I 

116TH CONGRESS 

1ST SESSION H. R. 3021 

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

adjustment for non-emergency ESRD ambulance transports under the 

Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 24, 2019 

Mr. LAHOOD (for himself and Ms. SEWELL of Alabama) 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 restructure the payment adjustment for non-emergency ESRD 

ambulance transports under the Medicare program. 

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 ‘‘Non-Emergency Am5 bulance Transportation Sustainability and Accountability 

6 Act of 2019’’ or the ‘‘NEATSA Act’’. 


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1 SEC. 2. RESTRUCTURE OF MEDICARE PAYMENT ADJUST2 MENT FOR NON-EMERGENCY ESRD AMBU3 LANCE TRANSPORTS. 

4 (a) IN GENERAL.—Section 1834(l)(15) of the Social 

5 Security Act (42 U.S.C. 1395m(l)(15)) is amended to read 

6 as follows: 

7 ‘‘(15) RESTRUCTURE OF PAYMENT ADJUST8 MENT FOR NON-EMERGENCY AMBULANCE TRANS9 PORTS FOR ESRD BENEFICIARIES.— 

10 ‘‘(A) IN GENERAL.—In the case of applica11 ble ambulance services, the fee schedule amount 

12 otherwise applicable under the preceding provi13 sions of this subsection shall be reduced as fol14 lows: 

15 ‘‘(i) In the case of applicable ambu16 lance services furnished during the period 

17 beginning on October 1, 2013, and ending 

18 on September 30, 2019, reduced by 10 

19 percent. 

20 ‘‘(ii) In the case of applicable ambu21 lance services furnished during the period 

22 beginning on October 1, 2019, and ending 

23 on December 31, 2019, reduced by 15.5 

24 percent. 


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1 ‘‘(iii) In the case of applicable ambu2 lance services furnished during 2020 or a 

3 subsequent year— 

4 ‘‘(I) by a provider or supplier of 

5 ambulance services that the Secretary 

6 has designated under subparagraph 

7 (C) for the year and for which such 

8 transport originates in an area not de9 scribed in paragraph (13)(A)(i), re10 duced by 29.5 percent; or 

11 ‘‘(II) that are not described in 

12 subclause (I), reduced by 15.5 per13 cent. 

14 ‘‘(B) APPLICABLE AMBULANCE SERV15 ICES.—In this paragraph, the term ‘applicable 

16 ambulance services’ means ambulance services 

17 consisting of non-emergency basic life support 

18 services involving transport of an individual 

19 with end-stage renal disease for renal dialysis 

20 services (as described in section 

21 1881(b)(14)(B)) furnished other than on an 

22 emergency basis by a provider of services or a 

23 renal dialysis facility. 

24 ‘‘(C) DESIGNATION.— 


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1 ‘‘(i) IN GENERAL.—For 2020 and 

2 each subsequent year, the Secretary shall 

3 designate the providers or suppliers of am4 bulance services for which the total pay5 ments made to the provider or supplier for 

6 applicable ambulance services furnished 

7 during the applicable period for the year 

8 makes up at least 50 percent of the total 

9 payments made to the provider or supplier 

10 under this part for all ambulance services 

11 furnished during such applicable period. 

12 ‘‘(ii) METHODOLOGY.—The Secretary 

13 shall, through notice and comment rule14 making, establish the methodology for des15 ignating providers and suppliers under 

16 clause (i) for a year. Under such method17 ology, the applicable period for a year shall 

18 be a 12-month period determined by the 

19 Secretary that begins and ends prior to the 

20 beginning of such year. 

21 ‘‘(iii) TIMING.—Not later than No22 vember 1 of each year (beginning with 

23 2019), the Secretary shall notify any pro24 vider or supplier that will be designated 

25 under clause (i) for the subsequent year. 


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1 ‘‘(iv) TARGETED REVIEW.—The Sec2 retary shall establish a process under 

3 which a provider or supplier may seek an 

4 informal review of the designation under 

5 clause (i) with respect to the provider or 

6 supplier. 

7 ‘‘(v) PUBLIC REPORTING.—Beginning 

8 in 2021, the Secretary shall, in an easily 

9 understandable format, make available on 

10 the Internet website of the Centers for 

11 Medicare & Medicaid Services the fol12 lowing: 

13 ‘‘(I) The total number of claims 

14 paid under this part for applicable 

15 ambulance services. 

16 ‘‘(II) The total number of claims 

17 paid under this part for applicable 

18 ambulance services that were subject 

19 to the payment reduction under sub20 paragraph (A)(iii), broken out for 

21 each of subclauses (I) and (II) of such 

22 subparagraph. 

23 ‘‘(III) The total number of pro24 viders and suppliers that were des25 ignated under clause (i). 


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1 ‘‘(IV) Any other data regarding 

2 applicable ambulance services that the 

3 Secretary determines appropriate.’’. 

4 (b) GAO STUDY AND REPORT.— 

5 (1) IN GENERAL.—The Comptroller General of 

6 the United States (in this subsection referred to as 

7 the ‘‘Comptroller General’’) shall conduct a study on 

8 payments under section 1834(l) of the Social Secu9 rity Act (42 U.S.C. 1395m(l)) for applicable ambu10 lance services (as defined in subparagraph (B) of 

11 paragraph (15) of such section, as added by sub12 section (a)). Such study shall include an analysis of 

13 the impact of the amendment made by subsection 

14 (a), including the impact on beneficiary access and 

15 any steps providers and suppliers of ambulance serv16 ices have taken to avoid payment reductions under 

17 such paragraph (15). 

18 (2) REPORT.—Not later than March 1, 2023, 

19 the Comptroller General shall submit to Congress a 

20 report containing the results of the study conducted 

21 under paragraph (1), together with recommenda22 tions for such legislation and administrative action 

23 as the Comptroller General determines appropriate. 

Æ 


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