II

107TH CONGRESS

1ST SESSION S. 1350

To amend the title XVIII of the Social Security Act to provide payment

to medicare ambulance suppliers of the full costs of providing such

services, and for other purposes.

IN THE SENATE OF THE UNITED STATES

AUGUST 3, 2001

Mr. DAYTON introduced the following bill; which was read twice and referred

to the Committee on Finance

A BILL

To amend the title XVIII of the Social Security Act to

provide payment to medicare ambulance suppliers of the

full costs of providing such services, and for other purposes.

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.

4 This Act may be cited as the ‘‘Medicare Ambulance

5 Payment Reform Act of 2001’’.

6 SEC. 2. AMBULANCE PAYMENT RATES.

7 (a) PAYMENT RATES.—
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1 (1) IN GENERAL.—Section 1834(l)(3) of the

2 Social Security Act (42 U.S.C. 1395m(l)(3)) is

3 amended to read as follows:

4 ‘‘(3) PAYMENT RATES.—

5 ‘‘(A) IN GENERAL.—Subject to any adjust6 ment under subparagraph (B) and paragraph

7 (9) and the full payment of a national mileage

8 rate pursuant to subparagraph (2)(E), in estab9 lishing such fee schedule, the following rules

10 shall apply:

11 ‘‘(i) PAYMENT RATES IN 2002.—

12 ‘‘(I) GROUND AMBULANCE SERV13 ICES.—In the case of ground ambu14 lance services furnished under this

15 part in 2002, the Secretary shall set

16 the payment rates under the fee

17 schedule for such services at a rate

18 based on the average costs (as deter19 mined by the Secretary on the basis of

20 the most recent and reliable informa21 tion available) incurred by full cost

22 ambulance suppliers in providing non23 emergency basic life support ambu24 lance services covered under this title,

25 with adjustments to the rates for
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1 other ground ambulance service levels

2 to be determined based on the rule es3 tablished under paragraph (1). For

4 the purposes of the preceding sen5 tence, the term ‘full cost ambulance

6 supplier’ means a supplier for which

7 volunteers or other unpaid staff com8 prise less than 20 percent of the sup9 plier’s total staff and which receives

10 less than 20 percent of space and

11 other capital assets free of charge.

12 ‘‘(II) OTHER AMBULANCE SERV13 ICES.—In the case of ambulance serv14 ices not described in subclause (I)

15 that are furnished under this part in

16 2002, the Secretary shall set the pay17 ment rates under the fee schedule for

18 such services based on the rule estab19 lished under paragraph (1).

20 ‘‘(ii) PAYMENT RATES IN SUBSE21 QUENT YEARS FOR ALL AMBULANCE SERV22 ICES.—In the case of any ambulance serv23 ice furnished under this part in 2003 or

24 any subsequent year, the Secretary shall

25 set the payment rates under the fee sched-
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1 ule for such service at amounts equal to

2 the payment rate under the fee schedule

3 for that service furnished during the pre4 vious year, increased by the percentage in5 crease in the Consumer Price Index for all

6 urban consumers (United States city aver7 age) for the 12-month period ending with

8 June of the previous year.

9 ‘‘(B) ADJUSTMENT IN RURAL RATES.—For

10 years beginning with 2004, the Secretary, after

11 taking into consideration the recommendations

12 contained in the report submitted under section

13 221(b)(3) the Medicare, Medicaid, and SCHIP

14 Benefits Improvements and Protection Act of

15 2000, shall adjust the fee schedule payment

16 rates that would otherwise apply under this

17 subsection for ambulance services provided in

18 low density rural areas based on the increased

19 cost (if any) of providing such services in such

20 areas.’’.

21 (2) CONFORMING AMENDMENT.—Section

22 221(c) of the Medicare, Medicaid, and SCHIP Bene23 fits Improvement and Protection Act of 2000 (114

24 Stat. 2763A–487), as enacted into law by section

25 1(a)(6) of Public Law 106–554, is repealed.
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1 (3) TECHNICAL AMENDMENT.—

2 (A) IN GENERAL.—Paragraph (8) of sec3 tion 1834(l) of the Social Security Act (42

4 U.S.C. 1395m(l)), as added by section 221(a)

5 of the Medicare, Medicaid, and SCHIP Benefits

6 Improvement and Protection Act of 2000 (114

7 Stat. 2763A–487), as enacted into law by sec8 tion 1(a)(6) of Public Law 106–554, is redesig9 nated as paragraph (9).

10 (B) EFFECTIVE DATE.—The amendment

11 made by subparagraph (A) shall take effect as

12 if included in the enactment of such section

13 221(a).

14 (b) USE OF MEDICAL CONDITIONS FOR CODING AM15 BULANCE SERVICES.—Section 1834(l)(7) of the Social Se16 curity Act (42 U.S.C. 1395m(l)(7)) is amended to read

17 as follows:

18 ‘‘(7) CODING SYSTEM.—

19 ‘‘(A) IN GENERAL.—The Secretary shall,

20 in accordance with section 1173(c)(1)(B), es21 tablish a system or systems for the coding of

22 claims for ambulance services for which pay23 ment is made under this subsection, including a

24 code set specifying the medical condition of the

25 individual who is transported and the level of
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1 service that is appropriate for the transpor2 tation of an individual with that medical condi3 tion.

4 ‘‘(B) MEDICAL CONDITIONS.—The code set

5 established under subparagraph (A) shall—

6 ‘‘(i) take into account the list of med7 ical conditions developed in the course of

8 the negotiated rulemaking process con9 ducted under paragraph (1); and

10 ‘‘(ii) notwithstanding any other provi11 sion of law, be adopted as a standard code

12 set under section 1173(c).’’.

13 SEC. 3. PRUDENT LAYPERSON STANDARD FOR EMERGENCY

14 AMBULANCE SERVICES UNDER MEDICARE

15 AND MEDICAID.

16 (a) AMBULANCE SERVICES FOR MEDICARE FEE17 FOR-SERVICE BENEFICIARIES.—Section 1861(s)(7) of

18 the Social Security Act (42 U.S.C. 1395x(s)(7)) is amend19 ed by inserting before the semicolon at the end the fol20 lowing: ‘‘, except that such regulations shall not fail to

21 treat ambulance services as medical and other health serv22 ices solely because the ultimate diagnosis of the individual

23 receiving the ambulance services results in the conclusion

24 that ambulance services were not necessary, as long as the

25 request for ambulance services is made after the sudden
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1 onset of a medical condition that would be classified as

2 an emergency medical condition (as defined in section

3 1852(d)(3)(B)).’’.

4 (b) AMBULANCE SERVICES FOR MEDICARE+CHOICE

5 ENROLLEES.—Section 1852(d)(3)(A) of the Social Secu6 rity Act (42 U.S.C. 1395w–22(d)(3)(A)) is amended by

7 inserting ‘‘(including the services described in section

8 1861(s)(7))’’ after ‘‘outpatient services’’ in the matter

9 preceding clause (i).

10 (c) AMBULANCE SERVICES IN MEDICAID MANAGED

11 CARE PLANS.—Section 1932(b)(2)(B) of the Social Secu12 rity Act (42 U.S.C. 1396u–2(b)(2)(B)) is amended by in13 serting ‘‘(including the services described in section

14 1861(s)(7) (if covered by the State plan))’’ after ‘‘out15 patient services’’ in the matter preceding clause (i).

16 (d) EFFECTIVE DATE.—The amendments made by

17 this section shall apply with respect to services provided

18 on and after the date of enactment of the Act.

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