A bill to amend title XVIII of the Social Security Act to require reporting of certain data by providers and suppliers of air ambulance services for purposes of reforming reimbursements for such services under the Medicare program, and for other purposes.

Summary: This bill amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services, with respect to air ambulance services furnished during 2017 or any subsequent year, to reduce the mandatory percentage increase (inflation adjustment) for payments under the fee schedule by 2.0% for any supplier or provider that fails to submit to the Secretary specified data. The Secretary is required to select at least two quality measures with respect to which such providers and suppliers may voluntarily submit such data. The Government Accountability Office is required to report to Congress on all such data, together with a recommendation on the adequate amount of Medicare reimbursement to providers and suppliers that would reflect their operational costs and preserve access to critical air medical services. The Secretary is required, in the case of air ambulance services furnished during calendar 2017 through 2021 to make a percentage increase in the base rate of the fee schedule: (1) by 20% during 2017, and (2) by 5% during 2018-2020. The Secretary must also, for 2017 through 2020, adjust such percentages, by either increasing or reducing them (but in no case below zero) to ensure that the increased expenditures under this Act are equal to the reduced expenditures.

SECTION 1. FINDINGS.

    The Congress finds the following:
            (1) Air medical critical care transport is an essential 
        component of the healthcare system.
            (2) The presence of air medical services in rural areas 
        provides tens of millions of rural Americans with access to 
        critical care within an hour of injury.
            (3) As an emergency responder, air medical providers must 
        maintain readiness 24 hours a day and 7 days a week.
            (4) Air medical providers transport all emergent patients 
        for which they are dispatched regardless of insurance status or 
        ability to pay.
            (5) The air ambulance fee schedule under the Medicare 
        program was first implemented in 2002 and developed through 
        negotiated rulemaking, which required the new fee schedule to 
        be created in a budget neutral manner. As such, the Medicare 
        air ambulance fee schedule has never reflected true costs.
            (6) Since the implementation of the air ambulance fee 
        schedule under the Medicare program, reimbursements have only 
        been adjusted by inflationary updates averaging 2.2 percent a 
        year.
            (7) Operational readiness and safety enhancement costs have 
        grown at a far faster rate than the Medicare inflationary 
        updates, creating a fundamental imbalance within the air 
        ambulance fee schedule.
            (8) It is imperative that balance be restored to the air 
        ambulance fee schedule to preserve access to timely care for 
        tens of millions of Americans.

SEC. 2. AIR AMBULANCE DATA REPORTING PROGRAM.

    Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) is 
amended--
            (1) in paragraph (3)(B), by striking ``subparagraph (C)'' 
        and inserting ``subparagraph (C) and paragraph (16)''; and
            (2) by adding at the end the following new paragraphs:
            ``(16) Air ambulance data reporting program.--
                    ``(A) Reduction in update for failure to report.--
                            ``(i) In general.--With respect to air 
                        ambulance services furnished by a supplier or 
                        provider of air ambulance services during 2017 
                        or any subsequent year, in the case the 
                        supplier or provider does not submit data to 
                        the Secretary in accordance with subparagraph 
                        (C) with respect to such year, after 
                        determining the percentage increase under 
                        paragraph (3)(B), and after application of 
                        paragraph (3)(C), the Secretary shall reduce 
                        such percentage increase for payments under the 
                        fee schedule under this subsection during such 
                        year by 2.0 percentage points.
                            ``(ii) Special rule.--The application of 
                        this subparagraph may result in such percentage 
                        increase being less than 0.0 for a year, and 
                        may result in payment rates under the fee 
                        schedule under this subsection for a year being 
                        less than such payment rates for the preceding 
                        year.
                    ``(B) Noncumulative application.--Any reduction 
                under subparagraph (A) shall apply only with respect to 
                the year involved and the Secretary shall not take into 
                account such reduction in computing the payment amount 
                under the fee schedule under this subsection for a 
                subsequent year.
                    ``(C) Submission of data.--For 2017 and each 
                subsequent year, for purposes of this paragraph, each 
                supplier or provider of air ambulance services shall 
                submit to the Secretary data specified under 
                subparagraph (D) for the reporting period (specified by 
                the Secretary) for the year. Such data shall be 
                submitted in a form and manner, and at a time, 
                specified by the Secretary for purposes of this 
                subparagraph.
                    ``(D) Data.--For purposes of reporting data for air 
                ambulance services furnished during a year, the data 
                described in this subparagraph are cost data on the 
                following:
                            ``(i) Maintenance of aircrafts.
                            ``(ii) Medical supplies.
                            ``(iii) Fuel.
                            ``(iv) Employee expenses.
                            ``(v) Recurring training relating to 
                        aviation, maintenance, communication, and 
                        clinical.
                            ``(vi) Rent and utilities.
                            ``(vii) Communications.
                            ``(viii) Travel.
                            ``(ix) Hull and aviation liability 
                        insurance, life insurance, and professional 
                        malpractice insurance.
                            ``(x) Marketing.
                            ``(xi) Supplies.
                            ``(xii) Overhead support.
                            ``(xiii) Aircraft ownership expenses.
                            ``(xiv) Safety enhancement capital costs.
                            ``(xv) Safety enhancement recurring costs.
                    ``(E) Voluntary reporting on quality measures.--Not 
                later than January 1, 2018, the Secretary shall select 
                no less than two quality measures with respect to which 
                providers and suppliers of air ambulance services may 
                voluntarily submit to the Secretary data. In selecting 
                such measures, the Secretary shall consider the 
                following:
                            ``(i) Ventilator use in patients with 
                        advanced airways.
                            ``(ii) Blood glucose check for altered 
                        mental status.
                            ``(iii) Waveform capnography for ventilated 
                        patients.
                            ``(iv) First attempt tracheal tube success.
                            ``(v) DASH 1A-definitive airway sans 
                        hypoxia/hypotension on first attempt.
                            ``(vi) Verification of tracheal tube 
                        placement.
                            ``(vii) Medication errors on transport.
                            ``(viii) Rapid sequence intubation protocol 
                        compliance.
                            ``(ix) Unplanned dislodgements of 
                        therapeutic devices.
                            ``(x) Rate of serious reportable events.
                            ``(xi) Medical equipment failure.
                    ``(F) Reports.--
                            ``(i) By secretary.--Not later than July 1, 
                        2019, subject to clause (iii), the Secretary 
                        shall submit to Congress a report on the data 
                        described in subparagraph (E) submitted to the 
                        Secretary.
                            ``(ii) By comptroller general.--Not later 
                        than July 1, 2019, subject to clause (iii), the 
                        Comptroller General of the United States shall 
                        submit to Congress a report on the data 
                        described in subparagraph (D) and subparagraph 
                        (E) submitted under this paragraph. Such report 
                        shall include a recommendation on the adequate 
                        amount of reimbursement under this title to 
                        providers and suppliers of air ambulance 
                        services for furnishing such services that 
                        would reflect operational costs of such 
                        providers and suppliers and preserve access to 
                        critical air medical services and such other 
                        recommendations as the Comptroller General 
                        deems appropriate.
                            ``(iii) Limitation.--The reports submitted 
                        under subclauses (i) and (ii) shall not include 
                        any information that the Secretary or 
                        Comptroller General, respectively, determines 
                        is proprietary.
            ``(17) Increase in payment for air ambulance services.--
                    ``(A) In general.--Subject to subparagraph (B), In 
                the case of air ambulance services furnished on or 
                after January 1, 2017, and before January 1, 2021, the 
                Secretary shall provide for a percent increase in the 
                base rate of the fee schedule established under this 
                subsection--
                            ``(i) during 2017, by 20 percent; and
                            ``(ii) during 2018 through 2020, by 5 
                        percent.
                    ``(B) Adjustment to ensure budget neutrality.--For 
                2017 through 2020, the Secretary shall adjust the 
                percentages described in clauses (i) and (ii) of 
                subparagraph, by either increasing or reducing (but in 
                no case below zero) such percentages, to ensure that 
                the increased expenditures under this part by reason of 
                subparagraph (A) are equal to the reduced expenditures 
                under this part by reason of paragraph (16).''.