Metropolitan Area Ems Authority v. Secretary of Veterans Affairs

CourtCourt of Appeals for the Federal Circuit
DecidedDecember 9, 2024
Docket24-1104
StatusPublished

This text of Metropolitan Area Ems Authority v. Secretary of Veterans Affairs (Metropolitan Area Ems Authority v. Secretary of Veterans Affairs) is published on Counsel Stack Legal Research, covering Court of Appeals for the Federal Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Metropolitan Area Ems Authority v. Secretary of Veterans Affairs, (Fed. Cir. 2024).

Opinion

Case: 24-1104 Document: 71 Page: 1 Filed: 12/09/2024

United States Court of Appeals for the Federal Circuit ______________________

METROPOLITAN AREA EMS AUTHORITY, AKA MEDSTAR MOBILE HEALTHCARE, VALLEY AMBULANCE AUTHORITY, QUAKER VALLEY AMBULANCE AUTHORITY, ALTOONA LOGAN TOWNSHIP MOBILE MEDICAL EMERGENCY DEPARTMENT AUTHORITY, DBA AMED, Petitioners

v.

SECRETARY OF VETERANS AFFAIRS, Respondent ______________________

2024-1104 ______________________

Petition for review pursuant to 38 U.S.C. Section 502. ______________________

Decided: December 9, 2024 ______________________

BRIAN STIMSON, Arnall Golden Gregory LLP, Washington, DC, argued for petitioners. Also represented by SARA LORD.

BORISLAV KUSHNIR, Commercial Litigation Branch, Civil Division, United States Department of Justice, Washington, DC, argued for respondent. Also represented by BRIAN M. BOYNTON, WILLIAM JAMES GRIMALDI, PATRICIA M. MCCARTHY; ASHLEY CEDARS, BRYAN THOMPSON, Office of Case: 24-1104 Document: 71 Page: 2 Filed: 12/09/2024

General Counsel, United States Department of Veterans Affairs, Washington, DC. ______________________

Before LOURIE, STOLL, and STARK, Circuit Judges. STOLL, Circuit Judge. Metropolitan Area EMS Authority, a.k.a. MedStar Mobile Healthcare, Valley Ambulance Authority, Quaker Valley Ambulance Authority, and Altoona Logan Township Mobile Medical Emergency Department Authority (collectively, “Petitioners”) challenge the validity of the final rule Change in Rates VA Pays for Special Modes of Transportation, 88 Fed. Reg. 10,032 (Feb. 16, 2023) (“Final Rule”), promulgated by the Department of Veterans Affairs. The Final Rule amends 38 C.F.R. § 70.30(a)(4), changing how the VA pays for noncontract ground and air ambulance transports for eligible beneficiaries, purportedly pursuant to the VA’s discretionary authority under 38 U.S.C. § 111(b)(3)(C). Because the Final Rule exceeds the statutory authority vested in the VA by § 111(b)(3)(C), we grant the petition and set aside the Final Rule. BACKGROUND Congress has enacted an independent statutory regime for the coverage and payment of veterans’ healthcare benefits via Title 38 of the United States Code. This coverage and payment regime includes 38 U.S.C. § 1728 (“Reimbursement of certain medical expenses”) and 38 U.S.C. § 111 (“Payments or allowances for beneficiary travel”), which in relevant part relate to ambulance services for VA beneficiaries. Pursuant to § 1728, the Secretary of the VA reimburses or makes direct payments for veterans with service-connected conditions for certain emergency medical expenses. The relevant provisions include: Case: 24-1104 Document: 71 Page: 3 Filed: 12/09/2024

METROPOLITAN AREA EMS AUTHORITY v. 3 SECRETARY OF VETERANS AFFAIRS

(a) The Secretary shall, under such regulations as the Secretary prescribes, reimburse veterans eligible for hospital care or medical services under this chapter for the customary and usual charges of emergency treatment (including travel and incidental expenses under the terms and conditions set forth in section 111 of this title) for which such veterans have made payment, from sources other than the Department, where such emergency treatment was rendered to such veterans in need thereof . . . . (b) In any case where reimbursement would be in order under subsection (a) of this section, the Secretary may, in lieu of reimbursing such veteran, make payment of the reasonable value of emergency treatment directly . . . . 38 U.S.C. § 1728. Section 1728(a) incorporates § 111, which gives the Secretary discretionary authority to pay for certain travel expenses incurred by eligible beneficiaries for medical purposes like examination, treatment, or care. The provisions from § 111 most relevant here include: (a) Under regulations prescribed by the President pursuant to the provisions of this section, the Secretary may pay the actual necessary expense of travel (including lodging and subsistence), or in lieu thereof an allowance based upon mileage (at a rate of 41.5 cents per mile), of any person to or from a Department facility or other place in connection with vocational rehabilitation, counseling required by the Secretary pursuant to chapter 34 or 35 of this title, or for the purpose of examination, treatment, or care. Actual necessary expense of travel includes the reasonable costs of airfare if travel by air is the only practical way to reach a Department facility. In addition to the mileage Case: 24-1104 Document: 71 Page: 4 Filed: 12/09/2024

allowance authorized by this section, there may be allowed reimbursement for the actual cost of ferry fares, and bridge, road, and tunnel tolls. ... (b)(3)(C) In the case of transportation of a person to or from a Department facility by ambulance, the Secretary may pay the provider of the transportation the lesser of the actual charge for the 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))[1] unless the Secretary has entered into a contract for that transportation with the provider. 38 U.S.C. § 111 (emphasis added). The parties do not dispute that “Department” means the “Department of Veterans Affairs” or “VA,” and “Department facility” is a “VA facility” like a “VA Medical Center (VAMC), VA Outpatient Clinic (OPC), or VA Community Based Outpatient Clinic (CBOC).” 38 U.S.C. § 101(1); 38 C.F.R. § 70.2. The parties agree that the term “other place” is not defined in any statute or VA regulation but can be facilities served by ground and air ambulances that are not a “Department facility,” such as VA-authorized or other private healthcare facilities. The Secretary implements § 111 through 38 C.F.R. Part 70, Subpart A (“Beneficiary Travel and Special Mode Transportation Under 38 U.S.C. 111”). The current version of 38 C.F.R. § 70.30(a)(4) has been in effect since 2008. Pursuant thereto, the VA pays the “actual cost of a special mode of transportation” for eligible beneficiaries. 38 C.F.R.

1 The amount determined by the fee schedule established under § 1834(l) of the Social Security Act (42 U.S.C. § 1395m(l)) is referred to as the Medicare fee schedule (MFS) amount. Case: 24-1104 Document: 71 Page: 5 Filed: 12/09/2024

METROPOLITAN AREA EMS AUTHORITY v. 5 SECRETARY OF VETERANS AFFAIRS

§ 70.30(a)(4).

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Metropolitan Area Ems Authority v. Secretary of Veterans Affairs, Counsel Stack Legal Research, https://law.counselstack.com/opinion/metropolitan-area-ems-authority-v-secretary-of-veterans-affairs-cafc-2024.