```

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2121 Introduced in Senate (IS)]

<DOC>

115th CONGRESS
  1st Session
                                S. 2121

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.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           November 14, 2017

 Mr. Heller (for himself, Mr. Bennet, and Mr. Gardner) 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 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.

    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 ``Ensuring Access to Air Ambulance 
Services Act of 2017''.

SEC. 2. AIR AMBULANCE DATA REPORTING PROGRAM AND VALUE-BASED PURCHASING 
              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 paragraphs (17) and 
        (20)'';
            (2) in paragraph (3)(C), by inserting ``(other than 2018)'' 
        after ``each subsequent year''; and
            (3) by adding at the end the following new paragraphs:
            ``(17) Air ambulance data reporting program.--
                    ``(A) Submission of cost data.--With respect to 
                2019 and each subsequent year, each supplier or 
                provider of air ambulance services shall submit to the 
                Secretary data specified under subparagraph (B) for air 
                ambulance services furnished by such provider or 
                supplier during such year. Such data shall be submitted 
                in a form and manner, and on an annual basis, as 
                specified by the Secretary for purposes of this 
                subparagraph.
                    ``(B) Cost 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 and equipment.
                            ``(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 and equipment.
                            ``(xii) Overhead support.
                            ``(xiii) Aircraft ownership expenses.
                            ``(xiv) Depreciation.
                            ``(xv) Safety enhancement capital costs.
                            ``(xvi) Safety enhancement recurring costs.
                    ``(C) Consultation relating to cost reports.--For 
                purposes of this paragraph, the Secretary shall consult 
                with suppliers and providers of air ambulance services 
                to develop a cost reporting instrument and further 
                define the data specified under subparagraph (B) 
                through instructions.
                    ``(D) Submission of quality data.--With respect to 
                2020 and each subsequent year, each supplier or 
                provider of air ambulance services shall submit to the 
                Secretary data specified under subparagraph (E) for air 
                ambulance services furnished by such supplier or 
                provider during such year. Such data shall be submitted 
                in a form and manner, and on an annual basis, as 
                specified by the Secretary for purposes of this 
                subparagraph.
                    ``(E) Quality data.--For purposes of reporting data 
                for air ambulance services furnished during a year, the 
                data described in this subparagraph are quality data on 
                the following measures:
                            ``(i) Mechanical ventilator use in patients 
                        with advanced airways.
                            ``(ii) Interpretation of 12-lead 
                        electrocardiogram documented on patient care 
                        record for those transported with primary 
                        cardiac diagnoses.
                            ``(iii) Continuous waveform capnography for 
                        mechanically ventilated patients.
                            ``(iv) Advanced airway established without 
                        newly developed hypoxia or hypotension.
                            ``(v) Tracheal intubation verified with 
                        capnography and direct visualization, chest 
                        radiograph, or symmetric breath sounds.
                    ``(F) Consequence for not reporting quality data 
                for value-based purchasing.--
                            ``(i) In general.--With respect to 
                        ambulance services furnished by a provider or 
                        supplier of air ambulance services during a 
                        payment year (beginning with 2024), if such 
                        provider or supplier does not submit to the 
                        Secretary data specified under subparagraph (E) 
                        for the performance period for such year (as 
                        defined in paragraph (20)(F)), the Secretary 
                        shall provide for a percent reduction of 10 
                        percent to the percentage increase determined 
                        under paragraph (3)(B), after application of 
                        paragraphs (3)(C) and (19) for such payment 
                        year.
                            ``(ii) Application.--The reduction under 
                        clause (i) shall apply only with respect to the 
                        year involved and the Secretary shall not take 
                        into account such increase in computing the 
                        payment amount under the fee schedule under 
                        this subsection for a subsequent year.
                            ``(iii) Distribution.--For purposes of 
                        paragraph (20)(D)(iii)(III), of the total 
                        amount of reductions pursuant to clause (i) for 
                        a payment year--
                                    ``(I) 50 percent of such reductions 
                                shall be made available for purposes of 
                                performance payments under paragraph 
                                (20) for such payment year; and
                                    ``(II) 50 percent shall be 
                                transferred to the Federal Hospital 
                                Insurance Trust Fund under section 
                                1817.
                    ``(G) Data disclosures.--The Secretary shall 
                provide, with respect to data submitted under 
                subparagraph (D) by a supplier or provider of air 
                ambulance services--
                            ``(i) with respect to 2020, on a 
                        confidential basis to such supplier or 
                        provider, information with respect to such data 
                        and year, including a comparison of the results 
                        of such data submitted by such supplier or 
                        provider to the national average, with respect 
                        to such data reported; and
                            ``(ii) with respect to a subsequent year, 
                        for the public disclosure of such information 
                        with respect to such subsequent year, including 
                        the comparison described in clause (i) of such 
                        data with respect to such subsequent year.
                    ``(H) Reports.--
                            ``(i) By secretary.--Not later than July 1, 
                        2021, subject to clause (iii), the Secretary 
                        shall submit to Congress a report on the data 
                        described in subparagraphs (B) and (E) 
                        submitted to the Secretary.
                            ``(ii) By comptroller general.--Not later 
                        than July 1, 2021, subject to clause (iii), the 
                        Comptroller General of the United States shall 
                        submit to Congress a report on the data 
                        described in subparagraph (B) and subparagraph 
                        (E) submitted under this paragraph. Such report 
                        shall include an analysis of cost variation to 
                        providers and supplier of air ambulance 
                        services by geography and provider or supplier 
                        status and 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.
            ``(18) Temporary increase in payment for air ambulance 
        services.--
                    ``(A) Increase.--
                            ``(i) In general.--Subject to subparagraph 
                        (B), in the case of air ambulance services--
                                    ``(I) furnished during 2018, the 
                                Secretary shall provide for a percent 
                                increase of 12 percent in the base rate 
                                of the fee schedule established under 
                                this subsection for such air ambulance 
                                services; and
                                    ``(II) furnished during 2019 and 
                                2020, the Secretary shall provide for a 
                                percent increase of 20 percent in the 
                                base rate of the fee schedule 
                                established under this subsection for 
                                such air ambulance services.
                            ``(ii) Application.--The increase under 
                        clause (i) shall apply only with respect to the 
                        year involved and the Secretary shall not take 
                        into account such increase in computing the 
                        payment amount under the fee schedule under 
                        this subsection for a subsequent year.
                    ``(B) No increase for providers and suppliers that 
                do not report data.--The Secretary shall not provide 
                for the percent increase under subparagraph (A) in the 
                base rate of the fee schedule established under this 
                subsection--
                            ``(i) with respect to air ambulances 
                        services furnished by a supplier or provider of 
                        air ambulances services during 2019, unless the 
                        provider or supplier submits to the Secretary 
                        cost data in accordance with paragraph (17)(A) 
                        for such year; and
                            ``(ii) with respect to air ambulances 
                        services furnished by a supplier or provider of 
                        air ambulances services during 2020, unless the 
                        provider or supplier submits to the Secretary 
                        cost data in accordance with paragraph (17)(A) 
                        and quality data in accordance with paragraph 
                        (17)(D) for such year.
            ``(19) Rebasing air ambulance base rate.--The Secretary 
        shall, through rulemaking, provide for an update to the base 
        rate of the fee schedule established under this subsection for 
        air ambulance services, which shall be applied beginning with 
        air ambulance services furnished during 2021, so that such rate 
        reflects the actual costs of providing air ambulance services, 
        consistent with cost data submitted under paragraph (17)(A). In 
        carrying out the previous sentence, the Secretary shall ensure 
        that the aggregate data, methodology, and rationale applied for 
        determining the updated base rate shall be made publicly 
        available through rulemaking. The preceding sentence shall not 
        be applied in a budget neutral manner.
            ``(20) Value-based purchasing program.--
                    ``(A) In general.--The Secretary shall establish an 
                air ambulance services value-based purchasing program 
                (in this paragraph referred to as the `Program'). Under 
                the Program, the Secretary shall--
                            ``(i) for a performance period (as defined 
                        in subparagraph (F)) with respect to a payment 
                        year (beginning with 2024), determine the 
                        performance of each provider or supplier of air 
                        ambulance services, with respect to each 
                        quality measure described in paragraph (17)(E);
                            ``(ii) for each such performance period, 
                        establish performance benchmarks in accordance 
                        with subparagraph (B);
                            ``(iii) for each such performance period 
                        and each quality measure described in paragraph 
                        (17)(E), establish a performance score for each 
                        provider or supplier of air ambulance services, 
                        that is determined by measuring the performance 
                        of such provider or supplier described in 
                        clause (i), with respect to each quality 
                        measure described in such clause, against the 
                        performance benchmark established under 
                        subparagraph (B) for such quality measure;
                            ``(iv) for each such performance period and 
                        provider or supplier of air ambulance services, 
                        determine a composite performance quality 
                        score, in accordance with subparagraph (C);
                            ``(v) for each such performance period, 
                        rank each provider or supplier of air ambulance 
                        services, based on the composite performance 
                        quality score of such provider or supplier for 
                        such period (as determined under subparagraph 
                        (C)), in order from highest to lowest; and
                            ``(vi) for each such payment year specify a 
                        performance payment percentage point 
                        adjustment, in accordance with subparagraph 
                        (D)(ii), for each provider or supplier of air 
                        ambulance services to be applied under 
                        subparagraph (D)(i).
                    ``(B) Performance benchmarks.--Under the Program, 
                for each performance period with respect to a payment 
                year (beginning with payment year 2024), the Secretary 
                shall establish a nationwide performance benchmark for 
                each quality measure described in paragraph (17)(E). 
                Such a benchmark, with respect to such a quality 
                measure, shall be the average of the performance scores 
                for all such providers and suppliers for such measure.
                    ``(C) Composite performance quality scores.--Under 
                the Program, for each performance period with respect 
                to a payment year (beginning with payment year 2024), 
                the Secretary shall determine a composite performance 
                quality score for each provider or supplier of air 
                ambulance services, based on the cumulative performance 
                scores determined under subparagraph (A)(iii) for such 
                provider or supplier and performance period. For 
                purposes of ranking under subparagraph (A)(v), a 
                provider or supplier of air ambulance services who does 
                not submit required data to determine performance under 
                this paragraph for a performance period for a year 
                shall be treated as receiving a composite performance 
                quality score of zero under this subparagraph for such 
                period and shall be ranked accordingly under 
                subparagraph (A)(v).
                    ``(D) Performance payment.--
                            ``(i) In general.--With respect to 
                        ambulance services furnished by a provider or 
                        supplier of air ambulance services during a 
                        payment year (beginning with 2024), the 
                        Secretary shall apply a performance payment 
                        percentage point adjustment to the percentage 
                        increase determined under paragraph (3)(B), 
                        after application of paragraphs (3)(C), 
                        (17)(F), and (19) and subparagraph (E) for a 
                        payment year (beginning with 2024).
                            ``(ii) Performance payment percentage point 
                        adjustment.--The Secretary shall, in accordance 
                        with clause (iii), specify a performance 
                        payment percentage point adjustment for a 
                        provider or supplier of air ambulance services 
                        for a payment year (beginning with 2024) which 
                        may include a zero percentage.
                            ``(iii) Requirements.--In specifying the 
                        performance payment percentage point adjustment 
                        for a provider or supplier of air ambulance 
                        services for a payment year under clause (i), 
                        the Secretary shall ensure that--
                                    ``(I) such adjustment is based on 
                                the ranking of the provider or supplier 
                                under subparagraph (A)(v) for the 
                                performance period for such payment 
                                year;
                                    ``(II) the application of all such 
                                adjustments in such fiscal year results 
                                in an appropriate distribution of 
                                performance payment incentives applied 
                                under this paragraph such that--
                                            ``(aa) providers and 
                                        suppliers of air ambulance 
                                        services with the highest 
                                        rankings under subparagraph 
                                        (A)(v) receive the highest 
                                        payment increases under clause 
                                        (i); and
                                            ``(bb) providers and 
                                        suppliers of air ambulance 
                                        services with the lowest 
                                        rankings under subparagraph 
                                        (A)(v) receive the lowest 
                                        payment increases under clause 
                                        (i), which may include zero; 
                                        and
                                    ``(III) the total amount of 
                                increases in payment under this 
                                subsection for all providers and 
                                suppliers of air ambulance services, 
                                pursuant to this subparagraph, in such 
                                payment year shall be equal to the sum 
                                of the total amount, as estimated by 
                                the Secretary, of the reductions to 
                                payments under this subsection for such 
                                payment year pursuant to subparagraph 
                                (E) and the total amount, as estimated 
                                by the Secretary, of the reductions 
                                made under paragraph (17)(F)(i) and 
                                made available under paragraph 
                                (17)(F)(iii)(I) for purposes of 
                                performance payments under this 
                                paragraph for such payment year.
                    ``(E) Funding for performance incentive 
                adjustments.--
                            ``(i) In general.--With respect to air 
                        ambulance services furnished by a supplier or 
                        provider of air ambulance services during 2024 
                        or a subsequent year, the Secretary, after 
                        determining the percentage increase under 
                        paragraph (3)(B), and after application of 
                        paragraphs (3)(C), (17), and (19), shall reduce 
                        such percentage increase for payments under the 
                        fee schedule under this subsection otherwise 
                        applicable to such provider or supplier for 
                        services furnished by such provider or supplier 
                        during such year by the applicable percent (as 
                        defined in clause (ii)). The Secretary shall 
                        make such reductions for all providers and 
                        suppliers of air ambulance services in the year 
                        involved, regardless of whether or not the 
                        provider or supplier has been determined by the 
                        Secretary to have earned a performance payment 
                        percentage point adjustment under subparagraph 
                        (D) for such year.
                            ``(ii) Applicable percent.--For purposes of 
                        clause (i), the term `applicable percent' 
                        means, with respect to 2024 and succeeding 
                        years, 2 percent.
                    ``(F) Performance period.--For purposes of this 
                paragraph, the term `performance period' means, with 
                respect to a payment year, the previous year (or, if 
                specified by the Secretary, portion or portions of such 
                previous year).''.
                                 <all>
```