II 

114TH CONGRESS 

1ST SESSION S. 1149 

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 

APRIL 30, 2015 

Mr. VITTER (for himself, Mr. BENNET, Mr. GARDNER, and Mr. SCOTT) 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. 

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

3 SECTION 1. FINDINGS. 

4 The Congress finds the following: 

5 (1) Air medical critical care transport is an es6 sential component of the healthcare system. 


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1 (2) The presence of air medical services in rural 

2 areas provides tens of millions of rural Americans 

3 with access to critical care within an hour of injury. 

4 (3) As an emergency responder, air medical 

5 providers must maintain readiness 24 hours a day 

6 and 7 days a week. 

7 (4) Air medical providers transport all emergent 

8 patients for which they are dispatched regardless of 

9 insurance status or ability to pay. 

10 (5) The air ambulance fee schedule under the 

11 Medicare program was first implemented in 2002 

12 and developed through negotiated rulemaking, which 

13 required the new fee schedule to be created in a 

14 budget neutral manner. As such, the Medicare air 

15 ambulance fee schedule has never reflected true 

16 costs. 

17 (6) Since the implementation of the air ambu18 lance fee schedule under the Medicare program, re19 imbursements have only been adjusted by infla20 tionary updates averaging 2.2 percent a year. 

21 (7) Operational readiness and safety enhance22 ment costs have grown at a far faster rate than the 

23 Medicare inflationary updates, creating a funda24 mental imbalance within the air ambulance fee 

25 schedule. 


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1 (8) It is imperative that balance be restored to 

2 the air ambulance fee schedule to preserve access to 

3 timely care for tens of millions of Americans. 

4 SEC. 2. AIR AMBULANCE DATA REPORTING PROGRAM. 

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

6 1395m(l)) is amended— 

7 (1) in paragraph (3)(B), by striking ‘‘subpara8 graph (C)’’ and inserting ‘‘subparagraph (C) and 

9 paragraph (16)’’; and 

10 (2) by adding at the end the following new 

11 paragraphs: 

12 ‘‘(16) AIR AMBULANCE DATA REPORTING PRO13 GRAM.— 

14 ‘‘(A) REDUCTION IN UPDATE FOR FAILURE

15 TO REPORT.— 

16 ‘‘(i) IN GENERAL.—With respect to 

17 air ambulance services furnished by a sup18 plier or provider of air ambulance services 

19 during 2017 or any subsequent year, in the 

20 case the supplier or provider does not sub21 mit data to the Secretary in accordance 

22 with subparagraph (C) with respect to 

23 such year, after determining the percent24 age increase under paragraph (3)(B), and 

25 after application of paragraph (3)(C), the 


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1 Secretary shall reduce such percentage in2 crease for payments under the fee schedule 

3 under this subsection during such year by 

4 2.0 percentage points. 

5 ‘‘(ii) SPECIAL RULE.—The application 

6 of this subparagraph may result in such 

7 percentage increase being less than 0.0 for 

8 a year, and may result in payment rates 

9 under the fee schedule under this sub10 section for a year being less than such pay11 ment rates for the preceding year. 

12 ‘‘(B) NONCUMULATIVE APPLICATION.— 

13 Any reduction under subparagraph (A) shall 

14 apply only with respect to the year involved and 

15 the Secretary shall not take into account such 

16 reduction in computing the payment amount 

17 under the fee schedule under this subsection for 

18 a subsequent year. 

19 ‘‘(C) SUBMISSION OF DATA.—For 2017 

20 and each subsequent year, for purposes of this 

21 paragraph, each supplier or provider of air am22 bulance services shall submit to the Secretary 

23 data specified under subparagraph (D) for the 

24 reporting period (specified by the Secretary) for 

25 the year. Such data shall be submitted in a 


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1 form and manner, and at a time, specified by 

2 the Secretary for purposes of this subpara3 graph. 

4 ‘‘(D) DATA.—For purposes of reporting 

5 data for air ambulance services furnished dur6 ing a year, the data described in this subpara7 graph are cost data on the following: 

8 ‘‘(i) Maintenance of aircrafts. 

9 ‘‘(ii) Medical supplies. 

10 ‘‘(iii) Fuel. 

11 ‘‘(iv) Employee expenses. 

12 ‘‘(v) Recurring training relating to 

13 aviation, maintenance, communication, and 

14 clinical. 

15 ‘‘(vi) Rent and utilities. 

16 ‘‘(vii) Communications. 

17 ‘‘(viii) Travel. 

18 ‘‘(ix) Hull and aviation liability insur19 ance, life insurance, and professional mal20 practice insurance. 

21 ‘‘(x) Marketing. 

22 ‘‘(xi) Supplies. 

23 ‘‘(xii) Overhead support. 

24 ‘‘(xiii) Aircraft ownership expenses. 


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1 ‘‘(xiv) Safety enhancement capital 

2 costs. 

3 ‘‘(xv) Safety enhancement recurring 

4 costs. 

5 ‘‘(E) VOLUNTARY REPORTING ON QUALITY

6 MEASURES.—Not later than January 1, 2018, 

7 the Secretary shall select no less than two qual8 ity measures with respect to which providers 

9 and suppliers of air ambulance services may 

10 voluntarily submit to the Secretary data. In se11 lecting such measures, the Secretary shall con12 sider the following: 

13 ‘‘(i) Ventilator use in patients with 

14 advanced airways. 

15 ‘‘(ii) Blood glucose check for altered 

16 mental status. 

17 ‘‘(iii) Waveform capnography for ven18 tilated patients. 

19 ‘‘(iv) First attempt tracheal tube suc20 cess. 

21 ‘‘(v) DASH 1A-definitive airway sans 

22 hypoxia/hypotension on first attempt. 

23 ‘‘(vi) Verification of tracheal tube 

24 placement. 

25 ‘‘(vii) Medication errors on transport. 


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1 ‘‘(viii) Rapid sequence intubation pro2 tocol compliance. 

3 ‘‘(ix) Unplanned dislodgements of 

4 therapeutic devices. 

5 ‘‘(x) Rate of serious reportable events. 

6 ‘‘(xi) Medical equipment failure. 

7 ‘‘(F) REPORTS.— 

8 ‘‘(i) BY SECRETARY.—Not later than 

9 July 1, 2019, subject to clause (iii), the 

10 Secretary shall submit to Congress a re11 port on the data described in subparagraph 

12 (E) submitted to the Secretary. 

13 ‘‘(ii) BY COMPTROLLER GENERAL.— 

14 Not later than July 1, 2019, subject to 

15 clause (iii), the Comptroller General of the 

16 United States shall submit to Congress a 

17 report on the data described in subpara18 graph (D) and subparagraph (E) sub19 mitted under this paragraph. Such report 

20 shall include a recommendation on the ade21 quate amount of reimbursement under this 

22 title to providers and suppliers of air am23 bulance services for furnishing such serv24 ices that would reflect operational costs of 

25 such providers and suppliers and preserve 


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1 access to critical air medical services and 

2 such other recommendations as the Comp3 troller General deems appropriate. 

4 ‘‘(iii) LIMITATION.—The reports sub5 mitted under subclauses (i) and (ii) shall 

6 not include any information that the Sec7 retary or Comptroller General, respectively, 

8 determines is proprietary. 

9 ‘‘(17) INCREASE IN PAYMENT FOR AIR AMBU10 LANCE SERVICES.— 

11 ‘‘(A) IN GENERAL.—Subject to subpara12 graph (B), In the case of air ambulance services 

13 furnished on or after January 1, 2017, and be14 fore January 1, 2021, the Secretary shall pro15 vide for a percent increase in the base rate of 

16 the fee schedule established under this sub17 section— 

18 ‘‘(i) during 2017, by 20 percent; and 

19 ‘‘(ii) during 2018 through 2020, by 5 

20 percent. 

21 ‘‘(B) ADJUSTMENT TO ENSURE BUDGET

22 NEUTRALITY.—For 2017 through 2020, the 

23 Secretary shall adjust the percentages described 

24 in clauses (i) and (ii) of subparagraph, by ei25 ther increasing or reducing (but in no case 


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1 below zero) such percentages, to ensure that the 

2 increased expenditures under this part by rea3 son of subparagraph (A) are equal to the re4 duced expenditures under this part by reason of 

5 paragraph (16).’’. 

Æ 


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