I 

116TH CONGRESS 

1ST SESSION H. R. 4938 

To amend title XVIII to strengthen ambulance services furnished under 

part B of the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 31, 2019 

Ms. SEWELL of Alabama (for herself, Mr. NUNES, Mr. WELCH, Mr. MULLIN, 

and Mr. BLUMENAUER) introduced the following bill; which was referred 

to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII to strengthen ambulance services 

furnished under part B of the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare Ambulance Access, Fraud Prevention, and Re6 form Act of 2019’’. 

7 (b) TABLE OF CONTENTS.—The table of contents for 

8 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

TITLE I—PROTECT ACCESS TO HIGH QUALITY AMBULANCE CARE 

Sec. 101. Reform to the Medicare ambulance fee schedule. 

Sec. 102. National expansion of prior authorization model for repetitive scheduled non-emergent ambulance transport. 

TITLE II—REDUCE ADMINISTRATIVE BURDENS TO EXPAND 

PATIENT CARE 

Sec. 201. Elimination of duplicative paperwork requirements in the Medicare 

ambulance benefit. 

TITLE III—LEVERAGE AMBULANCE SERVICES TO PROTECT 

ACCESS TO CARE IN RURAL AMERICA 

Sec. 301. Protecting access to ambulance services in rural and low population 

density areas. 

1 TITLE I—PROTECT ACCESS TO 

2 HIGH QUALITY AMBULANCE 

3 CARE 

4 SEC. 101. REFORM TO THE MEDICARE AMBULANCE FEE 

5 SCHEDULE. 

6 (a) IN GENERAL.—Section 1834(l) of the Social Se7 curity Act (42 U.S.C. 1395m(l)) is amended by adding 

8 at the end the following new paragraph: 

9 ‘‘(18) INCREASE IN CONVERSION FACTOR FOR

10 GROUND AMBULANCE SERVICES.—In the case of 

11 ground ambulance services furnished on or after 

12 January 1, 2020, for purposes of determining the 

13 fee schedule amount for such services under this 

14 subsection, the conversion factor otherwise applica15 ble to such services shall be increased by— 

16 ‘‘(A) with respect to ground ambulance 

17 services for which the transportation originates 


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1 in a qualified rural area, as identified using the 

2 methodology described in paragraph 

3 (12)(B)(iii), 25.6 percent; 

4 ‘‘(B) with respect to ground ambulance 

5 services not described in subparagraph (A) and 

6 for which the transportation originates in a 

7 rural area described under paragraph (9) or in 

8 a rural census tract described in such para9 graph, 3 percent; and 

10 ‘‘(C) with respect to ground ambulance 

11 services not described in subparagraph (A) or 

12 (B), 2 percent. 

13 ‘‘(19) INCREASE IN MILEAGE RATE FOR

14 GROUND AMBULANCE SERVICES.—In the case of 

15 ground ambulance services furnished on or after 

16 January 1, 2020, for purposes of determining the 

17 fee schedule amount for such services under this 

18 subsection, the payment rate for mileage otherwise 

19 applicable to such services shall be increased by— 

20 ‘‘(A) with respect to ground ambulance 

21 services for which the transportation originates 

22 in a qualified rural area, as identified using the 

23 methodology described in paragraph 

24 (12)(B)(iii), 3 percent; 


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1 ‘‘(B) with respect to ground ambulance 

2 services not described in subparagraph (A) and 

3 for which the transportation originates in a 

4 rural area described under paragraph (9) or in 

5 a rural census tract described in such para6 graph, 3 percent; and 

7 ‘‘(C) with respect to ground ambulance 

8 services not described in subparagraph (A) or 

9 (B), 2 percent.’’. 

10 (b) STUDY AND REPORT.— 

11 (1) STUDY.—The Secretary of Health and 

12 Human Services shall conduct a study on how the 

13 conversion factor applicable to ground ambulance 

14 services under the ambulance fee schedule under sec15 tion 1834(l) of the Social Security Act (42 U.S.C. 

16 1395m(l)), as adjusted under paragraph (18) of 

17 such section (as added by subsection (a)), should be 

18 modified, if at all, to take into account the cost of 

19 providing services in urban, rural, and super-rural 

20 areas. In determining such costs, the Secretary shall 

21 use the data collected through the data collection 

22 system under paragraph (17) of such section. 

23 (2) REPORT.—Not later than January 1, 2022, 

24 the Secretary of Health and Human Services shall 

25 submit to Congress a report on the study conducted 


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1 under paragraph (1), together with recommenda2 tions for such legislation and administrative action 

3 as the Secretary determines appropriate. 

4 SEC. 102. NATIONAL EXPANSION OF PRIOR AUTHORIZA5 TION MODEL FOR REPETITIVE SCHEDULED 

6 NON-EMERGENT AMBULANCE TRANSPORT. 

7 (a) IN GENERAL.—Section 1834(l)(16) of the Social 

8 Security Act (42 U.S.C. 1395m(l)(16)) is amended— 

9 (1) by redesignating subparagraphs (B) and 

10 (C) as subparagraphs (C) and (D), respectively; and 

11 (2) by inserting after subparagraph (A) the fol12 lowing new subparagraph: 

13 ‘‘(B) PERMANENT EXPANSION.— 

14 ‘‘(i) If by July 1, 2019, the Secretary 

15 has not already expanded to all States the 

16 model of prior authorization described in 

17 paragraph (2) of section 515(a) of the 

18 Medicare Access and CHIP Reauthoriza19 tion Act of 2015, by January 1, 2020, the 

20 Secretary shall expand the prior authoriza21 tion model to all States using notice and 

22 comment rulemaking, regardless of wheth23 er or not the expansion meets the require24 ments described in paragraphs (1) through 

25 (3) of section 1115A(c). 


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1 ‘‘(ii) If the Secretary expands the 

2 model of prior authorization under this 

3 subparagraph— 

4 ‘‘(I) the prior authorization shall 

5 be limited to ambulance services con6 sisting of non-emergency basic life 

7 support services involving transport of 

8 an individual with end-stage renal dis9 ease for renal dialysis services (as de10 scribed in section 1881(b)(14)(B)) 

11 furnished other than on an emergency 

12 basis; and 

13 ‘‘(II) in making the prior author14 ization determination with respect to 

15 a service and individual, the Secretary 

16 shall evaluate the medical necessity of 

17 the service by determining— 

18 ‘‘(aa) whether the individual 

19 is unable to get up from bed 

20 without assistance, unable to am21 bulate, and unable to sit in a 

22 chair or wheelchair; 

23 ‘‘(bb) whether the individual 

24 has a medical condition that, re25 gardless of bed confinement, is 


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1 such that transport by ambulance 

2 is medically necessary; or 

3 ‘‘(cc) whether the individual 

4 meets other criteria as deter5 mined appropriate by the Sec6 retary.’’. 

7 TITLE II—REDUCE ADMINISTRA8 TIVE BURDENS TO EXPAND 

9 PATIENT CARE 

10 SEC. 201. ELIMINATION OF DUPLICATIVE PAPERWORK RE11 QUIREMENTS IN THE MEDICARE AMBULANCE 

12 BENEFIT. 

13 Section 1834(l) of the Social Security Act (42 U.S.C. 

14 1395m(l)), as amended by section 101, is further amended 

15 by adding the following new paragraph: 

16 ‘‘(20) REDUCING ADMINISTRATIVE BURDEN.— 

17 No later than July 1, 2020— 

18 ‘‘(A) The Secretary shall through notice 

19 and comment rulemaking eliminate the fol20 lowing requirements to reduce the burden on 

21 ambulance services providers and suppliers: 

22 ‘‘(i) The vehicle section and the 

23 ‘extra’ practice locations for emergency 

24 medical services section of the 855B Am25 bulance Enrollment Form required under 


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1 section 424.505 of title 42, Code of Fed2 eral Regulations (or successor regulations). 

3 ‘‘(ii) The requirement that individuals 

4 sign ambulance service claims under sec5 tion 424.36 of title 42, Code of Federal 

6 Regulations (or successor regulations), 

7 when other documentation establishing 

8 that the individual received the ambulance 

9 services is available. 

10 ‘‘(B) Not later than July 1, 2020, the Sec11 retary shall through notice and comment rule12 making— 

13 ‘‘(i) require ambulance providers and 

14 suppliers to update the 855B Ambulance 

15 Enrollment Form required under section 

16 424.505 of title 42, Code of Federal Regu17 lations (or successor regulations), no more 

18 than once a calendar year; and 

19 ‘‘(ii) establish a process to take into 

20 account inaccuracies in Social Security 

21 records or other official death records be22 fore revoking billing authority for ambu23 lance providers and suppliers under section 

24 424.535 of title 42, Code of Federal Regu25 lations (or successor regulations).’’. 


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1 TITLE III—LEVERAGE AMBU2 LANCE SERVICES TO PRO3 TECT ACCESS TO CARE IN 

4 RURAL AMERICA 

5 SEC. 301. PROTECTING ACCESS TO AMBULANCE SERVICES 

6 IN RURAL AND LOW POPULATION DENSITY 

7 AREAS. 

8 Section 1834(l)(12) of the Social Security Act (42 

9 U.S.C. 1395m(l)(12)) is amended by adding at the end 

10 the following new subparagraphs: 

11 ‘‘(C) EXCEPTION FOR RURAL AND QUALI12 FIED RURAL AREAS.—The Secretary shall deem 

13 an area designated as a rural or qualified rural 

14 area under this paragraph that would otherwise 

15 no longer receive such designation to retain its 

16 previous designated status if there are 1,000 or 

17 fewer individuals per square mile in the area. 

18 ‘‘(D) RIGHT TO APPEAL RURAL AREAS

19 AND QUALIFIED RURAL AREAS.—The Secretary 

20 shall establish an administrative appeals proc21 ess to allow ambulance services providers and 

22 suppliers to seek reconsideration of a change in 

23 a ZIP code’s status as a rural or qualified rural 

24 area during the first 12 months after the SecVerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938

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1 retary finalizes a change in the designation 

2 made under this paragraph.’’. 

Æ 


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