II 

116TH CONGRESS 

1ST SESSION S. 228 

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 SENATE OF THE UNITED STATES 

JANUARY 25 (legislative day, JANUARY 24), 2019 

Mr. CASSIDY (for himself and Mr. JONES) 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 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 (NEATSA) Act of 2019’’. 


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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 December 31, 2018, reduced by 10 per19 cent. 

20 ‘‘(ii) In the case of applicable ambu21 lance services furnished during 2019, re22 duced by 15.5 percent. 

23 ‘‘(iii) In the case of applicable ambu24 lance services furnished during 2020 or a 

25 subsequent year— 


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1 ‘‘(I) by a provider or supplier of 

2 ambulance services that the Secretary 

3 has designated under subparagraph 

4 (C) for the year and for which such 

5 transport originates in an area not de6 scribed in paragraph (13)(A)(i), re7 duced by 29.5 percent; or 

8 ‘‘(II) that are not described in 

9 subclause (I), reduced by 15.5 per10 cent. 

11 ‘‘(B) APPLICABLE AMBULANCE SERV12 ICES.—In this paragraph, the term ‘applicable 

13 ambulance services’ means ambulance services 

14 consisting of non-emergency basic life support 

15 services involving transport of an individual 

16 with end-stage renal disease for renal dialysis 

17 services (as described in section 

18 1881(b)(14)(B)) furnished other than on an 

19 emergency basis by a provider of services or a 

20 renal dialysis facility. 

21 ‘‘(C) DESIGNATION.— 

22 ‘‘(i) IN GENERAL.—For 2020 and 

23 each subsequent year, the Secretary shall 

24 designate the providers or suppliers of am25 bulance services for which the total payVerDate Sep 11 2014 01:09 Feb 02, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S228.IS S228

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1 ments made to the provider or supplier for 

2 applicable ambulance services furnished 

3 during the applicable period for the year 

4 makes up at least 50 percent of the total 

5 payments made to the provider or supplier 

6 under this part for all ambulance services 

7 furnished during such applicable period. 

8 ‘‘(ii) METHODOLOGY.—The Secretary 

9 shall, through notice and comment rule10 making, establish the methodology for des11 ignating providers and suppliers under 

12 clause (i) for a year. Under such method13 ology, the applicable period for a year shall 

14 be a 12-month period determined by the 

15 Secretary that begins and ends prior to the 

16 beginning of such year. 

17 ‘‘(iii) TIMING.—Not later than No18 vember 1 of each year (beginning with 

19 2019), the Secretary shall notify any pro20 vider or supplier that will be designated 

21 under clause (i) for the subsequent year. 

22 ‘‘(iv) TARGETED REVIEW.—The Sec23 retary shall establish a process under 

24 which a provider or supplier may seek an 

25 informal review of the designation under 


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1 clause (i) with respect to the provider or 

2 supplier. 

3 ‘‘(v) PUBLIC REPORTING.—Beginning 

4 in 2021, the Secretary shall, in an easily 

5 understandable format, make available on 

6 the Internet website of the Centers for 

7 Medicare & Medicaid Services the fol8 lowing: 

9 ‘‘(I) The total number of claims 

10 paid under this part for applicable 

11 ambulance services. 

12 ‘‘(II) The total number of claims 

13 paid under this part for applicable 

14 ambulance services that were subject 

15 to the payment reduction under sub16 paragraph (A)(iii), broken out for 

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

18 subparagraph. 

19 ‘‘(III) The total number of pro20 viders and suppliers that were des21 ignated under clause (i). 

22 ‘‘(IV) Any other data regarding 

23 applicable ambulance services that the 

24 Secretary determines appropriate.’’. 

25 (b) GAO STUDY AND REPORT.— 


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

2 the United States (in this subsection referred to as 

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

4 payments under section 1834(l) of the Social Secu5 rity Act (42 U.S.C. 1395m(l)) for applicable ambu6 lance services (as defined in subparagraph (B) of 

7 paragraph (15) of such section, as added by sub8 section (a)). Such study shall include an analysis of 

9 the impact of the amendment made by subsection 

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

11 any steps providers and suppliers of ambulance serv12 ices have taken to avoid payment reductions under 

13 such paragraph (15). 

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

15 the Comptroller General shall submit to Congress a 

16 report containing the results of the study conducted 

17 under paragraph (1), together with recommenda18 tions for such legislation and administrative action 

19 as the Comptroller General determines appropriate. 

Æ 


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