View Rule

This rule proposes amendments to the Department of Veterans Affairs (VA) regulations concerning beneficiary travel. The revisions would update the regulations to conform to amendments to the statutes that authorize beneficiary travel benefits, and would also reorganize and clarify the current regulations. VA is also proposing to modify certain provisions to establish new VA policies and procedures to expand travel benefits for veterans and other beneficiaries in several areas, including for veterans and donors undergoing organ transplants, those being transferred between facilities, and for veterans with terminal illnesses.

Statement of Need:

VA proposes to amend its regulations concerning beneficiary travel. The revisions would update the regulations to conform to a statute authorizing VA to pay the lesser of the actual cost of ambulance transportation or the amount determined by the ambulance travel fee schedule established by Centers for Medicare and Medicaid, unless VA has entered into a contract for that ambulance transportation.

Summary of the Legal Basis:

38 U.S.C. 111 authorizes VA  to provide beneficiary travel benefits to eligible veterans who need to travel for examination, treatment, or care.  We propose to amend the relevant regulations to conform to changes made by Pub. L. 112-56 and 112-154, permitting VA to pay the lesser of the actual cost 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)), unless VA has entered into a contract for that transportation.

Alternatives:

VA considered the consequences of taking no action. We concluded, however, that taking doing so would cause VHA to continue to pay non-emergency medical transportation (NEMT) market rates, which are up to 25% higher than Medicare, based on several variables including the location of the VA Medical Center. VA considered alternatives such as seeking a national contract for BT NEMT services. However, it became apparent that taking this action would dampen current market-based pricing schemes and the pricing schemes would likely remain above Medicare rates. Moreover, creating a market of this type would not permit VA to avail itself of any cost savings. VA believes that a rulemaking, rather than a policy document, is the appropriate mechanism to change its payment rates for non-emergency medical transportation because this change affects the rights and obligations of the public.

Anticipated Costs and Benefits:

VA has determined that there are no transfer costs associated with this rulemaking.  However, there are transfers estimated at $47 million in FY 2018 and $252.4 million over a five year period (FY 2018-2022).  The government will save money as a result of VA making transport payments under the CMS methodology instead of utilizing non-contract special mode transportation payments, the CMS methodology payments are less.  There are no other ancillary costs associated with this rulemaking.  There are no provisions constituting a collection or reduction of information under the Paperwork Reduction Act.  Therefore, we expect no increased and/or decreased PRA costs.

Risks: