I
106TH CONGRESS
2D SESSION
H. R. 5153
To amend title XVIII of the Social Security Act to ensure adequate payment
rates for ambulance services, to apply a prudent layperson standard
to the determination of medical necessity for emergency ambulance serv-
ices, and to recognize the additional costs of providing ambulance services
in rural areas.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 12, 2000
Mr. HOUGHTON (for himself, Mr. MINGE, Mr. STUPAK, and Mrs. KELLY) in-
troduced the following bill; which was referred to the Committee on
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 com-
mittee concerned
A BILL
To amend title XVIII of the Social Security Act to ensure
adequate payment rates for ambulance services, to apply
a prudent layperson standard to the determination of
medical necessity for emergency ambulance services, and
to recognize the additional costs of providing ambulance
services in rural areas.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare Access to
Ambulance Services Act of 2000’’.
SEC. 2. PAYMENT RATES.
(a) IN GENERAL.—Section 1834(l)(3) of the Social
Security Act (42 U.S.C. 1395m(l)(3)) is amended to read
as follows:
‘‘(3) PAYMENT RATES.—
‘‘(A) GROUND AND AIR AMBULANCE PAY-
MENT RATES.—Subject to the succeeding provi-
sions of this paragraph, in establishing such fee
schedule, the Secretary shall—
‘‘(i) set the payment rates provided
under the fee schedule for ground ambu-
lance services furnished under this part
during 2001 at a rate based on the aver-
age costs (as determined by the Secretary
based on a study performed by an inde-
pendent research organization of such
costs, adjusted for inflation if necessary)
incurred by full cost ambulance suppliers
in providing nonemergency basic life sup-
port ambulance services covered under this
title, with adjustments to the rates for
other service levels to be determined based
on the rule negotiated in accordance with
paragraph (1); and
‘‘(ii) set the payment amounts pro-
vided under the fee schedule for all ambu-
lance services furnished in 2002 and each
subsequent year at amounts equal to the
payment amounts under the fee schedule
for services furnished during the previous
year, increased by the percentage increase
in the Consumer Price Index for all urban
consumers (United States city average) for
the 12-month period ending with June of
the previous year.
‘‘(B) STUDY AND REPORT ON THE COSTS
OF RURAL AMBULANCE SERVICES.—
‘‘(i) STUDY.—The Secretary, in con-
sultation with the Office of Rural Health
Policy, shall conduct a study of the means
by which rural areas with low population
densities can be identified for the purpose
of designating areas in which the cost of
providing ambulance services would be ex-
pected to be higher than similar services
provided in more heavily populated areas
because of low usage. Such study shall also
include an analysis of the additional costs
of providing ambulance services in areas
designated under the previous sentence.
‘‘(ii) REPORT.—Not later than June
30, 2001, the Secretary shall submit to
Congress a report on the results of the
study conducted under this section, to-
gether with a regulation based on that
study which adjusts the fee schedule pay-
ment rates for ambulance services provided
in low density rural areas based on the in-
creased cost of providing such services in
such areas.
‘‘(iii) IMPLEMENTATION OF REGULA-
TION.—The regulation submitted under
clause (ii) shall become effective not later
than January 1, 2002.
‘‘(C) INTERIM
PAYMENTS
FOR
RURAL
GROUND
AMBULANCE
SERVICES.—Notwith-
standing subparagraph (A)(i) of this paragraph,
until such time as the fee schedule established
under this subsection is modified by the regula-
tion under subparagraph (B), the amount of
payment under this subsection for ground am-
bulance services provided in a rural area (as de-
fined in section 1886(d)(2)(D)) shall be the
greater of—
‘‘(i) the amount determined under the
fee schedule established under this sub-
section (without regard to any phase-in es-
tablished pursuant to paragraph (2)(E));
or
‘‘(ii) the amount that would have been
paid for such service if the amendments
made by section 4531(b) of the Balanced
Budget Act of 1997 had not been enacted;
as adjusted for inflation pursuant to subpara-
graph (A)(ii). For purposes of this subpara-
graph, an ambulance trip shall be considered to
have been provided in a rural area only if the
transportation of the patient originated in a
rural area.’’.
(b) 
CONFORMING
AMENDMENTS.—Section
1833(a)(1) of the Social Security Act (42 U.S.C.
1395l(a)(1)) is amended—
(1) in subparagraph (R)—
(A) by inserting ‘‘except as provided in
subparagraph (T),’’ before ‘‘with respect’’; and
(B) by striking ‘‘and’’ at the end; and
(2) in subparagraph (S), by striking the semi-
colon at the end and inserting ‘‘, and (T) with re-
spect to ambulance services described in section
1834(l)(3)(C), the amount paid shall be 80 percent
of the lesser of the actual charge for the services or
the amount determined under such section;’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to services provided
on and after January 1, 2001.
SEC. 3. PRUDENT LAYPERSON STANDARD FOR EMERGENCY
AMBULANCE SERVICES.
(a) IN GENERAL.—Section 1861(s)(7) of the Social
Security Act (42 U.S.C. 1395x(s)(7)) is amended by strik-
ing ‘‘regulations;’’ and inserting ‘‘regulations, except that
such regulations shall not fail to treat ambulance services
as medical and other health services solely because the ul-
timate diagnosis of the individual receiving the ambulance
services results in the conclusion that ambulance services
were not necessary, as long as the request for ambulance
services is made after the sudden onset of a medical condi-
tion that is manifested by symptoms of such sufficient se-
verity, including severe pain, that a prudent layperson,
who possesses an average knowledge of health and medi-
cine, could reasonably expect to result, without immediate
medical attention, in—
‘‘(A) placing the individual’s health in seri-
ous jeopardy;
‘‘(B) serious impairment to the individual’s
bodily functions; or
‘‘(C) serious dysfunction of any bodily
organ or part of the individual;’’.
(b) EFFECTIVE DATE.—The amendment made by
this section shall apply with respect to services provided
on and after the date of enactment of this Act.
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