Veterans Affairs Directed to Use "Prudent Layperson Standard" for EMS Claims

Historically, the U.S. Department of Veterans Affairs (VA) has only approved payment for ambulance service when a medical emergency actually existed. The patient who thought he was having a heart attack but it was just bad heartburn? No payment. That patient who was probably having a stroke, but your fire department was unable to access her hospital records to confirm that she had a medical emergency? No payment.

The IAFC, and other national fire/emergency medical services (EMS) associations, urged Congress to pass the Veterans Reimbursement for Emergency Ambulance Services Act (VREASA; H.R. 1445). This bill would have required the VA to adopt the “prudent layperson” standard when processing EMS-related claims. This would have required the VA to pay EMS-related claims when a prudent layperson would have reasonably believed that they were experiencing a medical emergency.

Last month, Congress passed legislation to fund the VA, along with several other agencies, through Fiscal Year 2019. This bill was accompanied by a report which contained additional instructions for the VA from the House and Senate’s respective appropriations committees. Senator Susan Collins (R-ME), a co-chair of the Congressional Fire Services Caucus, played a critical role by including language in the report to require the VA to adopt the “prudent layperson” standard when processing EMS-related claims. While this report language does not contain the full weight of legislation, it is a strong directive to the VA which all but carries the weight of legislation.

The IAFC applauds Senator Collins for her leadership in addressing this issue. Not only does this solution improve the EMS-related funds available to fire departments, but it prevents patients from having to decide whether a healthcare provider should assess their condition. This common sense solution provides additional support for fire departments and keeps the healthcare priority focused on the patient rather than bureaucratic red tape.

Evan Davis is the IAFC's government relations manager and liaison to the EMS Section.

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