VA Issues Notice on Delay of Special Modes of Transportation Final Rule
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Tag: Department of Veterans Affairs (VA)
2023 Year-End Government Affairs Update
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VA Final Rule Delayed One Year
Hot off the press! The Department of Veteran’s Affairs has announced a one year delay of the VA Final Rule. This delay pushes implementation of the final rule to February of 2025.
We want to thank all of our AAA members, partner organizations, and legislative champions for their collaborative efforts and commitment to securing this critical delay.
Please see the following press release from the Office of Senator Tester.
Following Tester Efforts, VA Takes Action to Avoid Potential Reduction in Air and Ground Transportation Services
VA delays rule that could have resulted in severe reductions in access to emergency ground and air transportation services in Montana
(Big Sandy, Mont.) – Following sustained efforts from U.S. Senator Jon Tester to protect rural veterans’ access to lifesaving emergency medical transportation services, the Department of Veterans Affairs is delaying a rule to change reimbursement rates for special mode transportation, including air and ground ambulances. This delay will give VA more time to work with stakeholders and Congress to implement the rule in a way that would ensure access and availability of emergency transportation to veterans and civilians, especially in rural America.
“The availability of emergency air and ground transportation services in Montana and rural America can be the difference between life and death,” said Tester, Chairman of the Senate Veterans’ Affairs Committee. “VA’s hasty implementation of its rate change for these services could have been the final straw for providers in rural America, and I’m glad to see VA answering my call and taking steps to fix this reimbursement issue. VA still has a lot more work to do, and I’ll continue pushing my VA Emergency Transportation Access Act to ensure VA gets this rule right for veterans and anyone who calls rural America home.”
VA’s rule was set to go into effect in February 2024, despite significant opposition from Tester, transportation providers, and Veteran Service Organizations. Now, VA is committing to delaying the rule’s effective date until February 2025, which would give the Department more time to work with providers to ensure the rule will not negatively impact their services and ability to serve veterans, especially those in rural and hard-to-reach areas. The previous implementation timeline of rate reductions could have resulted in emergency transportation providers severely reducing services, closing bases, or even billing veterans for the remainder of their costs in order to shoulder the financial impacts of this change.
Tester has led the bipartisan charge to push back on the Biden Administration’s proposed rule change and protect Montana veterans’ access to emergency medical transportation services since day one. In September 2022, he wrote to VA Secretary Denis McDonough to express his concerns with VA’s rule, and in February of this year, he called on the Secretary again to delay this rule. This September, he introduced the bipartisan VA Emergency Transportation Access Act to bar VA from reducing rates of pay and reimbursement for special mode transportation providers, including ground and air ambulances, unless the Department meets certain requirements that ensure rate changes will not reduce veterans’ access to this essential service.
The Senator also recently secured a bipartisan amendment to prohibit VA from implementing this rule in fiscal year 2024 to a key Senate bill that passed earlier this month.
Tester’s efforts have been applauded by emergency medical service leaders in Montana and across the nation. Earlier this month, the Senator was awarded Legislator of the Year by the American Ambulance Association for his work to push back on VA’s rule.
VA Final Rule on Ambulance Services Update
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Department of Veterans Affairs Issues Final Rule on Reimbursement for Ambulance Services and Other Special Modes of Transportation
On February 16, 2023, the Department of Veterans published in the Federal Register the final rule to revise the payment methodology for beneficiary travel by ambulance and other so-called “special modes of transportation. The changes contained within the final rule were first included in a November 5, 2020 proposed rule.
The final rule will become effective on February 16, 2024.
Relevant Background
The VA currently pays for beneficiary travel under certain circumstances. To be eligible for reimbursement, the veteran must meet certain eligibility criteria. Specifically, the veteran must be traveling either: (i) for care at a VA health facility or (ii) for care at a non-VA facility that has been previously approved by the VA. The veteran must also meet one of the following additional criteria:
- The veteran must have a VA disability rating of 30% or higher;
- The veteran must be traveling for treatment of a service-related condition (if their VA disability rating is less than 30%);
- The veteran receives a VA pension;
- The veteran has an income below the maximum annual VA pension rate;
- The veteran cannot otherwise afford to pay for their travel; or
- The veteran is traveling for one of the following reasons: (i) to obtain a VA compensation and pension exam, (ii) to obtain a VA service dog, or (iii) to obtain VA-approved transplant care.
Beneficiary travel covers all modes of transportation, including transportation by private vehicle, common carriers (e.g., taxi, livery, and public transportation), mass transit, etc. Beneficiary travel also covers so-called “special modes of transportation,” which includes air and ground ambulance services, wheelchair vans services, and stretcher vans services.
The rules governing the payment for beneficiary travel services at set forth in 38 C.F.R. § 70.30.
Subpart (a)(4) sets forth the payment methodology for the reimbursement of special modes of transport, and simply provides that payment is based on “[t]he actual cost of a special mode of transportation. In the context of ambulance services, this has historically been interpreted to mean the ambulance provider’s full billed charges.
Provisions of Final Rule
Under the final rule, the VA would revise its existing payment methodology for beneficiary travel by ambulance and other special modes of transportation to no longer reimburse providers for their actual costs, and to instead base reimbursement on:
- For ground and air ambulance services, the lesser of: (i) the actual charge for ambulance transportation (i.e., the provider’s billed charges) or (ii) the amount determined under the Medicare Ambulance Fee Schedule.
- For other special modes of transportation (i.e., ambulette, wheelchair van, or stretcher van), the lesserof: (i) the provider’s actual charge, (ii) the applicable Medicaid rate in the state where the provider is domiciled (using the lowest Medicaid rate where the provider is domiciled in multiple states), or (iii) the applicable Medicaid rate in the state where the transport occurred (or the lowest Medicaid rate if the transport occurred in more than one state). Note: the revised regulations provide that if none of the states involved has a “posted rate,” the VA would continue to pay the provider’s full billed charges
The revised payment methodology for non-ambulance special modes of transport is intended to be temporary. In its proposed rule, the VA indicated that it would use this payment methodology for a minimum of 90 calendar days after a final rule was posted in the Federal Register. This period of time was intended to allow the VA to gather payment data. If the VA believes that it gathered sufficient payment data during this initial 90-day period, it indicated that it would develop a new payment methodology “using the lowest possible rate.” If the VA determined that it did not have sufficient payment data after the initial 90-day period, it would extend the proposed payment methodology for additional 90-day periods as needed until it believed it had sufficient data. The VA indicated that it did not anticipate needing more than 18 months from the effective date of the final rule to gather sufficient payment data to implement a new payment method
VHA Office of Community Care Overview
In this series of live webinars provider participants will receive an overview of Community Care which includes the background on Community Care programs and the corresponding VA regulations. In-dept discussions on topics from referrals and authorizations, authorized emergency and unauthorized emergency care, urgent care, claims, and more. This webinar will take place in February, April, June, and August in 2022.
Prior to the webinar, please send any questions you have to vha13communitycaresupportstaff@va.gov +
Mar 17, 2022
1:00 pm EST
Apr 21, 2022
1:00 pm EST
May 19, 2022
1:00 pm EST
Jun 16, 2022
1:00 pm EST
Jul 21, 2022
1:00 pm EST
Aug 18, 2022
1:00 pm EST
Sep 15, 2022
1:00 pm EST
Update on AAA Legislative Priorities
The American Ambulance Association has been working hard to accomplish the legislative goals of the membership in the 116th Congress. The AAA would like to take this opportunity to provide an update on what we have accomplished thus far in the 116th Congress.
Balance/Surprise Billing
Balance/surprise billing is a hot button issue that recently came into the spotlight at the start of the 116th Congress. With the President’s announcement calling for Congress to pass legislation that would end surprise billing for patients, there has been an increase in Congressional action on the issue including introduced legislation, discussion drafts and hearings in all committees of jurisdiction. The AAA has been working tirelessly with the Congressional committees of jurisdiction to educate Members and staff on the unique characteristics of EMS systems and that it would be inappropriate to apply the same restrictions on balanced billing to ground ambulance services.
The AAA has formed a working group comprised of AAA member volunteers that have worked on policy and messaging on balance billing. The working group has submitted comments to the Energy and Commerce Committee and Senate HELP committees advocating that the ambulance industry is unique from other stakeholders, and as such, should be looked at differently. Ambulance service providers and suppliers are required by law to treat and transport all patients, regardless of their ability to pay and are heavily regulated at the local level. The AAA has been working to communicate these factors that place the ambulance industry in a different situation than many other stakeholders.
Public Safety Officers Death Benefit (PSOB)
The Public Safety Officers Death Benefit (PSOB), a one-time benefit paid to families of first responders killed in the line of duty, is an issue that the AAA has passionately advocated for over many years. In the 116th Congress, the AAA has secured introduction of legislation in the House of Representatives, H.R. 2887, the Emergency Medical Service Providers Protection Act. H.R. 2887 would extend the PSOB to first responders employed by private for-profit EMS agencies. The AAA was able to secure several commitments from Members of Congress to cosponsor the legislation during Stars of Life meetings in Washington, DC. In addition to taking action to move H.R. 2887 through the legislative process, the AAA will be engaging in an outreach campaign in the next few weeks.
Dialysis Off-Set Restructuring
The AAA has worked toward reintroduction of legislation to restructure the offset that was passed into law in the Bipartisan Budget Act of 2018 (H.R. 1892) in the 115th Congress. This offset included a total cut of 23% to the Medicare reimbursement for basic life support (BLS) non-emergency transports performed by all ambulance service suppliers and providers to and from dialysis centers. This cut served as an offset to the 5-year extension of Medicare add on payments that our industry worked hard to get extended.
The AAA has secured introduction of legislation in both the House and Senate. H.R. 3021 was introduced by Representatives LaHood (R-IL) and Sewell (D-AL) and S. 228 by Senators Cassidy (R-LA) and Jones (D-AL). If passed, this legislation would change the cut that is currently in place so that it applies specifically to companies conducting over 50% ESRD non-emergency transports. Those ambulance services with over 50% ESRD transports would get a cut of 29.5%, while those doing less would receive a 15.5% cut. The AAA will continue to work toward movement and passage of this legislation that would better distribute the reduction to those providers which do almost exclusively non-emergency dialysis transports and thus have a lower cost of providing services.
Medicare Priorities Bill
The AAA has crafted legislation that is specifically aimed at addressing major Medicare ambulance industry issues. The issues that will be included in future legislation include making Medicare ambulance add-ons permanent, implementing a prior-authorization program across the nation, allowing for transportation to alternative destinations, reducing regulatory burdens, and providing relief through maintaining many zip codes as rural following the next census. The AAA is working to get this Medicare priorities legislation introduced in the coming months so that we can get to work on solving these Medicare issues that impact our industry as a whole.
VA Legislation
Another priority that that the AAA has been diligently working toward getting introduced is Veterans Affairs (VA) legislation. The Veterans Reimbursement for Emergency Ambulance Services Act (VREASA) introduced by Congressman Tipton (R-CO) would provide veterans with reimbursement for emergency ambulance services when a Prudent Layperson would have a reasonable expectation that a delay in seeking immediate medical attention will jeopardize the life or health of the veteran. This legislation was introduced as a result of the VA consistently requiring all medical records be provided, including the records of treatment after the emergency service has taken place. Should those records show that it was not a life threatening emergency or a false alarm, the claim for reimbursement is being denied. The VA legislation would mandate that the VA apply the “prudent layperson” definition of emergency to determine coverage of ambulance claims.
The AAA is also working toward addressing two other issues with the VA to enforce more prompt payment by the VA and treating the VA as the first payor, similar to Medicare, as it is determined whether there is a different primary payor. The AAA has been working with Senators Collins and Tester on language help solve this ongoing and serious reimbursement issue.
In our next update, we will be reporting on the progress the AAA has made this year on regulatory issues.
Questions? Contact Us
If you have questions about the discussion draft or balance billing initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.
Tristan North – Senior Vice President of Government Affairs
tnorth@ambulance.org | (202) 802-9025
Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs
rhazdovac@ambulance.org | (202) 802-9027
Aidan Camas – Manager of State & Federal Government Affairs
acamas@ambulance.org | (202) 802-9026
Thank you for your continued membership and support
New SNF PPS Edits Highlight the Importance of Facility Agreements
On April 1, 2019, CMS implemented a new series of Common Working File (CWF) edits that are intended to better identify ground ambulance transports that are furnished in connection with an outpatient hospital service that is properly bundled to the skilled nursing facility (SNF) under the SNF Consolidated Billing regime.
These edits work by comparing the ambulance claim to the associated outpatient hospital claim. Hospital claims were already subject to CWF edits designed to identify outpatient hospital services that should be bundled to the SNF. These hospital edits operate by referencing a list of Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes that correspond to outpatient hospital services that are expressly excluded from SNF Consolidated Billing. Hospital claims for outpatient services that are submitted with one of these excluded codes bypass the existing CWF edits, and are then sent to the appropriate Medicare Administrative Contractor for further editing and payment. Hospital claims submitted without one of these codes are denied for SNF Consolidated Billing.
The new ambulance edits will extend these process one step further. The ambulance claim will be associated with the outpatient hospital claim on the same date. To the extent that hospital claim is bundled under SNF Consolidated Billing, the associated ambulance claim will also be bundled. To the extent the hospital claim is unbundled, the associated ambulance claim will be unbundled.
In order for these new edits to work properly, there must be an outpatient hospital in Medicare’s claim history. If the ambulance claim beats the hospital claim into the system, the ambulance claim will be rejected. If and when an outpatient hospital claim with the same date of service enters Medicare’s system, the initial rejection of the ambulance claim will be overturned, and the ambulance claim will be reprocessed using the same edits.
It is important to note that the new edits were designed to reject the ambulance claim as a bundled service unless the hospital claim indicates that it should not be bundled. In other words, these edits are designed to be “over inclusive.” This over-inclusiveness creates the potential for ambulance denials in situations that, on their face, would not appear to be bundled.
A few examples will help illustrate this point. Imagine a situation where the patient elects, for whatever reason, to pay out-of-pocket for their hospital care (in a situation where that care would not be bundled to the SNF), and, as a result, the hospital does not submit a bill to Medicare for its services. Based on how the new edits are designed, your ambulance claim for the transport to that excluded service will be rejected based on the lack of a hospital claim. Or maybe the patient has both Medicare and the V.A., and has elected to have the V.A. be the primary payer for their required hospital care. Again, there would likely be no outpatient hospital claim submitted to Medicare on that date of service, resulting in the rejection of your ambulance claim.
I can see your point, but those examples are pretty far-fetched. How big an issue is this really?
I agree those examples are pretty far-fetched. However, there are other situations that create the same problem. For example, what about an emergent response to transport an SNF patient to the hospital for necessary emergency services? Imagine if you are called to respond late at night (e.g., 11:30 p.m.) tonight. Now imagine that, by the time you get to the patient, load them into the vehicle, and transport them to the ED, it has crossed over midnight into the next day.
What date of service is going to be on the hospital’s claim? Almost certainly, the hospital will use tomorrow’s date. As a result, when your claim hits Medicare’s system, there will not be an associated hospital claim, which will result in your claim being rejected as the responsibility of the SNF. In this situation, Medicare’s edit has worked as intended, but the result is the denial of a claim that should be separately payable by Medicare Part B.
Okay, I can see how this might be annoying,
but I can appeal the claim and likely win on appeal, right?
Yes and no. The problem is that you are not likely to win on either of the first two levels of appeal, as they are likely going to rely upon the information in the CWF. I can see you possibly winning your appeal at the ALJ level…5 to 7 years from now.
In other words, the appeals process is unlikely to provide an acceptable resolution. Instead, I think the majority of ambulance providers are going to look to the SNFs to make good in these situations. Of course, the SNFs are likely going to disclaim liability, arguing (correctly) that ambulance transportation to an ED is an excluded service.
This is where the agreement with the SNF comes into play. One key purpose of contracts is to allocate known risks between the parties. In this instance, the “risk” that needs to be addressed is the possibility that Medicare might incorrectly reject your claim thinking it is bundled to the SNF. I would argue that this risk should be absorbed by the SNF. The transport to the ED should have suspended the patient’s SNF stay, which would have allowed you to receive a separate payment from Medicare. However, the fact that your claim was rejected is proof positive that the CWF does not reflect the suspension of the patient’s SNF stay. Indirectly, it also serves as proof that the SNF received a per diem payment for the patient on that date. To me, the fact that they accepted the per diem payment means they accepted the risk of a bundled ambulance service on that date. I would also argue that it was their failure to properly suspend the patient’s SNF stay that set in motion your denial. Either way, I would be looking to the SNF for payment.
Based on my experience, the typical agreement with an SNF does not address this situation. Frequently, these agreements do not even address the specifics of SNF Consolidated Billing. Instead, I tend to see general language indicating that the ambulance provider will bill the SNF when payment responsibility lies with the SNF under an applicable federal or state health care program. I doubt that language is going to convince an SNF to take financial responsibility for the situation discussed above.
The good news is that your existing agreements can easily be revised to address this situation. The language I would recommend is something along the lines of:
“The parties acknowledge and agree that a denial from Medicare for SNF consolidated billing shall constitute conclusive evidence that a transportation service is the financial responsibility of the facility.”
In sum, the new SNF Consolidated Billing edits are going to increase the frequency with which we are forced to look to the SNFs for payment. In most instances, it will be a situation where the SNF is legally responsible under SNF Consolidated Billing. However, there will also be situations where the over-inclusive nature of the edits results in the claim being incorrectly denied as the SNF’s responsibility. The question becomes how you want to handle these incorrect denials. Do you want to appeal and hope CMS reverses its decision? Or do you want to hold the SNF responsible? If you want to hold the SNF responsible, you will likely need to revise your agreements with the SNFs.
Have an issue you would like to see discussed in a future Talking Medicare blog?
Please write to me at bwerfel@aol.com.
VA Issues Rule Expanding Coverage of Ambulance Services
Veterans Administration Issues Interim Final Rule Expanding
Coverage of Ambulance Services under Millennium Bill
On January 9, 2018, the Department of Veterans Affairs issued an interim final rule that would amend its policy for payment of Millennium Bill claims. The Millennium Bill authorizes the Veterans Administration (VA) to pay for emergency care provided to veterans in non-VA facilities — including emergency ambulance transportation — provided the veteran has no other health insurance that would cover the costs of such emergency care. These changes were necessitated, in part, by a recent decision of the U.S. Court of Appeals for Veterans’ Appeals (Staab v. McDonald, 28 Vet. App. 50, 2016).
The two major changes being made by the interim final rule are: (1) the expansion of payment eligibility to include veterans who received partial payment or reimbursement from a health plan for their non-VA emergency care and (2) the expansion of payment eligibility for emergency transportation associated with a veteran’s receipt of emergency treatment in a non-VA facility.
These changes went into effect on January 9, 2018.
Relevant Background
38 U.S.C. §1725 authorizes the VA to reimburse veterans for the costs of emergency treatment for non-service connected conditions furnished in a non-VA facility, provided certain criteria were met. One requirement was that the veteran be personally liable for the costs of that emergency treatment. As originally enacted in 1999, the statute indicated that the veteran would be personally liable if the veteran: (1) has no entitlement to care or services under a health-plan contract and/or (2) the veteran had no contractual or legal recourse against a third party that would, in part or in whole, extinguish such liability. The VA historically interpreted its payment obligations under the Millennium Bill to be limited to situations where the veteran had no entitlement to coverage under their health insurance or any other contractual or legal recourse against a third party.
The Expansion of Veteran Eligibility for Reimbursement Act of 2010 amended the requirements related to non-health insurance payments to remove the phrase “in part”. As a result, the VA revised its regulations to permit it to make a payment under the Millennium Bill in situations where automobile or other forms of non-health insurance made a partial payment, and where the veteran remained liable for the balance of the health care provider’s bill. However, there was no corresponding change made to the provisions related to health insurance contracts. As a result, the VA continued to view partial payment by a health plan as a bar to payment by the VA.
In Staab, the Court of Appeals adopted a more lenient interpretation of the statute, i.e., a more restrictive view of the VA’s statutory bar on reimbursement. Specifically, the Court held that the reimbursement bar would only apply when the payment from the health plan fully extinguished the veteran’s liability. The practical effect was to place health insurance plans on equal footing with other forms of insurance. The Court remanded the case back to the lower court for further proceedings.
The VA subsequently appealed the Court of Appeals decision. However, on June 14, 2017, Veterans Affairs Secretary David Shulkin announced that the Department would drop its appeal. Reversing course, Secretary Shulkin indicated that the VA had drafted regulations to implement the expanded Millennium Bill coverage. Those regulations form the basis of this interim final rule.
Provisions of Interim Final Rule
Partial Payment from Health Insurance Plan
The VA revised its regulations at 38 C.F.R. §17.1002(f) to indicate that the VA will make payment under the Millennium Bill to the extent the veteran otherwise qualifies for coverage to the extent that the veteran “does not have coverage under a health-plan contract that would fully extinguish the medical liability for the emergency treatment.” The VA retained the reimbursement bar for situations where the veteran would have been covered under a health plan had the veteran or the provider failed to comply with the requirements of that health plan, e.g., by failing to submit a timely claim. This change will apply to: (1) all claims pending with the VA as of April 8, 2016 or (2) submitted after that date.
Expansion of Payment Authority for Emergency Transportation
The VA historically viewed emergency ambulance transportation to the non-VA facility as part of the overall emergency treatment of the veteran. As a result, the VA believed that a health plan’s payment for the hospital care, in whole or in part, triggered its reimbursement bar. One common situation that impacts ambulance suppliers involves veterans that have Medicare Part A benefits (which cover the costs of their hospital care), but where the veteran has elected to forego paying for Medicare Part B. In these situations, Medicare would pay for the hospital care. The VA took the position that this triggered the reimbursement bar, and therefore prevented it from making payment for the emergency ambulance transportation.
Because the interim final rule expands Millennium Bill coverage to include situations where a health plan makes a partial payment, the VA found it necessary to amend its regulations governing the payment of ambulance claims. Specifically, the VA amended its regulations at 38 C.F.R. 17.1003 to provide that ambulance providers will now be eligible for payment provided the following conditions are met:
- Payment for emergency care provided at the non-VA facility is authorized or would have been authorized had:
- The veteran’s personal liability for the emergency treatment was not fully extinguished by payment by the health plan or other third-party; or
- Death not occurred before emergency treatment (at the hospital) could be provided);
- The veteran is financially liable to the ambulance provider;
- The veteran does not have coverage under a health insurance plan that would fully extinguish the medical liability for the emergency transport (and further provided that the veteran or the provider has timely filed a claim with the health plan);
- If the emergency transportation is the result of an accident or work-related injury, the veteran must have reasonably exhausted his remedies against a third-party payor (e.g., auto insurance policy or workers’ compensation policy); and
- The veteran remains liable for all copayments and deductibles.
Effect of Coinsurance and Deductibles
The A.A.A. has confirmed that the VA does not consider the coinsurance or deductible obligations imposed by a veteran’s health plan for the purposes of determining whether the veteran’s liability has been fully extinguished by the health plan’s payment.
Therefore, in situations where the veteran has health care coverage, payment by the VA is likely to be limited to situations where the ambulance provider is permitted under state and local laws to bill patients for the difference between their billed charges and the amounts allowed by the health insurer, i.e., those areas that currently permit balance billing. This would also mean that the VA would be unlikely to have any payment responsibility in situations where Medicare has made payment on the ambulance claim (although it leaves open the possibility that the VA may be responsible for non-covered Medicare services such as excess mileage).
Amount of Payment
When the VA pays under this expanded Millennium Bill authority, its payment will be based on the following methodology:
- When the veteran has no coverage under a health plan or other third-party payor, the VA will pay the lesser of: (a) the amount for which the veteran is personally liable or (b) 70% of the applicable Medicare allowable;
- When partial payment is made by a health plan or other third party payer, the VA will pay the difference between: (a) the amount the VA would have paid under the preceding bullet point (typically 70% of the Medicare allowable) or (b) the amount paid (or payable) by the health plan or other third-party payor; provided that amount is greater than zero;
- If the calculation in the preceding bullet point would not result in the VA making a payment (i.e., because the resulting amount would be less than zero), the VA will pay the lesser of: (a) the veteran’s personal liability after the third-party payment (excluding deductibles and copayments) and (b) 70% of the applicable Medicare allowable;
- In the absence of a corresponding allowable, the VA will be the lesser of: (a) the amount for which the veteran is personally liable or (b) the amount calculated by the VA Fee Schedule in 38 C.F.R. 17.56(a)(2)(i)(B).
Payment from the VA is generally considered to be payment-in-full, and extinguishes the veteran’s remaining liability to the provider for unpaid amounts. Note: the veteran would remain liable for unpaid co-payments and deductibles. If the provider does not wish to accept the VA’s payment, it has 30 days from its receipt of such payment to reject and refund the payment.
Have any Medicare questions? Contact Brian at bwerfel@aol.com
House Holds Hearing on Veterans Choice Program
The House VA Committee hearing started at 7:30 p.m., but it was well-attended and lasted until 10 p.m. The witnesses included Senator John McCain (R-AZ), VA Secretary David Shulkin, and representatives of the VA Office of Inspector General and the Government Accountability Office. Senator McCain and Secretary Shulkin were both warmly welcomed by Members of the Committee on a bipartisan basis.
Chairman Roe (R-TN) emphasized the need to act quickly to extend the authorization for the Veterans Choice Program, which expires on August 7. To that end, the House VA Committee is voting today on a bill to eliminate the sunset of the program’s authorization. In addition, the Committee will consider broader legislation later this year to make comprehensive reforms to the Choice Program. He noted that the VA has additional funds available but will not be able to spend them once the authorization expires. A copy of Chairman Roe’s opening statement is available here.
Secretary Shulkin testified in support of extending the Choice Program, and he clarified that the VA was not seeking additional funding – just the authority to spend funds already obligated. He noted that the VA already is being forced to deny Choice Program coverage to veterans whose episodes of care would extend beyond the August 7 expiration date (e.g., pregnancy).
Secretary Shulkin also urged Congress to support the VA’s efforts to bring appointment scheduling in-house for care coordination purposes. However, the VA OIG witness noted challenges in records going out to community-based providers and coming back to the VA. The GAO witness also underscored the need for the VA to have better systems in place in order to effectively coordinate care, which will take time to procure and implement. Rep. Brownley (D-CA) echoed that point, calling the VA’s information technology systems a “Model T in a Tesla world.” Rep. Esty (D-CT) also urged improvements in the VA’s information systems and expressed concern that veterans are being improperly billed.
Other Members, including Rep. Wenstrup (R-OH) and Rep. Poliquin (R-ME), raised concerns about continuing delays in the processing of claims and payments to providers. Secretary Shulkin agreed that providers deserve to be paid for their services, noting his own experience as a physician in the private sector. He acknowledged that the VA is not processing enough claims electronically today, and he advised that he plans to pursue options outside the VA for systems procurement going forward.
Many Members also raised serious concerns about treatment of PTSD and mental health conditions for veterans, including Rep. Wenstrup (R-OH), Rep. O’Rourke (D-TX), Rep. Sablan (D-MP), Rep. Banks (R-IN), Rep. Rutherford (R-FL) and Rep. Takano (D-CA). Rep. O’Rourke emphasized that suicide among veterans is the most serious crisis, and Secretary Shulkin agreed that it is his number one priority. The Secretary announced that the VA will begin providing urgent mental health care that also will include individuals other than those service members who were honorably discharged. He added that the VA needs 1,000 more mental health providers, as well as telemental health services, and is looking to expand community partnerships to address suicide.
Rep. Banks noted interest among Indiana veterans in greater access to alternative treatments for PTSD and traumatic brain injury. Secretary Shulkin underscored that he is “most concerned about areas like PTSD, where we do not have effective treatments.” He also advised that the VA has established an “Office of Compassionate Innovation” (separate from the VA’s Center for Innovation), which will focus on finding new approaches to health and physical wellness and explore alternative treatment options for veterans when traditional methods fall short.
Rep. Wenstrup inquired about the VA’s GME and residency programs, as well as its associations with academic institutions. Secretary Shulkin responded that the VA is “doubling down” on partnerships with academic medical institutions.
Chairman Roe concluded his remarks by emphasizing the need to extend the Choice Program authorization soon and to consolidate the VA’s community-based care programs. He also expressed support for the VA’s decision to stop developing its own information technology internally.
Update: House & Senate Approve Veterans Health Care Choice Act
Yesterday, the House of Representatives voted overwhelmingly to approve H.R. 3236, the Surface Transportation and Veterans Health Care Choice Improvement Act. Update 2:16 p.m. on July 30: The Senate approved the legislation today, and it is now headed to the President’s desk for signature.
Among its provisions, the bill would allow the Department of Veterans Affairs (VA) to use $3.3 billion from the Veterans Choice Fund to pay for care provided to veterans by non-VA providers between May 1 and October 1, 2015 under the VA’s community care programs.
H.R. 3236 also would require the VA to develop a plan to consolidate all non-VA programs into a single “Veterans Choice Program” and to submit a report on the plan to Congress by November 1, 2015. Among its provisions, the plan must include the structuring of the billing and reimbursement process; a description of the reimbursement rate to be paid; and an explanation of the processes to be used to ensure that the Secretary will fully comply with the federal Prompt Payment Act.
Further, H.R. 3236 would make a number of changes to the current Veterans Choice Program, including: eliminating the requirement that a veteran be enrolled in the VA health care system by Aug. 1, 2014 in order to participate; allowing the VA to expand the number of non-VA providers that may offer medical services; waiving the program’s wait-time eligibility threshold if clinically necessary for the veteran; and allowing veterans residing within 40 driving miles of a VA medical facility to use non-VA services if the VA facility does not have a full-time physician on staff.
M. Todd Tuten is a Senior Policy Advisor at Akin Gump Strauss Hauer & Feld, LLP.