I 

114TH CONGRESS 

1ST SESSION H. R. 822 

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 HOUSE OF REPRESENTATIVES 

FEBRUARY 10, 2015 

Mr. SESSIONS (for himself, Mr. MEEKS, Mr. YOUNG of Indiana, and Mr. 

JOHNSON of Ohio) 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 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: 


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1 (1) Air medical critical care transport is an es2 sential component of the healthcare system. 

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

4 areas provides tens of millions of rural Americans 

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

6 (3) As an emergency responder, air medical 

7 providers must maintain readiness 24 hours a day 

8 and 7 days a week. 

9 (4) Air medical providers transport all emergent 

10 patients for which they are dispatched regardless of 

11 insurance status or ability to pay. 

12 (5) The air ambulance fee schedule under the 

13 Medicare program was first implemented in 2002 

14 and developed through negotiated rulemaking, which 

15 required the new fee schedule to be created in a 

16 budget neutral manner. As such, the Medicare air 

17 ambulance fee schedule has never reflected true 

18 costs. 

19 (6) Since the implementation of the air ambu20 lance fee schedule under the Medicare program, re21 imbursements have only been adjusted by infla22 tionary updates averaging 2.2 percent a year. 

23 (7) Operational readiness and safety enhance24 ment costs have grown at a far faster rate than the 

25 Medicare inflationary updates, creating a fundaVerDate Sep 11 2014 07:05 Feb 14, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H822.IH H822

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1 mental imbalance within the air ambulance fee 

2 schedule. 

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

4 the air ambulance fee schedule to preserve access to 

5 timely care for tens of millions of Americans. 

6 SEC. 2. AIR AMBULANCE DATA REPORTING PROGRAM. 

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

8 1395m(l)) is amended— 

9 (1) in paragraph (3)(B), by striking ‘‘subpara10 graph (C)’’ and inserting ‘‘subparagraph (C) and 

11 paragraph (16)’’; and 

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

13 paragraphs: 

14 ‘‘(16) AIR AMBULANCE DATA REPORTING PRO15 GRAM.— 

16 ‘‘(A) REDUCTION IN UPDATE FOR FAILURE

17 TO REPORT.— 

18 ‘‘(i) IN GENERAL.—With respect to 

19 air ambulance services furnished by a sup20 plier or provider of air ambulance services 

21 during 2017 or any subsequent year, in the 

22 case the supplier or provider does not sub23 mit data to the Secretary in accordance 

24 with subparagraph (C) with respect to 

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1 age increase under paragraph (3)(B), and 

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

3 Secretary shall reduce such percentage in4 crease for payments under the fee schedule 

5 under this subsection during such year by 

6 2.0 percentage points. 

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

8 of this subparagraph may result in such 

9 percentage increase being less than 0.0 for 

10 a year, and may result in payment rates 

11 under the fee schedule under this sub12 section for a year being less than such pay13 ment rates for the preceding year. 

14 ‘‘(B) NONCUMULATIVE APPLICATION.— 

15 Any reduction under subparagraph (A) shall 

16 apply only with respect to the year involved and 

17 the Secretary shall not take into account such 

18 reduction in computing the payment amount 

19 under the fee schedule under this subsection for 

20 a subsequent year. 

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

22 and each subsequent year, for purposes of this 

23 paragraph, each supplier or provider of air am24 bulance services shall submit to the Secretary 

25 data specified under subparagraph (D) for the 


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1 reporting period (specified by the Secretary) for 

2 the year. Such data shall be submitted in a 

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

4 the Secretary for purposes of this subpara5 graph. 

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

7 data for air ambulance services furnished dur8 ing a year, the data described in this subpara9 graph are cost data on the following: 

10 ‘‘(i) Maintenance of aircrafts. 

11 ‘‘(ii) Medical supplies. 

12 ‘‘(iii) Fuel. 

13 ‘‘(iv) Employee expenses. 

14 ‘‘(v) Recurring training relating to 

15 aviation, maintenance, communication, and 

16 clinical. 

17 ‘‘(vi) Rent and utilities. 

18 ‘‘(vii) Communications. 

19 ‘‘(viii) Travel. 

20 ‘‘(ix) Hull and aviation liability insur21 ance, life insurance, and professional mal22 practice insurance. 

23 ‘‘(x) Marketing. 

24 ‘‘(xi) Supplies. 

25 ‘‘(xii) Overhead support. 


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1 ‘‘(xiii) Aircraft ownership expenses. 

2 ‘‘(xiv) Safety enhancement capital 

3 costs. 

4 ‘‘(xv) Safety enhancement recurring 

5 costs. 

6 ‘‘(E) VOLUNTARY REPORTING ON QUALITY

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

8 the Secretary shall select no less than two qual9 ity measures with respect to which providers 

10 and suppliers of air ambulance services may 

11 voluntarily submit to the Secretary data. In se12 lecting such measures, the Secretary shall con13 sider the following: 

14 ‘‘(i) Ventilator use in patients with 

15 advanced airways. 

16 ‘‘(ii) Blood glucose check for altered 

17 mental status. 

18 ‘‘(iii) Waveform capnography for ven19 tilated patients. 

20 ‘‘(iv) First attempt tracheal tube suc21 cess. 

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

23 hypoxia/hypotension on first attempt. 

24 ‘‘(vi) Verification of tracheal tube 

25 placement. 


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1 ‘‘(vii) Medication errors on transport. 

2 ‘‘(viii) Rapid sequence intubation pro3 tocol compliance. 

4 ‘‘(ix) Unplanned dislodgements of 

5 therapeutic devices. 

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

7 ‘‘(xi) Medical equipment failure. 

8 ‘‘(F) REPORTS.— 

9 ‘‘(i) BY SECRETARY.—Not later than 

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

11 Secretary shall submit to Congress a re12 port on the data described in subparagraph 

13 (E) submitted to the Secretary. 

14 ‘‘(ii) BY COMPTROLLER GENERAL.— 

15 Not later than July 1, 2019, subject to 

16 clause (iii), the Comptroller General of the 

17 United States shall submit to Congress a 

18 report on the data described in subpara19 graph (D) and subparagraph (E) sub20 mitted under this paragraph. Such report 

21 shall include a recommendation on the ade22 quate amount of reimbursement under this 

23 title to providers and suppliers of air am24 bulance services for furnishing such serv25 ices that would reflect operational costs of 


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1 such providers and suppliers and preserve 

2 access to critical air medical services and 

3 such other recommendations as the Comp4 troller General deems appropriate. 

5 ‘‘(iii) LIMITATION.—The reports sub6 mitted under subclauses (i) and (ii) shall 

7 not include any information that the Sec8 retary or Comptroller General, respectively, 

9 determines is proprietary. 

10 ‘‘(17) INCREASE IN PAYMENT FOR AIR AMBU11 LANCE SERVICES.—In the case of air ambulance 

12 services furnished on or after January 1, 2016, and 

13 before January 1, 2020, the Secretary shall provide 

14 for a percent increase in the base rate of the fee 

15 schedule established under this subsection— 

16 ‘‘(A) during 2016, by 20 percent; and 

17 ‘‘(B) during 2017 through 2019, by 5 per18 cent.’’. 

Æ 


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