Rule2023-03013
Change in Rates VA Pays for Special Modes of Transportation
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
February 16, 2023
Effective
February 16, 2024
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) amends its beneficiary travel regulations to establish a new payment methodology for special modes of transportation. The new payment methodology will apply in the absence of a contract between VA and a vendor of the special mode of transportation. For transport by ambulance, 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. For travel by modes other than ambulance, VA will establish a payment methodology based on States' posted rates or the actual charge.
Full Text
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<title>Federal Register, Volume 88 Issue 32 (Thursday, February 16, 2023)</title>
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[Federal Register Volume 88, Number 32 (Thursday, February 16, 2023)]
[Rules and Regulations]
[Pages 10032-10037]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-03013]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 70
RIN 2900-AP89
Change in Rates VA Pays for Special Modes of Transportation
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: The Department of Veterans Affairs (VA) amends its beneficiary
travel regulations to establish a new payment methodology for special
modes of transportation. The new payment methodology will apply in the
absence of a contract between VA and a vendor of the special mode of
transportation. For transport by ambulance, 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. For travel by modes other than ambulance, VA will
establish a payment methodology based on States' posted rates or the
actual charge.
DATES: The rule is effective February 16, 2024.
FOR FURTHER INFORMATION CONTACT: Ben Williams, Director, Veterans
Transportation Program (15MEM), Veterans Health Administration,
Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC
20420, (404) 828-5691. (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: Pursuant to section 111 of title 38 United
States Code (U.S.C.), VA provides beneficiary travel benefits to
eligible individuals who need to travel in connection with vocational
rehabilitation, counseling required by the Secretary pursuant to
chapter 34 or 35 of Title 38, U.S.C., or for the purpose of
examination, treatment, or care. Regulations governing beneficiary
travel benefits provided by the Veterans Health Administration (VHA)
are in part 70 of title 38 Code of Federal Regulations (CFR). Under
part 70, VA has established limiting criteria to pay for a
[[Page 10033]]
``special mode of transportation'' when that travel is medically
required, the beneficiary is unable to defray the cost of that
transportation, and VHA approved the travel in advance or the travel
was undertaken in connection with a medical emergency. See 38 CFR 70.2
(defining the term ``[s]pecial mode of transportation''), and 38 CFR
70.4(d) (establishing criteria for approval of special mode travel).
On November 5, 2020, VA proposed amending its beneficiary travel
regulations to implement the discretionary authority in 38 U.S.C.
111(b)(3)(C), which permits VA to pay the lesser of the actual charge
for ambulance transportation or the amount determined by the Centers
for Medicare and Medicaid (CMS) Medicare Part B Ambulance Fee Schedule
(hereafter referred to the CMS ambulance fee schedule) established
under section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)),
unless VA has entered into a contract for that transportation.
Additionally, VA proposed to establish a payment methodology for other
types of special modes of transportation, including wheelchair and
stretcher van services, which would be used while VA collects data for
the purpose of developing a new payment methodology. See 85 FR 70551.
We provided a 60-day comment period that ended on January 4, 2021, and
we received six comments, five of which were substantive comments.
Those five comments all raised similar concerns to 38 CFR 70.30(a)(4)
introductory text and (a)(4)(i) and (ii) as proposed, related to using
the CMS ambulance fee schedule or the posted rates from each State. We
first clarify one aspect of the regulation for the commenters in
general, and then address more specific concerns of the individual
commenters as applicable (we note that we refer to issues raised by a
``commenter'' or ``commenters'' below). Based on the summary and
responses below, we adopt the proposed rule as final with two
nonsubstantive changes.
After the close of the comment period, VA received several
Congressional letters that expressed some concerns also raised in
comments. At Congress' request, VA also attended four meetings with
members of Congress and their staff between December 20, 2022, and
December 22, 2022, during which VA outlined the terms of the proposed
rule.
General Clarification for Commenters
At the outset of our responses, we note that we read the
commenters' assertions to rely on the assumption that the proposed rule
would create a scenario where VA in all cases will shift from paying
billed charges to instead paying amounts derived from the CMS ambulance
fee schedule. We first clarify that Sec. 70.30(a)(4)(i) as proposed
would only provide that VA pay the lesser of actual charges or the
rates determined under the CMS ambulance fee schedule if VA has not
otherwise entered into a contract with a vendor of special mode
transportation (to include ambulance transport) as provided in Sec.
70.30(a)(4) as proposed. Therefore, VA's payment of rates as determined
under the CMS ambulance fee schedule, to the extent they would be
lesser than actual charges under Sec. 70.30(a)(4)(i) as proposed, is
only enabled if VA has not otherwise entered into a contract under
Sec. 70.30(a)(4) as proposed. If VA enters into a contract under Sec.
70.30(a)(4), such contract could provide for an agreed rate that may be
different than the CMS ambulance fee schedule. Therefore, it is not an
accurate assumption that in all cases VA will pay rates that result
from the CMS ambulance fee schedule. We make this clarification so that
our additional responses below can be understood in that context.
Specific Concerns Raised by Individual Commenters
One commenter asserted that VA using Medicare rates for ambulance
transports is a bad idea because those rates are below what it actually
costs to transport patients, and subsequently that VA would receive
horrible service and veterans would suffer. Further, the commenter
asserted that if a patient is not Medicare covered or is under the age
of 65, the rates for ambulance transports should be higher, and that
each hospital (we assume the commenter was referring to each VA medical
facility) should instead enter into contracts with agreed upon rates.
Regarding the assertion that Medicare rates are inadequate to cover
the actual costs of ambulance transport, we do not make changes from
the proposed rule. Congress granted VA the discretion in 38 U.S.C.
111(b)(3)(C) to use the CMS ambulance fee schedule as part of VA's
methodology to calculate ambulance payments, ostensibly finding such
schedule to be sufficient. Further, in its most recent ambulance
report, the Medicare Payment Advisory Commission (MedPAC),
<a href="http://www.medpac.gov">www.medpac.gov</a>, found that, in aggregate, Medicare ambulance margins
were adequate, and VA has no cause or expertise to challenge that
finding. Regarding the assertion that VA's use of the CMS ambulance fee
schedule would result in bad service for VA and veterans, VA is not
aware of, and the commenter did not provide evidence to demonstrate
that veterans are currently receiving preferential treatment from
ambulance providers by virtue of VA paying billed charges or that such
preferential treatment would stop were VA to pay CMS ambulance fee
schedule rates in the absence of a contract. Additionally, that
assertion would assume that ambulance carriers and operators do not
apply their professional certification or other standards and ethics in
all cases regardless of whether an individual is a veteran, which VA
does not believe to be the case. VA has no reason to doubt that the
same level of ambulance services would be provided regardless of the
payment source or amount of payment for ambulance services.
Regarding the assertion that there should be higher rates paid for
ambulance for individuals who are not covered by Medicare or who are
below the age of 65, we do not make any changes from the proposed rule.
VA does not adopt multiple rate structures or schedules that are
dependent on age or other health insurance coverage as VA health care
benefits are not private insurance. Rather, VA benefits are created by
statute and administered by regulations, through which VA pays for
certain services provided to individuals who meet the administrative
eligibility and other clinical criteria, without regard to factors such
as age. Regarding the assertion that VA medical facilities should
contract for adequate rates, we do not make any changes from the
proposed rule and reiterate from our responses above that VA will
retain the authority in this final rule to enter into contracts with
ambulance providers and pay the agreed-upon negotiated rate. We make no
changes to the regulation based on this comment.
One commenter, a provider of air ambulance transport, asserted that
VA's proposed change to use the CMS ambulance fee schedule would hinder
their ability to continue to serve rural areas because the CMS
ambulance fee schedule reimburses less than 50 percent of their
operational costs, which would cause a loss of several millions of
dollars for their company and would impact the rest of emergency air
medical services provided throughout the United States. This commenter
further asserted that, although they have submitted comments to CMS to
review and adjust air ambulance rates under the CMS ambulance fee
schedule, such adjustments have not occurred in a manner to keep up
with increased costs in providing this transport. The commenter opined
that this lack of adjustment in CMS ambulance fee schedule rates,
combined with the
[[Page 10034]]
effects that COVID-19 has had in increasing transport costs and
deteriorating their payer mix, make their provision of services less
sustainable.
Regarding the commenter's assertions that the rates determined
under the CMS ambulance fee schedule are inadequate and would hinder
their ability to serve rural areas, and that CMS should adjust their
ambulance fee schedule in any particular manner, we are not making any
changes from the proposed rule. VA cannot modify or increase the CMS
ambulance fee schedule rates. We further reiterate that Sec.
70.30(a)(4) as proposed would provide VA the option to enter into a
contract with a vendor of special mode transportation (to include air
ambulance transport), and the terms of that contract would govern the
payment rates for such transport. Such contracts could provide for a
different rate as agreed, in the event that VA determined it may be
justified based on local considerations, such as for rural areas, or to
include any additional consideration of difficulties presented during
the COVID-19 pandemic. Regarding the assertion that changes in the
final rule to permit VA to pay the lesser or the billed charges or the
CMS ambulance fee schedule rates would have a detrimental effect on
their business we do not make changes from the proposed rule but rely
on the Regulatory Flexibility Act section of the proposed rule where VA
has estimated there will not be a significant economic impact on
vendors of ambulance services because the potential impact per vendor
has been estimated to be less than 1 percent of their annual reported
receipts, using North American Industry Classification System (NAICS)
Code 62910. Therefore, in addition to the ability for ambulance
providers to contract with VA for potentially different rates under the
final rule, VA has analyzed that any potential effect on ambulance
providers would not be significant. We make no changes to the
regulation based on this comment.
One commenter, also a provider of air ambulance transport, more
specifically asserted that indexing government reimbursement to the CMS
ambulance fee schedule was a gross miscalculation that is poorly timed,
as this fee schedule is flawed and cutting reimbursement rates during a
global pandemic is unconscionable. This commenter urged that, rather
than cutting reimbursements for air ambulance care for veterans, VA
should work with the Department of Health and Human Services (HHS) to
reform the CMS ambulance fee schedule to bring rates closer to actual
costs of providing the service. We do not make any changes to the rule
as proposed based on this comment. We restate from our responses above
that we believe VA's use of this schedule is appropriate. Regarding the
assertion that it is poor timing for VA to implement this change during
the COVID-19 pandemic, we reiterate that Sec. 70.30(a)(4) as proposed
would provide VA the option to enter into a contract with a vendor of
special mode transportation to provide for different rates as VA
determines may be justified based on local considerations (for
instance, to address any difficulties due to the COVID-19 pandemic).
Regarding the assertion that CMS should adjust their ambulance fee
schedule in any particular manner, or that VA should engage with HHS to
reform this schedule, we do not make changes from the proposed rule as
those subjects are beyond the scope of the proposed rule.
One commenter, a trade association representing providers of air
ambulance services, offered more specific data regarding the background
of air ambulance transport in support of establishing actual costs, as
well as background on the establishment of the CMS ambulance fee
schedule in support of the assertion that the schedule has not been
adjusted appropriately to keep up with actual costs. This commenter
also more specifically asserted that, should VA move to parity with the
CMS ambulance fee schedule, the cost of uncompensated care will only
increase, furthering the increased costs shifted to commercial payors
or, should those costs not be covered, leading to the increased closure
of air ambulance bases, which would increasingly impact low-volume
rural areas and other areas with a higher portion of Medicare and
Medicaid beneficiaries, as well as VA beneficiaries. This commenter
also expressed concern that any effort by the government to limit
payments during the global health crisis presented by COVID-19 may be
disastrous and have far-reaching consequences for the healthcare and
emergency medical systems. Ultimately, this commenter urged VA to delay
the implementation of this proposal and revisit the proposed changes
only after appropriate data has been collected and analyzed by CMS to
determine a fair reimbursement rate, and to otherwise delay any
decision to limit payments to providers until the end of the COVID-19
pandemic.
We do not make any changes from the proposed rule based on this
commenter's assertions. Regarding the assertions that CMS rates are
inadequate, we restate that Congress granted VA the discretion in 38
U.S.C. 111(b)(3)(C) to use the CMS ambulance fee schedule as part of
VA's methodology to calculate ambulance payments (ostensibly finding
such schedule to be sufficient), and VA has no cause to question the
most recent MedPAC report finding that Medicare ambulance margins were
adequate.
Regarding the assertion that VA should delay implementation of
Sec. 70.30(a)(4) until more data can be collected by CMS to adjust
their ambulance fee schedule, the comment alluded to ``recent
legislation passed by Congress'' that ``will create a federal database
of air ambulance costs which we hope will allow for CMS to modernize
the current'' ambulance fee schedule. We believe the comment may be
referencing provisions of title I (No Surprises Act) and title II
(Transparency) of Division BB of the Consolidated Appropriations Act
(CAA), 2021 (Pub. L. 116-260). We are aware of a notice of proposed
rulemaking published on September 16, 2021 (86 FR 51730), that would
implement certain provisions of title I (No Surprises Act) and title II
(Transparency) of Division BB of the CAA. Among other things, this
proposed rule would increase transparency by requiring group health
plans and health insurance issuers in the group and individual markets,
and Federal Employee Health Benefits carriers, to submit certain
information about air ambulance services to the Secretaries of Health
and Human Services (HHS), Labor, and the Treasury, and the Director of
the Office of Personnel Management, as applicable, and by requiring
providers of air ambulance services to submit certain information to
the Secretaries of HHS and Transportation. The information submitted
under this proposed rule will include specific elements outlined in law
that are necessary for HHS, along with the Department of
Transportation, to develop a comprehensive public report on air
ambulance services. VA does not have a clear understanding as to how
this public report would be used, or whether HHS or CMS may use the
report or any product of the required reporting under the proposed rule
to determine (as we believe is suggested by the commenter) whether
changes to the ambulance fee schedule are warranted.
Because VA does not have a sense of whether changes to the CMS
ambulance fee schedule could be pending as suggested by the commenter,
VA will not delay the implementation of this final rule until such time
as any changes to CMS ambulance rates may occur. We note that because
VA is referencing the CMS fee schedule in general in this regulation
and not the specific amount
[[Page 10035]]
that is currently established in the CMS fee schedule, any changes to
the CMS rates will be automatically applicable without the need for
future rulemaking. 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.
Regarding the assertion that VA should delay implementation of
Sec. 70.30(a)(4) until the end of the COVID-19 pandemic, VA is not in
a position to know when that time may be, although as stated above VA
will delay the implementation of the final rule to provide additional
time for vendors of special mode transportation who are concerned with
the CMS fee schedule to enter into a contract with VA. Such contracts
could provide for a different rate, in the event that VA determined
different rates may be justified based on local considerations (to
include any additional difficulties presented during the COVID-19
pandemic, or for rural areas as the commenter asserted such areas could
be disproportionately affected).
One commenter asserted that some of the information presented in
the proposed rule would make it more difficult for patients to access
transportation assistance, and specifically opposed the payment
methodology in proposed Sec. 70.30(a)(4) for travel by modes other
than ambulance. The commenter noted that the problem with this
methodology was that the resulting rates (given that they were
available for each State) are often quoted as lower than what the
actual transportation cost may be. The commenter further inquired as to
what happens with any remaining balance, and whether the patient is
responsible for the payment of transportation services. Ultimately, the
commenter asserted that there needed to be further clarification
regarding this methodology for modes of transportation other than
ambulance, and that VA should continue to pay for the total cost of
non-ambulance transport until more data can be collected and another
proposed rule submitted regarding a different methodology.
Regarding the assertions of the commenter that the quoted rates per
State for non-ambulance transports are lower than actual costs of such
transportation, we do not make any changes from the proposed rule.
Similar to our responses regarding adequacy of rates for ambulance
transport, we believe it is reasonable and appropriate to rely on
posted rates as available per State. Using the rates posted by States
ensures consistency and predictability for how much VA will pay to
vendors in each State. Section 70.30(a)(4) as proposed would provide VA
the option to enter into a contract with a vendor of special mode
transportation (to travel by modes other than ambulance under Sec.
70.30(a)(4)(ii) as proposed), and the terms of that contract would
govern the payment rates for such transport. Such contracts could
provide for a different rate in the event that VA determines that may
be justified based on local considerations. We further note that, based
on the Regulatory Flexibility Act section of proposed rule, VA has
estimated there will not be a significant economic impact on non-
ambulance vendors within NAICS Code 621999 (All Other Miscellaneous
Ambulatory Health Care Services) or NAICS Code 485991 (Special Needs
Transportation) because VA estimates that over 99 percent of its
payments to vendors potentially covered within these NAICS Codes are
made pursuant to a contract.
Regarding the commenter's inquiry related to billing by non-
ambulance providers of veterans for any remaining balance after VA
payment for the transport, over 99 percent of these non-ambulance
transports are paid for by VA under contract, and the terms of such
contracts indicate that payment by VA constitutes payment in full and
extinguishes any liability on the part of the individual transported.
For the remaining 1 percent of non-ambulance providers that we estimate
are not covered by a contract, we do not have knowledge that such
providers bill veterans for any remaining balance after receipt of VA's
payment. However, if VA becomes aware of such billing of veterans for
any remaining balance, we could propose an additional regulatory
revision to address that issue in a future rulemaking. We do not make
any changes from the proposed rule.
Regarding the commenter's request that VA delay implementation of
the methodology for non-ambulance transports until more data can be
collected, we will be delaying implementation of the final rule until
February 16, 2024, and additional data will be obtained once this rule
is implemented. We stated in the proposed rule that after utilizing
this methodology for an initial 90 calendar day period after this rule
becomes final in the Federal Register, VA will analyze the payments
made to vendors for travel by modes other than ambulance and determine
whether we have enough payment data (e.g., arithmetic average of actual
charges, locality rates, or posted rates) to develop a new payment
methodology. If VA determines that it has enough payment data, then VA
will develop a payment methodology using the lowest possible rate. If
VA does not have enough payment data to create a new methodology after
the initial 90 calendar day period, then VA would continue to collect
data for as many 90 calendar day intervals as VA would deem necessary
to gather sufficient payment data, which we do not anticipate exceeding
18 months from the effective date of the final rule. Subsequently, VA
would propose a new methodology for travel by modes other than
ambulance in a separate rulemaking in the Federal Register.
Technical Changes Not Based on Comments
VA makes technical changes not based on comments. The first is to
move the last sentence from Sec. 70.30(a)(4) as proposed to instead be
placed in Sec. 70.30(a)(4)(ii)(B), which occurs after Sec.
70.30(a)(4)(ii)(A)(3) (Sec. 70.30(a)(4)(ii)(C) as proposed). The new
language in Sec. 70.30(a)(4)(ii)(B) will provide that the term
``posted rate'' refers to the applicable Medicaid rate for the special
mode transport in the State or States where the vendor is domiciled or
where transport occurred (``involved States''). And, in the absence of
a posted rate for an involved State, VA will pay the lowest among the
available posted rates or the vendor's actual charge. This is not a
substantive change, but rather moving language into one location so
that all interpretation of the meaning of the term ``posted rate'' in
Sec. 70.30(a)(4)(ii) is located in one place.
Second, we are amending the language to capitalize the word
``State'' in the regulations affected by the proposed rule to be
consistent with how VA capitalizes the word ``State'' throughout our
regulations.
Based on the rationale set forth in the proposed rule and in this
document, we are adopting the provisions of the proposed rule as final
with the changes noted above.
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).
[[Page 10036]]
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. The Regulatory Impact Analysis associated with this rulemaking
can be found as a supporting document at <a href="https://www.regulations.gov">https://www.regulations.gov</a>.
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. VA estimates that this final rule will potentially impact 2,979
small entities within NAICS Code 621910 (Ambulance Services), which
represents 97 percent of the total entities covered by NAICS Code
621910. However, VA assumes that all entities within NAICS Code 621910
would bear VA's cost avoidance equally. The per entity burden is
estimated to be less than 1 percent of preliminary receipts for all
entities in NAICS Code 621910.
VA does not believe the impact on vendors within NAICS Code 621999
(All Other Miscellaneous Ambulatory Health Care Services) or NAICS Code
485991 (Special Needs Transportation) will be significant because we do
not typically pay for non-contract wheelchair or stretcher van
services. Because VA estimates that over 99 percent of its payments to
vendors potentially covered within NAICS Codes 621999 and 485991 are
made pursuant to a contract, less than 1 percent of small entities
within these NAICS Codes are estimated to be impacted by this final
rule. Therefore, pursuant to 5 U.S.C. 605(b), the initial and final
regulatory flexibility analysis requirements of 5 U.S.C. 603 and 604 do
not apply.
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.
Paperwork Reduction Act
This final rule contains no provisions constituting a collection of
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).
Catalog of Federal Domestic Assistance
The catalog of Federal Domestic Assistance numbers and titles
affected by this document are 64.040,VHA Inpatient Medicine (C, D),
64.041, VHA Outpatient Specialty Care (C), 64.042, VHA Inpatient
Surgery (C), 64.043, VHA Mental Health Residential (C), 64.044, VHA
Home Care (C), 64.045, VHA Outpatient Ancillary Services (C), 64.046,
VHA Inpatient Psychiatry (C), 64.047, VHA Primary Care (C), 64.048, VHA
Mental Health clinics (C), 64.049, VHA Community Living Center (C),
64.050, VHA Diagnostic Care (C).
Congressional Review Act
Pursuant to the Subtitle E of the Small Business Regulatory
Enforcement Fairness Act of 1996 (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 70
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
Denis McDonough, Secretary of Veterans Affairs, approved this
document on February 6, 2023, 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.
Consuela Benjamin,
Regulation Development Coordinator Office of Regulation Policy &
Management, Office of General Counsel, Department of Veterans Affairs.
For the reasons stated in the preamble, the Department of Veterans
Affairs amends 38 CFR part 70 as follows:
PART 70--VETERANS TRANSPORTATION PROGRAMS
0
1. The authority citation for part 70 is revised to read as follows:
Authority: 38 U.S.C. 101, 111, 111A, 501, 1701, 1714, 1720,
1728, 1782, and 1783; E.O. 11302, 31 FR 11741, 3 CFR, 1966-1970
Comp., p. 578; and E.O. 13520, 74 FR 62201, 3 CFR, 2009 Comp., p.
274.
0
2. In Sec. 70.2, add a definition for ``Ambulance'' in alphabetical
order to read as follows:
Sec. 70.2 Definitions.
* * * * *
Ambulance, as used in this subpart, means advanced life support,
level 1 (ALS1); advanced life support, level 2 (ALS2); basic life
support (BLS); fixed wing air ambulance (FW); rotary wing air ambulance
(RW); and specialty care transport (SCT), as those terms are defined in
42 CFR 414.605.
* * * * *
0
3. In Sec. 70.30 revise paragraph (a)(4) to read as follows:
Sec. 70.30 Payment principles.
(a) * * *
(4) VA payments for special modes of transportation will be made in
accordance with this section, unless VA has entered into a contract
with the vendor in which case the terms of the contract will govern VA
payments. This section applies notwithstanding 38 CFR 17.55 and 17.56
for purposes of 38 CFR 17.120.
(i) Travel by ambulance. VA will pay the lesser of the actual
charge for ambulance transportation or the amount determined by the fee
schedule established under section 1834(l) of the Social Security Act
(42 U.S.C. 1395m(l)).
(ii) Travel by modes other than ambulance. (A) VA will pay the
lesser of:
(1) The vendor's actual charge.
(2) The posted rate in the State where the vendor is domiciled. If
the vendor is domiciled in more than one State, the lowest posted rate
among all involved States.
(3) The posted rate in the State where transport occurred. If
transport occurred in more than one State, the lowest posted rate among
all involved States.
(B) The term ``posted rate'' refers to the applicable Medicaid rate
for the special mode transport in the State or States where the vendor
is domiciled or where transport occurred (``involved States''). In the
absence of a posted rate for an involved State, VA will pay the lowest
among the available posted rates or the vendor's actual charge.
* * * * *
[[Page 10037]]
Sec. Sec. 70.1, 70.2, 70.3, 70.4, 70.10, 70.20, 70.21, 70.30, 70.31,
70.32, 70.40, 70.41, 70.42, 70.50, 70.70, 70.71, 70.72, 70.73
[Amended]
0
4. Part 70 is further amended in the following sections by removing the
parenthetical authority citation at the end of the section:
0
a. Section 70.1.
0
b. Section 70.2.
0
c. Section 70.3.
0
d. Section 70.4.
0
e. Section 70.10.
0
f. Section 70.20.
0
g. Section 70.21.
0
h. Section 70.30.
0
i. Section 70.31.
0
j. Section 70.32.
0
k. Section 70.40.
0
l. Section 70.41.
0
m. Section 70.42.
0
n. Section 70.50.
0
o. Section 70.70.
0
p. Section 70.71.
0
q. Section 70.72.
0
r. Section 70.73.
[FR Doc. 2023-03013 Filed 2-15-23; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on February 16, 2023.
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