II 

108TH CONGRESS 

1ST SESSION S. 171

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

to medicare ambulance suppliers of the full costs of providing such 

services, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 15, 2003

Mr. DAYTON introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL

To amend the title XVIII of the Social Security Act to 

provide payment to medicare ambulance suppliers of the 

full costs of providing such services, 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. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Ambulance 

5 Payment Reform Act of 2003’’. 

6 SEC. 2. AMBULANCE PAYMENT RATES. 

7 (a) PAYMENT RATES.—
2

•S 171 IS 

1 (1) IN GENERAL.—Section 1834(l)(3) of the 

2 Social Security Act (42 U.S.C. 1395m(l)(3)) is 

3 amended to read as follows: 

4 ‘‘(3) PAYMENT RATES.—

5 ‘‘(A) IN GENERAL.—Subject to any adjust6 ment under subparagraph (B) and paragraph 

7 (9) and the full payment of a national mileage 

8 rate pursuant to paragraph (2)(E), in estab9 lishing such fee schedule, the following rules 

10 shall apply: 

11 ‘‘(i) PAYMENT RATES IN 2003.—

12 ‘‘(I) GROUND AMBULANCE SERV13 ICES.—In the case of ground ambu14 lance services furnished under this 

15 part in 2003, the Secretary shall set 

16 the payment rates under the fee 

17 schedule for such services at a rate 

18 based on the average costs (as deter19 mined by the Secretary on the basis of 

20 the most recent and reliable informa21 tion available) incurred by full cost 

22 ambulance suppliers in providing non23 emergency basic life support ambu24 lance services covered under this title, 

25 with adjustments to the rates for 
3

•S 171 IS 

1 other ground ambulance service levels 

2 to be determined based on the rule es3 tablished under paragraph (1). For 

4 the purposes of the preceding sen5 tence, the term ‘full cost ambulance 

6 supplier’ means a supplier for which 

7 volunteers or other unpaid staff com8 prise less than 20 percent of the sup9 plier’s total staff and which receives 

10 less than 20 percent of space and 

11 other capital assets free of charge. 

12 ‘‘(II) OTHER AMBULANCE SERV13 ICES.—In the case of ambulance serv14 ices not described in subclause (I) 

15 that are furnished under this part in 

16 2003, the Secretary shall set the pay17 ment rates under the fee schedule for 

18 such services based on the rule estab19 lished under paragraph (1). 

20 ‘‘(ii) PAYMENT RATES IN SUBSE21 QUENT YEARS FOR ALL AMBULANCE SERV22 ICES.—In the case of any ambulance serv23 ice furnished under this part in 2004 or 

24 any subsequent year, the Secretary shall 

25 set the payment rates under the fee sched-
4

•S 171 IS 

1 ule for such service at amounts equal to 

2 the payment rate under the fee schedule 

3 for that service furnished during the pre4 vious year, increased by the percentage in5 crease in the Consumer Price Index for all 

6 urban consumers (United States city aver7 age) for the 12-month period ending with 

8 June of the previous year. 

9 ‘‘(B) ADJUSTMENT IN RURAL RATES.—For 

10 years beginning with 2004, the Secretary, after 

11 taking into consideration the recommendations 

12 contained in the report submitted under section 

13 221(b)(3) the Medicare, Medicaid, and SCHIP 

14 Benefits Improvements and Protection Act of 

15 2000, shall adjust the fee schedule payment 

16 rates that would otherwise apply under this 

17 subsection for ambulance services provided in 

18 low density rural areas based on the increased 

19 cost (if any) of providing such services in such 

20 areas.’’. 

21 (2) CONFORMING AMENDMENT.—Section 

22 221(c) of the Medicare, Medicaid, and SCHIP Bene23 fits Improvement and Protection Act of 2000 (114 

24 Stat. 2763A–487), as enacted into law by section 

25 1(a)(6) of Public Law 106–554, is repealed. 
5

•S 171 IS 

1 (b) USE OF MEDICAL CONDITIONS FOR CODING AM2 BULANCE SERVICES.—Section 1834(l)(7) of the Social Se3 curity Act (42 U.S.C. 1395m(l)(7)) is amended to read 

4 as follows: 

5 ‘‘(7) CODING SYSTEM.—

6 ‘‘(A) IN GENERAL.—The Secretary shall, 

7 in accordance with section 1173(c)(1)(B), es8 tablish a system or systems for the coding of 

9 claims for ambulance services for which pay10 ment is made under this subsection, including a 

11 code set specifying the medical condition of the 

12 individual who is transported and the level of 

13 service that is appropriate for the transpor14 tation of an individual with that medical condi15 tion. 

16 ‘‘(B) MEDICAL CONDITIONS.—The code set 

17 established under subparagraph (A) shall—

18 ‘‘(i) take into account the list of med19 ical conditions developed in the course of 

20 the negotiated rulemaking process con21 ducted under paragraph (1); and 

22 ‘‘(ii) notwithstanding any other provi23 sion of law, be adopted as a standard code 

24 set under section 1173(c).’’.

Æ