Veterans Healing Veterans Medical Access and Scholarship Program
| Citation | 84 FR 61548 |
| Record Number | 2019-24503 |
| Published date | 13 November 2019 |
| Section | Rules and Regulations |
| Court | Veterans Affairs Department |
Federal Register, Volume 84 Issue 219 (Wednesday, November 13, 2019)
[Federal Register Volume 84, Number 219 (Wednesday, November 13, 2019)]
[Rules and Regulations]
[Pages 61548-61552]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-24503]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AQ54
Veterans Healing Veterans Medical Access and Scholarship Program
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: The Department of Veterans Affairs (VA) is amending its
regulations that govern scholarships to certain health care
professionals. This rulemaking implements the mandates of the VA
MISSION Act of 2018 by establishing a pilot program to provide funding
for the medical education of eligible veterans who are enrolled in
covered medical schools.
DATES: This final rule is effective December 13, 2019.
FOR FURTHER INFORMATION CONTACT: Marjorie A. Bowman, MD, Chief Academic
Affiliations Officer, Office of Academic Affiliations (10X1), U.S.
Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC
20420, (202) 461-9490. (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: In a document published in the Federal
Register on May 21, 2019, VA published a proposed rule, which proposed
to amend its regulations that govern scholarships to certain health
care professionals. 84 FR 22990. VA provided a 60-day comment period,
which ended on July 22, 2019. We received 7 comments on the proposed
rule.
On June 6, 2018, section 304 of Public Law 115-182, the John S.
McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining
Internal Systems and Strengthening Integrated Outside Networks Act of
2018, or the VA MISSION Act of 2018, established a pilot program that
would provide funding for medical education to 18 eligible veterans who
enroll in covered medical schools. This is known as the Veterans
Healing Veterans Medical Access and Scholarship Program (VHVMASP). For
the VHVMASP, the VA MISSION Act of 2018 sets forth the eligibility
criteria; the amount and types of available funding; established terms
of an agreement to be entered into by the participant; as well as, the
consequences for a breach in such agreement. This final rule
establishes the regulations needed to carry out the VHVMASP.
Immediately following title 38 of the Code of Federal Regulations (CFR)
17.612, we are adding a new undesignated center heading titled
``Veterans Healing Veterans Medical Access and Scholarship Program''
and add new Sec. Sec. 17.613 through 17.618.
One commenter was in support of the proposed rule. The commenter
stated that they commend the proposition of a program that allows those
who have fought so selflessly for our country the opportunity to better
themselves through education and then turn around and give back to
fellow veterans. The commenter believes that the rule will not only be
immensely powerful for the veterans that are able to have their medical
education funded, but also for the large number of veterans that they
will be able to help. We make no changes based on this comment.
Multiple commenters recommended that the program include more
universities. In particular, a commenter stated that they understand
that the pilot program is in its infancy, but recommends that more
universities be included and more scholarships be granted as the
program grows and progresses. Another commenter similarly stated that
there needs to be more schools where the VHVMASP is provided since
there is not even one covered school in every state that has a VA
medical facility. This same commenter also stated that this is an
amazing idea and maybe some other types of schooling should be included
in the VHVMASP, such as law school and drug and alcohol training for
counseling, as this is a big area of issues for veterans. Another
commenter also stated that the program should not be limited to these
six schools, but should be allowed to be available at any accredited
medical school, for example, Harvard, Wisconsin, or the University of
California at San Francisco. VA understands that the VHVMASP is
limited. Section 304 of the VA MISSION Act of 2018 limits the VHVMASP
to the nine covered medical schools and to provide funding specifically
for medical education. VA does not have the authority to expand the
program to additional medical schools or to expand the program to
degrees that do not lead to a medical education. We are not making any
changes based on these comments.
Multiple commenters also raised concerns about the limitation that
a veteran is only eligible if discharged within the past ten years. A
commenter questioned why the proposed rule stated that the veterans
need to have only been out of the military for no more than ten years.
Another commenter suggested that VA should reconsider and drop the
within ten-year requirement because this requirement serves veterans to
no benefit except to limit and disqualify a number of veterans who
would be interested in this program. This commenter stated that the
program is already extremely limited because it is a pilot program and
that there also seems to be no obvious benefit to VA except cutting out
applicants for no good reason. The commenter added that if the
limitation targeted older veterans less likely to complete the program
it might be justifiable, but a requirement of having to have served
within ten years does not target the age of the applicant. Also, an
applicant could have been any age when retiring or being discharged
from service. Lastly, the commenter stated that the limitation does not
seem justified and should be reconsidered or VA should consider adding
exceptions to this portion of the rule. Another commenter similarly
stated that narrowing this program down to only veterans who have been
out of the armed forces for a period of no less than ten years is a
disservice to thousands of veterans. Several commenters stated that the
current proposal allows a veteran out of the military for four years
with a general discharge (or perhaps even a bad conduct discharge) to
be eligible for this scholarship while a veteran with an honorable
discharge who has been working as a nurse for ten years and wishes to
take advantage of this program and go to medical school would not be
eligible. The commenters indicated that at a minimum, there should be
an exception to the ten-year rule for honorably discharged veterans or
veterans should not be allowed to count time using the GI Bill or
Vocational Rehabilitation against them (i.e.: if a veteran has been out
of the military for 12 years but five years of that was spent using GI
Bill or Vocational Rehabilitation, for this program VA should allow the
veteran to subtract those five years from the 12). A commenter added
that given that this scholarship is limited to two students per school,
there is no burden to
[[Page 61549]]
removing the ten-year requirement, VA saves no money capping it out at
ten-years. A commenter stated that the ten-year limitation should be
extended to at least 15 years. The commenter indicated that someone who
leaves the military at 24 could be engaged in graduate education at 39
and contribute to a supply of veteran physicians.
VA acknowledges that the VHVMASP has limitations, however, VA does
not have the authority to amend the selection criteria for the VHVMASP.
Section 304 of the VA MISSION Act of 2018 sets out the eligibility
criteria for veterans to be eligible to receive the VHVMASP. The first
criterion is that the veteran shall have been discharged from the Armed
Forces not more than 10 years before the date of application for
admission to a covered medical school. VA does not have the authority
to amend this criterion. Also, section 211(b)(7) of the Department of
Veterans Affairs Expiring Authorities Act of 2018 clarified that a
veteran may not concurrently receive educational assistance under
chapter 30, 31, 32, 33, 34, or 35 of title 38 United States Code or
chapter 1606 or 1607 of title 10 United States Code at the time the
veteran would be receiving VHVMASP funding. VA would not count time
using the GI Bill or Vocational Rehabilitation against funding received
for the VHVMASP, but the veteran would not be able to receive VHVMASP
funding if such veteran is concurrently receiving other types of
educational assistance. We are not making any changes based on these
comments.
Another commenter stated that the ten-year limit should be dropped.
The commenter added that three years would help ease the process for
the program so that the veteran doesn't have to wait ten years and so
the program can function properly with the rotation of veterans in
need. The ten-year limitation is the maximum allowable time after a
veteran is discharged from service to be eligible to apply for the
VHVMASP. The veteran does not have to wait ten years to apply for the
program after they have left military service. We are not making any
changes based on this comment.
A commenter stated that the proposed rule was not clear with
respect to the period of obligated service. For instance, would a
participating veteran work for VA upon graduation, would such
employment be full time, will the veteran receive benefits, and good
pay. VA disagrees that the rule is not clear regarding the period of
obligated service. Section 304(d)(1)(E) of the VA MISSION Act of 2018,
states that each eligible veteran who accepts funding for medical
education under this section shall enter into an agreement with the
Secretary that provides that the veteran agree to serve as a full-time
clinical practice employee in the Veterans Health Administration for a
period of four years, after completion of medical school and post-
graduate training. We stated this requirement in proposed Sec.
17.617(a)(4). We also stated in Sec. 17.617(b)(1) that an eligible
veteran's obligated service will begin on the date on which the
eligible veteran begins full-time permanent employment with VA as a
clinical practice employee. As a full-time permanent VA employee, the
participant will receive pay as well as be entitled to any other
benefit afforded to full-time clinical VA employees. We are not making
any changes based on this comment.
Another commenter suggested that VA include the cost of the United
States Medical Licensing Examination, Step 1 and Step 2 exams, as part
of the covered costs for the participants of the VHVMASP. The commenter
also recommended that VA clarify in the final rule that the monthly
stipend will be adjusted for inflation. VA has various other
scholarship programs and would like to administer the programs as
consistently as possible. Under VA's current programs, such as the
Employee Incentive Scholarship Program, exams and certifications are
not authorized expenses. As an example, students pursuing a nursing
degree do not get reimbursed to take the National Council Licensure
Exam (NCLEC). Also, the current Health Professional Scholarship Program
(HPS) program does not pay for licensures or boards for other
disciplines. VA will pay a monthly stipend directly to VHVMASP
participants. The payment will be made for each month a participant is
enrolled in coursework, beginning with the first month of the school
year. The stipend will be adjusted annually based on the approved Cost
of Living Allowance (COLA) increase. We are not making any changes
based on this comment.
A commenter stated that in 2018, 351 American Medical College
Application Service (AMCAS) applicants selected ``veteran'' for
military status on their AMCAS application, and 175 applicants selected
``active duty.'' The commenter urged VA to clarify whether the VHVMASP
is only applicable to the entering class of 2020 or whether it will be
extended in future years. The commenter added that given the VA's
physician workforce shortages, they would support the extension of this
program indefinitely and its expansion to additional medical schools.
VA understands the commenter's concern, however, section 304(b)(3) of
the VA MISSION Act 2018, as amended by section 211(b)(7) of the
Department of Veterans Affairs Expiring Authorities Act of 2018,
specified that the VHVMASP would only be for the entering class of
2020. In addition, VA has other scholarship programs that are available
for individuals who are enrolled in education courses that lead to
degrees in various health care professions, such as the HPSP, the
Visual Impairment and Orientation and Mobility Professional Scholarship
Program, and the Employee Incentive Scholarship Program. VA may award
these other scholarships to veterans who meet the eligibility criteria
for these other scholarship programs. We are not making any changes
based on this comment.
A commenter was concerned that VA would not afford some flexibility
for participants who fail to meet the terms of the acceptance agreement
due to extenuating circumstances, such as life events, or other
academic pursuits, that may require participants to take a leave of
absence. This same commenter similarly requested that extenuating
circumstances also be considered when VA recoups funds from
participants who breach their agreement and must pay the amount owed
within one year of such breach. Another commenter suggested that the
requirement for repayment of any liability for failure to complete the
program should be extended to at least five years rather than one year
and should consider the possibility of a return to the educational
track, i.e. someone might have to drop out for a year or two, but then
be able to resume their medical education. VA takes into account a
participant's extenuating circumstances when recouping funds. A
participant may seek a waiver or suspension of the service or financial
liability incurred under this program or agreement by written request
to the Under Secretary for Health setting forth the basis,
circumstances, and causes which support the requested action. We are
clarifying the regulation text based on this comment by adding a new
paragraph Sec. 17.618(c) to state that the Under Secretary for Health,
or designee, may waive or suspend any service or financial liability
incurred by a participant whenever compliance by the participant is
impossible, due to circumstances beyond the control of the participant,
or whenever the Under Secretary for Health, or designee, concludes that
a waiver or suspension of compliance is in the VA's best interest.
A commenter stated that the proposed rule outlines the terms of the
agreement,
[[Page 61550]]
which includes completing post-graduate training leading to eligibility
for board certification in a physician specialty applicable to VA. The
commenter asks VA to clarify the definition of a physician specialty
applicable to the VA. VA currently has many vacancies for physicians. A
physician specialty applicable to VA is one which is focused on the
diagnosis and treatment of healthcare conditions potentially
experienced by veterans. Participants of the VHVMASP would fill these
much-needed vacancies as part of the participant's obligated service.
This language is also found in section 304 (d)(1)(C) of the VA MISSION
Act of 2018. We are not making any changes based on this comment.
A commenter indicated that the proposed rule states that eligible
veterans must ensure the State licenses are obtained in a minimal
amount of time following completion of residency, or fellowship, if the
veteran is enrolled in a fellowship program approved by the VA. The
commenter requests that VA clarify whether participants will be
required to enter a VA residency program to complete their training and
comply with VHVMASP agreements. A participant will not be required to
enter a VA residency program because, in general, VA does not have its
own residency programs. VA will rely on graduate medical education
(GME) programs accredited by the Accreditation Council for Graduate
Medical Education (ACGME) or American Osteopathic Association (AOA) and
sponsored by academic affiliates to meet the participant's residency
requirement. We are not making any changes based on this comment.
We made minor technical edits to the numbering in Sec. 17.614. The
edits consist of adding numbering to the individual statements in the
definition of acceptable level of academic standing. We have also
renumbered the definition of covered medical school. No other edits to
the content of these paragraphs was made.
We clarified the definition of VHVMASP by adding the public law
number for the VA MISSION Act of 2018. The amended definition of
VHVMASP is the Veterans Healing Veterans Medical Access and Scholarship
Program authorized by section 304 of the VA MISSION Act of 2018, Public
Law 115-182.
Based on the rationale set forth in the Supplementary Information
to the proposed rule and in this final rule, VA is adopting the
proposed rule with the edits described in this rulemaking.
Effect of Rulemaking
The Code of Federal Regulations, as revised by this final
rulemaking, will represent the exclusive legal authority on this
subject. No contrary rules or procedures would be authorized. All VA
guidance would be read to conform with this final rulemaking if
possible or, if not possible, such guidance would be superseded by this
rulemaking.
Paperwork Reduction Act
The Paperwork Reduction Act of 1995 (44 U.S.C. 3507) requires that
VA consider the impact of paperwork and other information collection
burdens imposed on the public. Under 44 U.S.C. 3507(a), an agency may
not collect or sponsor the collection of information, nor may it impose
an information collection requirement unless it displays a currently
valid Office of Management and Budget (OMB) control number. This final
rule contains provisions constituting a new collection of information,
at 38 CFR 17.617 and will be included under OMB Control #2900-0793 for
approval and submitted under a separate PRA process as explained below.
The provisions in this final rule, under 38 CFR 17.617, would require
eligible veterans to sign and submit an agreement between VA and the
eligible veteran who accepts funding for the VHVMASP. This provision
would result in a new information collected burden under OMB control
#2900-0793. The notice of proposed rulemaking (NPRM) preceding and
associated with this final rule, published on May 19, 2019 (84 FR
22990). In that NPRM, VA detailed the new information collection burden
associated with the provisions under 38 CFR 17.617 in the PRA section
of the preamble. However, the associated PRA package was not submitted
to OMB for approval due to another VA NPRM also requiring a revised
information collection under the same approved OMB Control # 2900-0793.
Despite this discrepancy published in the NPRM and in accordance with
44 U.S.C. 3507(d), VA submitted the new and revised information
collection requests (ICRs) to OMB through a separate PRA process via
ROCIS and sought public comment through a Federal Register Notice
document (84 FR 42991). These separate ICRs are in the final review
stage with OMB.
Regulatory Flexibility Act
The Secretary hereby certifies that this final rule will not have a
significant economic impact on a substantial number of small entities
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. The provisions associated with this rulemaking are not processed
by any other entities outside of VA. Therefore, pursuant to 5 U.S.C.
605(b), this rulemaking would be exempt from the initial and final
regulatory flexibility analysis requirements of 5 U.S.C. 603 and 604.
Executive Orders 12866, 13563 and 13771
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 not a significant regulatory action under Executive Order
12866. VA's impact analysis can be found as a supporting document at
http://www.regulations.gov, usually within 48 hours after the
rulemaking document is published. Additionally, a copy of the
rulemaking and its impact analysis are available on VA's website at
http://www.va.gov/orpm by following the link for VA Regulations
Published from FY 2004 through FYTD.
This final rule is not expected to be an E.O. 13771 regulatory
action because this final rule is not significant under E.O. 12866.
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 final rule will have no such effect on
State, local, and tribal governments, or on the private sector.
Congressional Review Act
Pursuant to 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).
[[Page 61551]]
Catalog of Federal Domestic Assistance
There are no Catalog of Federal Domestic Assistance numbers and
titles for this rule.
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug abuse, Foreign relations,
Government contracts, Grant programs--health, Grant programs--veterans,
Health care, Health facilities, Health professions, Health records,
Homeless, Medical and dental schools, Medical devices, Medical
research, Mental health programs, Nursing homes, Philippines, Reporting
and recordkeeping requirements, Scholarships and fellowships, Travel
and transportation expenses, Veterans.
Signing Authority
The Secretary of Veterans Affairs approved this document and
authorized the undersigned to sign and submit the document to the
Office of the Federal Register for publication electronically as an
official document of the Department of Veterans Affairs. Pamela Powers,
Chief of Staff, Department of Veterans Affairs, approved this document
on November 5, 2019, for publication.
Michael P. Shores,
Director, Office of Regulation Policy & Management, Office of the
Secretary, Department of Veterans Affairs.
For the reasons set forth in the preamble, we are amending 38 CFR
part 17 as follows:
PART 17--MEDICAL
0
1. The authority citation for part 17 is amended by adding an entry for
Sec. Sec. 17.613 through 17.618 in numerical order to read in part as
follows:
Authority: 38 U.S.C. 501, and as noted in specific sections.
* * * * *
Sections 17.613 through 17.618 are also issued under Pub. L.
115-182, sec. 304.
* * * * *
0
2. Add an undesignated center heading and Sec. Sec. 17.613 through
17.618 to read as follows.
Veterans Healing Veterans Medical Access and Scholarship Program
17.613 Purpose.
17.614 Definitions.
17.615 Eligibility.
17.616 Award procedures.
17.617 Agreement and obligated service.
17.618 Failure to comply with terms and conditions of agreement.
Veterans Healing Veterans Medical Access and Scholarship Program
Sec. 17.613 Purpose.
The purpose of Sec. Sec. 17.613 through 17.618 is to establish the
requirement for the Veterans Healing Veterans Medical Access and
Scholarship Program (VHVMASP). The VHVMASP will provide funding for the
medical education of two eligible veterans from each covered medical
school.
Sec. 17.614 Definitions.
The following definitions apply to Sec. Sec. 17.613 through
17.618.
Acceptable level of academic standing means:
(1) Maintaining a cumulative grade point average at or above
passing, as determined by the medical school;
(2) Completing all required courses with a passing grade;
(3) Successfully completing the required course of study for
graduation within four academic years;
(4) Successfully passing the required United States Medical
Licensing Examinations steps 1 and 2, within the timeframe for
graduation from medical school; and
(5) Having no final determinations of unprofessional conduct or
behavior.
Covered medical school means any of the following:
(1) Texas A&M College of Medicine.
(2) Quillen College of Medicine at East Tennessee State University.
(3) Boonshoft School of Medicine at Wright State University.
(4) Joan C. Edwards School of Medicine at Marshall University.
(5) University of South Carolina School of Medicine.
(6) Charles R. Drew University of Medicine and Science.
(7) Howard University College of Medicine.
(8) Meharry Medical College.
(9) Morehouse School of Medicine.
VA means the Department of Veterans Affairs.
VHVMASP means the Veterans Healing Veterans Medical Access and
Scholarship Program authorized by section 304 of the VA MISSION Act of
2018, Public Law 115-182.
Sec. 17.615 Eligibility.
A veteran is considered eligible to receive funding for the VHVMASP
if such veteran meets the following criteria.
(a) Has been discharged or released, under conditions other than
dishonorable, from the Armed Forces for not more than 10 years before
the date of application for admission to a covered medical school;
(b) Is not concurrently receiving educational assistance under
chapter 30, 31, 32, 33, 34, or 35 of title 38 United States Code or
chapter 1606 or 1607 of title 10 United States Code at the time the
veteran would be receiving VHVMASP funding;
(c) Applies for admission to a covered medical school for the
entering class of 2020;
(d) Indicates on the application to the covered medical school that
they would like to be considered for the VHVMASP;
(e) Meets the minimum admissions criteria for the covered medical
school to which the eligible veteran applies; and
(f) Agrees to the terms stated in Sec. 17.617.
Sec. 17.616 Award procedures.
(a) Distribution of funds. (1) Each covered medical school that
opts to participate in the VHVMASP will reserve two seats in the
entering class of 2020 for eligible veterans who receive funds for the
VHVMASP. Funding will be awarded to two eligible veterans with the
highest admissions ranking among veteran applicants for such entering
class for each covered medical school.
(2) If two or more eligible veterans do not apply for admission at
a covered medical school for the entering class of 2020, VA will
distribute the available funding to eligible veterans who applied, and
are accepted, for admission at other covered medical schools.
(b) Amount of funds. An eligible veteran will receive funding from
the VHVMASP equal to the actual cost of the following:
(1) Tuition at the covered medical school for which the veteran
enrolls for a period of not more than 4 years;
(2) Books, fees, and technical equipment;
(3) Fees associated with the National Residency Match Program;
(4) Two away rotations, performed during the fourth year of school,
at a VA medical facility; and
(5) A monthly stipend for the four-year period during which the
eligible veteran is enrolled in a covered medical school in an amount
to be determined by VA.
Sec. 17.617 Agreement and obligated service.
(a) Agreement. Each eligible veteran who accepts funds from the
VHVMASP will enter into an agreement with VA where the eligible veteran
agrees to the following:
(1) Maintain enrollment, attendance, and acceptable level of
academic standing as defined by the covered medical school;
(2) Complete post-graduate training leading to eligibility for
board
[[Page 61552]]
certification in a physician specialty applicable to VA;
(3) After completion of medical school and post-graduate training,
obtain and maintain a license to practice medicine in a State. Eligible
veterans must ensure that State licenses are obtained in a minimal
amount of time following completion of residency, or fellowship, if the
veteran is enrolled in a fellowship program approved by VA. If a
participant fails to obtain his or her degree, or fails to become
licensed in a State no later than 90 days after completion of
residency, or fellowship, if applicable, the participant is considered
to be in breach of the acceptance agreement; and
(4) Serve as a full-time clinical practice employee in VA for a
period of four years.
(b) Obligated service--(1) General. An eligible veteran's obligated
service will begin on the date on which the eligible veteran begins
full-time permanent employment with VA as a clinical practice employee.
VA will appoint the participant to such position as soon as possible,
but no later than 90 days after the date that the participant completes
residency, or fellowship, if applicable, or the date the participant
becomes licensed in a State, whichever is later.
(2) Location and position of obligated service. VA reserves the
right to make final decisions on the location and position of the
obligated service.
(The Office of Management and Budget has approved the information
collection requirements in this section under control number 2900-
0793.)
Sec. 17.618 Failure to comply with terms and conditions of
agreement.
(a) Participant fails to satisfy terms of agreement. If an eligible
veteran who accepts funding for the VHVMASP breaches the terms of the
agreement stated in Sec. 17.617, the United States is entitled to
recover damages in an amount equal to the total amount of VHVMASP
funding received by the eligible veteran.
(b) Repayment period. The eligible veteran will pay the amount of
damages that the United States is entitled to recover under this
section in full to the United States no later than 1 year after the
date of the breach of the agreement.
(c) Waivers. The Under Secretary for Health, or designee, may waive
or suspend any service or financial liability incurred by a participant
whenever compliance by the participant is impossible, due to
circumstances beyond the control of the participant, or whenever the
Under Secretary for Health, or designee, concludes that a waiver or
suspension of compliance is in the VA's best interest.
[FR Doc. 2019-24503 Filed 11-12-19; 8:45 am]
BILLING CODE 8320-01-P
