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[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 1407 Introduced in Senate (IS)]

112th CONGRESS
  1st Session
                                S. 1407

     To amend title XVIII of the Social Security Act to establish 
accreditation requirements for suppliers and providers of air ambulance 
                   services, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             July 22, 2011

Ms. Snowe (for herself and Ms. Cantwell) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
     To amend title XVIII of the Social Security Act to establish 
accreditation requirements for suppliers and providers of air ambulance 
                   services, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Air Ambulance Medicare Accreditation 
and Accountability Act''.

SEC. 2. ACCREDITATION REQUIREMENT.

    (a) In General.--Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by adding at the end the following new subsection:
    ``(p) Accreditation Requirement for Air Ambulance Services.--
            ``(1) In general.--Beginning with the date that is 2 years 
        after the date of enactment of the Air Ambulance Medicare 
        Accreditation and Accountability Act, with respect to air 
        ambulance services for which payment is made under the fee 
        schedule established under subsection (l) and that are 
        furnished by a supplier or provider (directly or under an 
        arrangement described in subsection (l)(1)), payment may only 
        be made for such services provided by an air ambulance if--
                    ``(A) the supplier or provider provides for 
                appropriate medical oversight by a physician (as 
                determined by the Secretary); and
                    ``(B) except as provided in paragraph (5), the air 
                ambulance is accredited by an accreditation 
                organization designated by the Secretary under 
                paragraph (3)(B) as a level III or higher air 
                ambulance.
            ``(2) Accreditation levels.--The Secretary shall establish 
        a process for accrediting the air ambulances of suppliers and 
        providers of air ambulance services. Under such process, an 
        accreditation organization designated by the Secretary under 
        paragraph (3)(B) may accredit an air ambulance of a supplier or 
        provider of air ambulance services at any of the following 
        levels (listed from lowest to highest level of accreditation):
                    ``(A) Level III.--The air ambulance--
                            ``(i) has the capability and scope of 
                        practice to provide advanced resuscitation 
                        during transport, including the criteria 
                        described in paragraph (4)(B); and
                            ``(ii) meets such other criteria as the 
                        Secretary determines appropriate for such 
                        accreditation.
                    ``(B) Level II.--The air ambulance--
                            ``(i) meets the criteria for being 
                        accredited as a level III air ambulance (as 
                        described in subparagraph (A));
                            ``(ii) has the capability to provide care 
                        during transport at the level of care and scope 
                        of practice of a hospital emergency department, 
                        including the criteria described in paragraph 
                        (4)(C); and
                            ``(iii) meets such other criteria as the 
                        Secretary determines appropriate for such 
                        accreditation.
                    ``(C) Level I.--The air ambulance--
                            ``(i) meets the criteria for being 
                        accredited as a level II air ambulance (as 
                        described in subparagraph (B));
                            ``(ii) has the capability to provide care 
                        during transport at the level of care and scope 
                        of practice of a tertiary level intensive care 
                        unit, including the criteria described in 
                        paragraph (4)(D); and
                            ``(iii) meets such other criteria as the 
                        Secretary determines appropriate for such 
                        accreditation.
            ``(3) Accreditation organizations.--
                    ``(A) Factors for designation of accreditation 
                organizations.--The Secretary shall consider the 
                following factors in designating accreditation 
                organizations under subparagraph (B) and in reviewing 
                and updating the list of accreditation organizations 
                designated pursuant to subparagraph (C):
                            ``(i) The ability of the organization to 
                        provide timely reviews of applications for such 
                        accreditation.
                            ``(ii) Whether the organization uses random 
                        site visits, audits, or other strategies to 
                        ensure adherence to the accreditation criteria 
                        described in paragraph (2).
                            ``(iii) The ability of the organization to 
                        take into account the capacities of and special 
                        circumstances applicable to air ambulances of 
                        suppliers or providers of air ambulance 
                        services located in a rural area (as defined in 
                        section 1886(d)(2)(D)).
                            ``(iv) The ability of the organization to 
                        take into account the capacities of and special 
                        circumstances applicable to air ambulances 
                        owned and operated by units of State or local 
                        government.
                            ``(v) Whether the organization has 
                        established reasonable fees for such 
                        accreditation.
                            ``(vi) Whether the organization has 
                        applicable accreditation experience.
                            ``(vii) Whether the organization has 
                        developed an accreditation program that is 
                        adequate and appropriate to the goal of 
                        ensuring high-caliber air ambulance services.
                            ``(viii) The ability of the organization to 
                        effectively enforce the accreditation criteria 
                        described in paragraph (2).
                            ``(ix) Such additional factors specified by 
                        the Secretary regarding quality, medical 
                        services, and emergency medical services 
                        integration.
                            ``(x) Such other factors as the Secretary 
                        determines appropriate.
                    ``(B) Designation.--The Secretary shall designate 
                organizations to accredit air ambulances of suppliers 
                and providers of air ambulance services under this 
                subsection. The list of accreditation organizations so 
                designated may be modified pursuant to subparagraph 
                (C).
                    ``(C) Review and modification of list of 
                accreditation organizations.--
                            ``(i) In general.--The Secretary shall 
                        review the list of accreditation organizations 
                        designated under subparagraph (B) taking into 
                        account the factors under subparagraph (A). 
                        Taking into account the results of such review, 
                        the Secretary may, by regulation, modify the 
                        list of accreditation organizations designated 
                        under subparagraph (B).
                            ``(ii) Special rule for accreditations done 
                        prior to removal from list of designated 
                        accreditation organizations.--In the case where 
                        the Secretary removes an organization from the 
                        list of accreditation organizations designated 
                        under subparagraph (B), any air ambulance of a 
                        supplier or provider that is accredited by the 
                        organization during the period beginning on the 
                        date on which the organization is designated as 
                        an accreditation organization under 
                        subparagraph (B) and ending on the date on 
                        which the organization is removed from such 
                        list shall be considered to have been 
                        accredited by an organization designated by the 
                        Secretary under subparagraph (B) for the 
                        remaining period such accreditation is in 
                        effect.
            ``(4) Criteria for accreditation.--
                    ``(A) In general.--Not later than 1 year after the 
                date of enactment of the Air Ambulance Medicare 
                Accreditation and Accountability Act, the Secretary 
                shall establish criteria for use by an accreditation 
                organization designated under paragraph (3)(B) to 
                evaluate an air ambulance of a supplier or provider of 
                air ambulance services for the purpose of accreditation 
                of such air ambulance. Such criteria shall be specific 
                to each accreditation level described in paragraph (2) 
                and include, at a minimum, the criteria applicable to 
                such level under such paragraph.
                    ``(B) Level III criteria described.--In the case of 
                accreditation of an air ambulance of a supplier or 
                provider as a level III air ambulance, the criteria 
                described in subparagraph (A) shall include the 
                following:
                            ``(i) Provision of patient care.--Minimum 
                        accreditation criteria related to the provision 
                        of patient care, including--
                                    ``(I) standards that require the 
                                air ambulance to have available during 
                                transport, medical equipment for the 
                                proper provision of patient care 
                                consistent with the provision of 
                                advanced resuscitation and life 
                                support, including communications 
                                necessary for the coordination of 
                                patient care, patient monitoring 
                                systems, on-board suction, oxygen, and 
                                electrical systems to maintain medical 
                                devices;
                                    ``(II) standards for maintaining a 
                                medically suitable patient care 
                                environment (including sanitation and 
                                infection control and permanently 
                                installed climate control);
                                    ``(III) standards for the design of 
                                aircraft medical bays to ensure access 
                                to medical equipment and patients in a 
                                manner that enables the medical crew to 
                                perform basic and advanced 
                                resuscitation and life support medical 
                                interventions while secure;
                                    ``(IV) standards for the medical 
                                training and qualifications of the 
                                medical crew of the air ambulance;
                                    ``(V) standards for medical 
                                oversight;
                                    ``(VI) standards for the makeup of 
                                the medical crew of the air ambulance 
                                and for the equipment and aircraft 
                                attributes needed for specific medical 
                                missions; and
                                    ``(VII) standards and reporting 
                                requirements related to quality 
                                assurance, peer review, and outcomes 
                                and proficiency measures.
                            ``(ii) Service requirements.--In the case 
                        of air ambulance services furnished in a State 
                        that does not impose minimum service 
                        requirements related to appropriate utilization 
                        and transport, such minimum service 
                        requirements, including--
                                    ``(I) standards for licensing by 
                                the State;
                                    ``(II) standards for transport from 
                                emergency scene calls of all 
                                individuals regardless of ability to 
                                pay;
                                    ``(III) standards for minimum 
                                availability for scene response 
                                (weather permitting);
                                    ``(IV) standards for response to 
                                emergency scene calls within a 
                                specified flight time;
                                    ``(V) standards for adherence to 
                                established criteria for the 
                                appropriate medical institution to 
                                receive a patient from emergency scene 
                                responses (including such criteria 
                                published by appropriate professional 
                                medical associations); and
                                    ``(VI) standards for appropriate 
                                utilization and transport.
                    ``(C) Level II criteria described.--In the case of 
                accreditation of an air ambulance of a supplier or 
                provider as a level II air ambulance, the criteria 
                described in subparagraph (A) shall include the 
                capability to provide care during transport at the 
                level of care and scope of practice of a hospital 
                emergency department, including--
                            ``(i) standards that require the air 
                        ambulance to--
                                    ``(I) be equipped with a ventilator 
                                fully capable of volume or pressure 
                                modes of ventilation; and
                                    ``(II) be equipped with multiple 
                                infusion pumps and use a pharmaceutical 
                                formulary;
                            ``(ii) standards that require the air 
                        ambulance and, as needed, medical personnel to 
                        have the capability to conduct invasive patient 
                        monitoring; and
                            ``(iii) standards for advanced 
                        qualifications, capability, and training of 
                        medical personnel of the air ambulance (such as 
                        standards for monitoring high-risk patients, 
                        managing critical care pharmaceuticals and 
                        blood, and point of care blood testing).
                    ``(D) Level I criteria described.--In the case of 
                accreditation of an air ambulance of a supplier or 
                provider as a level I air ambulance, the criteria 
                described in subparagraph (A) shall include the 
                capability to provide care during transport at the 
                level of care and scope of practice of a tertiary level 
                intensive care unit, including--
                            ``(i) standards that require the air 
                        ambulance and, as needed, medical personnel--
                                    ``(I) to have the capability to 
                                transport specialty care patients 
                                (including those on intra-aortic 
                                balloon pumps, extracorporeal membrane 
                                oxygenation, ventrical assist devices, 
                                or isolettes and high-risk obstetric 
                                patients);
                                    ``(II) to have the capability to 
                                provide critical care transport for an 
                                adult patient for not less than 100 
                                miles without refueling; and
                                    ``(III) to have within the medical 
                                bay of the air ambulance sufficient 
                                space and the capability to provide, as 
                                needed, either 3 person teams (such as 
                                in the case of patients with a 
                                ventrical assist device or patients 
                                needing critical care services) or to 
                                provide care for 2 patients needing 
                                critical care services simultaneously;
                            ``(ii) standards for sufficient power, 
                        configuration, and design of the medical bay of 
                        the air ambulance to provide critical care 
                        services during transport without delaying 
                        transport or compromising electrical systems 
                        supporting medical devices; and
                            ``(iii) standards that require the air 
                        ambulance to be equipped with multiple infusion 
                        pumps and use a pharmaceutical formulary 
                        consistent with critical care provided in a 
                        tertiary level intensive care unit.
                    ``(E) Requirements.--The Secretary shall consider 
                the following in establishing criteria under 
                subparagraph (A):
                            ``(i) Ensuring that the criteria described 
                        in such subparagraph does not adversely impact 
                        access to air ambulances for individuals, 
                        particularly in rural areas.
                            ``(ii) The needs of--
                                    ``(I) suppliers and providers of 
                                air ambulance services located in a 
                                rural area (as defined in section 
                                1886(d)(2)(D)); and
                                    ``(II) air ambulances owned and 
                                operated by units of State or local 
                                government.
                            ``(iii) The extent to which each of the 
                        criteria is economically feasible, particularly 
                        in rural areas (as so defined).
                            ``(iv) The extent to which each of the 
                        criteria is technically feasible, as well as 
                        market availability and future development of 
                        equipment and products that can be installed on 
                        or carried aboard existing aircraft.
                            ``(v) The incorporation of appropriate 
                        implementation timeframes for the criteria in a 
                        manner that does not impede access, 
                        particularly in rural areas (as so defined).
                            ``(vi) Ensuring that the criteria is 
                        developed and established through a transparent 
                        process with the input of stakeholders.
                            ``(vii) Ensuring that the criteria includes 
                        a requirement that the supplier or provider of 
                        air ambulance services follows an internal 
                        policy that provides clear direction on the 
                        distribution to and receipt of gifts from 
                        referring individuals or entities, including 
                        clear limitations on the provision of such 
                        gifts beyond those of nominal value.
                            ``(viii) Ensuring regular updating of the 
                        criteria.
            ``(5) Exception.--During the 3-year period beginning on the 
        effective date of the accreditation requirement under paragraph 
        (1)(B), the Secretary shall exempt an air ambulance of a 
        supplier or provider from such accreditation requirement if the 
        application of such requirement to the air ambulance would 
        require the supplier or provider to replace its air ambulance 
        or would impose on the supplier or provider an undue economic 
        burden with respect to compliance costs.
            ``(6) Data collection requirements.--The Secretary shall 
        establish the following requirements for the collection of data 
        related to the utilization of such services:
                    ``(A) The establishment of protocols for the 
                collection and reporting of data by the supplier or 
                provider of air ambulance services regarding patient 
                transport provided from the scene of an incident and 
                during an inter-hospital transfer, including 
                information regarding--
                            ``(i) patient on-board mileage for ground 
                        and air transport; and
                            ``(ii) the involvement of ground ambulance 
                        transportation in any portions or segments of 
                        the transportation of the patient.
                    ``(B) The collection and reporting of information 
                obtained via data use agreements with receiving 
                institutions regarding the rates of discharge from the 
                hospital emergency department of patients after 
                transport by air ambulance, including assessment of 
                injury and illness to describe utilization 
                appropriateness.
                    ``(C) The collection and reporting of information 
                regarding the extent to which air ambulance transports, 
                other than those by specialized pediatric and newborn 
                transport teams, are to receiving institutions with 
                whom the supplier or provider of air ambulance services 
                is affiliated or has a contractual arrangement for 
                receiving hospital destination.
            ``(7) Definition of air ambulance service.--For purposes of 
        this subsection, the term `air ambulance service' means a fixed 
        wing or a rotary wing air ambulance service.''.
    (b) Conforming Amendments.--Section 1862(a) of the Social Security 
Act (42 U.S.C. 1395y(a)) is amended--
            (1) in paragraph (24), by striking ``or'' at the end;
            (2) in paragraph (25), by striking the period at the end 
        and inserting ``; or''; and
            (3) by adding at the end the following new paragraph:
            ``(26) beginning with the date that is 2 years after the 
        date of enactment of the Air Ambulance Medicare Accreditation 
        and Accountability Act, which are air ambulance services (as 
        defined in section 1834(p)(7)) for which payment is made under 
        the fee schedule established under section 1834(l) and that are 
        furnished by a supplier or provider (directly or under an 
        arrangement described in section 1834(l)(1)), if the 
        requirements described in section 1834(p)(1) are not met.''.
    (c) Relationship to State Licensure Requirements.--
            (1) In general.--Nothing in this Act or the amendments made 
        by this Act shall affect any requirement that a supplier or 
        provider of air ambulance services comply with State or local 
        laws governing the licensing and certification of such supplier 
        or provider, an air ambulance, or the medical personnel of an 
        air ambulance.
            (2) Preemption.--Nothing in this Act or the Amendments made 
        by this Act shall preempt a State or local government from 
        establishing licensure or other requirements for suppliers or 
        providers of air ambulance services that exceed the criteria 
        established by the Secretary of Health and Human Services for 
        purposes of accreditation of air ambulances under section 
        1834(p) of the Social Security Act, as added by subsection (a), 
        except to the extent that the requirement directly conflicts 
        with a requirement under such subsection or other applicable 
        Federal law.

SEC. 3. REIMBURSEMENT FOR AIR AMBULANCE SERVICES UNDER MEDICAID.

    Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)), as 
amended by section 2001(a)(2)(B) of the Patient Protection and 
Affordable Care Act (Public Law 111-148), is amended--
            (1) in paragraph (25), by striking ``or'' at the end;
            (2) in paragraph (26), by striking the period at the end 
        and inserting ``; or''; and
            (3) by inserting after paragraph (26) the following new 
        paragraph:
            ``(27) with respect to amounts expended for the transport 
        by an air ambulance of a patient, in an emergency or 
        nonemergency situation (in this paragraph referred to as `air 
        ambulance services'), or for any medical services provided to 
        the patient in the course of such transport, unless--
                    ``(A) not later than 180 days after the date of 
                enactment of this paragraph, the State submits a State 
                plan amendment to the Secretary that describes the 
                State's licensing and regulatory requirements for the 
                provision of air ambulance services within the State, 
                including--
                            ``(i) such requirements relating to the 
                        provision of medical services in the course of 
                        transport by air ambulance;
                            ``(ii) the State's medically-related use 
                        and dispatch protocols for air ambulance 
                        services;
                            ``(iii) whether the State imposes minimum 
                        service requirements described under section 
                        1834(p)(4)(B)(ii); and
                            ``(iv) any other relevant information, as 
                        determined appropriate by the Secretary; and
                    ``(B) not later than January 1, 2015, the State 
                certifies to the Secretary that the State's licensing 
                and regulatory requirements for the provision of air 
                ambulance services within the State comply with 
                national guidelines published by the Federal 
                Interagency Committee on Emergency Medical Services for 
                the use and dispatch of air ambulance services.''.

SEC. 4. REIMBURSEMENT FOR AIR AMBULANCE SERVICES UNDER MEDICARE.

    (a) In General.--Section 1834(l) of the Social Security Act (42 
U.S.C. 1395m(l)) is amended by adding at the end the following new 
paragraph:
            ``(15) Payment for air ambulance services.--
                    ``(A) In general.--In the case of air ambulance 
                services furnished on or after the date that is 2 years 
                after the date of enactment of the Air Ambulance 
                Medicare Accreditation and Accountability Act (or, if 
                the Secretary determines additional time is necessary, 
                such other date (but not later than 3 years after such 
                date of enactment) as the Secretary specifies) the 
                Secretary shall establish a revised air ambulance rate 
                structure under the fee schedule under this subsection 
                in accordance with the succeeding provisions of this 
                paragraph.
                    ``(B) Objectives.--Revisions to the fee schedule 
                under this subsection pursuant to this paragraph shall 
                be limited to changes intended to accomplish the 
                following objectives:
                            ``(i) Better reflect relative cost 
                        differences for providing air ambulance 
                        services at higher levels of accreditation 
                        under subsection (p).
                            ``(ii) Promote quality care.
                            ``(iii) Preserve timely access to air 
                        ambulance services in those geographic areas 
                        that receive air ambulance services as of such 
                        date of enactment and incentivize the provision 
                        of such services in geographic areas that are 
                        unserved or underserved.
                    ``(C) Consideration of relative cost of services.--
                            ``(i) In general.--Subject to clause (ii) 
                        and subparagraph (D), revisions to the fee 
                        schedule under this subsection pursuant to this 
                        paragraph shall provide for higher levels of 
                        reimbursement for the transport of an 
                        individual as follows:
                                    ``(I) Air ambulance services 
                                provided by an air ambulance that is 
                                accredited under subsection (p) as a 
                                level II air ambulance shall be 
                                reimbursed at a higher rate than such 
                                services provided by an air ambulance 
                                that is accredited under such 
                                subsection as a level III air 
                                ambulance.
                                    ``(II) Air ambulance services 
                                provided by an air ambulance that is 
                                accredited under subsection (p) as a 
                                level I air ambulance shall be 
                                reimbursed at a higher rate than such 
                                services provided by an air ambulance 
                                that is accredited under such 
                                subsection as a level II air ambulance.
                            ``(ii) Requirements.--The Secretary shall 
                        ensure that the revisions under clause (i)--
                                    ``(I) reflect an assessment of the 
                                relative differential in the cost of 
                                care provided by air ambulances with 
                                differing levels of accreditation under 
                                subsection (p); and
                                    ``(II) do not alter any adjustments 
                                related to providing services in rural 
                                areas or accounting for geographic 
                                differences in cost as provided under 
                                the fee schedule under this subsection 
                                as of the date of enactment of the Air 
                                Ambulance Medicare Accreditation and 
                                Accountability Act, including any 
                                increase in payments under paragraph 
                                (12) or (13).
                    ``(D) Sole community air ambulance services.--
                            ``(i) In general.--Under such revised air 
                        ambulance rate structure, air ambulance 
                        services provided by a sole community air 
                        ambulance for which the transport originates in 
                        a rural area (as defined in section 
                        1886(d)(2)(D)) with a Rural-Urban Commuting 
                        Area code of level 7 or higher shall be 
                        reimbursed at a higher rate than such services 
                        provided by an air ambulance that is accredited 
                        under subsection (p) at the same level as the 
                        sole community air ambulance but which is not a 
                        sole community air ambulance.
                            ``(ii) Definition of sole community air 
                        ambulance.--In this paragraph, the term `sole 
                        community air ambulance' means an air ambulance 
                        that serves a rural area (as defined in section 
                        1886(d)(2)(D)) with a low population density 
                        and is a distance of not less than 100 air 
                        statute miles from the base of operation of any 
                        other air ambulance.
                    ``(E) Mitigation of potential impacts on access to 
                services.--The Secretary shall, prior to the 
                implementation of the revised air ambulance rate 
                structure under this paragraph, modify any potential 
                revisions in payment rates under such revised air 
                ambulance rate structure as necessary to ensure that 
                such revisions do not adversely impact current access 
                to air ambulance services, particularly in rural and 
                underserved areas, including by--
                            ``(i) providing for a reasonable transition 
                        period to the revised air ambulance rate 
                        structure, including through the use of payment 
                        floors for each year of the transition period;
                            ``(ii) limiting changes in such payment 
                        rates based on the assessment of relative 
                        costs; and
                            ``(iii) taking into consideration the 
                        capacities, volume, and special circumstances 
                        of--
                                    ``(I) suppliers or providers of air 
                                ambulance services located in a rural 
                                area (as defined in section 
                                1886(d)(2)(D)); and
                                    ``(II) air ambulances owned and 
                                operated by units of State or local 
                                government.
                    ``(F) Consultation.--The Secretary shall consult 
                with all relevant stakeholders in establishing the 
                revised air ambulance rate structure under this 
                paragraph.
                    ``(G) Independent cost study.--In establishing such 
                revised air ambulance rate structure, the Secretary 
                shall use a cost analysis conducted by an independent 
                organization under a contract with the Secretary.
                    ``(H) Budget neutrality.--Revisions in payment 
                implemented pursuant to this paragraph shall result in 
                the same estimated amount of aggregate expenditures 
                under this title for air ambulance services furnished 
                in the fiscal year in which such revisions in payment 
                are implemented and each subsequent year as would have 
                been made under this title for such care in such fiscal 
                year and each such subsequent year if such revisions 
                had not been implemented. For purposes of applying the 
                preceding sentence, the Secretary shall take into 
                account any updates or other adjustments applicable to 
                payments for such services or increases in utilization 
                of such services expected as of the date of enactment 
                of the Air Ambulance Medicare Accreditation and 
                Accountability Act.
                    ``(I) Noncoverage event.--Not later than 180 days 
                after the date of enactment of the Air Ambulance 
                Medicare Accreditation and Accountability Act, the 
                Secretary shall establish noncoverage events for which 
                reimbursement for air ambulance services will not be 
                provided under this subsection. Such noncoverage events 
                shall include the following:
                            ``(i) Patient death or serious disability 
                        caused by loss of oxygen supply.
                            ``(ii) Patient or passenger death or 
                        serious disability caused by emergency medical 
                        transportation vehicle failure or crash.
                            ``(iii) Patient death or serious disability 
                        caused by transport to an unintended 
                        destination.
                            ``(iv) Responding without a formal request 
                        by emergency medical services or hospital 
                        personnel.
                            ``(v) Patient death or serious disability 
                        caused by dropping a patient or allowing a 
                        fall.
                            ``(vi) Death or serious disability to 
                        emergency medical services personnel or a 
                        patient caused by the failure of the emergency 
                        medical transportation vehicle to communicate 
                        an initial estimated time of arrival or delays.
                    ``(J) Definition of air ambulance service.--In this 
                paragraph, the term `air ambulance service' has the 
                meaning given that term in subsection (p)(7).''.
    (b) Conforming Amendment.--Section 1862(a)(26) of the Social 
Security Act, as added by section 2(b), is amended by inserting ``, or 
(beginning with the date that is 180 days after the date of enactment 
of the Air Ambulance Medicare Accreditation and Accountability Act) in 
the case where the Secretary determines that a noncoverage event 
established under section 1834(l)(15)(I) has occurred in the furnishing 
of such service'' before the period at the end.

SEC. 5. AIR AMBULANCE QUALITY DATA REPORTING PROGRAM.

    Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)), as 
amended by section 4, 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 paragraph:
            ``(16) Air ambulance quality data reporting program.--
                    ``(A) Reduction in update for failure to report.--
                            ``(i) In general.--For each year (beginning 
                        with January 1 following the date that is 3 
                        years after the date of enactment of the Air 
                        Ambulance Medicare Accreditation and 
                        Accountability Act), in the case of a supplier 
                        or provider of air ambulance services that 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 0.4 percentage points (or, beginning 
                        with January 1 following the date that is 5 
                        years after such date of enactment, 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 quality data.--For each year 
                (beginning with January 1 following the date that is 3 
                years after the date of enactment of the Air Ambulance 
                Medicare Accreditation and Accountability Act), each 
                supplier or provider of air ambulance services shall 
                submit to the Secretary data on quality measures 
                specified under subparagraph (D). Such data shall be 
                submitted in a form and manner, and at a time, 
                specified by the Secretary for purposes of this 
                subparagraph.
                    ``(D) Quality measures.--
                            ``(i) In general.--The Secretary shall 
                        specify quality measures for each accreditation 
                        level for air ambulances under subsection (p) 
                        that reflect the capability of the air 
                        ambulance to deliver such services equal to 
                        each such accreditation level. Subject to 
                        clause (ii), any measure specified by the 
                        Secretary under this subparagraph must have 
                        been endorsed by the entity with a contract 
                        under section 1890(a).
                            ``(ii) Exception.--In the case of a 
                        specified area or medical topic determined 
                        appropriate by the Secretary for which a 
                        feasible and practical measure has not been 
                        endorsed by the entity with a contract under 
                        section 1890(a), the Secretary may specify a 
                        measure that is not so endorsed as long as due 
                        consideration is given to measures that have 
                        been endorsed or adopted by a consensus 
                        organization identified by the Secretary.
                            ``(iii) Time frame.--Not later than 2 years 
                        after the date of enactment of the Air 
                        Ambulance Medicare Accreditation and 
                        Accountability Act, the Secretary shall publish 
                        the measures selected under this subparagraph 
                        that will be applicable with respect to the 
                        year beginning on January 1 following the date 
                        that is 3 years after such date of enactment.
                            ``(iv) Updating measures specified.--
                                    ``(I) In general.--The Secretary 
                                may, by regulation, revise quality 
                                measures specified under this 
                                subparagraph on an annual basis.
                                    ``(II) Consultation.--The Secretary 
                                shall consult with relevant 
                                stakeholders in revising quality 
                                measures under subclause (I).
                    ``(E) Public availability of data submitted.--The 
                Secretary shall establish procedures for making data 
                submitted under subparagraph (C) available to the 
                public. Such procedures shall ensure that a supplier or 
                provider of air ambulance services has the opportunity 
                to review the data that is to be made public with 
                respect to the supplier or provider prior to such data 
                being made public. The Secretary shall report quality 
                measures that relate to air ambulance services on the 
                Internet website of the Centers for Medicare & Medicaid 
                Services.
                    ``(F) Implementation.--
                            ``(i) In general.--The Secretary shall 
                        promulgate regulations to carry out this 
                        paragraph.
                            ``(ii) Consultation.--The Secretary shall 
                        consult with relevant stakeholders in 
                        promulgating regulations under clause (i).''.

SEC. 6. STUDY AND REPORT BY THE INSTITUTE OF MEDICINE ON GROUND 
              CRITICAL CARE TRANSPORT.

    (a) In General.--The Secretary of Health and Human Services is 
authorized to enter into an agreement with the Institute of Medicine of 
the National Academies to conduct a study on ground critical care 
transport that identifies the following:
            (1) Any barriers to effective use of ground critical care 
        transport.
            (2) Any design issues with respect to emergency medical 
        transportation vehicles that may affect patient and crew 
        safety.
            (3) Any issues with respect to reimbursement for such 
        services under the Medicare program under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.) that may affect 
        the high quality of care and expeditious transport provided by 
        ground critical care ambulances.
    (b) Report.--An agreement entered into under subsection (a) shall 
provide for the Institute of Medicine to submit to the Secretary of 
Health and Human Services and to Congress a report containing the 
results of the study conducted under such subsection.
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