Zinke Co-Leads Bill Countering VA’s Outdated Emergency Transportation Rule

(WASHINGTON, D.C.) - This week, Western Montana Congressman and combat veteran Ryan Zinke joined House Veterans Affairs Committee Chairman Mike Bost (IL-12) in introducing  H.R. 5530, the VA Emergency Transportation Access Act. The bill is a response to the Department of Veterans Affairs (VA) rule “Changes in Rates VA Pays for Special Modes of Transportation” (88 Fed. Reg. 10032) which dramatically lowers ground and air ambulance reimbursement rates. The rule would become effective February 2024.

The VA rule changes reimbursement amounts for ambulance services and reverts to the outdated Centers for Medicare & Medicaid Services (CMS) schedule based on 1998 data for air transport and 2002 data for ground transport. If allowed to go into effect as planned, the availability of ground and air ambulances for veterans would be seriously threatened. Small, and mostly rural, operators would not be able to financially function and would be forced to either shut down completely or stop offering services to the VA. In July, Granite County, Montana, lost their only ambulance provider due to the infeasibility of operating with the CMS reimbursement rates.

H.R. 5530 would ensure the VA completes several due-diligence requirements before pursuing a change that could reduce reimbursement rates for emergency transportation. Additionally, this bill would ensure that future rates properly reflect the cost of emergency transportation.

“It’s simple we made a promise that if you are willing to die for your country, your country will take care of you. Our veterans were there when we needed them the most, and now it is our job to be there for them when they need us,” Zinke said. “Operating off  25 year-old data for life-saving measures when we have the resources to do better is inexcusable. In rural areas, especially in Montana, emergency transportation can be the difference between life and death, and we should address this issue with that urgency before another provider loses out like what we saw in Granite County.”

Statements of Support

“Representative Zinke has been the House leader on this issue since the VA published its bone-headed Final Rule on Emergency Air Transportation Reimbursement Rates last February. Leading the House in offering amendments to the FY24 MILCON-VA Appropriations Act to stop this unsupportable and drastic reduction in reimbursement rates and working with House Veterans Affairs Committee Chair Bost to offer this crucial legislation, Rep. Zinke has fought hard and quick to protect access to emergency health services for Montana and other States rural veterans.  Bravo Zulu, Rep. Zinke.  Bravo Zulu,” Co-Chair of the National Military and Veterans Alliance Bob Carey.

“We are grateful to Rep. Zinke for intervening on behalf of our nation’s Veterans to ensure Veterans have access to ambulance services. We routinely provide EMS response to Veterans, and if the VA is allowed to slash ambulance reimbursement rates, it will make it very difficult to continue services. Veterans deserve top tier ambulance response, and we stand with Rep Zinke in making sure the VA works with our nation’s ambulance providers,” General Manager for Great Falls Emergency Services in Great Falls, Montana Justin Grohs. 

“JWV has continuously expressed serious concerns about The Department of Veterans Affairs’ rule set to go into effect in February 2024. If implemented without change, VA’s reimbursement rate for emergency air ambulance services would be dramatically cut and millions of Veterans will lose access to life-saving emergency transportation. VA must delay putting the new reimbursement rates in place in February 2024. This bill addresses the issue directly and protects care and services for Veterans,” Jewish War Veterans National Executive Director Ken Greenberg.

“This timely proposal of the VA Emergency Transportation Access Act rightfully institutes accountability of the Department of Veterans Affairs and continuity for our nation’s veterans to receive the emergency care they need, when they need it most – without arbitrary reimbursement rate changes that leave veterans footing outrageous emergency transportation service bills and diminished access to emergency services. The H.R. 5530 is a step toward a more transparent, more veteran-focused VA healthcare system. The American Legion and our 1.6 million dues-paying members applaud the leadership of Congressman Zinke and Chairman Bost in introducing the VA Emergency Transportation Access Act.” American Legion Executive Director for Government Affairs, Chanin Nuntavong. 

"As the Manager of Missoula Emergency Services, and president of the Montana Ambulance Association, we are very pleased to get the support of Representative Ryan Zinke to help our Veterans in Montana continue to have access to ambulance transports (both air and ground) which is critical to meet their health care needs. Ambulance services across Montana are struggling with below-cost reimbursements, we have had some close their doors this year. The current direction the VA is taking will no doubt have a negative impact on all ambulance providers in Montana. Thank you Representative Zinke for all you do for our veterans and ambulance providers in Montana,” Missoula Emergency Services Manager Don Whalen. 

“We are grateful to Rep. Zinke for his leadership in cosponsoring vital legislation to preserve access to air medical transport services for Veterans, especially those living in rural areas. Air medical transport is a lifeline for millions of Veterans, and this bill will ensure that they continue to have access to the emergency care they need, when and where they need it,” CEO of Air Methods JaeLynn Williams.

"As a not-for-profit provider serving the rural areas of Montana, Oregon, Washington, and Idaho, Life Flight Network understands the strain this payment change would have on the ability of air and ground ambulance providers to maintain adequate service in rural areas. This rule from the VA must be delayed so that industry and government stakeholders can work together on a viable, long-term solution that protects access for our veterans to these critical life-saving services.  We applaud the efforts of Rep. Zinke and VA Committee Chairman Bost in addressing this important issue,” CEO of Life Flight Network Ben Clayton.

"Medicare reimburses ground ambulance services below the cost of providing vital medical care and transport services. The VA Emergency Transportation Access Act by Congressman Zinke and Chairman Bost would create a process for establishing reimbursement that would help ensure future access to often lifesaving emergency 9-1-1 ambulance services for veterans and entire communities," Randy Strozyk, President, American Ambulance Association.

“Every day, our members demonstrate the impact of specialty transport for patients in their time of need. Supporting veterans’ access to this vital service is critical to preserve the healthcare safety net for veterans around the country.

We applaud Congressman Zinke and Congressman Bost for their efforts to introduce H.R.5530 - the VA Emergency Transportation Access Act - to protect emergency transport access for our nation's veterans. AAMS remains committed to working with the Department of Veterans Affairs, Members of Congress, and veterans’ organizations to find a solution that improves access and guarantees care for veterans nationwide,” Jana Williams, President & CEO of the Association of Air Medical Services (AAMS). 

The bill includes:

• A review of the impact a change in rates would have on veterans’ access to care.
• Consultation with industry experts, CMS, VA subject matter experts, and Veterans Service Organizations.
• Developing a formal process of updating the rates that protects or expands veterans’ current access to emergency transportation. 

Background

• While Rep. Zinke opposed the VA rule from its finalization in February, there was the promise of negotiated contracts with VA to exempt vendors from reimbursement on the CMS schedule.
• In a March budget hearing, VA Secretary Denis McDonough promised Rep. Zinke that he would work with him on ensuring fair, negotiated contracts. Until this week, there has been no substantive communication with VA.
• In June, Rep. Zinke led a letter to Secretary McDonough, alongside 12 Members of Congress, asking basic questions about the rule and asking for a delay in the effective date. The VA has not responded.
• The next month, it was discovered that non-VA directed 911 emergency air and ground ambulance transports would automatically be reimbursed on the CMS schedule because they are ineligible to be negotiated via contract due to lack of VA statutory authority.
• In response, Rep. Zinke introduced a bipartisan amendment to the Fiscal Year 2024 Military Construction, Veterans Affairs, and Related Agencies appropriations bill that would defund the rule change. While Rep. Zinke testified in support of the amendment, it was not ruled in order by the House Rules Committee.
• On July 28^th, Rep. Zinke led a bipartisan group of thirty Members of Congress in another letter to Secretary McDonough asking him to delay the effective date of the finalized VA rule until Congress passes legislation authorizing the VA to contract emergency ambulance services. That letter has also gone unanswered, despite multiple follow-ups by staff.

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