VA Issues Final Rule on Parity with Medicare

AAMS Member Alert - February 16, 2023
 
Yesterday, the VA issued its Final Rule on changes to payments for ambulance transport. The Final Rule states that “VA will pay the lesser of the actual charge or the amount determined by the Medicare Part B Ambulance Fee Schedule established by the Centers for Medicare and Medicaid Services” and remains consistent with the November 2020 NPRM. The rule will go into effect February 16th, 2024; this delay in implementation is, according to the Final Rule, at least partially based on comments made by AAMS: 

VA will, however, delay the effective date of this final rule until February 16, 2024, to ensure that ambulance providers have adequate time to adjust to VA’s new methodology for calculating ambulance rates. Such adjustment could include ambulance providers entering into negotiations with VA to contract for payment rates different than those under the CMS fee schedule.

The full text of the rule can be found HERE.

However, this one year delay was not requested by AAMS; rather AAMS commented back in 2021 that VA should delay until such time as CMS has gathered and analyzed data (as required by the No Surprises Act) to determine the sufficiency of the Medicare rate and for other purposes. This is also what VA was directed to do via Appropriations Report language in last year’s Omnibus spending package(Public Law 117- 328, the Consolidated Appropriations Act, 2023); the Rule makes no mention of the Report language, but the issue is clearly stated in a letter to VA Secretary McDonough signed by Senators Tester and Moran, Chair and Ranking Member of the Senate Veteran Affairs Committee, a portion of which reads as follows: 

We urge VA to delay finalizing this rule and to coordinate with the Department of Health and Human Services to ensure VA is basing any changes to air ambulance payment rates on accurate data, as requested in the joint explanatory statement accompanying Public Law 117- 328, the Consolidated Appropriations Act, 2023. We also encourage VA to issue another comment period and hold a public forum on the rule given the changes that have occurred in the air ambulance and health care industries since the proposed rule was issued. We further ask VA to conduct extensive internal and external outreach to appropriately inform stakeholders of the implications of the proposed rule change and the tools prospective air ambulance partners may require to begin the contracting process and ensure continuity of care and services for veterans. Finally, we also ask that you take steps to make certain that the Veterans Health Administration demonstrates improved responsiveness and transparency on this and all other matters moving forward. 

In responding to the release of this rule AAMS is proceeding with the following action items:

• AAMS is drafting another letter to VA on the multiple issues with the rulemaking process, issues with the economic impact analysis conducted by the VA, and calling on the VA to recognize and proceed consistent with legislative report language and the attached letter from Senators Tester and Moran.
• AAMS is working with the Small Business Administration as they have the ability to reach back to Office of Management and Budget and demand a review of the final rule if they believe the economic analysis to be questionable- they can also comment to VA on the impact to small businesses (we should note that all non-profit entities are considered “small business” for the purposes of SBA Advocacy, regardless of their size).
• Continued Congressional Advocacy: AAMS will continue its efforts on Capitol Hill on this and other issues related to payments made to emergency healthcare providers, including policies related to the implementation of the No Surprises Act (the recent halt to IDRE determinations among them).

AAMS will continue to update the membership as progress is made.