;
                Final Rule
                Federal Register / Vol. 87 , No. 47 / Thursday, March 10, 2022 /
                Rules and Regulations
                [[Page 13806]]
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                DEPARTMENT OF VETERANS AFFAIRS
                38 CFR Part 78
                RIN 2900-AR16
                Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program
                AGENCY: Department of Veterans Affairs.
                ACTION: Interim final rule.
                -----------------------------------------------------------------------
                SUMMARY: The Department of Veterans Affairs (VA) is issuing this
                interim final rule to implement a new authority requiring VA to
                implement a three-year community-based grant program to award grants to
                eligible entities to provide or coordinate the provision of suicide
                prevention services to eligible individuals and their families for the
                purpose of reducing veteran suicide. This rulemaking specifies grant
                eligibility criteria, application requirements, scoring criteria,
                constraints on the allocation and use of the funds, and other
                requirements necessary to implement this grant program.
                DATES:
                 Effective date: This interim final rule is effective on April 11,
                2022.
                 Comments: Comments must be received on or before May 9, 2022.
                ADDRESSES: Comments must be submitted through www.Regulations.gov.
                Comments received will be available at regulations.gov for public
                viewing, inspection or copies.
                FOR FURTHER INFORMATION CONTACT: Sandra Foley, Supervisory Grants
                Manager--Suicide Prevention Program, Office of Mental Health and
                Suicide Prevention, 11MHSP, 810 Vermont Avenue NW, Washington, DC
                20420, 202-502-0002 (This is not a toll-free telephone number),
                [email protected].
                SUPPLEMENTARY INFORMATION:
                Background on Governing Statute and Public Input
                 On October 17, 2020, the Commander John Scott Hannon Veterans
                Mental Health Care Improvement Act of 2019, Public Law (Pub. L.) 116-
                171 (the Act), was enacted in law. Section 201 of the Act, codified as
                a note to section 1720F of title 38, United States Code (U.S.C.),
                mandated VA establish the Staff Sergeant Parker Gordon Fox Suicide
                Prevention Grant Program (SSG Fox SPGP), a community-based grant
                program that would support certain eligible entities to provide or
                coordinate the provision of suicide prevention services to eligible
                individuals and their families. Section 201 of the Act specified which
                entities are eligible for grants and those individuals eligible to
                receive suicide prevention services, defined the suicide prevention
                services that may be provided, described grant application
                requirements, and explained instances in which eligible entities must
                refer individuals to VA for additional care, among other requirements.
                This grant program is authorized for a period of three years starting
                on the date on which the first grant is awarded. The maximum amount per
                grant is capped by section 201(c)(2) of the Act at $750,000 per fiscal
                year.
                 Section 201 of the Act required that VA consult with certain
                entities to assist in developing a plan for the design and
                implementation of the provision of grants; establishing criteria for
                the selection of eligible entities; developing a framework for
                collecting and sharing information about grantees; and developing
                measures and metrics to be used by grantees to determine the
                effectiveness of programming provided pursuant to the suicide
                prevention services grant.
                 Section 201(h)(3) of the Act specifically required VA consult with
                the following entities: (1) Veterans service organizations; (2)
                National organizations (including national organizations that advocate
                for the needs of individuals with or at risk of behavioral health
                conditions; and those that represent mayors, unions, first responders,
                chiefs of police and sheriffs, governors, a territory of the United
                States, or a Tribal alliance) representing potential community partners
                of eligible entities in providing supportive services to address the
                needs of eligible individuals and their families; (3) National
                organizations representing members of the Armed Forces; (4) National
                organizations that represent counties; (5) Organizations with which VA
                has a current memorandum of agreement or understanding related to
                mental health or suicide prevention; (6) State departments of veterans
                affairs; (7) National organizations representing members of the Reserve
                Components of the Armed Forces; (8) National organizations representing
                members of the Coast Guard; (9) Organizations, including institutions
                of higher education, with experience in creating measurement tools for
                purposes of advising the Secretary on the most appropriate existing
                measurement tool or protocol for VA to utilize; (10) The National
                Alliance on Mental Illness; (11) A labor organization (as such term is
                defined in section 7103(a)(4) of title 5, U.S.C.); (12) The Centers for
                Disease Control and Prevention (CDC), the Substance Abuse and Mental
                Health Services Administration (SAMHSA), and the President's Roadmap to
                Empower Veterans and End a National Tragedy of Suicide (PREVENTS) Task
                Force; and such other organizations as the Secretary deems appropriate.
                 On April 1, 2021, VA published a Notice of Request for Information
                on the Department of Veterans Affairs' Staff Sergeant Parker Gordon Fox
                Suicide Prevention Grant Program (RIN 2900-AR16) in the Federal
                Register (FR), requesting information and comments from the public to
                meet the requirements for consultation in the Act. 86 FR 17268 (April
                1, 2021). Through this notice, VA asked the public, including those
                organizations listed in the previous paragraph, to comment on various
                aspects of the suicide prevention services grant program, such as
                distribution and selection of grants; administration of the grant
                program, including development of measures and metrics; training and
                technical assistance; referrals for care; degrees of risk of suicide
                and processes for determining degrees of risk of suicide; and
                nontraditional and innovative approaches and treatment practices that
                may be appropriate under this grant program. VA directly contacted
                various organizations that met the categories of organizations listed
                under section 201(h)(3) of the Act to notify them that VA was seeking
                input through this FR notice. VA received 124 comments, including
                comments outside the scope of the questions posed. Many commenters
                expressed support for awarding grants to entities with prior relevant
                experience. Many commenters also provided suggestions for training and
                technical assistance related to suicide prevention, evaluation and
                reporting requirements, and referrals to VA for further care.
                Additionally, numerous commenters provided suggestions for non-
                traditional and innovative treatment and services under this grant
                program. The comments received from this notice are publicly available
                online at www.regulations.gov.
                 On May 11, 2021, VA published a Notice of Listening Sessions on the
                Department of Veterans Affairs Staff Sergeant Parker Gordon Fox Suicide
                Prevention Grant Program (RIN 2900-AR16) in the FR notifying the public
                of two related listening sessions, which were held on May 25, 2021 and
                May 26, 2021. 86 FR 25938 (May 11, 2021). The topics for the first
                listening session included distribution and selection of grants,
                administration of the grant program, and training and technical
                assistance. The topics for the second listening session included
                referrals for
                [[Page 13807]]
                care, risk of suicide, and suicide prevention services. Similar to the
                April 1, 2021 notice, this second notice included specific questions
                for the public to consider and upon which to comment at the listening
                session. VA directly contacted various organizations that met the
                categories of organizations listed under section 201(h)(3) of the Act
                to notify them that VA was seeking input through these listening
                sessions. Thirty-two individuals presented oral comments at these
                listening sessions. Many of these comments were similar to those
                received in response to the April 1, 2021 notice. Commenters expressed
                support for awarding grants to entities with demonstrated experiences
                and capacity to implement evidence-based programs. Commenters also
                expressed support for awarding grants to entities that have experience
                working with veterans at risk of suicide and have or plan to have
                culturally competent care. Additionally, commenters supported awarding
                grants to entities that utilized validated assessment tools and
                entities that had area partnerships (including at local, regional, and
                national levels) as well as with VA. Many commenters also provided
                suggestions for training and for assessment tools. Additionally,
                numerous commenters provided suggestions for non-traditional and
                innovative treatment and services under this grant program. The
                transcript for these listening sessions is publicly available online at
                www.regulations.gov.
                 VA appreciates the time and attention from commenters who shared
                their opinions on how to implement section 201 of the Act. In
                developing this interim final rule, VA considered the feedback received
                from the April 1, 2021, Notice of Request for Information on the
                Department of Veterans Affairs' Staff Sergeant Parker Gordon Fox
                Suicide Prevention Grant Program (RIN 2900-AR16) and the listening
                sessions held on May 25, 2021, and May 26, 2021.
                Part 78 of Title 38, Code of Federal Regulations
                 Through this interim final rule, VA is establishing and
                implementing, in new part 78 of title 38, Code of Federal Regulations
                (CFR), SSG Fox SPGP required by section 201 of the Act. Establishment
                of this new part ensures organization and clarity for implementation of
                this new grant program. The interim final rule is establishing
                regulations authorizing VA to award suicide prevention services grants
                to eligible entities who will provide or coordinate the provision of
                suicide prevention services to eligible individuals and their families.
                 Consistent with section 201 of the Act, part 78 is titled the Staff
                Sergeant Parker Gordon Fox Suicide Prevention Grant Program.
                78.0 Purpose and Scope
                 Section 78.0 of this IFR explains the purpose and scope of new part
                78.
                 Paragraph (a) states that this part implements SSG Fox SPGP with
                the purpose of reducing veteran suicide by expanding suicide prevention
                programs for veterans through the award of suicide prevention services
                grants to eligible entities to provide or coordinate the provision of
                suicide prevention services to eligible individuals and their families.
                This purpose is consistent with section 201(a)(1) and (b) of the Act.
                Section 201(a)(1) states that its purpose is to reduce veteran suicide
                through a community-based grant program to award grants to eligible
                entities to provide or coordinate suicide prevention services to
                eligible individuals and their families. Section 201(b) states that the
                Secretary shall provide financial assistance through grants to eligible
                entities to provide or coordinate the provision of services to eligible
                individuals and their families to reduce the risk of suicide.
                 Paragraph (b) states that suicide prevention services covered by
                this part are those services that address the needs of eligible
                individuals and their families and are necessary for improving the
                mental health status and wellbeing and reducing the suicide risk of
                eligible individuals and their families. This broadly defines the
                intended effects of the program, is consistent with the intent of the
                law, and ensures that those services authorized under this grant
                program are those that meet the purpose of this grant program--to
                reduce suicide risk.
                78.5 Definitions
                 Section 78.5 contains the definitions for key terms that apply to
                new part 78 and to any Notice of Funding Opportunity (NOFO) for this
                grant program. The definitions are listed in alphabetical order,
                beginning with the definition of applicant.
                 VA is defining applicant to mean an eligible entity that submits an
                application for a suicide prevention services grant announced in a
                NOFO. VA is defining applicant in this manner since only an eligible
                entity (as that term is defined later in this rulemaking) that submits
                an application for a suicide prevention services grant under part 78
                will be able to apply for such a grant. This is based on a plain
                language understanding of the term ``applicant'' and is consistent with
                how VA defines this in the Supportive Services for Veteran Families
                (SSVF) Program. See 38 CFR 62.2. As explained in Sec. 78.15, VA will
                require submission of an application similar to other grant programs
                that VA administers.
                 Direct Federal financial assistance means Federal financial
                assistance received by an entity selected by the Government or a pass-
                through entity as defined in 38 CFR 50.1(d) to provide or carry out a
                service (e.g., by contract, grant, or cooperative agreement). This is
                used for purposes of Sec. 78.130 and is consistent with how VA defines
                this in the Homeless Providers Grant and Per Diem Program and the SSVF
                Program (see Sec. Sec. 61.64(b)(2) and 62.62, respectively).
                 Eligible child care provider is defined to mean a provider of child
                care services for compensation, including a provider of care for a
                school-age child during non-school hours, that (1) is licensed,
                regulated, registered, or otherwise legally operating, under State and
                local law; and (2) satisfies the State and local requirements,
                applicable to the child care services the provider provides. This is
                consistent with the definition of eligible child care provider that VA
                uses in the SSVF Program. See 38 CFR 62.2. This definition of eligible
                child care provider is also consistent with the broader definition used
                by the Department of Health and Human Services (HHS) for its Child Care
                and Development Block grant. See 42 U.S.C. 9859(2).
                 This term is used for purposes of Sec. 78.80(h), which includes
                among suicide prevention services certain child care services. Pursuant
                to section 201(q)(11)(A)(ix)(VIII) of the Act, child care services (not
                to exceed $5,000 per family of an eligible individual per fiscal year)
                are authorized as assistance with emergent needs under this grant
                program, and VA explains in Sec. 78.80(h) the limitations on such
                services and payments.
                 Eligible entity is defined to mean an entity that meets the
                definition of an eligible entity in section 201(q) of Public Law 116-
                171. VA refers to section 201(q) of Public Law 116-171 rather than
                include the exact definition from subsection (q)(3) of section 201, as
                this would allow VA to immediately implement any changes made by
                Congress to that definition without requiring amendment to these
                regulations. Currently, under section 201(q)(3) of the Act, an eligible
                entity must be one of the following: (1) An incorporated private
                institution or foundation (i) no part of the net earnings of which
                incurs to the benefit of any member, founder, contributor, or
                [[Page 13808]]
                individual, and (ii) that has a governing board that would be
                responsible for the operation of the suicide prevention services
                provided under this part; (2) a corporation wholly owned and controlled
                by an organization meeting the requirements of clauses (i) and (ii)
                above; (3) an Indian tribe; (4) a community-based organization that can
                effectively network with local civic organizations, regional health
                systems, and other settings where eligible individuals and their
                families are likely to have contact; or (5) a State or local
                government.
                 Eligible individual is defined to mean an individual that meets the
                requirements of Sec. 78.10(a). As discussed later in this rulemaking,
                Sec. 78.10(a) describes the eligibility criteria to be an eligible
                individual under part 78. These criteria are consistent with section
                201(q)(4) of the Act.
                 Family is defined to mean any of the following: A parent, spouse,
                child, sibling, step-family member, extended family member, and any
                other individual who lives with the eligible individual. This is
                consistent with section 201(q)(6) of the Act.
                 Grantee is defined to mean an eligible entity that is awarded a
                suicide prevention services grant under part 78. This is consistent
                with how VA defines grantee for other VA grant programs and the plain
                meaning of this term. See, e.g., 38 CFR 62.2; 38 CFR 61.1.
                 Indian tribe is defined to mean an Indian tribe as defined in 25
                U.S.C. 4103. Section 4103(13)(A) of title 25, U.S.C., defines Indian
                tribe in general to mean a tribe that is a Federally or a State
                recognized tribe. Section 4103(13)(B) of title 25, U.S.C., further
                defines Federally recognized tribe to mean any Indian tribe, band,
                nation, or other organized group or community of Indians, including any
                Alaska Native village or regional or village corporation as defined in
                or established pursuant to the Alaska Native Claims Settlement Act (43
                U.S.C. 1601 et seq.), that is recognized as eligible for the special
                programs and services provided by the United States to Indians because
                of their status as Indians pursuant to the Indian Self-Determination
                and Education Assistance Act (25 U.S.C. 450 et seq.). Section
                4103(13)(C) of title 25, U.S.C., also defines State recognized tribe to
                mean any tribe, band, nation, pueblo, village, or community--(1) that
                has been recognized as an Indian tribe by any State; and (2) for which
                an Indian Housing Authority has, before the effective date under
                section 705, entered into a contract with the Secretary of Housing and
                Urban Development pursuant to the United States Housing Act of 1937 (42
                U.S.C. 1437 et seq.) for housing for Indian families and has received
                funding pursuant to such contract within the 5-year period ending upon
                such effective date. This definition also includes certain conditions
                set forth in 25 U.S.C. 4103(13)(C)(ii). This definition of Indian tribe
                is consistent with section 201(q)(7) of the Act.
                 Indirect Federal financial assistance means Federal financial
                assistance in which a service provider receives program funds through a
                voucher, certificate, agreement or other form of disbursement, as a
                result of the genuine, independent choice of a participant. This is
                used for purposes of Sec. 78.130 and is consistent with how VA defines
                this in the VA Homeless Providers Grant and Per Diem Program and the
                SSVF Program. See Sec. Sec. 61.64(b)(2) and 62.62, respectively.
                 Section 201(d)(1)(A)(iv) of the Act authorizes VA to prioritize
                distribution of grants to medically underserved areas. While section
                201 of the Act does not define medically underserved areas, VA is
                defining medically underserved areas consistent with the definition of
                medically underserved population that is set forth in other Federal
                law. Section 254b(b)(3)(A) of 42 U.S.C. defines medically underserved
                population to mean the population of an urban or rural area designated
                by the HHS Secretary as an area with a shortage of personal health
                services or a population group designated by the HHS Secretary as
                having a shortage of such services. While section 254b(b)(3)(A) uses
                the term medically underserved population, section 254b(b)(3) generally
                establishes a process for identifying medically underserved areas that
                are designated by the United States Health Resources and Services
                Administration (HRSA), the HHS sub-agency responsible for issuing data
                and maps on medically underserved populations and areas in a combined
                manner. See HRSA's maps on medically underserved areas/populations at
                https://www.hrsa.gov/maps/quick-maps?config=mapconfig/MUA.jsondevelops.
                See also, https://data.hrsa.gov/tools/shortage-area/mua-find. Because
                42 U.S.C. 254b(b)(3) may be amended in the future, VA is not
                incorporating the actual definition in proposed Sec. 78.5. Rather, VA
                is defining medically underserved areas to mean an area that is
                designated as a medically underserved population under 42 U.S.C.
                254b(b)(3). This term is defined consistently with its use in 38 U.S.C.
                7601 note, and is widely known, commonplace, and established. It also
                allows VA to defer to the expertise of another agency that specializes
                in analyzing and identifying medically underserved areas and
                populations.
                 VA is defining Notice of Funding Opportunity (NOFO) to mean a
                Notice of Funding Opportunity published on grants.gov in accordance
                with Sec. 78.110. This is consistent with how VA defines a similar
                term, Notice of Funding Availability (NOFA), in other grant regulations
                and with the plain meaning of this term. This definition references
                Sec. 78.110, which explains that VA will publish a NOFO when funds for
                suicide prevention services grants are available and indicates the type
                of information that must be included in the application for this
                program. Pursuant to 2 CFR 200.203, all NOFOs must be posted on
                grants.gov.
                 Participant is defined to mean an eligible individual or their
                family who is receiving suicide prevention services for which they are
                eligible from a grantee. This definition is necessary for purposes of
                understanding part 78 and SSG Fox SPGP.
                 VA is defining rural communities to mean those communities
                considered rural according to the Rural-Urban Commuting Area (RUCA)
                system as determined by the United States Department of Agriculture
                (USDA). This is consistent with section 201(q)(9) of the Act. VA will
                use this term and its definition in Sec. 78.30 for purposes of
                prioritizing the distribution of grants to rural communities pursuant
                to section 201(d)(1)(A)(i) of the Act. For more information on RUCA,
                please refer to https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/.
                 VA is defining State to mean any of the several States of the
                United States, the District of Columbia, the Commonwealth of Puerto
                Rico, any territory or possession of the United States, or any agency
                or instrumentality of a State exclusive of local governments. This is
                identical to most of the definition of the same term for the SSVF
                Program (see Sec. 62.2), except that we do not include here the
                exception that is present in the SSVF regulations to public and Indian
                housing agencies under the United States Housing Act of 1937, as that
                portion of the definition is not relevant to the suicide prevention
                grant program established under these regulations. This definition is
                understood by VA and grantees.
                 Suicide prevention services is defined consistent with the
                definition of this term in section 201(q)(11) of the Act. VA is setting
                forth each of the suicide prevention services in their own individual
                sections (see 38 CFR 78.45 through 78.90) for clarity. Thus, VA is
                defining suicide prevention services to
                [[Page 13809]]
                include the following services provided to address the needs of a
                participant: (1) Outreach as specified under Sec. 78.45, (2) baseline
                mental health screening as specified under Sec. 78.50, (3) education
                as specified under Sec. 78.55, (4) clinical services for emergency
                treatment as specified under Sec. 78.60, (5) case management services
                as specified under Sec. 78.65, (6) peer support services as specified
                under Sec. 78.70, (7) assistance in obtaining VA benefits as specified
                under Sec. 78.75, (8) assistance in obtaining and coordinating other
                public benefits and assistance with emergent needs as specified under
                Sec. 78.80, (9) nontraditional and innovative approaches and treatment
                practices as specified under Sec. 78.85, and (10) other services as
                specified under Sec. 78.90.
                 VA is defining suicide prevention services grant to mean a grant
                awarded under part 78. This definition is based on the plain language
                understanding of this term.
                 VA is defining suicide prevention services grant agreement to mean
                the agreement executed between VA and a grantee as specified under
                Sec. 78.115. This definition is based on the plain language
                understanding of this term and is consistent with the definition of
                similar terms in other VA regulations. See Sec. 62.2.
                 Suspension is defined to mean an action by VA that temporarily
                withdraws VA funding under a suicide prevention services grant, pending
                corrective action by the grantee or pending a decision to terminate the
                suicide prevention services grant by VA. Suspension of a suicide
                prevention services grant is a separate action from suspension under VA
                regulations or guidance implementing Executive Orders 12549 and 12689,
                ``Debarment and Suspension.'' This definition is consistent with the
                SSVF grant program's definition for this term. See Sec. 62.2. However,
                with regards to implementing Executive Orders 12549 and 12689, VA has
                added the language, guidance, as not all of VA's implementations of
                Executive Orders are regulatory.
                 Territories is defined to mean the territories of the United
                States, including Puerto Rico, Guam, the U.S. Virgin Islands, American
                Samoa, and the Northern Mariana Islands. This is consistent with how
                the Federal government commonly describes U.S. territories (in
                comparison to States). This term is necessary to define as it is used
                in the Act, although not defined within section 201, and in Sec.
                78.30. VA is defining this term as VA has authority under section
                201(d)(1)(A)(iii) of the Act to prioritize distribution of grants to
                territories of the United States. As explained in Sec. 78.30, VA may
                prioritize territories, along with other areas such as medically
                underserved areas and tribal lands, for purposes of this grant program.
                While there is some overlap between this definition and the definition
                of State above--all territories are considered States under part 78 (as
                provided for under 38 U.S.C. 101(20)), but not all States are
                territories--the specific application of this potential priority under
                Sec. 78.30(d)(2)(iii) reflects the only meaningful distinction between
                the two terms.
                 Veteran is defined to mean veteran under 38 U.S.C. 101(2). This is
                based on section 201(q)(4)(A) of the Act. Section 101 of title 38,
                U.S.C., defines veteran as a person who served in the active military,
                naval, air, or space service, and who was discharged or released
                therefrom under conditions other than dishonorable. This term is used
                for purposes of peer support services in part 78.
                 The term Veterans Crisis Line is defined to mean the toll-free
                hotline for veterans in crisis and their families and friends
                established under 38 U.S.C. 1720F(h). This is consistent with section
                201(q)(12) of the Act. This term is used in Sec. 78.30(d)(2)(vi) for
                purposes of prioritizing selection of applicants for this grant
                program.
                 VA is defining withholding to mean that payment of a suicide
                prevention services grant will not be paid until such time as VA
                determines that the grantee provides sufficiently adequate
                documentation and/or actions to correct a deficiency for the suicide
                prevention services grant. This term is defined in this manner, as it
                is intended to provide a general description of how this term is used
                in 2 CFR part 200, which governs VA grant programs including the SSG
                Fox SPGP. This term relates to withholding payment of a suicide
                prevention services grant pursuant to Sec. 78.160, described later in
                this rulemaking.
                78.10 Eligible Individuals
                 Section 78.10 explains the criteria for determining the eligibility
                of individuals under part 78 consistent with the definition of eligible
                individual in section 201(q)(4) of the Act. As explained in the
                definitions section, an eligible individual is an individual that meets
                the requirements of Sec. 78.10(a).
                 Paragraph (a) states that to be an eligible individual under this
                part, a person must meet criteria that determine that person is at risk
                of suicide and further meet the definition of eligible individual in
                section 201 of Public Law 116-171. VA refers to section 201(q) of
                Public Law 116-171 rather than include the exact definition from
                subsection (q)(4), as this would allow VA to immediately implement any
                changes made by Congress to that definition without requiring amendment
                to these regulations. Subsection (q)(4) of section 201 currently states
                that an eligible individual must be one of the following: (1) A veteran
                as defined in 38 U.S.C. 101, (2) an individual described in 38 U.S.C.
                1720I(b), or (3) an individual described in 38 U.S.C. 1712A(a)(1)(C)(i)
                through (iv).
                 Section 101(2) of title 38, U.S.C. defines veteran as a person who
                served in the active military, naval, air, or space service, and who
                was discharged or released therefrom under conditions other than
                dishonorable. Section 1720I(b) requires VA furnish to certain former
                member of the Armed Forces (1) an initial mental health assessment and
                (2) mental health care or behavioral health care services authorized
                under 38 U.S.C. chapter 17 that are required to treat the mental or
                behavioral health care needs of these former service members, including
                risk of suicide or harming others. Such former members of the Armed
                Forces, including reserve components, are those who (1) while serving
                in the active military, naval, air, or space service, were discharged
                or released therefrom under a condition that is not honorable but not a
                dishonorable discharge or a discharge by court-martial; (2) are not
                enrolled in VA health care; and either served in the Armed Forces for a
                period of more than 100 cumulative days and were deployed in a theater
                of combat operations, in support of a contingency operation, or in an
                area at a time during which hostilities were occurring in that area
                during such service, including by controlling an unmanned aerial
                vehicle from a location other than such theater or area; or (3) while
                serving in the Armed Forces, were the victim of a physical assault of a
                sexual nature, a battery of a sexual nature, or sexual harassment.
                Section 1712A details the individuals to whom VA is required to furnish
                readjustment counseling. These include any individual who is a veteran
                or member of the Armed Forces, including a member of a reserve
                component of the Armed Forces, who served on active duty in a theater
                of combat operations or an area at a time during which hostilities
                occurred in that area; any individual who is a veteran or member of the
                Armed Forces, including a member of a reserve component of the Armed
                Forces, who provided direct emergency medical or mental health care, or
                mortuary services to the
                [[Page 13810]]
                causalities of combat operations or hostilities, but who at the time
                was located outside the theater of combat operations or area of
                hostilities; any individual who is a veteran or member of the Armed
                Forces, including a member of a reserve component of the Armed Forces,
                who engaged in combat with an enemy of the United States or against an
                opposing military force in a theater of combat operations or an area at
                a time during which hostilities occurred in that area by remotely
                controlling an unmanned aerial vehicle, notwithstanding whether the
                physical location of such veteran or member during such combat was
                within such theater of combat operations or area; and any individual
                who is a veteran or member of the Armed Forces, including a member of a
                reserve component of the Armed Forces, who served on active service in
                response to a national emergency or major disaster declared by the
                President or in the National Guard of a State under orders of the chief
                executive of that State in response to a disaster or civil disorder in
                such State.
                 For purposes of eligible individuals, paragraph (b) defines risk of
                suicide. Consistent with section 201(q)(8) of the Act, risk of suicide
                means exposure to, or the existence of, any of the following factors,
                to any degree, that increase the risk of suicidal ideation and/or
                behaviors: (1) Health risk factors, including mental health challenges,
                substance use disorder, serious or chronic health conditions or pain,
                and traumatic brain injury; (2) environmental risk factors, including
                prolonged stress, stressful life events, unemployment, homelessness,
                recent loss, and legal or financial challenges; and (3) historical risk
                factors, including previous suicide attempts, family history of
                suicide, and history of abuse, neglect or trauma, including military
                sexual trauma.
                 While section 201(q)(8) uses the language, substance abuse, VA
                instead uses the language, substance use disorder, in paragraph (b) to
                reduce stigma and discrimination related to substance use. For purposes
                of paragraph (b), an individual will not be required to have a
                diagnosis of substance use disorder. This definition is necessary to
                meet the intent and purpose of the program to provide grants to
                eligible entities to provide or coordinate the provision of suicide
                prevention services to eligible individuals who are considered at risk
                of suicide and is consistent with feedback received from commenters
                during consultation. This provision is thus used for determining
                eligibility of eligible individuals for receipt of suicide prevention
                services under this grant program. VA notes that this definition is
                overly inclusive, as to define this term otherwise could exclude
                individuals who may need these critical services prior to a crisis.
                 Section 201(q)(8)(iii)(III) includes a history of trauma as a
                potential historical risk factor for suicide. VA interprets this, for
                purposes of this grant program, to include military sexual trauma. VA
                notes that survivors of military sexual trauma are at higher risk of
                suicide. See the National Military and Veteran Suicide Prevention
                Strategy (https://www.whitehouse.gov/wp-content/uploads/2021/11/Military-and-Veteran-Suicide-Prevention-Strategy.pdf). This reference
                is not intended to exclude other forms of trauma, but rather serves as
                an example of how this language is interpreted by VA.
                 As noted in the previous paragraph, section 201(q)(8) of the Act
                defines risk of suicide based on exposure to, or the existence of,
                certain factors, to a degree determined by the Secretary pursuant to
                regulations. Thus, section 201(q)(8)(A) of the Act authorized VA to
                determine the degree required for these risk factors, and VA will
                require that grantees use the health, environmental, and historical
                risk factors just described and the impact thereof to determine the
                degree of risk of suicide for eligible individuals. This is explained
                in a note to paragraph (b). The note also explains that the degree of
                risk depends on the presence of one or more suicide risk factors and
                the impact of those factors on an individual's mental health and
                wellbeing.
                 VA will require grantees determine an individual's degree of risk
                of suicide through the use of a screening tool approved by the
                Department. To assist grantees in determining risk of suicide (and thus
                an individual's eligibility for suicide prevention services), VA will
                provide grantees with a screening tool that will determine the presence
                of suicide risk. This tool will be a validated tool that can be
                administered by non-clinical staff and/or a self-report tool such as
                the Columbia Suicide Severity Rating Scale. See https://cssrs.columbia.edu. VA is not identifying the specific tool in
                regulation, as the screening tool may change due to an evolving field
                of study and VA may approve the use of several tools. This tool is
                subject to the Paperwork Reduction Act because it is an information
                collection. As such, the public may comment on this screening tool as
                part of the information collections associated with this rulemaking,
                and VA welcomes public comment on use of this screening tool. VA will
                ensure that grantees are provided this tool before providing or
                coordinating suicide prevention services under this grant program and
                have access to publicly available training materials to support the
                grantees' use of this tool.
                 VA would not require a clinical tool to be used to determine
                eligibility because many of the authorized suicide prevention services
                are not clinical in nature. To require a clinical tool to determine the
                degree of risk of suicide would severely limit the number of applicants
                and grantees for this grant program, which VA does not believe was the
                intent of section 201 of the Act. This screening tool is not the same
                as the tool that will be used for purposes of the baseline mental
                health screening conduct pursuant to Sec. 78.50, which is described
                later in this discussion. This screening tool will assess health,
                environmental, and historical risk factors and the impact thereof. An
                individual's degree of risk of suicide can vary hour to hour, day to
                day, and thus, requiring a certain degree of risk of suicide to be
                eligible for services could result in the ineligibility of individuals
                whom this program was intended to cover. This is a non-clinical tool
                that will be used by grantees regardless of whether their staff are
                licensed, independent clinical providers.
                78.15 Applications for Suicide Prevention Services Grants
                 Under Sec. 78.15(a), applicants must submit a complete application
                package for a suicide prevention services grant under this new part 78,
                as described in the NOFO. Paragraph (a) also explains the information
                that must be included in the application to be considered a complete
                suicide prevention services grant application package. This list of
                items described in paragraph (a) is derived from section 201(d)(2),
                (f), and (h)(2) of the Act, and it ensures that VA can adequately
                evaluate applicants for the purposes of this grant program (that is, to
                provide or coordinate the provision of suicide prevention services to
                reduce the risk of suicide among eligible individuals).
                 The following information must be included in the application
                package: (1) Documentation evidencing the experience of the applicant
                and any identified community partners in providing or coordinating the
                provision of suicide prevention services to eligible individuals and
                their families; (2) a description of the suicide prevention services
                proposed to be provided by the applicant and the identified need for
                those services; (3) a detailed plan
                [[Page 13811]]
                describing how the applicant proposes to coordinate or deliver suicide
                prevention services to eligible individuals, including (i) if the
                applicant is a State or local government or an Indian tribe, an
                identification of the community partners, if any, with which the
                applicant proposes to work in delivering such services, (ii) a
                description of the arrangements currently in place between the
                applicant and such partners with regard to the provision or
                coordination of the provision of suicide prevention services, (iii) an
                identification of how long such arrangements have been in place, (iv) a
                description of the suicide prevention services provided by such
                partners that the applicant must coordinate, if any, and (v) an
                identification of local VA suicide prevention coordinators and a
                description of how the applicant will communicate with local VA suicide
                prevention coordinators; (4) a description of the location and
                population of eligible individuals and their families proposed to be
                provided suicide prevention services; (5) an estimate of the number of
                eligible individuals at risk of suicide and their families proposed to
                be provided suicide prevention services, including the percentage of
                those eligible individuals who are not currently receiving care
                furnished by VA; (6) evidence of measurable outcomes related to
                reductions in suicide risk and mood-related symptoms utilizing
                validated instruments by the applicant (and the proposed partners of
                the applicant, if any) in providing suicide prevention services to
                individuals at risk of suicide, particularly to eligible individuals
                and their families; (7) a description of the managerial and
                technological capacity of the applicant to (i) coordinate the provision
                of suicide prevention services with the provision of other services,
                (ii) assess on an ongoing basis the needs of eligible individuals and
                their families for suicide prevention services, (iii) coordinate the
                provision of suicide prevention services with VA services for which
                eligible individuals are also eligible, (iv) tailor (i.e., provide
                individualized) suicide prevention services to the needs of eligible
                individuals and their families, (v) seek continuously new sources of
                assistance to ensure the continuity of suicide prevention services for
                eligible individuals and their families as long as the eligible
                individuals are determined to be at risk of suicide, and (vi) measure
                the effects of suicide prevention services provided by the applicant or
                partner organization on the lives of eligible individuals and their
                families who receive such services provided by the organization using
                pre- and post-evaluations on validated measures of suicide risk and
                mood-related symptoms; (8) clearly defined objectives for the provision
                of suicide prevention services; (9) a description and physical address
                of the primary location of the applicant; (10) a description of the
                geographic area the applicant plans to serve during the grant award
                period for which the application applies; (11) if the applicant is a
                State or local government or an Indian tribe, the amount of grant funds
                proposed to be made available to community partners, if any, through
                agreements; (12) a description of how the applicant will assess the
                effectiveness of the provision of grants under this part; (13) an
                agreement to use the measures and metrics provided by VA for the
                purposes of measuring the effectiveness of the programming to be
                provided in improving mental health status, wellbeing, and reducing
                suicide risk and suicide deaths of eligible individuals and their
                families; (14) an agreement to comply with and implement the
                requirements of this part throughout the term of the suicide prevention
                services grant; and (15) any additional information as deemed
                appropriate by VA.
                 The items in paragraph (a) generally are consistent with
                requirements in section 201(f) and (h)(2) of the Act and are necessary
                for VA to properly evaluate whether applicants will be able to meet the
                requirements in this part to provide or coordinate suicide prevention
                services if they are awarded a grant under this new part 78. While
                language similar to paragraph (a)(1) does not appear in section 201(f)
                or (h)(2) of the Act, it does appear in section 201(d)(2) of the Act,
                where VA is instructed to give preference to eligible entities that
                have demonstrated the ability to provide or coordinate suicide
                prevention services. Paragraph (a)(14) similarly does not appear
                explicitly in section 201(f) or (h)(2) of the Act, but section
                201(f)(1) authorizes the Secretary to include such commitments as the
                Secretary considers necessary to carry out this section. Compliance
                with the requirements of the new part 78 is such a commitment. Section
                201(f)(2)(M) also authorizes the Secretary to include additional
                application criteria as the Secretary considers appropriate. Again, an
                agreement to comply with the requirements of this part is an
                appropriate obligation. VA notes that technical assistance with
                completing applications will be available for applicants, including how
                to determine the required estimates under paragraph (a)(5).
                 For purposes of paragraph (a)(7)(iv), VA notes that tailoring
                (i.e., providing individualized) suicide prevention services to the
                needs of eligible individuals and their families, includes how services
                would be tailored (provided) to priority sub-populations, including but
                not limited to survivors of military sexual trauma, women veterans
                under the age of 35, and other groups identified in the National
                Military and Veteran Suicide Prevention Strategy. See, https://www.whitehouse.gov/wp-content/uploads/2021/11/Military-and-Veteran-Suicide-Prevention-Strategy.pdf. Such services may include but not be
                limited to care and support with military sexual trauma, employment,
                and housing.
                 For purposes of paragraphs (a)(4) and (a)(10) of this section, as
                well as for other sections of this rule, VA is requiring applicants to
                provide information regarding the location of eligible individuals and
                a description of the geographic area the applicant plans to serve.
                Section 201(d)(1)(C) of the Act permits VA to provide grants to
                eligible entities that furnish services to eligible individuals and
                their families in geographically dispersed areas; this authority is
                discretionary. At this time, VA is choosing not to exercise this
                authority. While there may be some applicants who desire to serve a
                population that is geographically dispersed, it would be logistically
                difficult for such organizations to provide necessary services, and a
                number of other provisions in section 201 of the Act clearly state
                requirements related to geographic locations. For example, section
                201(d)(1)(A) and (B) of the Act permit and require, respectively, VA to
                prioritize grants to geographic areas, such as rural communities,
                Tribal lands, territories of the United States, medically underserved
                areas, areas with a high number or percentage of minority veterans or
                women veterans, areas with a high number or percentage of calls to the
                Veterans Crisis Line, and areas that have experienced high rates of
                suicide by eligible individuals. Each of these descriptions clearly
                requires a geographic description or scope. Other provisions of section
                201 of the Act also clearly refer to geographic areas. For example,
                section 201(f)(2)(I) requires applicants to provide ``a description of
                the geographic area the eligible entity plans to serve during the grant
                award period for which the application applies.'' Section 201(h)(2)(A)
                requires the Secretary to develop a framework for
                [[Page 13812]]
                collecting and sharing information about grantees for purposes of
                improving the services available for eligible individuals and their
                families set forth by locality, among other factors. Section
                201(q)(11)(A)(iv), which defines suicide prevention services, includes
                the provision of clinical services for emergency treatment as a suicide
                prevention service, and these services would generally need to be
                furnished in-person. Additionally, applicants seeking grant funds to
                support non-geographically focused populations would likely have higher
                overhead and administrative costs due to the need to conduct outreach
                across a broader area, maintain information and connections with more
                VA facilities and other entities, and deliver services in different
                locations. Higher overhead costs mean fewer available resources
                dedicated to the delivery of suicide prevention services, which, given
                the population being served by this program, would be less than ideal
                as those resources could be better utilized elsewhere to serve this
                unique population. Given the short period of time in which VA is
                authorized to operate this program, only three years from the date of
                the first grant award (see section 201(j) of the Act), it would be
                prudent to ensure these resources are used to maximal effect.
                 This does not prohibit organizations that function at a national
                level or in multiple geographic areas from applying for a grant in one
                or more location as long as they meet the requirements necessary to
                implement suicide prevention services for the specific geographic area.
                However, VA notes that many of the suicide prevention services,
                particularly emergent services for those at immediate risk of suicide,
                could not be furnished by entities without a physical presence in the
                area or could only be furnished at a greater risk of the loss of life
                of a participant and the services required by law and by the targeted
                population require engagement with local VA medical centers and
                community.
                 Paragraph (b) states that subject to funding availability, grantees
                may submit an application for renewal of a suicide prevention services
                grant if the grantee's program will remain substantially the same. To
                apply for renewal of a suicide prevention services grant, a grantee
                must submit to VA a complete suicide prevention services grant renewal
                application package, as described in the NOFO. This is consistent with
                how VA administers the SSVF Program under part 62 and will allow VA to
                renew grants in an efficient and timely manner so that there will be no
                lapse in the provision or coordination of the provision of suicide
                prevention services by grantees to participants from year to year.
                 Paragraph (c) establishes that VA may request in writing that an
                applicant or grantee, as applicable, submit other information or
                documentation relevant to the suicide prevention services grant
                application. This is authorized by section 201(f)(1) of the Act, which
                permits VA to require such commitments and information as the Secretary
                considers necessary to carry out this section. This provides VA with
                the authority to request additional information that may not be in the
                initial or renewal application but will be necessary for VA to properly
                evaluate the applicant or grantee for a suicide prevention services
                grant.
                78.20 Threshold Requirements Prior To Scoring Suicide Prevention
                Services Grant Applicants
                 Pursuant to section 201(h) of the Act, VA, in consultation with
                various entities listed in the Act, is required to establish selection
                criteria for this new grant program. As explained earlier in this
                rulemaking, VA conducted this consultation through an FR notice and
                through listening sessions. See 86 FR 17268 (April 1, 2021); 86 FR
                25938 (May 11, 2021). Section 78.20 sets forth the threshold
                requirements for further scoring applicants pursuant to Sec. 78.25.
                 Section 78.20 explains that VA will only score applicants for
                suicide prevention services grants if they meet certain threshold
                requirements as set forth in paragraphs (a) through (g).
                 These threshold requirements in paragraphs (a) through (g) include
                that the application is filed within the time period established in the
                NOFO, and any additional information or documentation requested by VA
                under Sec. 78.15(c) is provided within the time frame established by
                VA; the application is completed in all parts; the activities for which
                the suicide prevention services grant is requested are eligible for
                funding under this part; the applicant's proposed participants are
                eligible to receive suicide prevention services under this part; the
                applicant agrees to comply with the requirements of this part; the
                applicant does not have an outstanding obligation to the Federal
                government that is in arrears and does not have an overdue or
                unsatisfactory response to an audit; and the applicant is not in
                default by failing to meet the requirements for any previous Federal
                assistance.
                 These are minimum requirements that must be met before VA will
                score applications, and applicants will be able to understand whether
                they meet these threshold requirements in advance of application
                submission. VA anticipates this will reduce the amount of time and
                resources that VA will dedicate to evaluating and scoring applicants
                for suicide prevention services grants. These requirements are
                authorized by section 201(f)(1) of the Act, which permits VA to include
                such commitments and information as the Secretary considers necessary
                to carry out section 201. These threshold requirements are consistent
                with other VA grant programs, such as the Homeless Providers Grant and
                Per Diem Program and the SSVF Program (See Sec. Sec. 61.12 and 62.21,
                respectively).
                78.25 Scoring Criteria for Awarding Grants
                 Section 201(h)(1) of the Act requires the VA Secretary to establish
                criteria for the selection of eligible entities that have submitted
                applications for a suicide prevention services grant. Consistent with
                that authority, in Sec. 78.25, VA sets forth the criteria to be used
                to score applicants who are applying for a suicide prevention services
                grant, as the amount of funds available for grants each year will be
                limited and VA may receive a higher number of applicants than there are
                available grant funds. Scoring criteria will allow VA to award grants
                to those who are most qualified and will ensure that VA administers
                grants in a manner consistent with the intent and purpose of SSG Fox
                SPGP. The scoring criteria were developed based on the scoring criteria
                used for other VA grant programs, such as the SSVF Program (38 CFR
                62.22) and Homeless Providers Grant and Per Diem Program (38 CFR
                61.13), but tailored to the purpose and requirements of section 201 of
                the Act. These criteria are consistent with feedback received from
                commenters during consultation that expressed support for awarding
                grants to entities with prior experience working with veterans,
                including those at risk of suicide, entities that had partnerships
                within the area and with VA, and entities that have or plan to have
                culturally competent care related to veterans.
                 While this section does not include specific point values for each
                criterion, the regulation provides that such point values will be set
                forth in the NOFO. This will allow VA to retain flexibility in
                determining those point values each year of the grant program in the
                event that such point values need to change. At all times, VA will
                comply with the requirements in section 201(d) of the Act regarding
                prioritization of and
                [[Page 13813]]
                preference for certain applicants. VA will establish in each NOFO a
                minimum number of points that an applicant must be awarded, both in
                each category and in total, to ensure that all applicants who are
                awarded a grant can perform all necessary elements of the program, and
                that their program as a whole is likely to be successful. These dual
                requirements will ensure that VA is giving preference to applicants
                that have demonstrated the ability to provide or coordinate suicide
                prevention services, as required by section 201(d)(2) of the Act.
                 Paragraph (a) explains that VA will award points based on the
                background, qualifications, experience, and past performance, of the
                applicant and any community partners identified by the applicant in the
                suicide prevention services grant application, as demonstrated by the
                following: (1) Background and organizational history, (2) staff
                qualifications, and (3) organizational qualifications and past
                performance, including experience with veterans services. These scoring
                criteria are important to determine whether applicants have the
                necessary and relevant background and experience to administer a
                suicide prevention services program consistent with section 201 of the
                Act and 38 CFR part 78.
                 In scoring an applicant's background and organizational history
                under paragraph (a)(1), VA will consider the applicant's, and any
                identified community partners', background and organizational history
                that are relevant to the program; whether the applicant, and any
                identified community partners, maintain organizational structures with
                clear lines of reporting and defined responsibilities; and whether the
                applicant, and any identified community partners, have a history of
                complying with agreements and not defaulting on financial obligations.
                 Under paragraph (a)(2), VA will score applications based on staff
                qualifications. This includes determining the applicant's staff's, and
                any identified community partners' staff's, experience providing to, or
                coordinating services for, eligible individuals and their families; and
                the applicant's staff's, and any identified community partners'
                staff's, experience administering programs similar to SSG Fox SPGP.
                 VA will score applicants' organizational qualifications and past
                performance, including experience with veterans services, under
                paragraph (a)(3) based on the applicant's, and any identified community
                partners', organizational experience providing suicide prevention
                services to or coordinating suicide prevention services for eligible
                individuals and their families; the applicant's, and any identified
                community partners', organizational experience coordinating services
                for eligible individuals and their families among multiple
                organizations and Federal, State, local, and tribal governmental
                entities; the applicant's, and any identified community partners',
                organizational experience administering a program similar in type and
                scale to SSG Fox SPGP to eligible individuals and their families; and
                the applicant's, and any identified community partners', organizational
                experience working with veterans and their families.
                 Examples of experience VA will consider under paragraph (a) may
                include but are not limited to participation in VA-SAMHSA's Governors'
                and Mayors' Challenges to Prevent Suicide among service members,
                veterans, and their families; endorsement by a local or State public
                health agency or State Department of Veterans Affairs recognizing care
                coordination experience; and participation in the SSVF Program and
                Homeless Providers Grant and Per Diem Program.
                 While experience providing suicide prevention services to eligible
                individuals and their families is an important scoring criterion, we
                acknowledge that some organizations may not have such experience.
                However, they may have experience working with veterans and their
                families (other than those eligible under this grant program) for
                purposes other than those related to this grant program. Having an
                understanding of the veteran population as a whole and demonstrating
                related military cultural competency is critical for ensuring that the
                needs of eligible individuals and their families are met through this
                grant program. This is consistent with the feedback received through
                consultation as described earlier. This also allows VA the ability to
                award points at various levels (local, regional, State) since the types
                of experience entities at those levels may have can vary. Thus,
                pursuant to paragraph (a), VA will score applicants not only based on
                their experience administering similar programs to the suicide
                prevention grant programs and providing or coordinating services to
                eligible individuals, but also based on their experience working with
                veterans and their families.
                 Paragraph (b) explains that VA will award points based on the
                applicant's program concept and suicide prevention services plan. The
                scoring criteria under this paragraph are important for VA to use to
                determine whether the applicant has a fully developed program concept
                and plan that will meet the requirements of section 201 of the Act and
                38 CFR part 78.
                 VA will award points based on the applicant's program concept and
                suicide prevention services plan, as demonstrated by the (1) need for
                the program, (2) outreach and screening plan, (3) program concept, (4)
                program implementation timeline, (5) coordination with VA, (6) ability
                to meet VA's requirements, goals and objectives for SSG Fox SPGP, and
                (7) capacity to undertake the program.
                 VA will score the need for the program under paragraph (b)(1) based
                on whether the applicant has shown a need amongst eligible individuals
                and their families in the area where the program will be based and
                whether the applicant demonstrates an understanding of the unique needs
                for suicide prevention services of eligible individuals and their
                families.
                 VA will score the outreach and screening plan under paragraph
                (b)(2) based on whether the applicant has a feasible plan for outreach,
                consistent with Sec. 78.45, and referral to identify and assist
                individuals and their families that may be eligible for suicide
                prevention services and are most in need of suicide prevention
                services, has a feasible plan to process and receive participant
                referrals, and has a feasible plan to assess and accommodate the needs
                of incoming participants. As part of scoring the application based on
                whether the applicant has a feasible plan to assess and accommodate the
                needs of incoming participants, VA notes that this may include but not
                be limited to addressing language assistance needs of limited English
                proficient individuals, physical accommodation needs, and
                transportation needs.
                 Pursuant to paragraph (b)(3), VA will score the program concept
                based on whether the applicant's program concept, size, scope, and
                staffing plan are feasible; and that the applicant's program is
                designed to meet the needs of eligible individuals and their families.
                 VA will score the program implementation timeline under paragraph
                (b)(4) based on whether the applicant's program will be implemented in
                a timely manner and suicide prevention services will be delivered to
                participants as quickly as possible and within a specified timeline. VA
                will also score this based on whether the applicant has a feasible
                staffing plan in place to meet the
                [[Page 13814]]
                applicant's program timeline or has existing staff to meet such
                timeline.
                 Pursuant to paragraph (b)(5), VA will score applications based on
                whether the applicant has a feasible plan to coordinate outreach and
                services with local VA facilities.
                 In paragraph (b)(6), scoring criteria will include the applicant's
                ability to meet VA's requirements, goals, and objectives for SSG Fox
                SPGP. This will be based on whether the applicant demonstrates
                commitment to ensuring that its program meets VA's requirements, goals,
                and objectives for SSG Fox SPGP as identified in this part and the
                NOFO.
                 Under paragraph (b)(7), VA will score the applicant's capacity,
                including staff resources, to undertake its program.
                 Paragraph (c) states that VA will award points based on the
                applicant's quality assurance and evaluation plan, as demonstrated by
                (1) program evaluation, (2) monitoring, (3) remediation, and (4)
                management and reporting. This scoring criterion is important to ensure
                that applicants can meet any requirements for evaluation, monitoring,
                and reporting contained in section 201 of the Act and in 38 CFR part
                78, will help VA ensure that grant funds are being used appropriately,
                and will assist in the overall assessment of the grant program.
                 Pursuant to paragraph (c)(1), VA will evaluate whether the
                applicant has created clear, realistic, and measurable goals that
                reflect SSG Fox SPGP's aim of reducing and preventing suicide among
                veterans against which the applicant's program performance can be
                evaluated; and the applicant has a clear plan to continually assess the
                program.
                 The scoring criterion regarding monitoring in paragraph (c)(2) will
                be based on whether the applicant has adequate controls in place to
                regularly monitor the program, including any community partners, for
                compliance with all applicable laws, regulations, and guidelines;
                whether the applicant has adequate financial and operational controls
                in place to ensure the proper use of suicide prevention services grant
                funds; and the applicant has a feasible plan for ensuring that the
                applicant's staff and any community partners are appropriately trained
                and stay informed of SSG Fox SPGP policy, evidence-informed suicide
                prevention practices, and the requirements of 38 CFR part 78.
                 Paragraph (c)(3) includes the scoring criterion of remediation.
                This will be based on whether the applicant has an appropriate plan to
                establish a system to remediate non-compliant aspects of the program if
                and when they are identified.
                 Under paragraph (c)(4), VA will score the applicant's management
                and reporting, based on whether the applicant's program management team
                has the capability and a system in place to provide to VA timely and
                accurate reports at the frequency set by VA.
                 Paragraph (d) explains that VA will award points based on the
                applicant's financial capability and plan, as demonstrated by (1)
                organizational finances (based on whether the applicant, and any
                identified community partners, are financially stable); and (2)
                financial feasibility of the program (based on whether the applicant
                has a realistic plan for obtaining all funding required to operate the
                program for the time period of the suicide prevention services grant;
                and whether the applicant's program is cost-effective and can be
                effectively implemented on-budget). These are important to ensure that
                funds are not provided to an applicant that is financially unstable and
                that the applicant has considered the costs and necessary funding for
                administering a suicide prevention services program.
                 Paragraph (e) states that VA will award points based on the
                applicant's area linkages and relations, as demonstrated by the (1)
                area linkages, (2) past working relationships, (3) local presence and
                knowledge, and (4) integration of linkages and program concept. This is
                important for ensuring success of the suicide prevention services
                program. VA acknowledges that applicants may not have these existing
                linkages and relationships, but they may develop them over time. VA
                also acknowledges that certain applicants without these existing
                linkages and relationships may obtain them through community partners
                with which they enter into agreements (to the extent permitted under
                section 201 of the Act).
                 Area linkages under paragraph (e)(1) will include whether the
                applicant has a feasible plan for developing or relying on existing
                linkages with Federal (including VA), State, local, and tribal
                government agencies, and private entities for the purposes of providing
                additional services to participants within a given geographic area.
                 Past working relationships under paragraph (e)(2) will include
                whether the applicant (or applicant's staff), and any identified
                community partners (or community partners' staff), have fostered
                similar and successful working relationships and linkages with public
                and private organizations providing services to veterans or their
                families in need of services. These may include but not be limited to
                housing assistance non-profits and agencies, housing crisis centers,
                local food banks, employment assistance non-profits and agencies, rape
                crisis centers, and sexual assault and domestic violence programs with
                a history of serving veterans and military-connected victims of sexual
                trauma and abuse.
                 Local presence and knowledge under paragraph (e)(3) will be based
                on whether the applicant has a presence in the area to be served by the
                applicant and understands the dynamics of the area to be served by the
                applicant. This presence and knowledge does not necessarily mean the
                applicant has an address or physical office in the area, but rather
                that they are operating in the area such that they have sufficient
                knowledge of the area and that their staff has a presence in the area.
                For example, staff may travel from a nearby area to serve eligible
                individuals in the targeted area, or a national organization may have a
                local office through which it intends to make services available.
                Evaluation of whether an applicant understands the dynamics of the area
                to be served by the applicant will be based on information including
                but not limited to the applicant's description of the area, including
                mental health centers, and relationships with local mental health
                centers. These criteria under paragraph (e)(3) may be met through
                letters of support and documented coordination of care.
                 Integration of linkages and program concept under paragraph (e)(4)
                will be based on whether the applicant's linkages to the area to be
                served by the applicant enhance the effectiveness of the applicant's
                program.
                78.30 Selection of Grantees
                 Section 201(c) of the Act requires the VA Secretary to award a
                grant to each eligible entity for which the Secretary has approved an
                application to provide or coordinate the provision of suicide
                prevention services. Section 201(d) of the Act sets forth how VA may
                and shall distribute grants based on certain priorities, areas, and
                geography. Section 201(d)(2) requires the Secretary give preference to
                eligible entities that have demonstrated the ability to provide or
                coordinate suicide prevention services. Section 201(h) of the Act
                requires the Secretary to establish criteria for the selection of
                eligible entities that have submitted applications for a suicide
                prevention services grant. In accordance with these subsections of
                section 201 of the Act, 38 CFR 78.30 sets forth the process for
                selecting applicants for suicide prevention services grants, which will
                be a process similar to that of the SSVF Program (38 CFR 62.23) and the
                Homeless Providers Grant and Per
                [[Page 13815]]
                Diem Program (38 CFR 61.14 and 61.94). However, the selection process
                under Sec. 78.30 will also incorporate preference, priority, and
                distribution requirements from section 201(d) of the Act.
                 As part of the process for selecting applicants to receive suicide
                prevention services grants, paragraph (a) explains that VA will first
                score all applicants that meet the threshold requirements set forth in
                Sec. 78.20 using the scoring criteria set forth in Sec. 78.25.
                 Next, paragraph (b) states that VA will group applicants within the
                applicable funding priorities if any are set forth in the NOFO. As
                funding priorities can change annually, VA will set forth any funding
                priorities in the NOFO, which will allow VA flexibility in updating
                priorities in a quick and efficient manner every year that funds are
                available under this grant program.
                 Then, as set forth in paragraph (c), VA will rank those applicants
                that receive at least the minimum amount of total points and points per
                category set forth in the NOFO, within their respective funding
                priority group, if any. As noted above, VA will set forth the minimum
                amount of total points and points per category in the NOFO as these can
                change annually. Setting forth these points in the NOFO will provide VA
                flexibility in updating the minimum amount of points in an efficient
                and quick manner. The applicants will be ranked in order from highest
                to lowest scores, within their respective funding priority group, if
                any.
                 Paragraph (d) explains that VA will use the applicant's ranking as
                the primary basis for selection for funding. However, consistent with
                section 201(d)(1) and (d)(2) of the Act, paragraph (d) further explains
                that VA: (1) Will give preference to applicants that have demonstrated
                the ability to provide or coordinate suicide prevention services; (2)
                may prioritize the distribution of suicide prevention services grants
                to rural communities, Tribal lands, territories of the United States,
                medically underserved areas, areas with a high number or percentage of
                minority veterans or women veterans, and areas with a high number or
                percentage of calls to the Veterans Crisis Line; and (3) to the extent
                practicable, will ensure that suicide prevention services grants are
                distributed to provide services in areas of the United States that have
                experienced high rates of suicide by eligible individuals, including
                suicide attempts, to eligible entities that can assist eligible
                individuals at risk of suicide who are not currently receiving health
                care furnished by VA, and to ensure services are provided in as many
                areas as possible.
                 As explained above, pursuant to section 201(d)(2) of the Act, in
                paragraph (d)(1), VA will give preference to applicants that have
                demonstrated the ability to provide or coordinate suicide prevention
                services. This preference may be met by such experience that includes
                but is not limited to entities that are part of VA-SAMHSA's Governors'
                and Mayors' Challenge to Prevent Suicide among service members,
                veterans, and their families; entities that are part of local or State
                coalitions for suicide prevention; and entities that support suicide
                prevention services through receipt of local, State, and Federal
                funding. Additionally, entities may demonstrate this ability if they
                are currently providing or coordinating suicide prevention services
                that align with the National Strategy for Preventing Veteran Suicide,
                VA-Department of Defense (DoD) Clinical Practice Guideline for the
                Assessment and Management of Patients at Risk for Suicide, or CDC's
                Preventing Suicide: A Technical Package of Policy, Programs, and
                Practices. This is consistent with feedback received from commenters
                during consultation in which several commenters suggested awarding
                grants, or providing preference for grants, to entities with prior
                experience providing or coordinating suicide prevention services and
                programs, including those who are part of Governors' Challenges.
                 Pursuant to section 201(d)(1), VA has discretionary authority to
                prioritize the distribution of grants to rural communities, Tribal
                lands, territories of the United States, medically underserved areas,
                areas with a high number or percentage of minority veterans or women
                veterans, and areas with a high number or percentage of calls to the
                Veterans Crisis Line. This will be a consideration for the distribution
                of grants, as described in paragraph (d)(2), and is consistent with
                feedback received from commenters during consultation.
                 Due to funding limitations, VA may choose to utilize this
                discretionary authority in distributing grants. However, VA does not
                want to mandate use of this discretionary authority because it is
                important to ensure that grants can be distributed equitably across the
                country and provided to areas where the grants may be best utilized. If
                VA prioritized these areas for all awarded grants for this program, it
                may exhaust all of its funding annually with none of the grants being
                distributed to any other grantees that may also be deserving. VA does
                not want to limit itself by mandating this, but rather retain the
                discretion to distribute to these areas as warranted. As explained in
                paragraph (b) of Sec. 78.35 and in Sec. 78.110, VA would establish
                any priorities in a NOFO.
                 For purposes of this discretionary authority, VA will use the
                definitions for rural communities, Tribal lands, territories of the
                United States, and medically underserved areas in Sec. 78.5. In
                determining areas with a high number or percentage of minority veterans
                or women veterans, VA will base such determinations on the veteran
                population data from VA's National Center for Veterans Analysis and
                Statistics (NCVAS). VA will use the most recent data that NCVAS has
                published, which is made publicly available at https://www.va.gov/vetdata/veteran_population.asp. In determining areas with a high number
                or percentage of calls to the Veterans Crisis Line, VA will use
                internal data that VA maintains to determine where these areas are and
                will consider the most recent data VA has for purposes of using this
                discretionary authority when making these annual funding
                determinations. VA anticipates making this information available to the
                public and through technical assistance to grantees.
                 Consistent with section 201(d)(1)(B) of the Act, paragraph (d)(3)
                explains that to the extent practicable, VA will ensure that suicide
                prevention services grants are distributed to (1) provide services in
                areas of the United States that have experienced high rates of suicide
                by eligible individuals, including suicide attempts; and to (2)
                applicants that can assist eligible individuals at risk of suicide who
                are not currently receiving health care furnished by VA. Paragraph
                (d)(3) also explains that to the extent practicable, VA will ensure
                that suicide prevention services grants are distributed to ensure
                services are provided in as many areas as possible.
                 While the Act requires, to the extent practicable, distribution of
                grants to provide services in areas with high rates of suicide,
                including suicide attempts, by eligible individuals, VA notes that data
                on suicide attempts is generally insufficient, incomplete, and
                generally unavailable for purposes of determining areas with high rates
                of suicide. This is because this data is collected only when veterans
                report suicide attempts, and there is no requirement to report such
                attempts. Given the issues with the data on suicide attempts as
                explained above, for purposes of implementing section 201(d)(1)(B), VA
                will not utilize data on suicide attempts solely. If such data become
                available in a sufficient and complete manner, VA will utilize such
                [[Page 13816]]
                data to determine areas with high rates of suicide attempts.
                 Until and if such data become available, in order to meet the
                requirement of section 201(d)(1)(B) of the Act, VA will determine areas
                with high rates of suicide based on VA's most recently published
                National Veteran Suicide Prevention Annual Report, which is based on
                CDC's mortality and death index. This report is published annually, and
                the most recent report will be utilized by VA for purposes of paragraph
                (d)(3)(i).
                 For purposes of paragraph (d)(3)(ii) and determining whether
                applicants can assist eligible individuals at risk of suicide who are
                not currently receiving VA health care, VA will consider the
                information included in applicants' applications for this grant
                program. Such information could include, but not be limited to,
                existing arrangements (such as Memorandums of Understanding) with, or
                linkages to, VA and/or community partners in providing services to
                these individuals, plans on how the entity would coordinate with local
                VA medical facilities to identify these individuals, and plans to
                include these individuals as part of the population to be provided
                suicide prevention services if awarded a grant. VA will consider past
                and current actions as well as future plans to serve these individuals
                when determining whether to distribute a grant to an applicant that can
                assist eligible individuals at risk of suicide who are not currently
                receiving health care furnished by VA.
                 Paragraph (d)(3)(iii) allows VA, to the extent practicable, to
                ensure grants are distributed to provide services in as many areas as
                possible. This will allow VA to consider geographic location, in some
                cases, when determining distribution of grant awards. VA anticipates
                receiving applications from numerous applicants in the same location or
                serving the same population, and VA will not be able to award grants to
                every applicant due to funding limitations. If VA received five high-
                scoring applications from applicants proposing to serve eligible
                individuals in the same location, but one of those applicants alone can
                provide or coordinate suicide prevention services to the eligible
                population in that location, VA will be able to use this discretionary
                authority to distribute grants to applicants in other locations that
                can provide or coordinate services to eligible individuals and their
                families. This will allow VA to ensure that as many veterans as
                possible throughout the country are able to receive services under this
                grant program.
                 VA notes that suicide prevention services grant applications must
                include applicants' identification of the target populations and the
                area the applicant proposes to serve. VA will use this information in
                determining the distribution of suicide prevention services grants
                consistent with paragraph (d).
                 Paragraph (e) explains that subject to paragraph (d) of this
                section, which sets forth the preference and distribution requirements
                and considerations, VA will fund the highest-ranked applicants for
                which funding is available, within the highest funding priority group,
                if any. Under Sec. 78.110 (discussed later in this interim final
                rule), in order to meet the requirements of section 201 of the Act and
                the goals of SSG Fox SPGP, VA will be able to choose to include funding
                priorities in the NOFO. If VA establishes funding priorities in the
                NOFO, to the extent funding is available and subject to paragraph (d)
                of this section, VA will select applicants in the next highest funding
                priority group based on their rank within that group.
                 Similar to existing processes in other VA grant programs, such as
                the Homeless Providers Grant and Per Diem Program (38 CFR 61.63) and
                the SSVF Program (38 CFR 62.61), paragraph (f) authorizes VA to select
                an applicant for funding if that applicant is not selected because of a
                procedural error by VA. An applicant would not be required to submit a
                new application in this situation. This will ease any administrative
                burden on applications and could be used in situations where there is
                no material change in the information that would have resulted in the
                applicant's selection for a grant under this part.
                78.35 Scoring Criteria for Grantees Applying for Renewal of Suicide
                Prevention Services Grants
                 Section 201(h) of the Act requires the VA Secretary to establish
                criteria for the selection of eligible entities that have submitted
                applications for a suicide prevention services grant. Based on this
                requirement, Sec. 78.35 describes the criteria that VA will use to
                score those grantees who are applying for renewal of a grant. Such
                criteria will assist with VA's review and evaluation of grantees to
                ensure that those grantees have successful existing programs using the
                previously awarded grant funds and that they have complied with the
                requirements of this part and section 201 of the Act. The criteria in
                paragraphs (a) through (c) ensure that renewals of grants are awarded
                based on the grantee's program's success, cost-effectiveness, and
                compliance with VA goals and requirements for this grant program. This
                is consistent with how VA awards renewals of grants in the SSVF Program
                (38 CFR 62.24).
                 While this section does not include specific point values for the
                criteria, such point values will be set forth in the NOFO. This will
                allow VA to retain flexibility in determining those point values each
                year of the grant program.
                 Under paragraph (a), VA will award points based on the success of
                the grantee's program, as demonstrated by the following: (1) The
                grantee made progress in reducing veteran suicide deaths and attempts,
                reducing all-cause mortality, reducing suicidal ideation, increasing
                financial stability; improving mental health status, well-being, and
                social supports; and, engaging in best practices for suicide prevention
                services; (2) participants were satisfied with the suicide prevention
                services provided or coordinated by the grantee, as reflected by the
                satisfaction survey conducted under Sec. 78.95(d); (3) the grantee
                implemented the program by delivering or coordinating suicide
                prevention services to participants in a timely manner, consistent with
                SSG Fox SPGP policy, the NOFO, and the grant agreement; and (4) the
                grantee was effective in conducting outreach to eligible individuals
                and their families and increasing engagement of eligible individuals
                and their families in suicide prevention services, as assessed through
                an SSG Fox SPGP grant evaluation. VA notes that for purposes of
                paragraph (a)(1), best practices for suicide prevention services will
                include, but not be limited to, best practices recommended by the
                National Strategy for Preventing Veteran Suicide, VA-DoD Clinical
                Practice Guideline for the Assessment and Management of Patients at
                Risk for Suicide VA, CDC's Preventing Suicide: A Technical Package of
                Policy, Programs, and Practices, and the Surgeon General's Call to
                Action to Implement the National Strategy for Suicide Prevention.
                 Paragraph (b) states that points will be awarded based on the cost-
                effectiveness of the grantee's program, as demonstrated by the
                following: The cost per participant was reasonable and the grantee's
                program was effectively implemented on-budget. This criterion is
                important as it will assist with VA's review and evaluation of grantees
                to ensure that grantees have been fiscally responsible. This is also
                consistent with similar criterion used in the SSVF program. See 38 CFR
                62.24.
                [[Page 13817]]
                 Paragraph (c) states that VA will award points based on the extent
                to which the grantee's program complies with SSG Fox SPGP goals and
                requirements, as demonstrated by the following: The grantee's program
                was administered in accordance with VA's goals for SSG Fox SPGP as
                noted in the NOFO; the grantee's program was administered in accordance
                with all applicable laws, regulations, and guidelines; and the
                grantee's program was administered in accordance with the grantee's
                suicide prevention services grant agreement. This criterion is
                important to ensure that renewals of grants are awarded to those who
                comply with VA's goals and requirements for SSG Fox SPGP and who have
                shown competence regarding grant program implementation. This criterion
                is consistent with how VA awards renewals in the SSVF program. See 38
                CFR 62.24.
                78.40 Selection of Grantees for Renewal of Suicide Prevention Services
                Grants
                 Section 201(c) of the Act requires the VA Secretary to award a
                grant to each eligible entity for which the Secretary has approved an
                application to provide or coordinate the provision of suicide
                prevention services. Section 201(h) of the Act requires the Secretary
                to establish criteria for the selection of eligible entities that have
                submitted applications for a suicide prevention services grant. Based
                on these sections of the Act, section 78.40 describes the process for
                selecting grantees that have received suicide prevention services
                grants and are applying for renewal of such grants. It is important to
                note that this is a simpler process than awarding the initial grant.
                This is consistent with how VA awards renewals of grants in the SSVF
                Program (38 CFR 62.25).
                 Paragraph (a) explains that so long as grantees meet the threshold
                requirements in Sec. 78.20, VA will score the grantee using the
                scoring criteria set forth in Sec. 78.35. This ensures that grantees
                are still eligible to participate in the program.
                 Under paragraph (b), VA will rank those grantees who receive at
                least the minimum amount of total points and points per category set
                forth in the NOFO, and such grantees will be ranked in order from
                highest to lowest scores.
                 Paragraph (c) explains that VA will use the grantee's ranking as
                the basis for selection for funding, and that VA will fund the highest-
                ranked grantees for which funding is available.
                 In paragraph (d), at its discretion, VA may award any non-renewed
                funds to an applicant or existing grantee. If VA chooses to award non-
                renewed funds to an applicant or existing grantee, VA will first offer
                to award the non-renewed funds to the applicant or grantee with the
                highest grant score under the relevant NOFO that applies for, or is
                awarded a renewal grant in, the same area as, or a proximate area to,
                the affected area if available. Such applicant or grantee will be
                required to have the capacity and agree to provide prompt services to
                the affected area. Under Sec. 78.40, the relevant NOFO is the most
                recently published NOFO that covers the affected area, or for multi-
                year grant awards, the NOFO for which the grantee, who is offered the
                additional funds, received the multi-year award. If the first such
                applicant or grantee offered the non-renewed funds refuses the funds,
                VA will then offer to award the funds to the next highest-ranked such
                applicant or grantee, per the criteria in paragraph (d)(1) of this
                section, and continue in rank order until the non-renewed funds are
                awarded. VA notes that it does not anticipate offering multi-year
                awards at this time, but may choose to do so at a later point. To avoid
                the need for further rulemaking to authorize multi-year awards, such
                language is included now to allow for future flexibility.
                 Similar to existing processes in other VA grant programs, such as
                the Homeless Providers Grant and Per Diem Program (38 CFR 61.63) and
                the SSVF Program (38 CFR 62.61), paragraph (e) authorizes VA to select
                an existing grantee for available funding, based on the grantee's
                previously submitted renewal application, if that grantee is not
                selected for renewal because of a procedural error by VA. A grantee
                would not be required to submit a new renewal application in this
                situation. This will ease any administrative burden on grantees and
                could be used in situations where there is no material change in the
                renewal application that would have resulted in the grantee's selection
                for renewal of a grant under this part.
                78.45 Suicide Prevention Services: Outreach
                 As indicated in the definition of suicide prevention services,
                there are ten categories of suicide prevention services that can be
                provided or coordinated under this grant program. Each one has its own
                separate section in this regulation, and each will be discussed
                subsequently for clarity and readability.
                 In accordance with section 201(q)(11)(A)(i) of the Act, 38 CFR
                78.45 describes outreach, which is the first of ten sections describing
                the types of suicide prevention services that grantees may be approved
                to provide or coordinate the provision of through this grant program.
                 In paragraph (a), grantees providing or coordinating the provision
                of outreach must use their best efforts to ensure that eligible
                individuals, including those who are at highest risk of suicide or who
                are not receiving health care or other services furnished by VA, and
                their families are identified, engaged, and provided suicide prevention
                services. This is consistent with how outreach services are addressed
                in the definition of suicide prevention services in section
                201(q)(11)(A)(i) of the Act. Based on the assessment of suicide risk
                conducted by grantees to determine eligibility for services, eligible
                individuals that should be considered at highest risk of suicide are
                those with a recent suicide attempt, an active plan or preparatory
                behavior for suicide, or a recent hospitalization for suicidality.
                 Paragraph (b) explains that outreach must include active liaison
                with local VA facilities; State, local, or tribal government (if any);
                and private agencies and organizations providing suicide prevention
                services to eligible individuals and their families in the area to be
                served by the grantee. This can include, for example, local mental
                health and emergency or urgent care departments in local hospitals or
                clinics. Paragraph (b) effectively requires grantees to have a presence
                in the area to meet with individuals and organizations to create
                referral processes to the grantee, similar to VA's suicide prevention
                coordinators.
                 This section is consistent with how VA defines outreach in the SSVF
                Program (38 CFR 62.30). Outreach is important for ensuring that
                eligible individuals and families receive suicide prevention services
                to reduce the risk of suicide. Outreach also ensures that grantees are
                able to identify participants that may be eligible and in need of
                suicide prevention services. Working with local entities, including VA,
                that serve eligible individuals and their families can help grantees
                identify and reach potential participants.
                78.50 Suicide Prevention Services: Baseline Mental Health Screening
                 In accordance with section 201(q)(11)(A)(ii) of the Act, under
                Sec. 78.50(a), grantees must provide or coordinate the provision of a
                baseline mental health screening to all participants they serve at the
                time those services begin. For purposes of this grant program, all
                grantees will be required to provide, or coordinate the provision of, a
                baseline mental
                [[Page 13818]]
                screening to participants. This baseline mental health screening
                ensures that participants' mental health needs can be properly
                determined, and that suicide prevention services can be further
                tailored to meet the individual's needs.
                 This baseline mental health screening must be provided using a
                validated screening tool that assesses suicide risk and mental and
                behavioral health conditions. Information on the specific tools to be
                used will be included in the NOFO, as the tools VA will approve for
                baseline mental health screenings may vary from year to year as the
                screening tools may evolve over time due to emerging evidence through
                research. VA will provide these tools to grantees providing or
                coordinating the provision of baseline mental health screenings. These
                tools will be those that a non-clinician can administer, as many
                grantees may not be clinicians and may not be able to administer a
                clinical screening for suicide risk and mental or behavioral health
                conditions. These tools will also indicate when a participant must be
                referred for additional care, as explained in paragraph (b) of this
                section. These tools will ensure consistent screening and reporting of
                suicide risk and the need for referral for additional care or care
                coordination. It is also important to note that this is consistent with
                feedback VA received through consultation. These tools used to conduct
                the baseline mental health screening are different than the tool used
                to determine risk of suicide for purposes of eligibility and will be
                administered to participants after they have been deemed an eligible
                individual pursuant to Sec. 78.10.
                 Paragraph (b) states that if an eligible individual is at risk of
                suicide or other mental or behavioral health condition pursuant to the
                baseline mental health screening conducted under paragraph (a) of this
                section, the grantee must refer such individual to VA for care. If the
                eligible individual refuses the grantee's referral to VA, any ongoing
                clinical services provided to the eligible individual by the grantee is
                at the expense of the grantee. This is based on section 201(m)(1) and
                (3) of the Act, which explain that if a grantee determines that an
                eligible individual is at-risk of suicide or other mental or behavioral
                health condition pursuant to a baseline mental health screening, the
                grantee must refer the eligible individual to VA for additional care as
                authorized under the Act or any other provision of law, and if the
                eligible individual refuses the referral, any ongoing clinical services
                provided to the individual by the grantee will be at the grantee's
                expense. It is important to note that this is only required for
                eligible individuals and not the family of eligible individuals.
                 Section 201(m)(1) of the Act requires referral when the grantee
                determines that an eligible individual is at-risk of suicide or other
                mental health or behavioral health condition, consistent with the
                language in paragraph (b). This reflects Congressional intent that
                these referrals for care be required for those eligible individuals who
                are not only at risk of suicide but also those who have additional
                needs that require further evaluation by VA for additional care.
                Whether an eligible individual has additional needs that require
                referral for further evaluation by VA for additional care will be
                determined pursuant to the baseline mental health screening conducted
                under paragraph (a). For example, should the baseline mental health
                screening indicate a potential mental health disorder related to
                depression, the participant would need to be referred for further
                evaluation for diagnosis and treatment.
                 This baseline mental health screening will be performed by grantees
                using various VA-approved validated tools. These tools will indicate to
                the grantee if the eligible individual must be referred for additional
                evaluation and care based on the outcome of the screening for mental or
                behavioral health and suicide risk.
                 When referrals are made by grantees to VA, to the extent
                practicable, those referrals are required to be a ``warm hand-off'' to
                ensure that the eligible individual receives necessary care. This
                ``warm hand-off'' may include providing any necessary transportation to
                the nearest VA facility, assisting the eligible individual with
                scheduling an appointment with VA, and any other similar activities
                that may be necessary to ensure the eligible individual receives
                necessary care in a timely manner. This is consistent with feedback
                received from commenters during consultation. This ``warm hand-off'' is
                also consistent with other suicide prevention services that grantees
                may provide, such as assistance in obtaining any VA benefits and
                assistance with emergent needs, authorized under section
                201(q)(11)(A)(vii) and (ix), respectively.
                 To the extent that a veteran referred to VA for care is eligible
                for care in the community through VA's Community Care Program, that
                veteran may elect to receive care in the community under VA's Community
                Care Program regulations located at 38 CFR 17.4000 through 17.4040. For
                purposes of section 201(m)(3), this election would not be considered a
                refusal to receive care from VA.
                 Paragraph (b) further explains that if an eligible individual
                refuses referral to VA for care by a grantee, any ongoing clinical
                services provided to the eligible individual by the grantee are at the
                grantee's expense. This is based on section 201(m)(3) of the Act and
                ensures that grantees understand their responsibilities regarding the
                baseline mental health screening of an eligible individual.
                 Similar to the language in paragraph (b), paragraph (c) explains
                that if a participant other than an eligible individual is at risk of
                suicide or other mental or behavioral health condition pursuant to the
                baseline mental health screening conducted under paragraph (a) of this
                section, the grantee must refer such participant to appropriate health
                care services in the area. To the extent that the grantee is able to
                furnish such appropriate health care services on an ongoing basis and
                has available funding separate from funds provided under this grant
                program to do so, they would be able to furnish such services using
                those non-VA funds without being required to refer such participants to
                other services. VA requires that grantees refer those individuals (that
                is, families of eligible individuals) for further care as appropriate
                and will codify this in paragraph (c) to ensure that grantees do so.
                This ensures that those individuals' needs can be met by further care
                as needed.
                 Under paragraph (d), except as provided for under Sec. 78.60(a),
                funds provided under this grant program may not be used to provide
                clinical services to participants, and any clinical services provided
                to such individuals by the grantee are at the expense of the grantee.
                Paragraph (d) explicitly states that any clinical services provided by
                the grantee are at its expense and not VA's. Further, this language in
                the Act and in the regulation clarifies that grantees may not charge,
                bill, or otherwise hold liable eligible individuals for the receipt of
                such care or services; we interpret the phrase ``at the expense of the
                entity'' in section 201(m)(3) to bar the entity from billing, charging,
                or holding liable eligible individuals for the receipt of such care or
                services. This will also ensure that the relationship between the
                grantee and the eligible individual is not adversely affected through
                collections or other efforts. It also provides an incentive for
                grantees to work with eligible individuals to refer them to VA for
                their health care needs.
                 While grantees that provide participants ongoing clinical services
                pursuant to paragraphs (b) and (c) do so
                [[Page 13819]]
                at their own expense, this does not preclude the grantee from seeking
                to cover those expenses through other sources of funding and existing
                agreements. For example, a grantee that provides a participant with
                ongoing clinical services may bill a third-party payor, such as the
                participant's other health insurance, for the ongoing clinical services
                provided by the grantee. However, as explained in the previous
                paragraph, the grantee may not charge, bill, or otherwise hold liable
                participants for the receipt of ongoing clinical services under Sec.
                78.50. In the instance that a grantee bills a third-party payor (e.g.,
                health insurance) for ongoing clinical services provided to the
                participant, certain cost-sharing, such as copayments, imposed on the
                participant by a third-party payor, may be covered by the grantee at
                its discretion. VA does not interpret the language ``at the expense of
                the entity'' in section 201(m)(3) to preclude grantees from covering
                such copayments for participants for ongoing clinical services. VA
                would not require that grantees cover such costs, but rather, would
                permit grantees to do so if it chooses and has the funds to do so.
                However, as noted above, section 201(m)(3) bars the entity from
                billing, charging, or holding liable eligible individuals for the
                receipt of such care or services. Pursuant to Sec. 78.50(a), the
                grantee would be unable to use grant funds to cover such costs.
                 VA notes that while section 201(m)(3) is specific to eligible
                individuals, paragraph (d) applies to all participants because this
                would ensure that the potential liabilities of a family member would
                not deter a veteran from seeking services from a grantee and to make
                administration easier. VA has authority to extend this protection to
                include participants other than eligible individuals pursuant to
                section 201(f)(1) of the Act, which authorizes VA to require grantees
                to make such commitments as the Secretary considers necessary to carry
                out this section.
                78.55 Suicide Prevention Services: Education
                 In accordance with section 201(q)(11)(A)(iii), under Sec. 78.55,
                grantees providing or coordinating the provision of education must
                provide or coordinate the provision of suicide prevention education
                programs to educate communities, veterans, and families on how to
                identify those at risk of suicide, how and when to make referrals for
                care, and the types of suicide prevention resources available within
                the area. Education can include gatekeeper training, lethal means
                safety training, or specific education programs that assist with
                identification, assessment, or prevention of suicide.
                 Gatekeeper training generally refers to programs that seek to
                develop individuals' knowledge, attitudes, and skills to prevent
                suicide. Gatekeeper training is an educational course designed to teach
                clinical and non-clinical professionals or gatekeepers the warning
                signs of a suicide crisis and how to respond and refer individuals for
                care. For more information, see: http://www.sprc.org/sites/default/files/migrate/library/SPRC_Gatekeeper_matrix_Jul2013update.pdf.
                 Defining education in this manner is consistent with how education
                is administered in the community and is commonly understood by those in
                the community who work in the area of suicide prevention. Education is
                important because learning the signs of suicide risk, how to reduce
                access to lethal means, and to connect those at risk of suicide to care
                can improve understanding of suicide and has the potential to reduce
                suicide.
                78.60 Suicide Prevention Services: Clinical Services for Emergency
                Treatment
                 In accordance with section 201(q)(11)(A)(iv) of the Act, Sec.
                78.60(a) requires that grantees providing or coordinating the provision
                of clinical services for emergency treatment must provide or coordinate
                the provision of clinical services for emergency treatment of a
                participant.
                 Consistent with section 201(m)(2) and (3) of the Act, paragraph (b)
                explains that if an eligible individual is furnished clinical services
                for emergency treatment under paragraph (a) of this section and the
                grantee determines that the eligible individual requires ongoing
                services, the grantee must refer the eligible individual to VA for
                additional care. If the eligible individual refuses the grantee's
                referral to VA, any ongoing clinical services provided to the eligible
                individual by the grantee is at the expense of the grantee. This aligns
                with section 201(m)(2) of the Act, which explains that if a grantee
                furnishes clinical services for emergency treatment to an eligible
                individual and determines ongoing services are required, the grantee
                must refer the eligible individual to VA for additional care as
                authorized under the Act or any other provision of law. VA notes that
                this is only required for eligible individuals, not the family of
                eligible individuals. To the extent that an eligible individual
                referred to VA for care is eligible for care in the community through
                VA's Community Care Program, that eligible individual may elect to
                receive care in the community under VA's Community Care Program
                regulations located at 38 CFR 17.4000 through 17.4040. As stated above,
                such election is not considered a refusal to receive care from VA.
                 Subsection (m)(3) of section 201 of the Act further states that if
                an eligible individual refuses a referral by a grantee, any ongoing
                clinical services provided to the eligible individual by the grantee is
                at the grantee's expense. That is codified in paragraph (b) to ensure
                that grantees understand their responsibilities regarding clinical
                services of an eligible individual. Paragraph (b) further includes the
                same language as Sec. 78.50(d) regarding limitations on charging,
                billing, or otherwise holding liable eligible individuals for the
                receipt of such care. As explained in the discussion on Sec. 78.50(d),
                a grantee is not precluded from seeking to cover those expenses through
                other sources of funding and existing agreements.
                 In paragraph (c), if a participant other than an eligible
                individual (that is, the family member of an eligible individual) is
                furnished clinical services for emergency treatment under paragraph (a)
                of this section and the grantee determines that the participant
                requires ongoing services, the grantee must refer the participant to
                appropriate health care services in the area for additional care.
                Except as provided for under paragraph (a) of this section, funds
                provided under this grant program may not be used to provide ongoing
                clinical services to family, and any ongoing clinical services provided
                to the family by the grantee is at the expense of the grantee. VA
                expects that grantees will refer those participants for further care as
                appropriate and is codifying this requirement in this paragraph to
                ensure that grantees do so. This ensures that these participants' needs
                can be met by further care as needed. Except as provided for under
                Sec. 78.60(a), funds provided under this grant program may not be used
                to provide clinical services to such participants, and any ongoing
                clinical services provided to the participant by the grantee is at the
                expense of the grantee. This is because VA does not have authority to
                cover such expenses under this grant program. However, to the extent
                that a grantee can and desires to provide ongoing clinical services to
                such participants, they may do so, but it will be at their expense. As
                explained in discussion on Sec. 78.50(d), this language does not
                preclude the grantee from seeking to cover those expenses through other
                sources of funding and existing
                [[Page 13820]]
                agreements (for example, billing a participant's health insurance).
                Grantees also are not precluded from covering any copayments imposed on
                participants by their health insurance for ongoing clinical services
                provided by the grantee if the grantee so chooses and has the funds to
                cover such costs. However, the grantee may not charge, bill, or
                otherwise hold liable such participants for the receipt of such care or
                services. This is consistent with similar language in paragraph (b)
                relating to eligible individuals.
                 Consistent with section 201(q)(5) of the Act, paragraph (d)
                explains that for purposes of this section, emergency treatment means
                medical services, professional services, ambulance services, ancillary
                care and medication (including a short course of medication related to
                and necessary for the treatment of the emergency condition that is
                provided directly to or prescribed for the patient for use after the
                emergency condition is stabilized and the patient is discharged) was
                rendered in a medical emergency of such 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 is
                met by 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.
                 The description and standard are consistent with VA's description
                of medical emergency for purposes of payment or reimbursement for
                emergency treatment furnished by non-VA providers to certain veterans
                with service-connected disabilities pursuant to 38 CFR 17.120 and for
                nonservice-connected disabilities pursuant to 38 CFR 17.1000 et seq. It
                is important to note that emergency medical conditions includes
                emergency mental health conditions.
                 Paragraph (e) explains that the direct provision of clinical
                services for emergency treatment by grantees under this section is not
                prohibited by Sec. 78.80(a). As explained later in this discussion,
                Sec. 78.80(a) prohibits grantees from directly providing health care
                services, which include health insurance and referral to a governmental
                entity or grantee that provides certain services. As clinical services
                for emergency treatment under Sec. 78.60 are considered health care
                services and section 201 of the Act specifically authorizes the
                provision of clinical services for emergency treatment, paragraph (e)
                clarifies that such services do not fall under the prohibition in Sec.
                78.80(a). VA acknowledges that while some grantees may not be able to
                provide these services directly, others will. This ensures that if a
                grantee is capable of furnishing emergency treatment and needs to do
                so, there will be no delay in the delivery of such services.
                78.65 Suicide Prevention Services: Case Management Services
                 In accordance with section 201(q)(11)(A)(v), case management
                services are described in Sec. 78.65. These definitions are similar to
                case management services in the SSVF Program (see 38 CFR 62.31), but
                they are focused on suicide prevention to effectively assist
                participants at risk of suicide. The SSVF Program derived its
                definition from similar definitions of case management services
                provided in other Federal programs, such as the Department of Health
                and Human Services' Medicare and Medicaid Services Program, the
                Department of Housing and Urban Development's Congregate Housing
                Services Program, and the Housing and Urban Development--Veterans
                Affairs Supported Housing (see 42 CFR 440.169 and 24 CFR 700.105). 75
                FR 24514, 24518 (May 5, 2010). This description of case management
                services is also consistent with VA-DoD Clinical Practice Guidelines
                for the Assessment and Management of Patients at Risk for Suicide (see
                https://www.healthquality.va.gov/guidelines/MH/srb/VADoDSuicideRiskFullCPGFinal5088212019.pdf).
                 Grantees providing or coordinating the provision of case management
                services must provide or coordinate the provision of such services that
                include, at a minimum: (a) Performing a careful assessment of
                participants, and developing and monitoring case plans in coordination
                with a formal assessment of suicide prevention services needed,
                including necessary follow-up activities, to ensure that the
                participant's needs are adequately addressed; (b) establishing linkages
                with appropriate agencies and service providers in the area to help
                participants obtain needed suicide prevention services; (c) providing
                referrals to participants and related activities (such as scheduling
                appointments for participants) to help participants obtain needed
                suicide prevention services, such as medical, social, and educational
                assistance or other suicide prevention services to address
                participants' identified needs and goals; (d) deciding how resources
                and services are allocated to participants on the basis of need; (e)
                educating participants on issues, including, but not limited to,
                suicide prevention services availability and participant rights; and,
                (f) other activities, as approved by VA, to serve the comprehensive
                needs of participants for the purpose of reducing suicide risk. This
                list ensures that grantees have the same understanding of what
                activities are considered case management services, but it also
                provides VA authority to approve other activities that may be
                considered case management services. Such other activities will be
                included in any NOFO published as well as incorporated into any
                agreement with grantees.
                78.70 Suicide Prevention Services: Peer Support Services
                 Consistent with section 201(q)(11)(A)(vi) of the Act, 38 CFR 78.70
                explains the peer support services authorized under this grant program.
                Paragraph (a) explains that grantees providing or coordinating the
                provision of peer support services must provide or coordinate the
                provision of peer support services to help participants understand what
                resources and supports are available in their area for suicide
                prevention. Peer support services must be provided by veterans trained
                in peer support with similar lived experiences related to suicide or
                mental health. Peer support specialists serve as role models and a
                resource to assist participants with their mental health recovery. Peer
                support specialists function as interdisciplinary team members,
                assisting physicians and other professional and non-professional
                personnel in a rehabilitation treatment program. This is consistent
                with how VA defines peer support services for its programs, including
                its peer support program pursuant to 38 U.S.C. 1720F(j).
                 Paragraph (b) further explains that each grantee providing or
                coordinating the provision of peer support services must ensure that
                veterans providing such services to participants meet the requirements
                of 38 U.S.C. 7402(b)(13) and meet qualification standards for
                appointment or have completed peer support training, are pursuing
                credentials to meet the minimum qualification standards for
                appointment, and are under the supervision of an individual who meets
                the requirements of 38 U.S.C. 7402(b)(13). Section 7402(b)(13)
                establishes standards for
                [[Page 13821]]
                appointment as a VA peer support specialist. Qualification standards
                include that the individual is (1) a veteran who has recovered or is
                recovering from a mental health condition, and (2) certified by (i) a
                not-for-profit entity engaged in peer support specialist training as
                having met such criteria as the Secretary shall establish for a peer
                support specialist position, or (ii) a State as having satisfied
                relevant State requirements for a peer support specialist position. VA
                has further set forth qualifications for its peer support specialists
                in VA Handbook 5005, Staffing (last updated July 17, 2012). See https://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf.
                 Meeting minimum qualification standards for appointment under 38
                U.S.C. 7402(b)(13) ensures that participants receive peer support
                services in a safe and effective manner consistent with VA's standards
                and with those required by law. However, VA would also allow grantees
                to provide peer support services through veterans who have completed
                peer support training, are pursuing credentials to meet the minimum
                qualification standards for appointment, and are under the supervision
                of an individual who meets the minimum qualification standards. VA
                would allow this as a way to build capacity in the community for peer
                support services, particularly as there are individuals who may be
                supervised and working toward meeting the requirements of 38 U.S.C.
                7402(b)(13), but who have not yet met those conditions. Grant funds may
                be used to provide education and training for employees of the grantee
                or the community partner who provide peer support services based on the
                terms set forth in the grant agreement. VA believes the use of these
                funds to support education and training for peer support specialists is
                authorized by section 201(b) of the Act, which directs VA to provide
                financial assistance to eligible entities approved under this section
                to provide or coordinate the provision of suicide prevention services
                to eligible individuals and their families. Because the requirements to
                be a VA peer support specialist, as generally described above, are more
                specific than many community organizations might require, we believe
                the use of grant funds to support education and training is appropriate
                as it may be necessary to ensure these services are provided by
                appropriately qualified individuals. VA would set forth conditions
                regarding the use of funds, such as any limits on the amount of funds
                that may be used for these purposes or documentation requirements, in
                the NOFO and terms of the grant agreement.
                 These appointment requirements for those veterans providing peer
                support services would be included in the NOFO so that those applicants
                who apply to provide peer support services understand and know the
                applicable requirements for purposes of providing or coordinating such
                services. These requirements would also be included in any program
                guides developed for purposes of administering services under this
                grant program.
                78.75 Suicide Prevention Services: Assistance in Obtaining VA Benefits
                 In accordance with section 201(q)(11)(A)(vii), Sec. 78.75 sets
                forth the requirements associated with suicide prevention services
                authorized under this grant program related to assistance in obtaining
                VA benefits. The provision of this assistance will provide grantees
                with additional means by which VA can notify participants of available
                VA benefits and is consistent with the SSVF Program (see 38 CFR 62.32).
                 Paragraph (a) requires grantees assisting participants in obtaining
                VA benefits to assist participants in obtaining any benefits from VA
                for which the participants are eligible. Such benefits include but are
                not limited to: (1) Vocational and rehabilitation counseling; (2)
                supportive services for homeless veterans; (3) employment and training
                services; (4) educational assistance; and, (5) health care services.
                 Under paragraph (b), grantees will not be permitted to represent
                participants before VA with respect to a claim for VA benefits unless
                they are recognized for that purpose pursuant to 38 U.S.C. 5902.
                Employees and members of grantees are not permitted to provide such
                representation unless the individual providing representation is
                accredited pursuant to 38 U.S.C. chapter 59. Consistent with 38 U.S.C.
                5902, VA does not interpret section 201 of the Act to allow grantees to
                represent veterans in benefit claims before VA unless they are
                recognized under 38 U.S.C. 5902. VA also does not interpret section 201
                of the Act as requiring that grantees become recognized organizations
                pursuant to 38 U.S.C. 5092 or that their employees or members become
                accredited service organization representatives, claims agents, or
                attorneys. Instead, assistance in obtaining benefits may include
                providing information about available benefits, helping individuals
                locate a recognized veterans services organization or other accredited
                individual, and other services short of actual representation before
                VA, unless the grantee is accredited pursuant to 38 CFR 14.629 (that
                is, VA's regulation implementing 38 U.S.C. 5902), which sets forth
                requirements for accreditation of service organization representatives,
                agents, and attorneys.
                78.80 Suicide Prevention Services: Assistance in Obtaining and
                Coordinating Other Public Benefits and Assistance With Emergent Needs
                 Consistent with section 201(q)(11)(A)(viii) and (ix) of the Act,
                under Sec. 78.80, grantees assisting in obtaining and coordinating
                other public benefits or assisting with emergent needs will be required
                to assist participants to obtain and coordinate the provision of other
                public benefits. For purposes of this section, VA considers other
                public benefits and emergent needs to be the same types of benefits. At
                a minimum, grantees are required to assist participants in obtaining
                and coordinating the provision of benefits listed in paragraphs (a)
                through (h) of Sec. 78.80 that are being provided by Federal, State,
                local, or tribal agencies, or any other grantee in the area served by
                the grantee by referring the participant to and coordinating with such
                entity. If a public benefit is not being provided by Federal, State,
                local, or tribal agencies, or any other grantee in the area, the
                grantee is not required to obtain, coordinate, or provide such public
                benefit. Grantees may elect to provide directly to participants the
                public benefits identified in paragraphs (c) through (h) of Sec.
                78.80.
                 In accordance with section 201(q)(11)(A)(ix)(I) of the Act,
                paragraph (a) describes health care services, which include: (1) Health
                insurance, and (2) referral to a governmental entity or grantee that
                provides any of the following services: (i) Hospital care, nursing home
                care, outpatient care, mental health care, preventive care,
                habilitative and rehabilitative care, case management, respite care,
                and home care; (ii) the training of any eligible individual's family in
                the care of any eligible individual; and (iii) the provision of
                pharmaceuticals, supplies, equipment, devices, appliances, and
                assistive technology. This is consistent with how VA administers the
                SSVF Program (see 38 CFR 62.33(a)). VA believes services in paragraph
                (a) should not be provided directly by grantees as these services are
                commonly available in the area, including at VA. It also would be cost-
                prohibitive for grantees to provide these directly and would thus
                impact grantees' ability to provide
                [[Page 13822]]
                suicide prevention services to participants.
                 In accordance with section 201(q)(11)(A)(ix)(II) of the Act,
                paragraph (b) describes referral of a participant, as appropriate, to
                an entity that provides daily living services relating to the functions
                or tasks for self-care usually performed in the normal course of a day,
                including, but not limited to, eating, bathing, grooming, dressing, and
                home management activities. This is identical to how VA administers the
                SSVF Program (See 38 CFR 62.33(b)). VA believes that daily living
                services should not be provided directly by grantees as these services
                are commonly available in the community, including at VA. It also would
                be cost-prohibitive for grantees to provide these directly and would
                thus impact grantees' ability to provide suicide prevention services to
                participants. Thus, referrals for these services would be appropriate.
                 In accordance with section 201(q)(11)(A)(ix)(III) of the Act,
                paragraph (c) describes personal financial planning services, which
                include, at a minimum, providing recommendations regarding day-to-day
                finances and achieving long-term budgeting and financial goals. Grant
                funds may pay for credit counseling and other services necessary to
                assist participants with critical skills related to household
                budgeting, managing money, accessing a free personal credit report, and
                resolving credit problems. This is consistent with how VA administers
                the SSVF Program (see 38 CFR 62.33(c)).
                 In accordance with section 201(q)(11)(A)(ix)(IV) of the Act,
                paragraph (d) describes transportation services. Paragraph (d)(1)
                explains that the grantee may provide temporary transportation services
                directly to participants if the grantee determines such assistance is
                necessary; however, the preferred method of direct provision of
                transportation services is the provision of tokens, vouchers, or other
                appropriate instruments so that participants may use available public
                transportation options. Paragraph (d)(2) explains that if public
                transportation options are not sufficient within an area, costs related
                to the lease of vehicle(s) may be included in a suicide prevention
                services grant application if the applicant or grantee, as applicable,
                agrees that: (i) The vehicle(s) will be safe, accessible, and equipped
                to meet the needs of the participants; (ii) the vehicle(s) will be
                maintained in accordance with the manufacturer's recommendations; and
                (iii) all transportation personnel (employees and community partners)
                will be licensed, insured, and trained in managing any special needs of
                participants and handling emergency situations. This is consistent with
                how VA administers the SSVF Program (see 38 CFR 62.33(d)). However,
                unlike Sec. 62.33(d) which refers to subcontractors, VA refers to
                community partners under paragraph (d)(2)(iii).
                 Paragraph (d)(3) permits grantees to provide transportation
                services through reimbursement for transportation furnished through
                ride-sharing services, taxi services, or other similar sources if two
                conditions are met: First, the participant must lack any other means of
                transportation, including transportation or reimbursement for
                transportation from VA under part 70 of this title, and second, the
                grantee must document the participant's lack of other means. Such
                documentation would be maintained as part of the participant's case
                file, and consistent with the recordkeeping requirements in Sec.
                78.150. VA includes this provision to allow for flexibility in
                situations where transportation options may be limited, but the two
                conditions are intended to limit this support as a matter of last
                resort given that the expenses for such transportation are likely
                higher than other methods of transportation, and VA does not believe it
                would be an optimal use of grant funds. If beneficiary travel under
                subpart A of part 70 of title 38, Code of Federal Regulations, or
                transportation through the Veterans Transportation Service under
                subpart B of part 70 of title 38, Code of Federal Regulations, are
                available to the participant, the participant would be ineligible for
                assistance under paragraph (d)(3).
                 In accordance with section 201(q)(11)(A)(ix)(V) of the Act,
                paragraph (e) describes temporary income support services, which may
                consist of providing assistance in obtaining other Federal, State,
                tribal, and local assistance, in the form of, but not limited to,
                mental health benefits, food assistance, housing assistance, employment
                counseling, medical assistance, veterans' benefits, and income support
                assistance. This is consistent with how VA administers the SSVF Program
                (see 38 CFR 62.33(e)). However, unlike the SSVF Program, this suicide
                prevention services grant program will include food assistance because
                of the correlation between food insecurity and mental health issues
                including suicide risk. See Bergmans, R.S., Jannausch, M. and Ilgen,
                M.A. (2020), Prevalence of suicide ideation, planning and attempts
                among Supplemental Nutrition Assistance Program participants in the
                United States. Journal of Affective Disorders, 277, 99-103. The suicide
                prevention services grant program also expressly includes housing
                assistance, which does not appear in Sec. 62.33(e) because part 62 is
                designed in general to provide housing assistance and supportive
                services for very low-income veteran families who are occupying
                permanent housing.
                 In accordance with section 201(q)(11)(A)(ix)(VI) of the Act,
                paragraph (f) describes fiduciary and representative payee services,
                which may consist of acting on behalf of a participant by receiving the
                participant's paychecks, benefits or other income, and using those
                funds for the current and foreseeable needs of the participant and
                saving any remaining funds for the participant's future use in an
                interest-bearing account or saving bonds. This is consistent with how
                VA administers the SSVF Program (see 38 CFR 62.33(f)).
                 In accordance with section 201(q)(11)(A)(ix)(VII) of the Act,
                paragraph (g) explains that legal services includes those services to
                assist an eligible individual with issues that may contribute to the
                risk of suicide, including issues that interfere with the eligible
                individual's ability to obtain or retain permanent housing, cover basic
                needs such as food, transportation, medical care, and issues that
                affect the eligible individual's employability and financial security
                (such as debt, credit problems, and the lack of a driver's license).
                These bio-psychosocial stressors are suicide risk factors noted within
                the VA/DoD Clinical Practice Guidelines for the Assessment and
                Management of Patients at Risk for Suicide. See https://www.healthquality.va.gov/guidelines/MH/srb/VADoDSuicideRiskFullCPGFinal5088212019.pdf.
                 However, with the exception of legal assistance with resolving
                outstanding warrants, fines, expungements, and drivers' license
                revocations symptomatic of reentry obstacles in employment or housing,
                authorized legal services do not include legal assistance with criminal
                matters nor matters in which the eligible individual is taking or has
                taken any adversarial legal action against the United States (that is,
                the Federal government). Authorized legal services also do not include
                legal assistance with matters in which the United States (that is, the
                Federal government) is prosecuting an eligible individual. Thus, even
                with respect to the limited legal assistance for certain criminal
                matters otherwise permitted (for example, legal assistance
                [[Page 13823]]
                with resolving outstanding warrants), legal services do not include
                legal assistance in those criminal matters in which the United States
                is prosecuting the eligible individual.
                 Legal services under Sec. 78.80(g) are described in this manner to
                include those types of services VA believes are most relevant and
                applicable to the legal needs of eligible individuals. VA will limit
                these legal services to issues that contribute to the risk of suicide,
                which is consistent with the overall intent of this grant program. VA
                will authorize those services that support the legal needs of the
                eligible individual to address those issues that contribute to their
                risk of suicide, such as issues with housing, employability, and
                financial security.
                 With certain exceptions as noted and explained above, VA excludes
                legal assistance with most criminal matters and excludes all matters in
                which the eligible individual is taking or has taken any adversarial
                legal action against the United States, as VA does not believe it is
                reasonable to expect VA to pay for such services, especially for those
                situations in which an eligible individual takes adversarial legal
                action against the Federal government, including VA and other Federal
                agencies or in situations in which the Federal government is
                prosecuting an eligible individual. If VA covered such legal services,
                it could result in conflicts of interest. This restriction does not
                include non-adversarial legal assistance provided in pursuit of VA
                benefits or appeals to the Board of Veterans' Appeals. If legal
                assistance is needed with a matter for which grant funds are not
                authorized, the grantee should make referrals to other organizations,
                such as Legal Aid and local Bar Associations, to ensure that legal
                needs can be met.
                 In accordance with section 201(q)(11)(A)(ix)(VIII) of the Act,
                paragraph (h) describes the provision of child care, consistent with
                how VA administers these services in the SSVF Program (see 38 CFR
                62.33(h)). Child care will be authorized for children under the age of
                13, unless the child is disabled. Disabled children must be under the
                age of 18 to receive assistance under this paragraph. This is
                consistent with the SSVF Program's regulations at Sec. 62.33(h) as
                well as similar regulations issued by the Department of Housing and
                Urban Development. See 24 CFR 576.102(a)(1)(ii).
                 Child care includes the: (1) Referral of a participant, as
                appropriate, to an eligible child care provider that provides child
                care with sufficient hours of operation and serves appropriate ages, as
                needed by the participant; and (2) payment by a grantee on behalf of a
                participant for child care by an eligible child care provider.
                Consistent with the financial cap in section 201(q)(11)(A)(ix)(VIII) of
                the Act, payment may not exceed $5,000 per family of an eligible
                individual per Federal fiscal year.
                 In paragraphs (h)(2)(i) through (iii), certain limitations for
                payments for child care services are identified, which is consistent
                with the SSVF Program's regulations at 38 CFR 62.33(h). Pursuant to
                paragraph (h)(2)(i), payments for child care services must be paid by
                the grantee directly to an eligible child care provider. Unlike Sec.
                62.33(h), VA would not include the language that payments for child
                care services cannot exceed a maximum of 6 months in a 12-month period,
                and 10 months during a 2-year period. As payments are capped at $5,000
                per family per Federal fiscal year under section
                201(q)(11)(A)(ix)(VIII) of the Act, VA believes the financial cap
                imposed by the statute is a sufficient constraint to ensure proper use
                of resources for these services.
                 Under paragraph (h)(2)(ii), payments for child care services will
                not be provided on behalf of participants for the same period of time
                and for the same cost types that are being provided through another
                Federal (including VA), State or local subsidy program. The reference
                to the ``same period of time'' means the same dates and times in which
                child care benefits are being provided under another program. For
                example, a participant may be eligible for Arkansas's Child Care
                Assistance Program, which provides financial assistance for quality
                child care to certain individuals. If that participant was using those
                benefits under Arkansas's Child Care Assistance Program on a specific
                date and time, it would not render the participant ineligible for child
                care support generally under the suicide prevention services grant
                program. The only result would be that the individual could not receive
                a subsidy under VA's program for the same period of time for which
                child care services were being provided under the Arkansas program.
                 Paragraph (h)(2)(iii) further explains that as a condition of
                providing payments for child care services, the grantee must help the
                participant develop a reasonable plan to address the participant's
                future ability to pay for child care services. Grantees must assist the
                participant to implement such plan by providing any necessary
                assistance or helping the participant to obtain any necessary public or
                private benefits or services. Because the payments for child care
                services provided under paragraph (h) are intended to be temporary, VA
                would require that grantees assist in developing and implementing such
                plan to ensure that participants are able to plan for such services in
                the long-term as needed.
                78.85 Suicide Prevention Services: Nontraditional and Innovative
                Approaches and Treatment Practices
                 Section 78.85 explains that grantees providing or coordinating the
                provision of nontraditional and innovative approaches and treatment
                practices may provide or coordinate the provision of nontraditional and
                innovative approaches and treatment, including but not limited to
                complementary or alternative interventions with some evidence for
                effectiveness of improving mental health or mitigating a risk factor
                for suicidal thoughts and behavior, as set forth in the NOFO or as
                approved by VA that are consistent with SSG Fox SPGP. Applicants may
                propose nontraditional and innovative approaches and treatment
                practices in their suicide prevention services grant application, and
                grantees may propose these additional approaches and treatment
                practices by submitting a written request to modify the suicide
                prevention services grant in accordance with Sec. 78.125.
                 VA is authorized under section 201(f)(1) of the Act to include such
                commitments as it considers necessary to carry out this section. VA is
                exercising this authority here by reserving the right to approve or
                disapprove nontraditional and innovative approaches and treatment
                practices to be provided or coordinated to be provided using funds
                authorized under SSG Fox SPGP. These approaches and treatment practices
                can evolve, and by maintaining the right to approve or disapprove these
                treatment practices or approaches, VA can ensure that participants
                receive approaches and treatment practices that are safe and effective.
                VA is not providing a broad list of approved innovative approaches and
                treatment practices to allow for emerging services with some evidence
                in suicide risk reduction the opportunity for review and selection. It
                is also important for VA to note that any approaches and treatment
                practices approved will need to be consistent with applicable Federal
                law. For example, the use of grant funds to provide or coordinate the
                provision of marijuana to eligible individuals and their families will
                be prohibited, as marijuana is currently illegal under Federal law.
                [[Page 13824]]
                78.90 Suicide Prevention Services: Other Services
                 The definition of suicide prevention services in section
                201(q)(11)(A)(xi) of the Act includes other services necessary for
                improving the mental health status and wellbeing and reducing the
                suicide risk of eligible individuals and their families as the
                Secretary considers appropriate.
                 Consistent with section 201(q)(11)(A)(xi) of the Act, section
                78.90(a) explains general suicide prevention assistance that may be
                provided under this grant program. Pursuant to paragraph (a), a grantee
                may pay directly to a third party (and not to a participant), in an
                amount not to exceed $750 per participant during any 1-year period,
                beginning on the date that the grantee first submits a payment to a
                third party, the following types of expenses: (i) Expenses associated
                with gaining or keeping employment, such as uniforms, tools,
                certificates, and licenses; and (ii) expenses associated with lethal
                means safety and secure storage, such as gun locks and locked
                medication storage.
                 A limit of $750 per participant per year is an appropriate amount
                because such items as gun storage and locks can cost anywhere from $20
                to several hundred dollars. Similarly, for purposes of employment,
                licenses and uniforms can range from several dollars to several hundred
                dollars. The amount of $750 per year also is consistent with the amount
                of similar assistance authorized under the SSVF program of $1,500 every
                2 years. See 38 CFR 62.34(e)(2).
                 VA would allow payment for expenses associated with gaining or
                keeping employment as extended unemployment may lead to mental health
                issues and financial hardship. See Haw, C., K. Hawton, D. Gunnell, and
                S. Platt. 2015. Economic recession and suicidal behavior: Possible
                mechanisms and ameliorating factors. International Journal of Social
                Psychiatry 61, no. 1:73-81. Thus, it would be appropriate to cover
                these as other services as these would be necessary for improving the
                mental health status and wellbeing and reducing the suicide risk of
                eligible individuals and their families.
                 VA would also allow payment for expenses associated with lethal
                means safety and secure storage, as these would also be services
                necessary for improving the wellbeing and reducing the suicide risk of
                eligible individuals and their families. In 2018, 68.2 percent of
                Veteran suicide deaths were due to a self-inflicted firearm injury,
                while 48.2 percent of non-Veteran adult suicides resulted from a
                firearm injury. In 2018, 69.4 percent of male veteran suicide deaths
                and 41.9 percent of female veteran suicide deaths resulted from a
                firearm injury. In 2018, firearms were used in 41.9 percent of suicide
                deaths among women veterans, compared to 31.7 percent of suicide deaths
                among non-veteran women. See VA's 2020 National Veteran Suicide
                Prevention Annual Report. (Available online: https://www.mentalhealth.va.gov/docs/data-sheets/2020/2020-National-Veteran-Suicide-Prevention-Annual-Report-11-2020-508.pdf.) Research has shown
                that when lethal means are made less accessible or lethal, suicide
                rates by those means decline. See, Gunnell D and Eddleston M. Suicide
                by intentional ingestion of pesticides: A continuing tragedy in
                developing countries. International Journal of Epidemiology.
                2003;32:902-909; Gunnell D, Fernando R, Hewagama M, Priyangika WD,
                Konradsen F, Eddleston M. The impact of pesticide regulations on
                suicide in Sri Lanka. Int J Epidemiol. 2007;36(6):1235-42; Kreitman N.
                The coal gas story. United Kingdom suicide rates, 1960-71. Br J Prev
                Soc Med. 1976 Jun;30(2):86-93; Hawton K. United Kingdom legislation on
                pack sizes of analgesics: Background, rationale, and effects on suicide
                and deliberate self-harm. Suicide and Life-Threatening Behavior.
                2002;32(3):223-229. Furthermore, increasing time and space between
                individuals facing a suicidal crisis and a firearm has been shown to
                prevent suicide. Lubin, G., Werbeloff, N., Halperin, D., Shmushkevitch,
                M., Weise, M, & Knobler, H. (2010), Suicide & Life-Threatening
                Behavior, 40(5), 421-424. Thus, VA believes it is appropriate to allow
                payment for expenses associated with lethal means safety and secure
                storage, as these would also be services necessary for improving the
                wellbeing and reducing the suicide risk of eligible individuals and
                their families.
                 Paragraph (b) explains that grantees providing or coordinating the
                provision of other suicide prevention services may provide or
                coordinate the provision of other services as set forth in the NOFO or
                as approved by VA that are consistent with SSG Fox SPGP. Applicants may
                propose additional services in their suicide prevention services grant
                application, and grantees may propose additional services by submitting
                a written request to modify the suicide prevention services grant
                program in accordance with Sec. 78.125. VA reserves the right to
                approve or disapprove other suicide prevention services to be provided
                or coordinated to be provided using funds authorized under SSG Fox
                SPGP. This is consistent with how VA authorizes additional services for
                the SSVF Program (see 38 CFR 62.34) and is authorized by the statute as
                noted above.
                 Section 201(q)(11)(A)(xi) includes as examples of services the
                Secretary may include adaptive sports, equine assisted therapy, or in-
                place or outdoor recreational therapy; substance use reduction
                programming; individual, group, or family counseling; and relationship
                coaching. VA is not identifying these services as expressly covered in
                its regulations, but applicants may propose these services in their
                grant application. VA believes Congress included these as examples of
                other services to ensure that applicants proposing to furnish these
                services would be able to do so if VA determines that such services are
                appropriate and likely for the purpose of reducing veteran suicide. VA
                believes the list in section 201(q)(11)(A)(xi) also is indicative of
                the types of other services that may be approved. VA believes the
                intent of this section of law is to provide flexibility for different
                approaches; thus, VA is not regulating these services further to
                preserve that flexibility. Paragraph (b) will control the disposition
                of any requests by applicants and grantees to offer these or other
                services.
                78.95 General Operation Requirements
                 In Sec. 78.95, VA establishes requirements for the general
                operation of suicide prevention services programs. Paragraph (a)
                explains that prior to providing suicide prevention services, grantees
                must verify, document, and classify each participant's eligibility for
                suicide prevention services and determine and document each
                participant's degree of risk of suicide using tools identified in the
                suicide prevention services grant agreement. Such documentation must be
                maintained consistent with Sec. 78.150. This ensures that grantees are
                providing services and using grant funds for those who are eligible for
                such services under this grant program and consistent with the Act.
                 Paragraph (b) explains that prior to services ending, grantees must
                provide or coordinate the provision of a mental health screening to all
                participants they serve, when possible. This screening must be
                conducted with the same tool used to conduct the baseline mental health
                screening under Sec. 78.50. Having this screening occur at the
                beginning (pursuant to Sec. 78.50) and prior to services ending is
                important in evaluating the effectiveness of the
                [[Page 13825]]
                services provided, when possible. VA acknowledges that some
                participants may leave services early or opt out of screening so
                meeting this requirement may not always be possible. Thus, the language
                ``when possible'' is included in paragraph (b).
                 Under paragraph (c), for each participant who receives suicide
                prevention services from the grantee, the grantee must document the
                suicide prevention services provided or coordinated, how such services
                are provided or coordinated, the duration of the services provided or
                coordinated, and any goals for the provision or coordination of such
                services. Such documentation must be maintained consistent with Sec.
                78.150. This is information eligible entities typically maintain
                regarding the provision or coordination of these or similar services.
                Additionally, this information may be requested by VA for purposes of
                monitoring the grantee's operation and compliance with these
                regulations (under Sec. Sec. 78.135 and 78.145), will be collected as
                part of the grantee's reporting requirements in Sec. 78.145, and will
                be required to be maintained for at least three years (consistent with
                the recordkeeping requirements in Sec. 78.150), and may be requested
                by VA for auditing and evaluation purposes.
                 Consistent with section 201(e) of the Act, in paragraph (d)(1),
                prior to initially providing or coordinating suicide prevention
                services to an eligible individual and their family, the grantee is
                required to notify each eligible individual and their family that the
                suicide prevention services are being paid for, in whole or in part, by
                VA; the suicide prevention services available to the eligible
                individual and their family through the grantee's program; any
                conditions or restrictions on the receipt of suicide prevention
                services by the eligible individual and their family; and in the
                instance of an eligible individual who receives assistance from the
                grantee under this program, that the eligible individual is able to
                apply for enrollment in VA health care pursuant to 38 CFR 17.36. If the
                eligible individual wishes to enroll in VA health care, the grantee
                must inform the eligible individual of a VA point of contact for
                assistance in enrollment. These requirements concerning information
                about enrollment are consistent with section 201(e)(3) of the Act.
                While not every eligible individual may be able to enroll in VA health
                care under Sec. 17.36, they can apply to determine their eligibility.
                It may not be possible to know at the time the eligible individual
                expresses an interest in enrolling in VA health care whether or not the
                person is a veteran under 38 U.S.C. 101(2), so VA is using the term
                eligible individual, as it is more inclusive and potentially a more
                accurate description of the person at the point of time this
                information is provided. Other than members of the Armed Forces who are
                included as an eligible individual through reference to 38 U.S.C.
                1712A(a)(1)(C)(i)-(iv), eligible individuals may be able to enroll in
                VA health care. Consequently, VA includes an exception in paragraph
                (d)(1)(iv) stating that the requirements in this clause do not apply to
                eligible individuals who are members of the Armed Forces described in
                section 1712A(a)(1)(C)(i)-(iv) of title 38, United States Code.
                 In paragraph (d)(2), grantees must provide each participant with a
                satisfaction survey, which the participant can submit directly to VA,
                within 30 days of such participant's pending exit from the grantee's
                program. This is required to assist VA in evaluating grantees'
                performance and participants' satisfaction with the suicide prevention
                services they receive. This is consistent with the SSVF Program (see 38
                CFR 62.36(c)(2)).
                 Paragraph (e) requires that grantees regularly assess how suicide
                prevention services grant funds can be used in conjunction with other
                available funds and services to assist participants. This is consistent
                with the SSVF Program (see Sec. 62.36(d)) and encourages grantees to
                leverage other financial resources to ensure continuity of program
                operations and assistance to participants.
                 Paragraph (f) requires that for each participant, grantees must
                develop and document an individualized a plan with respect to the
                provision of suicide prevention services provided under this part.
                Consistent with section 201(e)(2) of the Act, this plan must be
                developed in consultation with the participant and must be maintained
                consistent with Sec. 78.150. This requirement would ensure that a plan
                is developed to address the needs of participants. Such plan would
                include, but not be limited to, the suicide prevention services needed,
                the goals and objectives of the plan, and the applicable services. This
                plan would allow grantees and VA to monitor the delivery of suicide
                prevention services to participants. VA would include information about
                the suicide prevention services plan in the program guide developed for
                grantees. This requirement for a suicide prevention services plan is
                also authorized under section 201(f)(1) of the Act, as VA has authority
                to include such commitments as it considers necessary to carry out this
                section.
                 In paragraph (g), VA requires grantees to coordinate with VA with
                respect to the provision of health care and other services to eligible
                individuals under 38 U.S.C. Chapters 17 and 20. This is consistent with
                the requirements in section 201(e)(3)(A), (m), and (n) of the Act. VA
                expects that grantees will work with local VA facilities on a regular
                basis to coordinate care when needed for eligible individuals.
                 Consistent with section 201(e)(4) of the Act, VA requires in
                paragraph (h) that the grantee submit to VA a description of the tools
                and assessments the grantee uses or will use to determine the
                effectiveness of the suicide prevention services furnished by the
                grantee. These include any measures and metrics developed and provided
                by VA for the purposes of measuring the effectiveness of the
                programming to be provided in improving mental health status and
                wellbeing, and reducing suicide risk and suicide deaths of eligible
                individuals. While the Act uses the phrase ``completed suicides'', VA
                uses the term ``suicide deaths'', as that is the terminology commonly
                used by VA. VA recognizes that messaging and language around suicide
                attempts and suicide death has an impact on beliefs and attitudes
                related to suicide. Thus, VA has developed a Safe Messaging Best
                Practices guide for public use regarding this topic. See https://www.mentalhealth.va.gov/suicide_prevention/docs/OMH-086-VA-OMHSP-Safe-Messaging-Factsheet-4-9-2019.pdf.
                 Consistent with section 201(o) of the Act, under paragraph (i),
                only grantees that are a State or local government or an Indian tribe
                are able to use grant funds to enter into an agreement with a community
                partner under which the grantee may provide funds to the community
                partner for the provision of suicide prevention services to eligible
                individuals and their families.
                 Paragraph (j) explains that grantees may enter into contracts for
                goods or services under this part. Section 201(o)(2) of the Act states
                that the ability of a grantee to provide grant funds to a community
                partner is limited to grantees that are a State or local government or
                an Indian tribe. VA does not interpret section 201(o)(2) of the Act to
                prohibit a grantee from using funds provided under this part to pay
                vendors or contractors for certain services, as VA does not interpret
                the term ``community partner'' to limit such arrangements. Indeed, VA
                believes that if the term ``community partner'' prohibited the use of
                grant funds to be used to pay vendors and other contractors, section
                201(o)(2) of the Act would effectively bar any entity that was not a
                State or local
                [[Page 13826]]
                government, or an Indian tribe, from participating in the grant
                program, or at least from providing many of the suicide prevention
                services defined in this rule. VA understands that the intent behind
                section 201(o)(2) of the Act was to clarify that only State or local
                governments and Indian tribes are able to provide sub-grants to
                community partners. VA's interpretation, which permits grantees to use
                grant funds to pay vendors and contractors for goods and services, is
                consistent with this intent and is necessary for effective operation of
                the program. No non-governmental entity, and likely no governmental
                entity, would be able to provide the full range of services identified
                as suicide prevention services in section 201(q)(11) of the Act absent
                the ability to pay vendors and contractors for goods and services. For
                example, assistance with emergent needs related to transportation
                services under section 201(q)(11)(A)(ix) often involves the provision
                of tokens or vouchers for use of transportation services such as buses
                or rail. However, no non-governmental entity, and few governmental
                entities, actually operate the transportation systems that would be
                needed to provide this assistance, so any effort to provide support
                with transportation services would require the use of grant funds to
                obtain goods or services from another party that is not a community
                partner. Similarly, Congress authorized up to $5,000 in assistance per
                family of an eligible individual per fiscal year for child care in
                section 201(q)(11)(A)(ix)(VIII) of the Act. Including a cap on the
                amount of funds that could be used for such services would not make
                sense unless Congress intended for grantees to be able to use grant
                funds to purchase goods and services like child care. Taken to its
                logical extreme, if section 201(o)(2) of the Act were to prohibit non-
                governmental grantees from providing any grant funds to any other
                party, these grantees would be prohibited from using grant funds to pay
                their utility bills, purchase office supplies, or pay rent. VA does not
                believe that such a result could possibly have been intended by
                Congress.
                 VA further believes that existing Federal regulations concerning
                the use of grants, set forth in 2 CFR part 200, support VA's
                interpretation. For example, 2 CFR 200.1 provides definitions
                applicable to the uniform administrative requirements, cost principles,
                and audit requirements for Federal awards. These regulations define the
                term ``contract'', for purposes of Federal financial assistance, as a
                legal instrument by which a recipient or subrecipient purchases
                property or services needed to carry out the project or program under a
                Federal award. This is clearly distinguished from a subaward, which is
                an award provided by a pass-through entity to a subrecipient for the
                subrecipient to carry out part of a Federal award received by the pass-
                through entity; subawards do not include payments to a contractor or
                payments to an individual that is a beneficiary of a Federal program.
                In this context, VA interprets section 201(o)(2) of the Act as limiting
                the use of subawards but not contracts by grantees. Grantees may choose
                to enter into contracts because in some situations, resources may be
                more readily available at a lower cost, or they may only be available,
                from another party in the community.
                 Lastly, in paragraph (k), VA requires grantees to ensure that
                suicide prevention services grants are administered in accordance with
                the requirements of part 78, the suicide prevention services grant
                agreement, and other applicable Federal, State, and local laws and
                regulations, including Federal civil rights laws. Grantees must ensure
                that any community partners carry out activities in compliance with
                this part. This is consistent with how VA administers the SSVF Program
                (see Sec. 62.36(e)).
                78.100 Fee Prohibition
                 In Sec. 78.100, VA prohibits grantees from charging a fee to
                participants for providing suicide prevention services that are funded
                with amounts from a suicide prevention services grant. VA believes this
                prohibition is appropriate because charging a fee could be a barrier to
                receiving care and services. There may be eligible individuals who may
                not be able to afford to pay any fees or those who do not otherwise
                seek care and services under this grant program because they do not
                want to pay a fee. Because of the importance of the services, including
                referrals to VA care as appropriate, provided under this grant program
                to eligible individuals at risk of suicide, VA does not want financial
                liability for fees to result in an eligible individual not receiving
                such critical services that may save such individual's life, as doing
                so would be inconsistent with the purpose of this grant program under
                section 201 of the Act to reduce suicide among veterans. This
                prohibition is authorized by section 201(f)(1) of the Act, which
                permits VA to include such commitments as the Secretary considers
                necessary to carry out this section. This is also similar to other
                prohibitions that have been implemented for other, similar grant
                programs, such as the SSVF Program (see 38 CFR 62.37). VA also notes
                that collecting and processing fees would increase administrative costs
                and time for the grantee, which would negatively affect the provision
                of services to eligible individuals.
                78.105 Ineligible Activities
                 Section 78.105 sets forth certain activities for which grantees
                will not be authorized to use suicide prevention services grant funds.
                Pursuant to section 201(q)(11)(B) of the Act, direct cash assistance to
                participants is prohibited, which is reflected in paragraph (a). Other
                prohibited activities are set forth in paragraphs (b) through (d) to
                include those legal services prohibited pursuant to Sec. 78.80(g);
                medical or dental care and medicines except for clinical services for
                emergency treatment authorized pursuant to Sec. 78.60; and any
                activities considered illegal under Federal law. Some of the items on
                this list of ineligible activities are consistent with those prohibited
                under the SSVF Program (see 38 CFR 62.38). However, VA does not feel it
                is necessary to include all of the activities that are ineligible under
                the SSVF program as these programs have distinct purposes, and many of
                those ineligible activities (for example, mortgage costs) are not
                necessarily applicable to the suicide prevention grant program. If VA
                wanted to include any of those activities under this grant program,
                such activities would be subject to Sec. 78.90. Similarly, VA does not
                think it is necessary to list every ineligible activity as all
                activities would be subject to the requirements in part 78. VA also
                notes that 2 CFR part 200 prohibits the use of grant awards for certain
                activities, such as entertainment. Such prohibitions are applicable to
                suicide prevention services grants awarded under part 78. However, it
                is unnecessary to include that language in Sec. 78.105 because 2 CFR
                part 200 controls the administration of these grants regardless of
                whether explicit language exists in part 78.
                78.110 Notice of Funding Opportunity
                 Consistent with existing processes for other VA grant programs, VA
                will notify the public, through a NOFO, when funds for this grant
                program are available. Section 78.110 explains that when funds are
                available for the grant program, VA will publish a NOFO on grants.gov.
                It also describes the information that will be included in such NOFO,
                including the location for obtaining suicide prevention services grant
                applications; the date, time, and place for submitting completed
                suicide
                [[Page 13827]]
                prevention services grant applications; the estimated amount and type
                of suicide prevention services grant funding available; any priorities
                for or exclusions from funding to meet the statutory mandates of
                section 201 of the Act and VA's goals for SSG Fox SPGP; the length of
                term for the suicide prevention services grant award; the minimum
                number of total points and points per category that an applicant or
                grantee, as applicable, must receive for a suicide prevention services
                grant to be funded; any maximum uses of suicide prevention services
                grant funds for specific suicide prevention services; the timeframes
                and manner for payments under the suicide prevention services grant;
                and other information necessary for the suicide prevention services
                grant application process as determined by VA.
                 This is consistent with the requirements and recommendations within
                2 CFR part 200 regarding notices of funding opportunity (see 2 CFR
                200.204).
                78.115 Suicide Prevention Services Grant Agreements
                 Consistent with other the SSVF Program (see 38 CFR 62.50) and 2 CFR
                200.201, section 78.115 explains that VA and the selected applicant
                will enter into an agreement prior to obligating funds under part 78
                and sets forth requirements that will be included in such agreement.
                Section 200.201 requires that Federal awarding agencies must decide on
                the appropriate instrument for Federal awards. Such appropriate
                instruments include grant agreements, which VA uses for the SSVF
                Program (see 38 CFR 62.50). This is also authorized by section
                201(f)(1) of the Act, which permits VA to include such commitments as
                the Secretary considers necessary to carry out this section.
                 This agreement will be enforceable against the grantee, providing
                VA assurance that the grantee will use the suicide prevention services
                grant funds in the manner described in the application and in
                accordance with the requirements of part 78.
                 Paragraph (a) states that after an applicant is selected for a
                suicide prevention services grant in accordance with Sec. 78.30, VA
                will draft a suicide prevention services grant agreement to be executed
                by VA and the applicant. Upon execution of the suicide prevention
                services grant agreement, VA will obligate suicide prevention services
                grant funds to cover the amount of the approved suicide prevention
                services grant, subject to the availability of funding. Such agreement
                will provide that the grantee agrees, and will ensure that each
                community partner agrees, to operate the program in accordance with the
                provisions of part 78 and the applicant's suicide prevention services
                grant application; comply with such other terms and conditions,
                including recordkeeping and reports for program monitoring and
                evaluation purposes, as VA may establish for purposes of carrying out
                SSG Fox SPGP, in an effective and efficient manner; and provide such
                additional information as deemed appropriate by VA.
                 Paragraph (b) explains that after a grantee is selected for renewal
                of a suicide prevention services grant in accordance with Sec. 78.40,
                VA will draft a suicide prevention services grant agreement to be
                executed by VA and the grantee. Upon execution of the suicide
                prevention services grant agreement, VA will obligate suicide
                prevention services grant funds to cover the amount of the approved
                suicide prevention services grant, subject to the availability of
                funding. Such grant agreement will contain the same provisions
                described in paragraph (a) of this section.
                 Pursuant to paragraph (c), no funds provided under part 78 may be
                used to replace Federal, State, tribal, or local funds previously used,
                or designated for use, to assist eligible individuals and their
                families.
                78.120 Amount and Payment of Grants
                 Consistent with section 201(c)(2)(A) of the Act, Sec. 78.120(a)
                states that the maximum funding that a grantee may be awarded under
                part 78 is $750,000 per fiscal year. VA may provide less than $750,000
                per award per its discretion under section 201 of the Act. As explained
                in Sec. 78.110, the NOFO will identify the estimated amount of grant
                funding available. However, because of the statutory restriction, VA
                will not provide more than $750,000 per grantee per fiscal year.
                 Section 78.120(b) explains that grantees are to be paid in
                accordance with the timeframes and manner set forth in the NOFO.
                Section 201(c)(2)(B) of the Act authorizes VA to establish intervals of
                payment for purposes of this grant program, and VA will do so in the
                NOFO, which is consistent with how VA establishes payment in other
                grant programs. See 38 CFR 62.51. Including such information in the
                NOFO provides VA with the flexibility to determine the time and manner
                of payment for suicide prevention services grants that is appropriate
                for each funding cycle.
                78.125 Program or Budget Changes and Corrective Action Plans
                 Section 78.125 sets forth the requirements if there are changes to
                the program or budget that alter the grantee's suicide prevention
                services grant program. This section is consistent with 2 CFR 200.308
                which establishes policy and processes for revision of budget and
                program plans for Federal awards. These requirements are authorized by
                section 201(f)(1) of the Act, which permits VA to include such
                commitments as the Secretary considers necessary to carry out this
                section. These requirements are also consistent with how VA handles
                program and budget changes and corrective action plans in the SSVF
                Program (see 62 CFR 62.60) and allow VA to ensure that grant funds are
                used appropriately and to maintain control over the quality of suicide
                prevention services provided by the grantee.
                 Paragraph (a) states that a grantee must submit to VA a written
                request to modify a suicide prevention services grant for any proposed
                significant change that will alter the suicide prevention services
                grant program. It further explains that if VA approves such change, it
                will issue a written amendment to the suicide prevention services grant
                agreement. A grantee must receive VA's approval prior to implementing a
                significant change. Significant changes include, but are not limited
                to, a change in the grantee or any community partners identified in the
                suicide prevention services grant agreement; a change in the area
                served by the grantee; additions or deletions of suicide prevention
                services provided by the grantee; a change in category of participants
                to be served; and a change in budget line items that are more than 10
                percent of the total suicide prevention services grant award. VA's
                approval of changes will be contingent upon the grantee's amended
                application retaining a sufficient rank to have been competitively
                selected for funding in the year that the application was granted, and
                each suicide prevention services grant modification request will be
                required to contain a description of, and justification for, the
                revised proposed use of suicide prevention services grant funds.
                 Under paragraph (b), VA may require that the grantee initiate,
                develop, and submit to VA for approval a Corrective Action Plan (CAP)
                if, on a quarterly basis, actual suicide prevention services grant
                expenditures vary from the amount disbursed to a grantee for that same
                quarter or actual suicide prevention services grant activities vary
                [[Page 13828]]
                from the grantee's program description provided in the suicide
                prevention services grant agreement. Paragraph (b) also sets forth
                specific requirements related to the CAP. These include that the CAP
                must identify the expenditure or activity source that has caused the
                deviation, describe the reason(s) for the variance, provide specific
                proposed corrective action(s), and provide a timetable for
                accomplishment of the corrective action. After receipt of the CAP, VA
                will send a letter to the grantee indicating that the CAP is approved
                or disapproved. If disapproved, VA will make beneficial suggestions to
                improve the proposed CAP and request resubmission or take other actions
                in accordance with this part.
                 Paragraph (c) explains that grantees are required to inform VA in
                writing of any key personnel changes (e.g., new executive director,
                suicide prevention services grant program director, or chief financial
                officer) and grantee address changes within 30 days of the change.
                78.130 Faith-Based Organizations
                 As VA anticipates that religious or faith-based organizations may
                apply for grants under part 78, Sec. 78.130 explains that religious or
                faith-based organizations are eligible for suicide prevention services
                grants and describes the conditions for use of these grants as they
                relate to religious activities. This is similar to the language used in
                the Homeless Providers Grant and Per Diem Program (38 CFR 61.64) and
                the SSVF Program (38 CFR 61.62). However, VA has moved the definitions
                of indirect financial assistance and direct federal financial
                assistance to the definitions section of part 78.
                 Under paragraph (a), organizations that are faith-based will be
                eligible, on the same basis as any other organization, to participate
                in SSG Fox SPGP under part 78. Decisions about awards of Federal
                financial assistance must be free from political interference or even
                the appearance of such interference and must be made on the basis of
                merit, not on the basis of religion or religious belief or lack
                thereof.
                 Paragraph (b)(1) states that no organization may use direct
                financial assistance from VA under this part to pay for any of the
                following: (i) Explicitly religious activities such as, religious
                worship, instruction, or proselytization; or (ii) equipment or supplies
                to be used for any of those activities. Paragraph (b)(2) states that
                references to financial assistance are deemed to be references to
                direct Federal financial assistance, unless the referenced assistance
                meets the definition of indirect Federal financial assistance in part
                78.
                 Under paragraph (c), organizations that engage in explicitly
                religious activities, such as worship, religious instruction, or
                proselytization, must offer those services separately in time or
                location from any programs or services funded with direct financial
                assistance from VA under this part, and participation in any of the
                organization's explicitly religious activities must be voluntary for
                the participants in a program or service funded by direct financial
                assistance from VA under part 78.
                 Paragraph (d) states that a faith-based organization that
                participates in SSG Fox SPGP under part 78 will retain its independence
                from Federal, State, or local governments. It further states that such
                organizations may continue to carry out its mission, including the
                definition, practice and expression of its religious beliefs, so long
                as the organization does not use direct financial assistance from VA
                under part 78 to support any explicitly religious activities, such as
                worship, religious instruction, or proselytization. Faith-based
                organizations may use space in their facilities to provide VA-funded
                services under part 78, without concealing, removing, or altering
                religious art, icons, scripture, or other religious symbols. In
                addition, a VA-funded faith-based organization retains its authority
                over its internal governance, and it may retain religious terms in its
                organization's name, select its board members and otherwise govern
                itself on a religious basis, and include religious reference in its
                organization's mission statements and other governing documents.
                 Under paragraph (e), an organization that participates in a VA
                program under this part must not, in providing direct program
                assistance, discriminate against a program participant or prospective
                program participant on the basis of religion or religious belief.
                 Under paragraph (f), if a State or local government voluntarily
                contributes its own funds to supplement Federally funded activities,
                the State or local government has the option to segregate the Federal
                funds or commingle them. However, if the funds are commingled, this
                provision applies to all of the commingled funds.
                 Under paragraph (g), to the extent otherwise permitted by Federal
                law, the restrictions on explicitly religious activities set forth in
                this section do not apply where VA funds are provided to faith-based
                organizations through indirect assistance as a result of a genuine and
                independent private choice of a participant, provided the faith-based
                organizations otherwise satisfy the requirements of this part. A faith-
                based organization may receive such funds as the result of a
                participant's genuine and independent choice if, for example, a
                participant redeems a voucher, coupon, or certificate, allowing the
                participant to direct where funds are to be paid, or a similar funding
                mechanism provided to that participant and designed to give that
                participant a choice among providers.
                78.135 Visits to Monitor Operation and Compliance
                 Section 78.135(a) authorizes VA, at all reasonable times, to make
                visits to all grantee locations where a grantee is using suicide
                prevention services grant funds to review grantee accomplishments and
                management control systems and to provide such technical assistance as
                may be required. VA may also conduct inspections of all program
                locations and records of a grantee at such times as are deemed
                necessary to determine compliance with the provisions of this part. In
                the event that a grantee delivers services in a participant's home, or
                at a location away from the grantee's place of business, VA may
                accompany the grantee. If the grantee's visit is to the participant's
                home, VA will only accompany the grantee with the consent of the
                participant. If any visit is made by VA on the premises of the grantee
                or a community partner under the suicide prevention services grant, the
                grantee must provide, and must require its community partners to
                provide, all reasonable facilities and assistance for the safety and
                convenience of the VA representatives in the performance of their
                duties. All visits and evaluations will be performed in such a manner
                as will not unduly delay services.
                 Paragraph (b) explains that the authority to inspect carries with
                it no authority over the management or control of any applicant or
                grantee under this part.
                 These provisions are critical for VA oversight over suicide
                prevention services grants and are consistent with how VA administers
                other grant programs (see 38 CFR 61.65 and 62.63). These provisions are
                authorized by section 201(f)(1) and 201(g) of the Act, which authorize
                VA to require eligible entities seeking grants to provide such
                commitments and information as VA considers necessary and require VA to
                provide training and technical assistance to eligible entities in
                receipt of grants. These provisions are also consistent with 2 CFR
                200.329 regarding
                [[Page 13829]]
                monitoring and reporting program performance for Federal awards.
                78.140 Financial Management and Administrative Costs
                 Section 78.140 sets forth requirements with which grantees must
                comply and ensures that grantees are aware of these requirements. These
                requirements are consistent with other grant programs, such as the SSVF
                Program (see 38 CFR 62.70) and the Homeless Providers Grant and Per
                Diem Program (see 38 CFR 61.66).
                 Paragraph (a) requires grantees to comply with applicable
                requirements of the Uniform Administrative Requirements, Cost
                Principles, and Audit Requirements for Federal Awards under 2 CFR part
                200. Part 200 of 2 CFR establishes the uniform administrative
                requirements, cost principles, and audit requirements for Federal
                awards to non-Federal entities.
                 Paragraph (b) requires grantees use a financial management system
                that provides adequate fiscal control and accounting records and meets
                the requirements set forth in 2 CFR part 200.
                 Under paragraph (c), payment up to the amount specified in the
                suicide prevention services grant must be made only for allowable,
                allocable, and reasonable costs in conducting the work under the
                suicide prevention services grant, and the determination of allowable
                costs must be made in accordance with the applicable Federal Cost
                Principles set forth in 2 CFR part 200.
                 Paragraph (d) prohibits costs for administration by a grantee from
                exceeding 10 percent of the total amount of the suicide prevention
                services grant. Administrative costs include all costs associated with
                the management of the program and include the administrative costs of
                community partners.
                 VA has determined this limitation on administrative costs to be
                reasonable and consistent with the purpose of SSG Fox SPGP, as VA
                believes it is important that almost all of funding provided by VA goes
                towards providing services for participants. This requirement ensures
                that the vast majority of suicide prevention services grant funds (at
                least 90 percent) are used to provide suicide prevention services to
                participants. These requirements are also consistent with the SSVF
                Program, which allows only 10 percent of the grant funds to be used for
                specified administrative costs. See 38 CFR 62.10. VA has not identified
                any issues with this limitation in the context of the SSVF program. VA
                believes that 10 percent is a reasonable maximum for administrative
                costs, and any additional funds needed by grantees to administer the
                suicide prevention services should be provided by non-VA funds.
                78.145 Grantee Reporting Requirements
                 Section 78.145 sets forth reporting requirements regarding the
                projects carried out using grant funds provided under part 78. Such
                reporting requirements ensure that grants funds are being properly used
                in accordance with the Act and with part 78, and that VA is being a
                good fiscal steward of the taxpayer dollar. These reporting
                requirements are consistent with subsections (e)(5) and (k) of section
                201 of the Act. Section 201(e)(5)(A) mandates that VA require each
                entity receiving a suicide prevention services grant to submit to VA an
                annual report that describes the projects carried out with such grant
                during the year covered by the report. Section 201(e)(5)(C) further
                authorizes VA to require each such entity to submit to VA such
                additional reports as VA considers appropriate. Section 201(k) of the
                Act requires VA to submit an interim report and final report on the
                provision of grants to eligible entities under part 78 to the
                appropriate committees of Congress. Subsection (k)(1)(C) further
                provides VA with the authority to require eligible entities to provide
                to Congress such information as VA determines necessary regarding
                certain information that must be included in such reports. These
                provisions of section 201 of the Act are implemented in paragraphs (b)
                and (c), as explained in more detail below. Additionally, these
                reporting requirements are consistent with how VA administers the SSVF
                Program. See 38 CFR 62.71.
                 In paragraph (a), VA reserves the right to require grantees to
                provide, in any form as may be prescribed, such reports or answers in
                writing to specific questions, surveys, or questionnaires as VA
                determines necessary to carry out SSG Fox SPGP.
                 Consistent with section 201(e)(5)(A) of the Act, paragraph (b)
                requires that at least once per year, each grantee must submit to VA a
                report that describes the projects carried out with such grant during
                the year covered by the report; and information relating to operational
                effectiveness, fiscal responsibility, suicide prevention services grant
                agreement compliance, and legal and regulatory compliance, including a
                description of the use of suicide prevention grant funds, the number of
                participants assisted, the types of suicide prevention services
                provided, and any other information that VA may request. The
                information gathered in this report should also support VA in carrying
                out its responsibilities under section 201(k) of the Act in providing
                necessary information to Congress to facilitate its oversight of this
                program.
                 Under paragraph (c), VA retains the discretion to request
                additional reports or information to be able to fully assess the
                provision or coordination of the provision of suicide prevention
                services under part 78. This is a catch-all provision to allow VA to
                request additional reports or information that it may need to further
                assess the project and the pilot program. These will vary on a case-by-
                case basis dependent on the project and its progression. Additionally,
                if VA is required to submit additional reports to Congress on this
                pilot program, VA reserves the right under this paragraph to request
                such information as needed to respond to Congress. This also provides a
                safeguard in instances where there may be confusing, misleading,
                inconsistent, or unclear statements in submitted reports. VA reserves
                the right to request additional reports to clarify any such information
                it receives in other reports that are submitted by a grantee. This
                requirement is authorized by section 201(f)(1) of the Act, which
                authorizes VA to require applicants to provide such commitments and
                information as VA considers necessary, and by section 201(e)(5)(C) of
                the Act, which authorizes VA to require eligible entities to submit to
                VA such additional reports as VA considers appropriate.
                 Paragraph (d) requires that all pages of the reports must cite the
                assigned suicide prevention services grant number and be submitted in a
                timely manner as set forth in the grant agreement. Including the
                assigned grant number on each page of the report is important for
                tracking reports and to ensure that all pages of the relevant report
                are received by VA for each grant.
                 Paragraph (e) further requires that grantees provide VA with
                consent to post information from reports on the internet and use such
                information in other ways deemed appropriate by VA. Grantees shall
                clearly mark information that is confidential to individual
                participants. This is consistent with the SSVF program (see 38 CFR
                62.71(f)).
                78.150 Recordkeeping
                 Section 78.150 requires grantees, consistent with 2 CFR 200.334, to
                keep records and maintain such records for at least a three-year
                period, to document compliance with SSG Fox SPGP requirements in part
                78. Grantees will need to produce these records at VA's
                [[Page 13830]]
                request. This will assist VA in providing oversight of grantees and is
                consistent with section 201(k)(1)(B)(i) of the Act, which requires VA
                to assess the effectiveness of this grant program, as well as the
                requirements for recordkeeping in 2 CFR 200.334.
                78.155 Technical Assistance
                 Consistent with section 201(g) of the Act, Sec. 78.155 explains
                that VA will provide technical assistance, as necessary, to applicants
                and grantees to meet the requirements of part 78. Section 201(g) of the
                Act specifically requires VA to provide training and technical
                assistance, in coordination with the Centers for Disease Control and
                Prevention (CDC), to grantees regarding (1) suicide risk identification
                and management, (2) the data required to be collected and shared with
                VA, (3) the means of data collection and sharing, (4) familiarization
                with and appropriate use of any tool to be used to measure the
                effectiveness of the use of grants, and (5) the requirements for
                reporting on services provided via such grants. Section 78.155 further
                explains that such technical assistance will be provided either
                directly by VA or through contracts with appropriate public or non-
                profit private entities. Technical assistance may consist of activities
                related to the planning, development, and provision of suicide
                prevention services to participants.
                 In addition to other forms of technical assistance that will be
                provided, such as training and assistance with the five categories
                described above, VA will develop a program guide to be used by
                applicants, grantees, VA staff members, and other interested third
                parties to assist with understanding and implementing SSG Fox SPGP.
                This technical assistance will be conducted in coordination with the
                CDC, as required by section 201(g)(1) of the Act. CDC will be available
                on technical assistance calls, including those relating to the
                availability of data on suicide in grantees' local areas. This is
                consistent with the technical assistance VA provides in the SSVF
                Program. See 38 CFR 62.73.
                78.160 Withholding, Suspension, Deobligation, Termination, and Recovery
                of Funds by VA
                 Section 78.160 explains that VA will enforce part 78 through such
                actions as may be appropriate. Appropriate actions include withholding,
                suspension, deobligation, termination, recovery of funds by VA, and
                actions in accordance with 2 CFR part 200.
                 As suicide prevention services grants are subject to the
                requirements of 2 CFR part 200, VA explicitly references 2 CFR part 200
                in Sec. 78.160 to ensure that grantees understand and know where to
                locate these requirements related to withholding, suspension,
                deobligation, termination, and recovery of funds. The specific sections
                of 2 CFR part 200 on withholding, suspension, deobligation,
                termination, and recovery of funds are 2 CFR 200.208, 200.305, and
                200.339 through 200.343, and 200.346, respectively. VA refers to 2 CFR
                part 200 rather than include those requirements in this section as
                those requirements in 2 CFR part 200 may change. Referencing 2 CFR part
                200 provides VA the ability to implement those changes without having
                to conduct further rulemaking.
                 VA acknowledges that when certain actions (such as suspension and
                termination) are taken against grantees pursuant to this section and 2
                CFR part 200, a disruption in services to participants may occur. While
                VA is not regulating responsibilities for grantees to continue to
                provide services or to coordinate the transfer of participants to other
                sources of support, VA will include such requirements and
                responsibilities in the grant agreement that VA and the grantee enter
                into pursuant to this part. This will ensure that the disruption and
                impact upon participants is minimized as much as possible.
                78.165 Suicide Prevention Services Grant Closeout Procedures
                 Section 78.165 explains that suicide prevention services grants
                will be closed out in accordance with 2 CFR part 200. Procedures for
                closing out Federal awards are currently located at 2 CFR 200.344 and
                200.345. As suicide prevention services grants are subject to the
                requirements of 2 CFR part 200, VA explicitly references 2 CFR part 200
                in Sec. 78.165 to ensure that grantees understand and know where to
                locate these requirements. VA refers to 2 CFR part 200 rather than
                include those requirements in this section as those requirements in 2
                CFR part 200 may change, and referencing 2 CFR part 200 provides VA
                ability to implement those changes without having to conduct further
                rulemaking.
                Administrative Procedure Act
                 The Administrative Procedure Act (APA), codified in part at 5
                U.S.C. 553, generally requires agencies publish substantive rules in
                the Federal Register for notice and comment. These notice and comment
                requirements generally do not apply to ``a matter relating to agency
                management or personnel or to public property, loans, grants, benefits
                or contracts.'' 5 U.S.C. 553(a)(2). However, 38 U.S.C. 501(d) requires
                VA comply with the notice and comment requirements in 5 U.S.C. 553 for
                matters relating to grants, notwithstanding section 553(a)(2). Thus, as
                this rulemaking relates to the grant program required by section 201 of
                the Act, VA is required to comply with the notice and comment
                requirements of 5 U.S.C. 553.
                 However, pursuant to 5 U.S.C. 553(b)(B), general notice and the
                opportunity for public comment are not required with respect to a
                rulemaking when an ``agency for good cause finds (and incorporates the
                finding and a brief statement of reasons therefor in the rules issued)
                that notice and public procedure thereon are impracticable,
                unnecessary, or contrary to the public interest.''
                 In accordance with 5 U.S.C. 553(b)(B), the Secretary has concluded
                that there is good cause to publish this rule without prior opportunity
                for public comment. This rule implements the mandates of section 201 of
                the Act to establish a new suicide prevention services grant program.
                This new grant program, SSG Fox SPGP, will provide eligible individuals
                and their families with suicide prevention services that will aim to
                reduce and prevent suicide by providing outreach, mental health
                screenings, education on suicide risk and prevention, clinical services
                for emergency treatment, case management services, peer support
                services, and assistance with obtaining VA and other government
                benefits, among other services.
                 Suicide is a national public health concern, and it is preventable.
                The rate of veteran suicide in the United States remains high, despite
                great effort. It is critical that this rulemaking publish without
                delay, as these grants will result in increased engagement with a
                specific population at risk of suicide, which is especially needed
                during the Coronavirus Disease-2019 (COVID-19) pandemic and the
                immediate period following this pandemic. The COVID-19 pandemic has
                caused significant psychological distress related to economic
                hardships, physical safety concerns, illness, and death of family and
                friends, uncertainty about the future, and isolation from social
                supports. See Panchal, N., Kamal, R., Orgera, K., Cox, C., Garfield,
                R., Hamel, L., Mu[ntilde]ana, C. & Chidambaram, P. (2021). The
                implications of COVID-19 for mental health and substance use. Kaiser
                Family Foundation. https://www.kff.org/coronavirus-covid-19/issuebrief/the-implications-of-covid-19-for-mental-health-and-substance-use;
                [[Page 13831]]
                See also, Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L.,
                Wessely, S., Greenberg, N., & Rubin, G.J., (2020). The psychological
                impact of quarantine and how to reduce it: Rapid review of the
                evidence. Lancet, 395, 912-920. COVID-19 has had a detrimental effect
                on mental health in the United States. See id.; see also, Czeisler,
                M[Eacute], Lane, RI, Petroski, E, et al. Mental Health, Substance Use,
                and Suicidal Ideation During the COVID-19 Pandemic--United States, June
                24-30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049; See also, National
                Center for Health Statistics (2021). Anxiety and depression: Household
                Pulse Survey. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm (Last accessed May 17,
                2021).
                 According to a recent CDC report, more Americans are reporting
                negative mental health impacts, including higher rates of suicidal
                thoughts, during the COVID-19 pandemic. Czeisler M[Eacute], Lane RI,
                Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation
                During the COVID-19 Pandemic--United States, June 24-30, 2020. MMWR
                Morb Mortal Wkly Rep 2020;69:1049-1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1. While this report examined the general
                population of America, there is also evidence of increased distress
                among the veteran population. For instance, there has been an increase
                in call volume to the Veterans Crisis Line (VCL). In fiscal year (FY)
                2019, VCL answered an average daily call volume of 1590.67 calls
                compared with 1765.02 FY 2020 and 1807.52 in FY 2021, with VCL call
                volume increasing over 22% in direct-date comparisons from FY 2019 to
                FY 2021.
                 Veterans, in particular, may be uniquely vulnerable to negative
                mental health effects of the pandemic such as suicidality due to their
                older age, previous trauma exposures, and higher pre-pandemic
                prevalence of physical and psychiatric risk factors and conditions. Na,
                P.J., Tsai, J., Hill, M.L., Nichter, B., Norman, S.B., Southwick, S.M.,
                & Pietrzak, R.H. (2021). Prevalence, risk and protective factors
                associated with suicidal ideation during the COVID-19 pandemic in U.S.
                military veterans with pre-existing psychiatric conditions. Journal of
                Psychiatric Research, 137, 351-359. In an analysis of data from the
                National Health and Resilience in Veterans Study, researchers found
                that 19.2% of veterans screened positive for suicidal ideation peri-
                pandemic, and such veterans had lower income, were more likely to have
                been infected with COVID-19, reported greater COVID-19-related
                financial and social restriction stress, and increases in psychiatric
                symptoms and loneliness during the pandemic when compared to veterans
                without suicidal ideation. Id. Additionally, they found that among
                veterans who were infected with COVID-19, those aged 45 or older and
                who reported lower purpose in life were more likely to endorse suicidal
                ideation. Id. These researchers noted that monitoring for suicide risk
                and worsening psychiatric symptoms in older veterans who have been
                infected with COVID-19 may be important, and that interventions that
                enhance purpose in life may help protect against suicidal ideation in
                this population. Consistent with the recommendations of this research,
                SSG Fox SPGP will support monitoring for suicide risk and worsening
                psychiatric symptoms by providing support to more organizations who can
                reach veterans who do not seek or obtain care through VA. Through this
                grant program, organizations' efforts can also help protect this
                population against suicidal ideation by enhancing purpose in life.
                 Furthermore, studies have shown increased suicide after pandemics
                such as the 1918 Influenza (H1N1) pandemic and the 2003 Severe Acute
                Respiratory Syndrome (SARS) outbreak, in which increased risk factors
                associated with negative impacts of epidemics were believed to
                contribute to suicide. See Wasserman IM. The impact of epidemic, war,
                prohibition and media on suicide: United States, 1910-1920. Suicide
                Life Threat Behav. 1992 Summer;22(2):240-54. PMID: 1626335.; See also,
                Cheung YT., Chau PH., and Yip PS. A revisit on older adults suicides
                and severe acute respiratory syndrome (SARS) epidemic in Hong Kong. Int
                J Geriatr Psychiatry. 2008; 23: 1231-1238. Thus, increased suicide
                death could occur after the COVID-19 pandemic unless action is taken.
                See Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A.,
                Kapur, N., Khan, M., O'Connor, R.C., & Pirkis, J. (2020). Suicide risk
                and prevention during the COVID-19 pandemic. The Lancet Psychiatry,
                7(6), 468-471.
                 It is therefore critical that VA publish this rulemaking without
                delay to ensure the services provided through this grant program will
                assist the growing number of eligible individuals who are suffering
                from mental health concerns and may be at risk of suicide as a result
                of the COVID-19 pandemic, particularly as the period immediately
                following a pandemic can result in elevated risk of suicide. Publishing
                this rulemaking without delay will help ensure that services under this
                grant program can be provided to eligible individuals during the
                pandemic or in the immediate aftermath of it when they can have the
                most impact. As noted earlier in this section, efforts and actions
                supported through this grant program will be consistent with recent
                findings and recommendations on the impact of the COVID-19 pandemic on
                veterans and can help protect this population against suicidal
                ideation. See, Na, P.J., Tsai, J., Hill, M.L., Nichter, B., Norman,
                S.B., Southwick, S.M., & Pietrzak, R.H. (2021). Prevalence, risk and
                protective factors associated with suicidal ideation during the COVID-
                19 pandemic in U.S. military veterans with pre-existing psychiatric
                conditions. Journal of Psychiatric Research, 137, 351-359.
                 VA believes that increased engagement with veterans and their
                families from VA and community partners through this grant program will
                help prevent veteran suicide. As detailed in VA's 2021 National Veteran
                Suicide Prevention Annual Report, the average number of veteran suicide
                deaths per day in 2019 was 17.2. (Available online: https://www.mentalhealth.va.gov/docs/data-sheets/2021/2021-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-9-8-21.pdf). Of those, 6.8 were
                veterans who recently used VA health care (that is, these veterans had
                received VA health care services within the preceding two years) and
                10.4 were veterans who had not recently used VA health care. See id.
                Furthermore, from 2005 to 2018, suicide rates fell among veterans with
                depression, anxiety, and substance use disorders who were in VA care.
                See VA's 2020 National Veteran Suicide Prevention Annual Report.
                (Available online: https://www.mentalhealth.va.gov/docs/data-sheets/2020/2020-National-Veteran-Suicide-Prevention-Annual-Report-11-2020-508.pdf. In addition to VA engagement and services reducing suicide
                rates, studies have shown that community-based and public health
                suicide prevention have been effective in reducing suicide rates in
                diverse communities. See Hegerl, U., Althaus, D., Schmidtke, A., &
                Niklewski, G. (2006); The alliance against depression: 2-year
                evaluation of a community-based intervention to reduce suicidality.
                Psychological Medicine, 36(9), 1225-1233. These statistics and studies
                support VA's contention that increased engagement from VA and community
                partners through this grant program can help reduce suicide risk among
                eligible individuals by providing critical
                [[Page 13832]]
                services connecting veterans with VA care and services.
                 Additionally, this rulemaking is not entirely without public input.
                VA reiterates that as described earlier in this document, VA published
                a request for information on this rulemaking and held multiple
                listening sessions to obtain input from the public as part of the
                consultation required by section 201 of the Act. Conducting
                consultation in this manner is consistent with VA's past practice and
                interpretation of consultation requirements under Federal law. VA
                received 124 comments in response to the request for information and
                had 32 speakers at the listening sessions. This public input has been
                reviewed and incorporated, as appropriate, into this rulemaking.
                 For these reasons, the Secretary has concluded that ordinary notice
                and comment procedures would be impracticable and contrary to the
                public interest and is accordingly issuing this rule as an interim
                final rule. The Secretary will consider and address comments that are
                received within 60 days after the date that this interim final rule is
                published in the Federal Register and address them in a subsequent
                Federal Register document announcing a final rule incorporating any
                changes made in response to the public comments.
                Executive Orders 12866 and 13563
                 Executive Orders 12866 and 13563 direct agencies to assess the
                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 effects, and other advantages; distributive impacts;
                and equity). Executive Order 13563 (Improving Regulation and Regulatory
                Review) emphasizes the importance of quantifying both costs and
                benefits, reducing costs, harmonizing rules, and promoting flexibility.
                The Office of Information and Regulatory Affairs has determined that
                this rule is a significant regulatory action under Executive Order
                12866. The Regulatory Impact Analysis associated with this rulemaking
                can be found as a supporting document at www.regulations.gov.
                Regulatory Flexibility Act
                 The Regulatory Flexibility Act, 5 U.S.C. 601-612, is not applicable
                to this rulemaking because notice of proposed rulemaking is not
                required. 5 U.S.C. 601(2), 603(a), 604(a).
                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 the 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 one year. This interim final rule will have no such
                effect on State, local, and tribal governments, or on the private
                sector.
                Paperwork Reduction Act
                 This interim final rule includes provisions constituting new
                collections of information under the Paperwork Reduction Act of 1995
                (44 U.S.C. 3501-3521) that require approval by the Office of Management
                and Budget (OMB). Accordingly, under 44 U.S.C. 3507(d), VA has
                submitted a copy of this rulemaking action to OMB for review.
                 OMB assigns control numbers to collections 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. Sections 78.10, 78.15, 78.95,
                78.125, 78.145 contain new collections of information under the
                Paperwork Reduction Act of 1995. If OMB does not approve the
                collections of information as requested, VA will immediately remove the
                provisions containing a collection of information or take such other
                action as is directed by OMB.
                 Comments on the new collection of information contained in this
                rulemaking should be submitted through www.regulations.gov. Comments
                should indicate that they are submitted in response to ``RIN 2900-
                AR16--Staff Sergeant Parker Gordon Fox Suicide Prevention Grant
                Program'' and should be sent within 30 days of publication of this
                rulemaking. The collection of information associated with this
                rulemaking can be viewed at: www.reginfo.gov/public/do/PRAMain.
                 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 interim final rule.
                 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 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.
                 The collections of information contained in 38 CFR 78.10, 78.15,
                78.95, 78.125, and 78.145 are described immediately following this
                paragraph, under their respective titles.
                 Title: Eligibility Screening.
                 OMB Control No: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.10.
                 Summary of collection of information: This new collection
                of information in 38 CFR 78.10 requires grantees to determine
                eligibility for purposes of this grant program using screening tools.
                 Description of need for information and proposed use of
                information: This collection of information is necessary to evaluate
                and determine eligibility for suicide prevention services and ensure
                that VA resources are directed at the intended population, in an
                efficient equitable method.
                 Description of likely respondents: Grantees.
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 67.
                 Estimated average burden per response: 30 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                3,015 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $81,616.05.
                 Title: Suicide Risk Screening.
                 OMB Control No: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.10.
                 Summary of collection of information: This new collection
                of information in 38 CFR 78.10 requires grantees to use screening tools
                to assess risk of suicide among program participants for purposes of
                implementing this grant program.
                 Description of need for information and proposed use of
                information: This collection of information is necessary to assess risk
                of suicide and ensure that VA resources are directed at the intended
                population, in an efficient equitable method.
                 Description of likely respondents: Grantees.
                [[Page 13833]]
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 67.
                 Estimated average burden per response: 15 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                1,507.5 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $40,808.03.
                 Title: Application Provisions for the Staff Sergeant Gordon Parker
                Fox Suicide Prevention Grant Program.
                 OMB Control No: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.15.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.15 requires applications be submitted to be
                evaluated and considered for a grant under this new part 78.
                Applications require specific information so that VA can properly
                evaluate such applications for grants.
                 Description of need for information and proposed use of
                information: This collection of information is necessary to award
                suicide prevention services grants to eligible entities.
                 Description of likely respondents: Eligible entities.
                 Estimated number of respondents: 250.
                 Estimated frequency of responses: 1.
                 Estimated average burden per response: 2,100 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                8,750 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $236,862.50.
                 Title: Suicide Prevention Services Grant Renewal Applications.
                 OMB Control No: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.15.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.15 requires that renewal applications be
                submitted to be evaluated and receive a renewal of a grant under this
                new part 78. Applications require specific information so that VA can
                properly evaluate such applications for renewal of grants.
                 Description of need for information and proposed use of
                information: This collection of information is necessary to award
                suicide prevention services grants to eligible entities.
                 Description of likely respondents: Grantees that seek
                renewal of their grants.
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 1.
                 Estimated average burden per response: 600 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                900 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $24,363.
                 Title: Participant Satisfaction Surveys.
                 OMB Control No: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.95.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.95 requires grantees to conduct
                satisfaction surveys from participants.
                 Description of need for information and proposed use of
                information: The collection of information is necessary to evaluate
                whether participants are satisfied with the suicide prevention services
                provided by the grantee and the effectiveness of such services.
                 Description of likely respondents: Eligible individuals
                and their families who receive suicide prevention services.
                 Estimated number of respondents: 5,000.
                 Estimated frequency of responses: 1.
                 Estimated average burden per response: 15 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                1,250 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $33,837.50.
                 Title: Intake Form.
                 OMB Control No: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.95.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.95 requires grantees to use tools and
                assessments (that is, an intake form) to determine the effectiveness of
                the suicide prevention services furnished by the grantee.
                 Description of need for information and proposed use of
                information: The collection of information is necessary to ensure that
                the appropriate services are offered to participants, and the data
                collected will be used by VA to determine the participant's baseline
                with regards to mood-related symptoms, overall wellbeing, and financial
                stressors and social supports. This will enable VA to measure the
                effectiveness of the programming provided in improving mental health
                status, wellbeing, and reducing suicide risk and suicide deaths of
                eligible individuals.
                 Description of likely respondents: Grantees.
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 67.
                 Estimated average burden per response: 30 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                3,015 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $81,616.05.
                 Title: Program Exit Checklist.
                 OMB Control No: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.95.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.95 requires grantees to use tools and
                assessments (that is, a program exit checklist) to determine the
                effectiveness of the suicide prevention services furnished by the
                grantee.
                 Description of need for information and proposed use of
                information: The collection of information is necessary to determine
                whether there was a reduction of the participant's mood-related
                symptoms, an overall improved wellbeing, and mitigation of any
                financial and social support stressors. This will enable VA to measure
                the effectiveness of the programming provided in improving mental
                health status, wellbeing, and reducing suicide risk and suicide deaths
                of eligible individuals.
                 Description of likely respondents: Grantees.
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 67.
                 Estimated average burden per response: 30 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                3,015 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $81,616.05.
                 Title: Program and Budget Changes.
                 OMB Control No: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.125.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.125 requires certain grantees to provide VA
                with program and/or budget changes.
                 Description of need for information and proposed use of
                information: Reporting of program/budget changes is necessary for VA to
                approve and ensure that such changes are consistent with proposed 38
                CFR part 78 and the goals and intent of the Staff Sergeant Parker
                Gordon Fox Suicide Prevention Grant Program. These collections are not
                required of every grantee and are needed only in limited instances.
                 Description of likely respondents: Grantees.
                [[Page 13834]]
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 2.
                 Estimated average burden per response: 15 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                45 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $1,218.15.
                 Title: Annual Performance Compliance Reports for Suicide Prevention
                Services Program.
                 OMB Control No: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.145.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.145 requires grantees to provide annual
                reports to assess the provision of services under this grant program.
                 Description of need for information and proposed use of
                information: The collection of information is necessary to determining
                compliance with the requirements for a suicide prevention services
                grant and to assess the provision of services under this grant program.
                 Description of likely respondents: Grantees.
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 1.
                 Estimated average burden per response: 45 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                67.50 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $1,827.23.
                 Title: Other Performance Compliance Reports for Suicide Prevention
                Services Program.
                 OMB Control No.: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.145.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.145 requires grantees to provide two
                performance reports to assess the provision of services under this
                grant program.
                 Description of need for information and proposed use of
                information: The collection of information is necessary to determining
                compliance with the requirements for a suicide prevention services
                grant and to assess the provision of services under this grant program.
                 Description of likely respondents: Grantees.
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 2.
                 Estimated average burden per response: 30 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                90 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $2,436.30.
                 Title: Other Financial Compliance Reports for Suicide Prevention
                Services Program.
                 OMB Control No.: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.145.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.145 requires grantees to provide two
                reports to assess financial compliance under this grant program.
                 Description of need for information and proposed use of
                information: The collection of information is necessary to determining
                compliance with the financial requirements for a suicide prevention
                services grant.
                 Description of likely respondents: Grantees.
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 2.
                 Estimated average burden per response: 30 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                90 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $2,436.30.
                 Title: Annual Financial Expenditure Reports for Suicide Prevention
                Services Program.
                 OMB Control No.: 2900-TBD (New).
                 CFR Provision: 38 CFR 78.145.
                 Summary of collection of information: The new collection
                of information in 38 CFR 17.145 requires grantees to provide annual
                reports to assess financial expenditure compliance under this grant
                program.
                 Description of need for information and proposed use of
                information: The collection of information is necessary to determining
                compliance with the financial expenditure requirements for a suicide
                prevention services grant.
                 Description of likely respondents: Grantees.
                 Estimated number of respondents: 90.
                 Estimated frequency of responses: 1.
                 Estimated average burden per response: 45 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                67.5 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $1,827.23.
                 Title: Compliance--Corrective Action Plan.
                 OMB Control No.: 2900-TBD (New).
                 CFR Provision: 38 CFR 17.145.
                 Summary of collection of information: The new collection
                of information in 38 CFR 78.145 requires grantees to provide ad hoc
                compliance corrective action plans under this grant program.
                 Description of need for information and proposed use of
                information: The collection of information is necessary to determining
                compliance with any necessary corrective action plans for a suicide
                prevention services grant.
                 Description of likely respondents: Grantees.
                 Estimated number of respondents: 25.
                 Estimated frequency of responses: 1.
                 Estimated average burden per response: 30 minutes.
                 Estimated total annual reporting and recordkeeping burden:
                12.5 hours.
                 * Estimated annual cost to respondents for the hour
                burdens for collections of information: $338.38.
                 * To estimate the total information collection burden cost, VA used
                the Bureau of Labor Statistics (BLS) median hourly wage for hourly wage
                for ``all occupations'' of $27.07 per hour. This information is
                available at https://www.bls.gov/oes/current/oes_nat.htm#13-0000.
                Assistance Listing
                 The Assistance Listing number and title for the program affected by
                this document is 64.009, Veterans Medical Care Benefits.
                Congressional Review Act
                 Pursuant to Subtitle E of the Small Business Regulatory Enforcement
                Fairness Act of 1996, also known as the Congressional Review Act (5
                U.S.C. 801 et seq.), the Office of Information and Regulatory Affairs
                designated this rule as not a major rule, as defined by 5 U.S.C.
                804(2).
                List of Subjects in 38 CFR Part 78
                 Administrative practice and procedure; Grant programs--health;
                Grant programs--veterans; Health care; Mental health programs;
                Reporting and recordkeeping requirements; Veterans.
                Signing Authority
                 Denis McDonough, Secretary of Veterans Affairs, approved this
                document on November 24, 2021, and authorized the undersigned to sign
                and submit the document to the Office of the Federal Register for
                publication
                [[Page 13835]]
                electronically as an official document of the Department of Veterans
                Affairs.
                Jeffrey M. Martin,
                Assistant Director, Office of Regulation Policy & Management, Office of
                General Counsel, Department of Veterans Affairs.
                0
                For the reasons stated in the preamble, the Department of Veterans
                Affairs amends 38 CFR chapter I by adding part 78 to read as follows:
                PART 78--STAFF SERGEANT PARKER GORDON FOX SUICIDE PREVENTION GRANT
                PROGRAM
                Sec.
                78.0 Purpose and scope.
                78.5 Definitions.
                78.10 Eligible individuals.
                78.15 Applications for suicide prevention services grants.
                78.20 Threshold requirements prior to scoring suicide prevention
                services grant applicants.
                78.25 Scoring criteria for awarding grants.
                78.30 Selection of grantees.
                78.35 Scoring criteria for grantees applying for renewal of suicide
                prevention services grants.
                78.40 Selection of grantees for renewal of suicide prevention
                services grants.
                78.45 Suicide prevention services: Outreach.
                78.50 Suicide prevention services: Baseline mental health screening.
                78.55 Suicide prevention services: Education.
                78.60 Suicide prevention services: Clinical services for emergency
                treatment.
                78.65 Suicide prevention services: Case management services.
                78.70 Suicide prevention services: Peer support services.
                78.75 Suicide prevention services: Assistance in obtaining VA
                benefits.
                78.80 Suicide prevention services: Assistance in obtaining and
                coordinating other public benefits and assistance with emergent
                needs.
                78.85 Suicide prevention services: Nontraditional and innovative
                approaches and treatment practices.
                78.90 Suicide prevention services: Other services.
                78.95 General operation requirements.
                78.100 Fee prohibition.
                78.105 Ineligible activities.
                78.110 Notice of Funding Opportunity.
                78.115 Suicide prevention services grant agreements.
                78.120 Amount and payment of grants.
                78.125 Program or budget changes and corrective action plans.
                78.130 Faith-based organizations.
                78.135 Visits to monitor operation and compliance.
                78.140 Financial management and administrative costs.
                78.145 Grantee reporting requirements.
                78.150 Recordkeeping.
                78.155 Technical assistance.
                78.160 Withholding, suspension, deobligation, termination, and
                recovery of funds by VA.
                78.165 Suicide prevention services grant closeout procedures.
                 Authority: 38 U.S.C. 501, 38 U.S.C. 1720F (note), sec. 201,
                Pub. L. 116-171, and as noted in specific sections.
                Sec. 78.0 Purpose and scope.
                 (a) Purpose. This part implements the Staff Sergeant Parker Gordon
                Fox Suicide Prevention Grant Program (SSG Fox SPGP) with the purpose of
                reducing veteran suicide by expanding suicide prevention programs for
                veterans through the award of suicide prevention services grants to
                eligible entities to provide or coordinate the provision of suicide
                prevention services to eligible individuals and their families.
                 (b) Scope. Suicide prevention services covered by this part are
                those services that address the needs of eligible individuals and their
                families and are necessary for improving the mental health status and
                wellbeing and reducing the suicide risk of eligible individuals and
                their families.
                Sec. 78.5 Definitions.
                 For purposes of this part and any Notice of Funding Opportunity
                (NOFO) issued under this part:
                 Applicant means an eligible entity that submits an application for
                a suicide prevention services grant announced in a NOFO.
                 Direct Federal financial assistance means Federal financial
                assistance received by an entity selected by the Government or a pass-
                through entity as defined in 38 CFR 50.1(d) to provide or carry out a
                service (e.g., by contract, grant, or cooperative agreement).
                 Eligible child care provider means a provider of child care
                services for compensation, including a provider of care for a school-
                age child during non-school hours, that--
                 (1) Is licensed, regulated, registered, or otherwise legally
                operating, under State and local law; and
                 (2) Satisfies the State and local requirements, applicable to the
                child care services the provider providers.
                 Eligible entity means an entity that meets the definition of an
                eligible entity in section 201(q) of Public Law 116-171.
                 Eligible individual means an individual that meets the requirements
                of Sec. 78.10(a).
                 Family means any of the following: A parent, spouse, child,
                sibling, step-family member, extended family member, and any other
                individual who lives with the eligible individual.
                 Grantee means an eligible entity that is awarded a suicide
                prevention services grant under this part.
                 Indian tribe means an Indian tribe as defined in 25 U.S.C. 4103.
                 Indirect Federal financial assistance means Federal financial
                assistance in which a service provider receives program funds through a
                voucher, certificate, agreement or other form of disbursement, as a
                result of the genuine, independent choice of a participant.
                 Medically underserved area means an area that is designated as a
                medically underserved population under 42 U.S.C. 254b(b)(3).
                 Notice of Funding Opportunity (NOFO) means a Notice of Funding
                Opportunity published on grants.gov in accordance with Sec. 78.110.
                 Participant means an eligible individual or their family who is
                receiving suicide prevention services for which they are eligible from
                a grantee.
                 Rural communities means those communities considered rural
                according to the Rural-Urban Commuting Area (RUCA) system as determined
                by the United States Department of Agriculture.
                 State means any of the several States of the United States, the
                District of Columbia, the Commonwealth of Puerto Rico, any territory or
                possession of the United States, or any agency or instrumentality of a
                State exclusive of local governments.
                 Suicide prevention services includes the following services
                provided to address the needs of a participant:
                 (1) Outreach as specified under Sec. 78.45.
                 (2) Baseline mental health screening as specified under Sec.
                78.50.
                 (3) Education as specified under Sec. 78.55.
                 (4) Clinical services for emergency treatment as specified under
                Sec. 78.60.
                 (5) Case management services as specified under Sec. 78.65.
                 (6) Peer support services as specified under Sec. 78.70.
                 (7) Assistance in obtaining VA benefits as specified under Sec.
                78.75.
                 (8) Assistance in obtaining and coordinating other public benefits
                and assistance with emergent needs as specified under Sec. 78.80.
                 (9) Nontraditional and innovative approaches and treatment
                practices as specified under Sec. 78.85.
                 (10) Other services as specified under Sec. 78.90.
                 Suicide prevention services grant means a grant awarded under this
                part.
                 Suicide prevention services grant agreement means the agreement
                executed between VA and a grantee as specified under Sec. 78.115.
                 Suspension means an action by VA that temporarily withdraws VA
                funding under a suicide prevention services grant, pending corrective
                action by the grantee or pending a decision to
                [[Page 13836]]
                terminate the suicide prevention services grant by VA. Suspension of a
                suicide prevention services grant is a separate action from suspension
                under VA regulations or guidance implementing Executive Orders 12549
                and 12689, ``Debarment and Suspension.''
                 Territories means the territories of the United States, including
                Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the
                Northern Mariana Islands.
                 Veterans means a veteran as defined under 38 U.S.C. 101(2).
                 Veterans Crisis Line means the toll-free hotline for veterans in
                crisis and their families and friends established under 38 U.S.C.
                1720F(h).
                 Withholding means that payment of a suicide prevention services
                grant will not be paid until such time as VA determines that the
                grantee provides sufficiently adequate documentation and/or actions to
                correct a deficiency for the suicide prevention services grant.
                Sec. 78.10 Eligible individuals.
                 (a) To be an eligible individual under this part, a person must be
                at risk of suicide and further meet the definition of eligible
                individual in section 201(q) of Public Law 116-171.
                 (b) For purposes of paragraph (a) of this section, risk of suicide
                means exposure to, or the existence of, any of the following factors,
                to any degree, that increase the risk for suicidal ideation and/or
                behaviors:
                 (1) Health risk factors, including mental health challenges,
                substance use disorder, serious or chronic health conditions or pain,
                and traumatic brain injury.
                 (2) Environmental risk factors, including prolonged stress,
                stressful life events, unemployment, homelessness, recent loss, and
                legal or financial challenges.
                 (3) Historical risk factors, including previous suicide attempts,
                family history of suicide, and history of abuse, neglect, or trauma,
                including military sexual trauma.
                 Note 1 to paragraph (b): Grantees must use these risk factors
                and the impact thereof to determine the degree of risk of suicide
                for eligible individuals using a screening tool approved by the
                Department. The degree of risk depends on the presence of one or
                more suicide risk factors and the impact of those factors on an
                individual's mental health and wellbeing.
                (The Office of Management and Budget has approved the information
                collection provisions in this section under control number 2900-TBD.)
                Sec. 78.15 Applications for suicide prevention services grants.
                 (a) To apply for a suicide prevention services grant, an applicant
                must submit to VA a complete suicide prevention services grant
                application package, as described in the NOFO. A complete suicide
                prevention services grant application package includes the following:
                 (1) Documentation evidencing the experience of the applicant and
                any identified community partners in providing or coordinating the
                provision of suicide prevention services to eligible individuals and
                their families.
                 (2) A description of the suicide prevention services proposed to be
                provided or coordinated by the applicant and the identified need for
                those services.
                 (3) A detailed plan describing how the applicant proposes to
                coordinate or deliver suicide prevention services to eligible
                individuals, including:
                 (i) If the applicant is a State or local government or an Indian
                tribe, an identification of the community partners, if any, with which
                the applicant proposes to work in delivering such services;
                 (ii) A description of the arrangements currently in place between
                the applicant and such partners with regard to the provision or
                coordination the provision of suicide prevention services;
                 (iii) An identification of how long such arrangements have been in
                place;
                 (iv) A description of the suicide prevention services provided by
                such partners that the applicant must coordinate, if any; and
                 (v) An identification of local VA suicide prevention coordinators
                and a description of how the applicant will communicate with local VA
                suicide prevention coordinators.
                 (4) A description of the location and population of eligible
                individuals and their families proposed to be provided suicide
                prevention services.
                 (5) An estimate of the number of eligible individuals at risk of
                suicide and their families proposed to be provided suicide prevention
                services, including the percentage of those eligible individuals who
                are not currently receiving care furnished by VA.
                 (6) Evidence of measurable outcomes related to reductions in
                suicide risk and mood-related symptoms utilizing validated instruments
                by the applicant (and the proposed partners of the applicant, if any)
                in providing suicide prevention services to individuals at risk of
                suicide, particularly to eligible individuals and their families.
                 (7) A description of the managerial and technological capacity of
                the applicant to:
                 (i) Coordinate the provision of suicide prevention services with
                the provision of other services;
                 (ii) Assess on an ongoing basis the needs of eligible individuals
                and their families for suicide prevention services;
                 (iii) Coordinate the provision of suicide prevention services with
                VA services for which eligible individuals are also eligible;
                 (iv) Tailor (i.e., provide individualized) suicide prevention
                services to the needs of eligible individuals and their families;
                 (v) Seek continuously new sources of assistance to ensure the
                continuity of suicide prevention services for eligible individuals and
                their families as long as the eligible individuals are determined to be
                at risk of suicide; and
                 (vi) Measure the effects of suicide prevention services provided by
                applicant or partner organization on the lives of eligible individuals
                and their families who receive such services provided by the
                organization using pre- and post-evaluations on validated measures of
                suicide risk and mood-related symptoms.
                 (8) Clearly defined objectives for the provision of suicide
                prevention services.
                 (9) A description and physical address of the primary location of
                the applicant.
                 (10) A description of the geographic area the applicant plans to
                serve during the grant award period for which the application applies.
                 (11) If the applicant is a State or local government or an Indian
                tribe, the amount of grant funds proposed to be made available to
                community partners, if any, through agreements.
                 (12) A description of how the applicant will assess the
                effectiveness of the provision of grants under this part.
                 (13) An agreement to use the measures and metrics provided by VA
                for the purposes of measuring the effectiveness of the programming to
                be provided in improving mental health status, wellbeing, and reducing
                suicide risk and suicide deaths of eligible individuals and their
                families.
                 (14) An agreement to comply with and implement the requirements of
                this part throughout the term of the suicide prevention services grant.
                 (15) Any additional information as deemed appropriate by VA.
                 (b) Subject to funding availability, grantees may submit an
                application for renewal of a suicide prevention services grant if the
                grantee's program will remain substantially the same. To apply for
                renewal of a suicide prevention
                [[Page 13837]]
                services grant, a grantee must submit to VA a complete suicide
                prevention services grant renewal application package, as described in
                the NOFO.
                 (c) VA may request in writing that an applicant or grantee, as
                applicable, submit other information or documentation relevant to the
                suicide prevention services grant application.
                (The Office of Management and Budget has approved the information
                collection provisions in this section under control number 2900-TBD.)
                Sec. 78.20 Threshold requirements prior to scoring suicide
                prevention services grant applicants.
                 VA will only score applicants who meet the following threshold
                requirements:
                 (a) The application is filed within the time period established in
                the NOFO, and any additional information or documentation requested by
                VA under Sec. 78.15(c) is provided within the time frame established
                by VA;
                 (b) The application is completed in all parts;
                 (c) The activities for which the suicide prevention services grant
                is requested are eligible for funding under this part;
                 (d) The applicant's proposed participants are eligible to receive
                suicide prevention services under this part;
                 (e) The applicant agrees to comply with the requirements of this
                part;
                 (f) The applicant does not have an outstanding obligation to the
                Federal government that is in arrears and does not have an overdue or
                unsatisfactory response to an audit; and
                 (g) The applicant is not in default by failing to meet the
                requirements for any previous Federal assistance.
                Sec. 78.25 Scoring criteria for awarding grants.
                 VA will score applicants who are applying for a suicide prevention
                services grant. VA will set forth specific point values to be awarded
                for each criterion in the NOFO. VA will use the following criteria to
                score these applicants:
                 (a) VA will award points based on the background, qualifications,
                experience, and past performance of the applicant, and any community
                partners identified by the applicant in the suicide prevention services
                grant application, as demonstrated by the following:
                 (1) Background and organizational history. (i) Applicant's, and any
                identified community partners', background and organizational history
                are relevant to the program.
                 (ii) Applicant, and any identified community partners, maintain
                organizational structures with clear lines of reporting and defined
                responsibilities.
                 (iii) Applicant, and any identified community partners, have a
                history of complying with agreements and not defaulting on financial
                obligations.
                 (2) Staff qualifications. (i) Applicant's staff, and any identified
                community partners' staff, have experience providing services to, or
                coordinating services for, eligible individuals and their families.
                 (ii) Applicant's staff, and any identified community partners'
                staff, have experience administering programs similar to SSG Fox SPGP.
                 (3) Organizational qualifications and past performance, including
                experience with veterans services. (i) Applicant, and any identified
                community partners, have organizational experience providing suicide
                prevention services to, or coordinating suicide prevention services
                for, eligible individuals and their families.
                 (ii) Applicant, and any identified community partners, have
                organizational experience coordinating services for eligible
                individuals and their families among multiple organizations, and
                Federal, State, local and tribal governmental entities.
                 (iii) Applicant, and any identified community partners, have
                organizational experience administering a program similar in type and
                scale to SSG Fox SPGP to eligible individuals and their families.
                 (iv) Applicant, and any identified community partners, have
                organizational experience working with veterans and their families.
                 (b) VA will award points based on the applicant's program concept
                and suicide prevention services plan, as demonstrated by the following:
                 (1) Need for program. (i) Applicant has shown a need amongst
                eligible individuals and their families in the area where the program
                will be based.
                 (ii) Applicant demonstrates an understanding of the unique needs
                for suicide prevention services of eligible individuals and their
                families.
                 (2) Outreach and screening plan. (i) Applicant has a feasible plan
                for outreach, consistent with Sec. 78.45, and referral to identify and
                assist individuals and their families that may be eligible for suicide
                prevention services and are most in need of suicide prevention
                services.
                 (ii) Applicant has a feasible plan to process and receive
                participant referrals.
                 (iii) Applicant has a feasible plan to assess and accommodate the
                needs of incoming participants, including language assistance needs of
                limited English proficient individuals.
                 (3) Program concept. (i) Applicant's program concept, size, scope,
                and staffing plan are feasible.
                 (ii) Applicant's program is designed to meet the needs of eligible
                individuals and their families.
                 (4) Program implementation timeline. (i) Applicant's program will
                be implemented in a timely manner and suicide prevention services will
                be delivered to participants as quickly as possible and within a
                specified timeline.
                 (ii) Applicant has a feasible staffing plan in place to meet the
                applicant's program timeline or has existing staff to meet such
                timeline.
                 (5) Coordination with VA. Applicant has a feasible plan to
                coordinate outreach and services with local VA facilities.
                 (6) Ability to meet VA's requirements, goals, and objectives for
                SSG Fox SPGP. Applicant demonstrates commitment to ensuring that its
                program meets VA's requirements, goals, and objectives for SSG Fox SPGP
                as identified in this part and the NOFO.
                 (7) Capacity to undertake program. Applicant has sufficient
                capacity, including staff resources, to undertake the program.
                 (c) VA will award points based on the applicant's quality assurance
                and evaluation plan, as demonstrated by the following:
                 (1) Program evaluation. (i) Applicant has created clear, realistic,
                and measurable goals that reflect SSG Fox SPGP's aim of reducing and
                preventing suicide among veterans against which the applicant's program
                performance can be evaluated.
                 (ii) Applicant has a clear plan to continually assess the program.
                 (2) Monitoring. (i) Applicant has adequate controls in place to
                regularly monitor the program, including any community partners, for
                compliance with all applicable laws, regulations, and guidelines.
                 (ii) Applicant has adequate financial and operational controls in
                place to ensure the proper use of suicide prevention services grant
                funds.
                 (iii) Applicant has a feasible plan for ensuring that the
                applicant's staff and any community partners are appropriately trained
                and stay informed of SSG Fox SPGP policy, evidence-informed suicide
                prevention practices, and the requirements of this part.
                 (3) Remediation. Applicant has an appropriate plan to establish a
                system to remediate non-compliant aspects of the program if and when
                they are identified.
                [[Page 13838]]
                 (4) Management and reporting. Applicant's program management team
                has the capability and a system in place to provide to VA timely and
                accurate reports at the frequency set by VA.
                 (d) VA will award points based on the applicant's financial
                capability and plan, as demonstrated by the following:
                 (1) Organizational finances. Applicant, and any identified
                community partners, are financially stable.
                 (2) Financial feasibility of program. (i) Applicant has a realistic
                plan for obtaining all funding required to operate the program for the
                time period of the suicide prevention services grant.
                 (ii) Applicant's program is cost-effective and can be effectively
                implemented on-budget.
                 (e) VA will award points based on the applicant's area linkages and
                relations, as demonstrated by the following:
                 (1) Area linkages. Applicant has a feasible plan for developing or
                relying on existing linkages with Federal (including VA), State, local,
                and tribal government agencies, and private entities for the purposes
                of providing additional services to participants within a given
                geographic area.
                 (2) Past working relationships. Applicant (or applicant's staff),
                and any identified community partners (or community partners' staff),
                have fostered similar and successful working relationships and linkages
                with public and private organizations providing services to veterans or
                their families in need of services.
                 (3) Local presence and knowledge. (i) Applicant has a presence in
                the area to be served by the applicant.
                 (ii) Applicant understands the dynamics of the area to be served by
                the applicant.
                 (4) Integration of linkages and program concept. Applicant's
                linkages to the area to be served by the applicant enhance the
                effectiveness of the applicant's program.
                Sec. 78.30 Selection of grantees.
                 VA will use the following process to select applicants to receive
                suicide prevention services grants:
                 (a) VA will score all applicants that meet the threshold
                requirements set forth in Sec. 78.20 using the scoring criteria set
                forth in Sec. 78.25.
                 (b) VA will group applicants within the applicable funding
                priorities if funding priorities are set forth in the NOFO.
                 (c) VA will rank those applicants that receive at least the minimum
                amount of total points and points per category set forth in the NOFO,
                within their respective funding priority group, if any. The applicants
                will be ranked in order from highest to lowest scores, within their
                respective funding priority group, if any.
                 (d) VA will use the applicant's ranking as the primary basis for
                selection for funding. However, VA will also use the following
                considerations to select applicants for funding:
                 (1) VA will give preference to applicants that have demonstrated
                the ability to provide or coordinate suicide prevention services;
                 (2) VA may prioritize the distribution of suicide prevention
                services grants to:
                 (i) Rural communities;
                 (ii) Tribal lands;
                 (iii) Territories of the United States;
                 (iv) Medically underserved areas;
                 (v) Areas with a high number or percentage of minority veterans or
                women veterans; and
                 (vi) Areas with a high number or percentage of calls to the
                Veterans Crisis Line.
                 (3) To the extent practicable, VA will ensure that suicide
                prevention services grants are distributed to:
                 (i) Provide services in areas of the United States that have
                experienced high rates of suicide by eligible individuals, including
                suicide attempts; and
                 (ii) Applicants that can assist eligible individuals at risk of
                suicide who are not currently receiving health care furnished by VA.
                 (iii) Ensure services are provided in as many areas as possible.
                 (e) Subject to paragraph (d) of this section, VA will fund the
                highest-ranked applicants for which funding is available, within the
                highest funding priority group, if any. If funding priorities have been
                established, to the extent funding is available and subject to
                paragraph (d) of this section, VA will select applicants in the next
                highest funding priority group based on their rank within that group.
                 (f) If an applicant would have been selected but for a procedural
                error committed by VA, VA may select that applicant for funding when
                sufficient funds become available if there is no material change in the
                information that would have resulted in the applicant's selection. A
                new application will not be required for this purpose.
                Sec. 78.35 Scoring criteria for grantees applying for renewal of
                suicide prevention service grants.
                 VA will score grantees who are applying for a renewal of suicide
                prevention services grant. VA will set forth specific point values to
                be awarded for each criterion in the NOFO. VA will use the following
                criteria to score grantees applying for renewal of a suicide prevention
                services grant:
                 (a) VA will award points based on the success of the grantee's
                program, as demonstrated by the following:
                 (1) The grantee made progress in reducing veteran suicide deaths
                and attempts, reducing all-cause mortality, reducing suicidal ideation,
                increasing financial stability; improving mental health status, well-
                being, and social supports; and engaging in best practices for suicide
                prevention services.
                 (2) Participants were satisfied with the suicide prevention
                services provided or coordinated by the grantee, as reflected by the
                satisfaction survey conducted under Sec. 78.95(d).
                 (3) The grantee implemented the program by delivering or
                coordinating suicide prevention services to participants in a timely
                manner consistent with SSG Fox SPGP policy, the NOFO, and the grant
                agreement.
                 (4) The grantee was effective in conducting outreach to eligible
                individuals and their families and increasing engagement of eligible
                individuals and their families in suicide prevention services, as
                assessed through SSG Fox SPGP grant evaluation.
                 (b) VA will award points based on the cost-effectiveness of the
                grantee's program, as demonstrated by the following:
                 (1) The cost per participant was reasonable.
                 (2) The grantee's program was effectively implemented on-budget.
                 (c) VA will award points based on the extent to which the grantee's
                program complies with SSG Fox SPGP goals and requirements, as
                demonstrated by the following:
                 (1) The grantee's program was administered in accordance with VA's
                goals for SSG Fox SPGP as noted in the NOFO.
                 (2) The grantee's program was administered in accordance with all
                applicable laws, regulations, and guidelines.
                 (3) The grantee's program was administered in accordance with the
                grantee's suicide prevention services grant agreement.
                Sec. 78.40 Selection of grantees for renewal of suicide prevention
                services grants.
                 VA will use the following process to select grantees applying for
                renewal of suicide prevention services grants:
                 (a) So long as the grantee continues to meet the threshold
                requirements set forth in Sec. 78.20, VA will score the grantee using
                the scoring criteria set forth in Sec. 78.35.
                 (b) VA will rank those grantees who receive at least the minimum
                amount of
                [[Page 13839]]
                total points and points per category set forth in the NOFO. The
                grantees will be ranked in order from highest to lowest scores.
                 (c) VA will use the grantee's ranking as the basis for selection
                for funding. VA will fund the highest-ranked grantees for which funding
                is available.
                 (d) At its discretion, VA may award any non-renewed funds to an
                applicant or existing grantee. If VA chooses to award non-renewed funds
                to an applicant or existing grantee, funds will be awarded as follows:
                 (1) VA will first offer to award the non-renewed funds to the
                applicant or grantee with the highest grant score under the relevant
                NOFO that applies for, or is awarded a renewal grant in, the same area
                as, or a proximate area to, the affected area if available. Such
                applicant or grantee must have the capacity and agree to provide prompt
                services to the affected area. Under this section, the relevant NOFO is
                the most recently published NOFO which covers the affected area, or for
                multi-year grant awards, the NOFO for which the grantee, who is offered
                the additional funds, received the multi-year award.
                 (2) If the first such applicant or grantee offered the non-renewed
                funds refuses the funds, VA will offer to award the funds to the next
                highest-ranked such applicant or grantee, per the criteria in paragraph
                (d)(1) of this section, and continue on in rank order until the non-
                renewed funds are awarded.
                 (e) If an applicant would have been selected but for a procedural
                error committed by VA, VA may select that applicant for funding when
                sufficient funds become available if there is no material change in the
                information that would have resulted in the applicant's selection. A
                new application will not be required for this purpose.
                Sec. 78.45 Suicide prevention services: Outreach.
                 (a) Grantees providing or coordinating the provision of outreach
                must use their best efforts to ensure that eligible individuals,
                including those who are at highest risk of suicide or who are not
                receiving health care or other services furnished by VA, and their
                families are identified, engaged, and provided suicide prevention
                services.
                 (b) Outreach must include active liaison with local VA facilities;
                State, local, or tribal government (if any); and private agencies and
                organizations providing suicide prevention services to eligible
                individuals and their families in the area to be served by the grantee.
                Sec. 78.50 Suicide prevention services: Baseline mental health
                screening.
                 (a) Grantees must provide or coordinate the provision of a baseline
                mental health screening to all participants they serve at the time
                those services begin. This mental health screening must be provided
                using a validated screening tool that assesses suicide risk and mental
                and behavioral health conditions. Information on the specific tool or
                tools to be used will be included in the NOFO.
                 (b) If an eligible individual is at risk of suicide or other mental
                or behavioral health condition pursuant to the baseline mental health
                screening conducted under paragraph (a) of this section, the grantee
                must refer such individual to VA for care. If the eligible individual
                refuses the grantee's referral to VA, any ongoing clinical services
                provided to the eligible individual by the grantee is at the expense of
                the grantee.
                 (c) If a participant other than an eligible individual is at risk
                of suicide or other mental or behavioral health condition pursuant to
                the baseline mental health screening conducted under paragraph (a) of
                this section, the grantee must refer such participant to appropriate
                health care services in the area unless the grantee is capable of
                furnishing such care. Any ongoing clinical services provided to the
                participant by the grantee is at the expense of the grantee.
                 (d) Except as provided for under Sec. 78.60(a), funds provided
                under this grant program may not be used to provide clinical services
                to participants, and any ongoing clinical services provided to such
                individuals by the grantee is at the expense of the grantee. The
                grantee may not charge, bill, or otherwise hold liable participants for
                the receipt of such care or services.
                Sec. 78.55 Suicide prevention services: Education.
                 Grantees providing or coordinating the provision of education must
                provide or coordinate the provision of suicide prevention education
                programs to educate communities, veterans, and families on how to
                identify those at risk of suicide, how and when to make referrals for
                care, and the types of suicide prevention resources available within
                the area. Education can include gatekeeper training, lethal means
                safety training, or specific educations programs that assist with
                identification, assessment, or prevention of suicide.
                Sec. 78.60 Suicide prevention services: Clinical services for
                emergency treatment.
                 (a) Grantees providing or coordinating the provision of clinical
                services for emergency treatment must provide or coordinate the
                provision of clinical services for emergency treatment of a
                participant.
                 (b) If an eligible individual is furnished clinical services for
                emergency treatment under paragraph (a) of this section and the grantee
                determines that the eligible individual requires ongoing services, the
                grantee must refer the eligible individual to VA for additional care.
                If the eligible individual refuses the grantee's referral to VA, any
                ongoing clinical services provided to the eligible individual by the
                grantee is at the expense of the grantee. The grantee may not charge,
                bill, or otherwise hold liable eligible individuals for the receipt of
                such care or services.
                 (c) If a participant other than an eligible individual is furnished
                clinical services for emergency treatment under paragraph (a) of this
                section and the grantee determines that the participant requires
                ongoing services, the grantee must refer the participant to appropriate
                health care services in the area for additional care. Except as
                provided for under paragraph (a) of this section, funds provided under
                this grant program may not be used to provide ongoing clinical services
                to such participants, and any ongoing clinical services provided to the
                participant by the grantee is at the expense of the grantee. The
                grantee may not charge, bill, or otherwise hold liable such
                participants for the receipt of such care or services.
                 (d) For purposes of this section, emergency treatment means medical
                services, professional services, ambulance services, ancillary care and
                medication (including a short course of medication related to and
                necessary for the treatment of the emergency condition that is provided
                directly to or prescribed for the patient for use after the emergency
                condition is stabilized and the patient is discharged) was rendered in
                a medical emergency of such 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 is met by 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
                [[Page 13840]]
                the health of the individual in serious jeopardy, serious impairment to
                bodily functions, or serious dysfunction of any bodily organ or part.
                 (e) The direct provision of clinical services for emergency
                treatment by grantees under this section is not prohibited by Sec.
                78.80(a).
                Sec. 78.65 Suicide prevention services: Case management services.
                 Grantees providing or coordinating the provision of case management
                services must provide or coordinate the provision of case management
                services that include, at a minimum:
                 (a) Performing a careful assessment of participants, and developing
                and monitoring case plans in coordination with a formal assessment of
                suicide prevention services needed, including necessary follow-up
                activities, to ensure that the participant's needs are adequately
                addressed;
                 (b) Establishing linkages with appropriate agencies and service
                providers in the area to help participants obtain needed suicide
                prevention services;
                 (c) Providing referrals to participants and related activities
                (such as scheduling appointments for participants) to help participants
                obtain needed suicide prevention services, such as medical, social, and
                educational assistance or other suicide prevention services to address
                participants' identified needs and goals;
                 (d) Deciding how resources and services are allocated to
                participants on the basis of need;
                 (e) Educating participants on issues, including, but not limited
                to, suicide prevention services availability and participant rights;
                and
                 (f) Other activities, as approved by VA, to serve the comprehensive
                needs of participants for the purpose of reducing suicide risk.
                Sec. 78.70 Suicide prevention services: Peer support services.
                 (a) Grantees providing or coordinating the provision of peer
                support services must provide or coordinate the provision of peer
                support services to help participants understand what resources and
                supports are available in their area for suicide prevention. Peer
                support services must be provided by veterans trained in peer support
                with similar lived experiences related to suicide or mental health.
                Peer support specialists serve as role models and a resource to assist
                participants with their mental health recovery.
                 (b) Each grantee providing or coordinating the provision of peer
                support services must ensure that veterans providing such services to
                participants meet the requirements of 38 U.S.C. 7402(b)(13) and meet
                qualification standards for appointment; or have completed peer support
                training, are pursuing credentials to meet the minimum qualification
                standards for appointment, and are under the supervision of an
                individual who meets the requirements of 38 U.S.C. 7402(b)(13). Grant
                funds may be used to provide education and training for employees of
                the grantee or the community partner who provide peer support services
                consistent with the terms set forth in the grant agreement.
                Sec. 78.75 Suicide prevention services: Assistance in obtaining VA
                benefits.
                 (a) Grantees assisting participants in obtaining VA benefits must
                assist participants in obtaining any benefits from VA for which the
                participants are eligible. Such benefits include but are not limited
                to:
                 (1) Vocational and rehabilitation counseling;
                 (2) Supportive services for homeless veterans;
                 (3) Employment and training services;
                 (4) Educational assistance; and
                 (5) Health care services.
                 (b) Grantees are not permitted to represent participants before VA
                with respect to a claim for VA benefits unless they are recognized for
                that purpose pursuant to 38 U.S.C. 5902. Employees and members of
                grantees are not permitted to provide such representation unless the
                individual providing representation is accredited pursuant to 38 U.S.C.
                chapter 59.
                Sec. 78.80 Suicide prevention services: Assistance in obtaining and
                coordinating other public benefits and assistance with emergent needs.
                 Grantees assisting in obtaining and coordinating other public
                benefits or assisting with emergent needs must assist participants with
                obtaining and coordinating the provision of other public benefits,
                including at a minimum those listed in paragraphs (a) through (h) of
                this section, that are being provided by Federal, State, local, or
                tribal agencies, or any other grantee in the area served by the grantee
                by referring the participant to and coordinating with such entity. If a
                public benefit is not being provided by Federal, State, local, or
                tribal agencies, or any other grantee in the area, the grantee is not
                required to obtain, coordinate, or provide such public benefit.
                Grantees may elect to provide directly to participants the public
                benefits identified in paragraphs (c) through (h) of this section.
                 (a) Health care services, which include:
                 (1) Health insurance; and
                 (2) Referral to a governmental entity or grantee that provides any
                of the following services:
                 (i) Hospital care, nursing home care, outpatient care, mental
                health care, preventive care, habilitative and rehabilitative care,
                case management, respite care, and home care;
                 (ii) The training of any eligible individual's family in the care
                of any eligible individual; and
                 (iii) The provision of pharmaceuticals, supplies, equipment,
                devices, appliances, and assistive technology.
                 (b) Referral of a participant, as appropriate, to an entity that
                provides daily living services relating to the functions or tasks for
                self-care usually performed in the normal course of a day, including,
                but not limited to, eating, bathing, grooming, dressing, and home
                management activities.
                 (c) Personal financial planning services, which include, at a
                minimum, providing recommendations regarding day-to-day finances and
                achieving long-term budgeting and financial goals. Grant funds may pay
                for credit counseling and other services necessary to assist
                participants with critical skills related to household budgeting,
                managing money, accessing a free personal credit report, and resolving
                credit problems.
                 (d) Transportation services:
                 (1) The grantee may provide temporary transportation services
                directly to participants if the grantee determines such assistance is
                necessary; however, the preferred method of direct provision of
                transportation services is the provision of tokens, vouchers, or other
                appropriate instruments so that participants may use available public
                transportation options.
                 (2) If public transportation options are not sufficient within an
                area, costs related to the lease of vehicle(s) may be included in a
                suicide prevention services grant application if the applicant or
                grantee, as applicable, agrees that:
                 (i) The vehicle(s) will be safe, accessible, and equipped to meet
                the needs of the participants;
                 (ii) The vehicle(s) will be maintained in accordance with the
                manufacturer's recommendations; and
                 (iii) All transportation personnel (employees and community
                partners) will be licensed, insured, and trained in managing any
                special needs of participants and handling emergency situations.
                 (3) Transportation services furnished under this paragraph may
                include
                [[Page 13841]]
                reimbursement for transportation furnished through ride sharing
                services, taxi services, or similar sources, but only if:
                 (i) The participant lacks any other means of transportation,
                including transportation or reimbursement for transportation from the
                Department under part 70 of this title; and
                 (ii) The grantee documents the participant's lack of other means.
                 (e) Temporary income support services, which may consist of
                providing assistance in obtaining other Federal, State, tribal and
                local assistance, in the form of, but not limited to, mental health
                benefits, food assistance, housing assistance, employment counseling,
                medical assistance, veterans' benefits, and income support assistance.
                 (f) Fiduciary and representative payee services, which may consist
                of acting on behalf of a participant by receiving the participant's
                paychecks, benefits or other income, and using those funds for the
                current and foreseeable needs of the participant and saving any
                remaining funds for the participant's future use in an interest bearing
                account or saving bonds.
                 (g) Legal services to assist eligible individuals with issues that
                may contribute to the risk of suicide. This may include issues that
                interfere with the eligible individual's ability to obtain or retain
                permanent housing, cover basic needs such as food, transportation,
                medical care, and issues that affect the eligible individual's
                employability and financial security (such as debt, credit problems,
                and lacking a driver's license).
                 (1) Except for legal assistance with resolving outstanding
                warrants, fines, expungements, and drivers' license revocations
                symptomatic of reentry obstacles in employment or housing, legal
                services do not include legal assistance with criminal matters nor
                matters in which the eligible individual is taking or has taken any
                adversarial legal action against the United States.
                 (2) Legal services do not include matters in which the United
                States is prosecuting an eligible individual.
                 (h) Child care for children under the age of 13, unless the child
                is disabled. Disabled children must be under the age of 18 to receive
                assistance under this paragraph. Child care includes the:
                 (1) Referral of a participant, as appropriate, to an eligible child
                care provider that provides child care with sufficient hours of
                operation and serves appropriate ages, as needed by the participant;
                and
                 (2) Payment by a grantee on behalf of a participant for child care
                by an eligible child care provider. Payment may not exceed $5,000 per
                family of an eligible individual per Federal fiscal year.
                 (i) Payments for child care services must be paid by the grantee
                directly to an eligible child care provider.
                 (ii) Payments for child care services cannot be provided on behalf
                of participants for the same period of time and for the same cost types
                that are being provided through another Federal (including VA), State
                or local subsidy program.
                 (iii) As a condition of providing payments for child care services,
                the grantee must help the participant develop a reasonable plan to
                address the participant's future ability to pay for child care
                services. Grantees must assist the participant to implement such plan
                by providing any necessary assistance or helping the participant to
                obtain any necessary public or private benefits or services.
                Sec. 78.85 Suicide prevention services: Nontraditional and
                innovative approaches and treatment practices.
                 Grantees providing or coordinating the provision of nontraditional
                and innovative approaches and treatment practices may provide or
                coordinate the provision of nontraditional and innovative approaches
                and treatment, including but not limited to complementary or
                alternative interventions with some evidence for effectiveness of
                improving mental health or mitigating a risk factor for suicidal
                thoughts and behaviors, as set forth in the NOFO or as approved by VA
                that are consistent with SSG Fox SPGP. Applicants may propose
                nontraditional and innovative approaches and treatment practices in
                their suicide prevention services grant application, and grantees may
                propose these additional approaches and treatment practices by
                submitting a written request to modify the suicide prevention services
                grant in accordance with Sec. 78.125. VA reserves the right to approve
                or disapprove nontraditional and innovative approaches and treatment
                practices to be provided or coordinate to be provided using funds
                authorized under SSG Fox SPGP. VA will only approve approaches and
                treatment practices consistent with applicable Federal law.
                Sec. 78.90 Suicide prevention services: Other services.
                 (a) General suicide prevention assistance. A grantee may pay
                directly to a third party (and not to a participant), in an amount not
                to exceed $750 per participant during any 1-year period, beginning on
                the date that the grantee first submits a payment to a third party, the
                following types of expenses:
                 (i) Expenses associated with gaining or keeping employment, such as
                uniforms, tools, certificates, and licenses.
                 (ii) Expenses associated with lethal means safety and secure
                storage, such as gun locks and locked medication storage.
                 (b) Other. Grantees providing or coordinating the provision of
                other suicide prevention services may provide or coordinate the
                provision of the other services as set forth in the NOFO or as approved
                by VA that are consistent with SSG Fox SPGP. Applicants may propose
                additional services in their suicide prevention services grant
                application, and grantees may propose additional services by submitting
                a written request to modify the suicide prevention services grant
                program in accordance with Sec. 78.125. VA reserves the right to
                approve or disapprove other suicide prevention services to be provided
                or coordinate to be provided using funds authorized under SSG Fox SPGP.
                Sec. 78.95 General operation requirements.
                 (a) Eligibility documentation. Prior to providing suicide
                prevention services, grantees must verify, document, and classify each
                participant's eligibility for suicide prevention services, and
                determine and document each participant's degree of risk of suicide
                using tools identified in the suicide prevention services grant
                agreement. Documentation must be maintained consistent with Sec.
                78.150.
                 (b) Required screening prior to services ending. Prior to services
                ending, grantees must provide or coordinate the provision of a mental
                health screening using the screening tool described in Sec. 78.50(a)
                to all participants they serve, when possible.
                 (c) Suicide prevention services documentation. For each participant
                who receives suicide prevention services from the grantee, the grantee
                must document the suicide prevention services provided or coordinated,
                how such services are provided or coordinated, the duration of the
                services provided or coordinated, and any goals for the provision or
                coordination of such services. Such documentation must be maintained
                consistent with Sec. 78.150.
                 (d) Notifications to participants. (1) Prior to initially providing
                or coordinating suicide prevention services to an eligible individual
                and their family, the grantee must notify each eligible individual and
                their family of the following:
                [[Page 13842]]
                 (i) The suicide prevention services are being paid for, in whole or
                in part, by VA;
                 (ii) The suicide prevention services available to the eligible
                individual and their family through the grantee's program;
                 (iii) Any conditions or restrictions on the receipt of suicide
                prevention services by the eligible individual and their family; and
                 (iv) In the instance of an eligible individual who receives
                assistance from the grantee under this program, that the eligible
                individual is able to apply for enrollment in VA health care pursuant
                to 38 CFR 17.36. If the eligible individual wishes to enroll in VA
                health care, the grantee must inform the eligible individual of a VA
                point of contact for assistance with enrollment. The requirements in
                this clause do not apply to eligible individuals who are members of the
                Armed Forces described in 38 U.S.C. 1712A(a)(1)(C)(i)-(iv).
                 (2) The grantee must provide each participant with a satisfaction
                survey, which the participant can submit directly to VA, within 30 days
                of such participant's pending exit from the grantee's program.
                 (e) Assessment of funds. Grantees must regularly assess how suicide
                prevention services grant funds can be used in conjunction with other
                available funds and services to assist participants.
                 (f) Development of a suicide prevention services plan. For each
                participant, grantees must develop and document an individualized plan
                with respect to the provision of suicide prevention services provided
                under this part. This plan must be developed in consultation with the
                participant and must be maintained consistent with Sec. 78.150.
                 (g) Coordination with VA. The grantee will coordinate with VA with
                respect to the provision of health care and other services to eligible
                individuals pursuant to 38 U.S.C. chapters 17 and 20.
                 (h) Measurement and monitoring. The grantee will submit to VA a
                description of the tools and assessments the grantee uses or will use
                to determine the effectiveness of the suicide prevention services
                furnished by the grantee. These will include any measures and metrics
                developed and provided by VA for the purposes of measuring the
                effectiveness of the programming to be provided in improving mental
                health status, wellbeing, and reducing suicide risk and suicide deaths
                of eligible individuals.
                 (i) Agreements with community partners. Only grantees that are a
                State or local government or an Indian tribe may use grant funds to
                enter into an agreement with a community partner under which the
                grantee may provide funds to the community partner for the provision of
                suicide prevention services to eligible individuals and their families.
                 (j) Contracts for goods and services under this part. Grantees may
                enter into contracts for good or services under this part.
                 (k) Administration of suicide prevention services grants. Grantees
                must ensure that suicide prevention services grants are administered in
                accordance with the requirements of this part, the suicide prevention
                services grant agreement, and other applicable Federal, State, and
                local laws and regulations, including Federal civil rights laws.
                Grantees are responsible for ensuring that any community partners carry
                out activities in compliance with this part.
                (The Office of Management and Budget has approved the information
                collection provisions in this section under control number 2900-TBD.)
                Sec. 78.100 Fee prohibition.
                 Grantees must not charge a fee to participants for providing
                suicide prevention services that are funded with amounts from a suicide
                prevention services grant.
                Sec. 78.105 Ineligible activities.
                 Notwithstanding any other section in this part, grantees are not
                authorized to use suicide prevention services grant funds to pay for
                the following:
                 (a) Direct cash assistance to participants.
                 (b) Those legal services prohibited pursuant to Sec. 78.80(g).
                 (c) Medical or dental care and medicines except for clinical
                services authorized pursuant to Sec. 78.60.
                 (d) Any activities considered illegal under Federal law.
                Sec. 78.110 Notice of Funding Opportunity.
                 When funds are available for suicide prevention services grants, VA
                will publish a NOFO on grants.gov. The NOFO will identify:
                 (a) The location for obtaining suicide prevention services grant
                applications;
                 (b) The date, time, and place for submitting completed suicide
                prevention services grant applications;
                 (c) The estimated amount and type of suicide prevention services
                grant funding available;
                 (d) Any priorities for or exclusions from funding to meet the
                statutory mandates of section 201 of Public Law 116-171 and VA's goals
                for SSG Fox SPGP;
                 (e) The length of term for the suicide prevention services grant
                award;
                 (f) The minimum number of total points and points per category that
                an applicant or grantee, as applicable, must receive for a suicide
                prevention services grant to be funded;
                 (g) Any maximum uses of suicide prevention services grant funds for
                specific suicide prevention services;
                 (h) The timeframes and manner for payments under the suicide
                prevention services grant; and
                 (i) Other information necessary for the suicide prevention services
                grant application process as determined by VA.
                Sec. 78.115 Suicide prevention services grant agreements.
                 (a) After an applicant is selected for a suicide prevention
                services grant in accordance with Sec. 78.30, VA will draft a suicide
                prevention services grant agreement to be executed by VA and the
                applicant. Upon execution of the suicide prevention services grant
                agreement, VA will obligate suicide prevention services grant funds to
                cover the amount of the approved suicide prevention services grant,
                subject to the availability of funding. The suicide prevention services
                grant agreement will provide that the grantee agrees, and will ensure
                that each community partner agrees, to:
                 (1) Operate the program in accordance with the provisions of this
                part and the applicant's suicide prevention services grant application;
                 (2) Comply with such other terms and conditions, including
                recordkeeping and reports for program monitoring and evaluation
                purposes, as VA may establish for purposes of carrying out SSG Fox
                SPGP, in an effective and efficient manner; and
                 (3) Provide such additional information as deemed appropriate by
                VA.
                 (b) After a grantee is selected for renewal of a suicide prevention
                services grant in accordance with Sec. 78.40, VA will draft a suicide
                prevention services grant agreement to be executed by VA and the
                grantee. Upon execution of the suicide prevention services grant
                agreement, VA will obligate suicide prevention services grant funds to
                cover the amount of the approved suicide prevention services grant,
                subject to the availability of funding. The suicide prevention services
                grant agreement will contain the same provisions described in paragraph
                (a) of this section.
                 (c) No funds provided under this part may be used to replace
                Federal, State, tribal, or local funds previously used, or designated
                for use, to assist eligible individuals and their families.
                [[Page 13843]]
                Sec. 78.120 Amount and payment of grants.
                 (a) Amount of grants. The maximum funding that a grantee may be
                awarded under this part is $750,000 per fiscal year.
                 (b) Payment of grants. Grantees are to be paid in accordance with
                the timeframes and manner set forth in the NOFO.
                Sec. 78.125 Program or budget changes and corrective action plans.
                 (a) A grantee must submit to VA a written request to modify a
                suicide prevention services grant for any proposed significant change
                that will alter the suicide prevention services grant program. If VA
                approves such change, VA will issue a written amendment to the suicide
                prevention services grant agreement. A grantee must receive VA's
                approval prior to implementing a significant change. Significant
                changes include, but are not limited to, a change in the grantee or any
                community partners identified in the suicide prevention services grant
                agreement; a change in the area served by the grantee; additions or
                deletions of suicide prevention services provided by the grantee; a
                change in category of participants to be served; and a change in budget
                line items that are more than 10 percent of the total suicide
                prevention services grant award.
                 (1) VA's approval of changes is contingent upon the grantee's
                amended application retaining a sufficient rank to have been
                competitively selected for funding in the year that the application was
                granted.
                 (2) Each suicide prevention services grant modification request
                must contain a description of, and justification for, the revised
                proposed use of suicide prevention services grant funds.
                 (b) VA may require that the grantee initiate, develop, and submit
                to VA for approval a Corrective Action Plan (CAP) if, on a quarterly
                basis, actual suicide prevention services grant expenditures vary from
                the amount disbursed to a grantee for that same quarter or actual
                suicide prevention services grant activities vary from the grantee's
                program description provided in the suicide prevention services grant
                agreement.
                 (1) The CAP must identify the expenditure or activity source that
                has caused the deviation, describe the reason(s) for the variance,
                provide specific proposed corrective action(s), and provide a timetable
                for accomplishment of the corrective action.
                 (2) After receipt of the CAP, VA will send a letter to the grantee
                indicating that the CAP is approved or disapproved. If disapproved, VA
                will make beneficial suggestions to improve the proposed CAP and
                request resubmission or take other actions in accordance with this
                part.
                 (c) Grantees must inform VA in writing of any key personnel changes
                (e.g., new executive director, the suicide prevention services grant
                program director, or chief financial officer) and grantee address
                changes within 30 days of the change.
                (The Office of Management and Budget has approved the information
                collection provisions in this section under control number 2900-TBD.)
                Sec. 78.130 Faith-based organizations.
                 (a) Organizations that are faith-based are eligible, on the same
                basis as any other organization, to participate in SSG Fox SPGP under
                this part. Decisions about awards of Federal financial assistance must
                be free from political interference or even the appearance of such
                interference and must be made on the basis of merit, not on the basis
                of religion or religious belief or lack thereof.
                 (b)(1) No organization may use direct financial assistance from VA
                under this part to pay for any of the following:
                 (i) Explicitly religious activities such as, religious worship,
                instruction, or proselytization; or
                 (ii) Equipment or supplies to be used for any of those activities.
                 (2) References to ``financial assistance'' will be deemed to be
                references to direct Federal financial assistance, unless the
                referenced assistance meets the definition of ``indirect Federal
                financial assistance'' in this part.
                 (c) Organizations that engage in explicitly religious activities,
                such as worship, religious instruction, or proselytization, must offer
                those services separately in time or location from any programs or
                services funded with direct financial assistance from VA under this
                part, and participation in any of the organization's explicitly
                religious activities must be voluntary for the participants of a
                program or service funded by direct financial assistance from VA under
                this part.
                 (d) A faith-based organization that participates in SSG Fox SPGP
                under this part will retain its independence from Federal, State, or
                local governments and may continue to carry out its mission, including
                the definition, practice and expression of its religious beliefs,
                provided that it does not use direct financial assistance from VA under
                this part to support any explicitly religious activities, such as
                worship, religious instruction, or proselytization. Among other things,
                faith-based organizations may use space in their facilities to provide
                VA-funded services under this part, without concealing, removing, or
                altering religious art, icons, scripture, or other religious symbols.
                In addition, a VA-funded faith-based organization retains its authority
                over its internal governance, and it may retain religious terms in its
                organization's name, select its board members and otherwise govern
                itself on a religious basis, and include religious reference in its
                organization's mission statements and other governing documents.
                 (e) An organization that participates in a VA program under this
                part must not, in providing direct program assistance, discriminate
                against a program participant or prospective program participant on the
                basis of religion or religious belief.
                 (f) If a State or local government voluntarily contributes its own
                funds to supplement Federally funded activities, the State or local
                government has the option to segregate the Federal funds or commingle
                them. However, if the funds are commingled, this provision applies to
                all of the commingled funds.
                 (g) To the extent otherwise permitted by Federal law, the
                restrictions on explicitly religious activities set forth in this
                section do not apply where VA funds are provided to faith-based
                organizations through indirect assistance as a result of a genuine and
                independent private choice of a participant, provided the faith-based
                organizations otherwise satisfy the requirements of this part. A faith-
                based organization may receive such funds as the result of a
                participant's genuine and independent choice if, for example, a
                participant redeems a voucher, coupon, or certificate, allowing the
                participant to direct where funds are to be paid, or a similar funding
                mechanism provided to that participant and designed to give that
                participant a choice among providers.
                Sec. 78.135 Visits to monitor operation and compliance.
                 (a) VA has the right, at all reasonable times, to make visits to
                all grantee locations where a grantee is using suicide prevention
                services grant funds to review grantee accomplishments and management
                control systems and to provide such technical assistance as may be
                required. VA may conduct inspections of all program locations and
                records of a grantee at such times as are deemed necessary to determine
                compliance with the provisions of this part. In the event that a
                grantee delivers services in a participant's home, or at a
                [[Page 13844]]
                location away from the grantee's place of business, VA may accompany
                the grantee. If the grantee's visit is to the participant's home, VA
                will only accompany the grantee with the consent of the participant. If
                any visit is made by VA on the premises of the grantee or a community
                partner under the suicide prevention services grant, the grantee must
                provide, and must require its community partners to provide, all
                reasonable facilities and assistance for the safety and convenience of
                the VA representatives in the performance of their duties. All visits
                and evaluations will be performed in such a manner as will not unduly
                delay services.
                 (b) The authority to inspect carries with it no authority over the
                management or control of any applicant or grantee under this part.
                Sec. 78.140 Financial management and administrative costs.
                 (a) Grantees must comply with applicable requirements of the
                Uniform Administrative Requirements, Cost Principles, and Audit
                Requirements for Federal Awards under 2 CFR part 200.
                 (b) Grantees must use a financial management system that provides
                adequate fiscal control and accounting records and meets the
                requirements set forth in 2 CFR part 200.
                 (c) Payment up to the amount specified in the suicide prevention
                services grant must be made only for allowable, allocable, and
                reasonable costs in conducting the work under the suicide prevention
                services grant. The determination of allowable costs must be made in
                accordance with the applicable Federal Cost Principles set forth in 2
                CFR part 200.
                 (d) Costs for administration by a grantee must not exceed 10
                percent of the total amount of the suicide prevention services grant.
                Administrative costs will consist of all costs associated with the
                management of the program. These costs will include the administrative
                costs of community partners.
                Sec. 78.145 Grantee reporting requirements.
                 (a) VA may require grantees to provide, in any form as may be
                prescribed, such reports or answers in writing to specific questions,
                surveys, or questionnaires as VA determines necessary to carry out SSG
                Fox SPGP.
                 (b) At least once per year, each grantee must submit to VA a report
                that describes the projects carried out with such grant during the year
                covered by the report; and information relating to operational
                effectiveness, fiscal responsibility, suicide prevention services grant
                agreement compliance, and legal and regulatory compliance, including a
                description of the use of suicide prevention grant funds, the number of
                participants assisted, the types of suicide prevention services
                provided, and any other information that VA may request.
                 (c) VA may request additional reports or information to allow VA to
                fully assess the provision or coordination of the provision of suicide
                prevention services under this part.
                 (d) All pages of the reports must cite the assigned suicide
                prevention services grant number and be submitted in a timely manner as
                set forth in the grant agreement.
                 (e) Grantees must provide VA with consent to post information from
                reports on the internet and use such information in other ways deemed
                appropriate by VA. Grantees shall clearly mark information that is
                confidential to individual participants.
                (The Office of Management and Budget has approved the information
                collection provisions in this section under control number 2900-TBD.)
                Sec. 78.150 Recordkeeping.
                 Grantees must ensure that records are maintained for at least a 3-
                year period to document compliance with this part. Grantees must
                produce such records at VA's request.
                Sec. 78.155 Technical assistance.
                 VA will provide technical assistance, as necessary, to applicants
                and grantees to meet the requirements of this part. Such technical
                assistance will be provided either directly by VA or through contracts
                with appropriate public or non-profit private entities.
                Sec. 78.160 Withholding, suspension, deobligation, termination, and
                recovery of funds by VA.
                 VA will enforce this part through such actions as may be
                appropriate. Appropriate actions include withholding, suspension,
                deobligation, termination, recovery of funds by VA, and actions in
                accordance with 2 CFR part 200.
                Sec. 78.165 Suicide prevention services grant closeout procedures.
                 Suicide prevention services grants will be closed out in accordance
                with 2 CFR part 200.
                [FR Doc. 2022-04477 Filed 3-9-22; 8:45 am]
                BILLING CODE 8320-01-P
                

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