88888 Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Rules and Regulations 

Before using any approved AMOC, notify 

your appropriate principal inspector, or 

lacking a principal inspector, the manager of 

the responsible Flight Standards Office. 

(2) Contacting the Manufacturer: For any 

requirement in this AD to obtain instructions 

from a manufacturer, the instructions must 

be accomplished using a method approved 

by the Manager, International Validation 

Branch, FAA; or Transport Canada; or 

Bombardier, Inc.’s Transport Canada Design 

Approval Organization (DAO). If approved by 

the DAO, the approval must include the 

DAO-authorized signature. 

(i) Additional Information 

For more information about this AD, 

contact William Reisenauer, Aviation Safety 

Engineer, FAA, 1600 Stewart Avenue, Suite 

410, Westbury, NY 11590; phone: 516–228– 

7300; email: 9-avs-nyaco-cos@faa.gov. 

(j) Material Incorporated by Reference 

(1) The Director of the Federal Register 

approved the incorporation by reference 

(IBR) of the material listed in this paragraph 

under 5 U.S.C. 552(a) and 1 CFR part 51. 

(2) You must use this material as 

applicable to do the actions required by this 

AD, unless this AD specifies otherwise. 

(i) Bombardier Service Bulletin 700–26– 

7505, dated February 10, 2023. 

(ii) [Reserved] 

(3) For Bombardier material identified in 

this AD, contact Bombardier Business 

Aircraft Customer Response Center, 400 CoˆteVertu Road West, Dorval, Que ́bec H4S 1Y9, 

Canada; telephone 514–855–2999; email 

ac.yul@aero.bombardier.com; website 

bombardier.com. 

(4) You may view this material at the FAA, 

Airworthiness Products Section, Operational 

Safety Branch, 2200 South 216th St., Des 

Moines, WA. For information on the 

availability of this material at the FAA, call 

206–231–3195. 

(5) You may view this material at the 

National Archives and Records 

Administration (NARA). For information on 

the availability of this material at NARA, 

visit www.archives.gov/federal-register/cfr/ 

ibr-locations, or email fr.inspection@

nara.gov. 

Issued on July 10, 2024. 

James D. Foltz, 

Deputy Director, Compliance & Airworthiness 

Division, Aircraft Certification Service. 

Editorial Note: This document was 

received for publication by the Office of the 

Federal Register on November 5, 2024. 

[FR Doc. 2024–25978 Filed 11–8–24; 8:45 am] 

BILLING CODE 4910–13–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 70 

RIN 2900–AS19 

Changes in Rates VA Pays for Special 

Modes of Transportation; Delay of 

Effective Date From February 16, 2025, 

Until February 16, 2029 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule; delay of effective 

date. 

SUMMARY: The Department of Veterans 

Affairs (VA) published in the Federal 

Register on February 16, 2023, a final 

rule to amend its beneficiary travel 

regulations to establish a new payment 

methodology for special modes of 

transportation available through the VA 

beneficiary travel program. The 

preamble of that final rule stated the 

effective date was February 16, 2024. 

VA published in the Federal Register on 

December 29, 2023, a final rule to delay 

the effective date for the rule from 

February 16, 2024, to February 16, 2025. 

This rulemaking further delays the 

effective date of February 16, 2025, to 

February 16, 2029. 

DATES: Effective Date: The effective date 

for the final rule published February 16, 

2023, at 88 FR 10032, and delayed on 

December 29, 2023, at 88 FR 90120, 

until February 16, 2025, is further 

delayed until February 16, 2029. 

FOR FURTHER INFORMATION CONTACT: Ben 

Williams, Director, Veterans 

Transportation Program (15MEM), 

Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue NW, Washington, DC 

20420, (404) 828–5691. (This is not a 

toll-free number.) 

SUPPLEMENTARY INFORMATION: On 

November 5, 2020, VA proposed 

amending its beneficiary travel 

regulations to implement the 

discretionary authority in 38 U.S.C. 

111(b)(3)(C), which permits VA to pay 

the lesser of the actual charge for 

ambulance transportation or the amount 

determined by the Centers for Medicare 

and Medicaid Services (CMS) Medicare 

Part B Ambulance Fee Schedule 

(hereafter referred to the CMS 

ambulance 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. We provided a 

60-day comment period that ended on 

January 4, 2021, and we received six 

comments, five of which were 

substantive. Those five comments all 

raised similar concerns about 38 CFR 

70.30(a)(4) introductory text and (a)(4)(i) 

and (ii) as proposed, related to using the 

CMS ambulance fee schedule or, in the 

case of travel by modes other than 

ambulance, the posted rates from each 

State. We responded to all comments in 

a final rule published in the Federal 

Register on February 16, 2023 (88 FR 

10032), wherein we stated that we 

would not make changes from the 

proposed rule related to application of 

the CMS ambulance fee schedule but 

would delay the effective date of the 

final rule by one year (to be February 16, 

2024) to ensure that ambulance 

providers have adequate time to adjust 

to VA’s new methodology for 

calculating ambulance rates. (88 FR 

10035). We further stated in the final 

rule that such adjustment could include 

ambulance providers entering 

negotiations with VA to contract for 

payment rates different than those 

under the CMS ambulance fee schedule, 

as contemplated in the final rule. 

After the final rule was published, VA 

received feedback from both internal 

and external stakeholders, including VA 

employees, ambulance providers, and 

industry experts, that more time would 

be necessary for successful 

implementation of the rule. Specifically, 

delaying the effective date was intended 

to accommodate unforeseen difficulties 

in air ambulance broker contracting. At 

the time, VA believed it would be able 

to enter into contracts and/or 

subcontract relationships with air 

ambulance service providers for non-VA 

initiated service calls if given more time 

for negotiations. Based on this feedback 

and evaluation of the continued effort 

that would be required by air ambulance 

brokers to negotiate and enter into 

contracts before February 16, 2024, VA 

published a final rule on December 29, 

2023, (88 FR 90120) that delayed the 

effective date of the regulation by one 

year to February 16, 2025. 

After the final rule delaying the 

effective date to February 2025 was 

published, however, VA learned 

through continued discussions with 

industry experts, including air 

ambulance providers and brokers, that 

contracting for emergency, non-VA 

initiated air transportation is not 

feasible at this time. Impediments 

include the lack of air industry 

infrastructure for air ambulance brokers 

to enter into subcontracts with 

providers for non-VA initiated 

ambulance transports, as well as the 

general lack of authority of non-VA 

individuals to enter into orders or other 

contractually binding agreements for 

transportation on behalf of VA. 

Air ambulance providers contend that 

the Medicare reimbursement rate that 


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Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Rules and Regulations 88889 

will apply absent a contract is 

unsustainable for their business 

operations and may result in either a 

reduction in the availability of air 

ambulance services for both veterans 

and the public and/or will place 

veterans at risk of receiving bills for the 

balance of charges for services. As a 

result, VA is delaying the effective date 

of the regulation by four years to allow 

time for VA to establish additional 

protections to veterans against balance 

billing for non-VA initiated air 

emergency ambulance transports that 

are reimbursed at a rate other than 

actual charges. In addition, the delay 

will provide time for VA to examine 

alternative payment methodologies for 

non-VA initiated air ambulance 

transports. VA has determined that a 4- 

year delay is necessary to ensure 

sufficient time to evaluate and address 

these concerns, which may require 

additional notice and comment 

rulemaking. 

Administrative Procedure Act 

The Administrative Procedure Act 

(APA), codified in part at 5 U.S.C. 553, 

generally requires that agencies publish 

substantive rules in the Federal Register 

for notice of proposed rulemaking and 

to solicit public comment. However, 

pursuant to 5 U.S.C. 553(b)(B) of the 

APA, general notice and the opportunity 

for public comment are not required 

with respect to a rulemaking when an 

‘‘agency for good cause finds (and 

incorporates the finding and a brief 

statement of reasons therefor in the 

rules issued) that notice and public 

procedure thereon are impracticable, 

unnecessary, or contrary to the public 

interest.’’ 

VA finds that there is good cause 

under the APA to issue this rule without 

prior notice and opportunity for public 

comment. As stated previously, VA last 

delayed the effective date of the final 

rule (that published on February 16, 

2023, at 88 FR 10032) in late December 

2023, to provide additional time for air 

ambulance brokers to enter into 

subcontracts with ambulance providers 

for emergency, non-VA initiated 

transports. During the first few months 

of 2024, VA engaged in continued 

discussions and further contracting 

efforts with the ambulance industry 

generally, with a particular focus on 

emergent, non-VA initiated air 

ambulance transportation. In the spring 

of 2024, however, VA learned that 

contracting for emergency, non-VA 

initiated air transportation is not 

feasible at this time due to the lack of 

air industry infrastructure for 

ambulance brokers to enter into 

subcontracts with providers for non-VA 

initiated ambulance transports, as well 

as the general lack of authority of nonVA individuals to enter into orders or 

other contractually binding agreements 

for transportation on behalf of VA. As a 

result, VA promptly began developing 

alternative courses of action to address 

emergent non-VA initiated air 

ambulance transportation. However, 

due to the upcoming effective date of 

the final rule, VA ultimately determined 

that the best and most veteran-centric 

way forward would be to further delay 

the final rule, to allow additional time 

for VA to ensure that veterans would 

not be negatively impacted by balance 

billing from these ambulance providers. 

The final rule published at 88 FR 

10032 would become effective on 

February 16, 2025, pursuant to the final 

rule delaying its effective date that 

published at 88 FR 90120. Seeking prior 

notice and the opportunity for public 

comment on this delay is impracticable. 

Specifically, VA was not aware of the 

need to delay the effective date until 

summer of 2024. Given the process for 

publishing a notice of proposed 

rulemaking followed by an adequate 

public comment period on the proposed 

rule, and adequate time to respond to 

any comments and publish a final rule, 

VA does not believe there would be 

sufficient time to ensure that the new 

rule would be effective before February 

16, 2025. As a result, the current final 

rule would become effective February 

16, 2025, and ambulance providers who 

have been unable to contract for services 

would be subject to those payment 

methodologies, which is likely to cause 

confusion, uncertainty, and possibly 

result in veterans being billed directly. 

Similarly, VA finds that prior notice 

and opportunity for comment would be 

contrary to the public interest because it 

could adversely impact veteran care or 

result in veterans being billed directly 

for services. If the new regulation 

becomes effective on February 16, 2025, 

VA will pay the lesser of actual charges 

associated with an air ambulance 

service or the CMS ambulance fee 

schedule rate for non-VA initiated 

ambulance services, because separate 

contract rates will not exist (as 

explained earlier, VA now knows that it 

cannot effectively establish contractual 

or sub contractual relationships with air 

ambulance service providers at this time 

for non-VA initiated emergency 

transportation). Air ambulance 

providers contend that the Medicare 

reimbursement rate that would apply is 

unsustainable for their business 

operations and may result in either a 

reduction in the availability of air 

ambulance services for veterans and the 

public, and/or place veterans at risk for 

being billed directly for the difference 

between the Medicare rate that VA pays 

for emergency, non-VA initiated trips 

and the amount billed by the ambulance 

provider. For these reasons, VA finds 

that good cause exists to dispense with 

the prior notice and public comment 

procedures for this final rule, as it 

concludes that such procedures are 

impracticable and contrary to the public 

interest pursuant to 5 U.S.C. 553(b)(B). 

Executive Orders 12866, 13563, and 

14094 

Executive Order 12866 (Regulatory 

Planning and Review) directs agencies 

to assess the costs and benefits of 

available regulatory alternatives and, 

when regulation is necessary, to select 

regulatory approaches that maximize 

net benefits (including potential 

economic, environmental, public health 

and safety effects, and other advantages; 

distributive impacts; and equity). 

Executive Order 13563 (Improving 

Regulation and Regulatory Review) 

emphasizes the importance of 

quantifying both costs and benefits, 

reducing costs, harmonizing rules, and 

promoting flexibility. Executive Order 

14094 (Executive Order on Modernizing 

Regulatory Review) supplements and 

reaffirms the principles, structures, and 

definitions governing contemporary 

regulatory review established in 

Executive Order 12866 of September 30, 

1993 (Regulatory Planning and Review), 

and Executive Order 13563 of January 

18, 2011 (Improving Regulation and 

Regulatory Review). The Office of 

Information and Regulatory Affairs has 

determined that this rulemaking is a 

significant regulatory action under 

Executive Order 12866, as amended by 

Executive Order 14094. The Regulatory 

Impact Analysis associated with this 

rulemaking can be found as a 

supporting document at 

www.regulations.gov. 

Signing Authority 

Denis McDonough, Secretary of 

Veterans Affairs, approved and signed 

this document on October 31, 2024, and 

authorized the undersigned to sign and 

submit the document to the Office of the 

Federal Register for publication 

electronically as an official document of 

the Department of Veterans Affairs. 

Luvenia Potts, 

Regulation Development Coordinator, Office 

of Regulation Policy & Management, Office 

of General Counsel, Department of Veterans 

Affairs. 

[FR Doc. 2024–25975 Filed 11–8–24; 8:45 am] 

BILLING CODE 8320–01–P 


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