Fairness in Ambulance Reimbursement Act of 2015

Summary: Fairness in Ambulance Reimbursement Act of 2015 This bill directs the Secretary of Health and Human Services to suspend through December 31, 2015, implementation of the reclassification of rural to urban zip codes for payments under the fee schedule for ambulance services, as contained in the final rule published in the Federal Register by the Centers for Medicare &amp; Medicaid Services on November 13, 2014. The Secretary is required to ensure that claims for ambulance services furnished on or after July 1, 2015, are paid according to the classification of zip codes applied the day before the effective date of that final rule. The Secretary must reclassify rural to urban zip codes for payment for ambulance services furnished on or after January 1, 2016, taking into account specified revised geographic delineations of the Office of Management and Budget. Payments for ambulance services (other than air ambulance services) furnished during 2016 must be adjusted according to a certain formula to achieve budget-neutral results. 

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Fairness in Ambulance Reimbursement 
Act of 2015''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The Centers for Medicare & Medicaid Services in both 
        its proposed and final calendar year 2015 physician fee 
        schedule rules made adjustments to the geographic area 
        designations used to calculate payments for ambulance providers 
        and suppliers and misidentified the number of zip code 
        designations that would be impacted by the change.
            (2) On July 11, 2014, the Centers for Medicare & Medicaid 
        Services published a proposal (79 FR 40375) informing the 
        public that no zip codes in the State of California, only two 
        zip codes in the State of Louisiana, and only one zip code in 
        the State of Texas would be changed based on the Office of 
        Management and Budget's revised delineations and updated Rural-
        Urban Commuting Area codes.
            (3) After publication of the zip code proposal, the public 
        had 60 days to submit comments, per the requirements of the 
        Administration Procedures Act.
            (4) On November 13, 2014, the Centers for Medicare & 
        Medicaid Services published a final regulation (79 FR 67748) 
        informing the public, for the first time, that 3.45 percent of 
        zip codes (or 94 zip codes) in the State of California, 13.67 
        percent of zip codes (or 101 zip codes) in the State of 
        Louisiana, 5.96 percent of zip codes (or 155 zip codes) in the 
        State of Texas, and 7.1 percent of zip codes (or 35 zip codes) 
        in the State of Oregon would change based on the Office of 
        Management and Budget's revised delineations of the Rural-Urban 
        Commuting Area codes.
            (5) This change from the data that was published in the 
        proposed rule to the data that was published in the final rule 
        did not afford the public proper notice and comment and 
        therefore is an apparent violation of the Administration 
        Procedures Act.
            (6) Further, the corrected final list of zip code changes 
        was not posted until December 4, 2014, less than a month before 
        the new policy was implemented on January 1, 2015, giving 
        ambulance providers and suppliers insufficient time to prepare 
        for the change in reimbursement.
            (7) The Centers for Medicare & Medicaid Services also did 
        not provide an impact analysis or certification determining 
        whether there is a significant economic impact on small 
        entities, as required by law.
            (8) These changes will result in nearly 9 percent cut in 
        reimbursement under the Medicare program for transports 
        originating in areas losing rural status.

SEC. 3. SUSPENSION OF IMPLEMENTATION OF RURAL TO URBAN ZIP CODE 
              RECLASSIFICATIONS FOR MEDICARE PAYMENT FOR AMBULANCE 
              SERVICES.

    (a) Suspension of Rural to Urban Zip Code Reclassifications.--Not 
later than July 1, 2015, the Secretary of Health and Human Services 
shall issue a notice suspending through December 31, 2015, the 
implementation of the reclassification of rural to urban zip codes for 
payment for ambulance services under the fee schedule under section 
1834(l) of the Social Security Act (42 U.S.C. 1395m(l)), as contained 
in the final rule published by the Centers for Medicare & Medicaid 
Services in the Federal Register on November 13, 2014 (76 Fed. Reg. 
67744 through 67750). The Secretary shall ensure, subject to subsection 
(d)(1), that claims for payment under the fee schedule under section 
1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) for ambulance 
services furnished during 2015 (beginning on July 1, 2015) are paid as 
if the reclassification of rural to urban zip codes applied under such 
final rule were the classification of zip codes applied the day before 
the effective date of such final rule.
    (b) Reclassifications Pursuant to Notice and Comment Rulemaking.--
Not later than November 1, 2015, the Secretary of Health and Human 
Services shall, through notice and comment rulemaking, reclassify rural 
to urban zip codes for payment under the fee schedule under section 
1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) for ambulance 
services furnished on or after January 1, 2016, taking into account the 
revised geographic delineations of the Office of Management and Budget, 
as described in the February 28, 2013 Office of Management and Budget 
Bulletin No. 13-01.
    (c) Treatment of 2015 Claims; Budget Neutrality.--
            (1) Treatment of 2015 claims.--Nothing in this section, or 
        the amendment made by this section, shall be construed as 
        instructing the Secretary of Health and Human Services to re-
        process any claims for payment under the fee schedule under 
        section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) 
        for ambulance services furnished during 2015.
            (2) Budget neutrality.--
                    (A) Determining affect of 2015 suspension.--The 
                Secretary of Health and Human Services shall estimate 
                the amount, if any, by which--
                            (i) the aggregate amount of payments under 
                        the fee schedule under section 1834(l) of the 
                        Social Security Act (42 U.S.C. 1395m(l)) for 
                        ambulance services furnished during 2015 after 
                        application of subsection (a), exceeds
                            (ii) the aggregate amount of payments that 
                        would have been made under such fee schedule 
                        for such services furnished during such year if 
                        subsection (a) had not been enacted.
                    (B) Adjustments in 2016.--If the Secretary 
                estimates the amount under clause (i) of subparagraph 
                (A) exceeds the amount described in clause (ii) of such 
                subparagraph, the Secretary shall, through notice and 
                comment rulemaking, adjust payments under the fee 
                schedule under section 1834(l) of the Social Security 
                Act (42 U.S.C. 1395m(l)) for ambulance services (other 
                than air ambulance services) furnished during 2016 such 
                that the total amount of such adjustments is equal to 
                the amount by which the amount described in such clause 
                (i) exceeds the amount described in such clause (ii).