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A federal appeals court has ruled that the Department of Veterans Affairs may not pay ambulance services for transports to and from community facilities at low rates set by Medicare, in a case in which AMED and three other ambulance services from around the country were plaintiffs.
Had the court ruled in favor of the VA, AMED was at risk of losing about $500,000 per year, and veterans could have been technically liable to make up the difference between the Medicare rate and the list prices of those transports, according to AMED Executive Director Gary Watters.
"A win for the ambulance guys," Watters stated in a letter to the board outlining the ruling from the U.S. Court of Appeals for the Federal Circuit.
Applicable law allows the VA to pay either the actual cost of ambulance transports or the Medicare reimbursement amount, whichever is lower when transporting patients to or from VA facilities.
The VA proposed a rule that would have extended that option for Medicare-based payments to transports to other facilities than those operated by the VA, based on a phrase in a different section of the law related to individual medical travel reimbursements that includes transports to "other place(s)."
The VA pushed for the rule change in response to advice it received from its Office of Inspector General, according to the ruling.
Adopting the rule could have saved the VA $11 million between 2012 and 2015, according to the OIG.
The court ruled in favor of the ambulance services largely because the segment of the law that mentions "other places" does not explicitly also mention ambulance transports, while the section that discusses reimbursement for ambulance transports confines itself to "department facilities."
The VA argued that the ambulance services lost their chance to block the rule by failing to object during the period set for comment on it.
But the ambulance services countered by pointing out the ramifications of the U.S. Supreme Court's Loper Bright decision, which overturned the Chevron precedent, which used to require courts to defer to legal interpretations by agencies like the VA if those interpretations were reasonable.
Under Loper Bright, the court took back authority on all legal questions about whether agencies are acting within the law, according to the ruling.
"(W)e conclude that the (VA's proposed) final rule is not in accordance with law, as it exceeds the discretionary authority Congress granted the VA," the ruling states.
Mirror Staff Writer William Kibler is at 814-949-7038.