H. R. 1—214
in establishing the fee schedule under paragraph (1)) to cal-
culate a regional conversion factor and a regional mileage pay-
ment rate and using the same payment adjustments and the
same relative value units as used in the fee schedule under
such paragraph.’’.
(b) ADJUSTMENT IN PAYMENT FOR CERTAIN LONG TRIPS.—Sec-
tion 1834(l), as amended by subsection (a), is amended by adding
at the end the following new paragraph:
‘‘(11) ADJUSTMENT IN PAYMENT FOR CERTAIN LONG TRIPS.—
In the case of ground ambulance services furnished on or after
July 1, 2004, and before January 1, 2009, regardless of where
the transportation originates, the fee schedule established
under this subsection shall provide that, with respect to the
payment rate for mileage for a trip above 50 miles the per
mile rate otherwise established shall be increased by 1⁄4 of
the payment per mile otherwise applicable to miles in excess
of 50 miles in such trip.’’.
(c) IMPROVEMENT
IN
PAYMENTS
TO
RETAIN
EMERGENCY
CAPACITY FOR AMBULANCE SERVICES IN RURAL AREAS.—
(1) IN GENERAL.—Section 1834(l) (42 U.S.C. 1395m(l)), as
amended by subsections (a) and (b), is amended by adding
at the end the following new paragraph:
‘‘(12) ASSISTANCE FOR RURAL PROVIDERS FURNISHING SERV-
ICES IN LOW POPULATION DENSITY AREAS.—
‘‘(A) IN GENERAL.—In the case of ground ambulance
services furnished on or after July 1, 2004, and before
January 1, 2010, for which the transportation originates
in a qualified rural area (identified under subparagraph
(B)(iii)), the Secretary shall provide for a percent increase
in the base rate of the fee schedule for a trip established
under this subsection. In establishing such percent
increase, the Secretary shall estimate the average cost
per trip for such services (not taking into account mileage)
in the lowest quartile as compared to the average cost
per trip for such services (not taking into account mileage)
in the highest quartile of all rural county populations.
‘‘(B) IDENTIFICATION OF QUALIFIED RURAL AREAS.—
‘‘(i) DETERMINATION
OF
POPULATION
DENSITY
IN
AREA.—Based upon data from the United States decen-
nial census for the year 2000, the Secretary shall deter-
mine, for each rural area, the population density for
that area.
‘‘(ii) RANKING OF AREAS.—The Secretary shall rank
each such area based on such population density.
‘‘(iii) IDENTIFICATION OF QUALIFIED RURAL AREAS.—
The Secretary shall identify those areas (in subpara-
graph (A) referred to as ‘qualified rural areas’) with
the lowest population densities that represent, if each
such area were weighted by the population of such
area (as used in computing such population densities),
an aggregate total of 25 percent of the total of the
population of all such areas.
‘‘(iv) RURAL AREA.—For purposes of this paragraph,
the term ‘rural area’ has the meaning given such term
in section 1886(d)(2)(D). If feasible, the Secretary shall
treat a rural census tract of a metropolitan statistical
area (as determined under the most recent modification
H. R. 1—215
of the Goldsmith Modification, originally published in
the Federal Register on February 27, 1992 (57 Fed.
Reg. 6725) as a rural area for purposes of this para-
graph.
‘‘(v) JUDICIAL REVIEW.—There shall be no adminis-
trative or judicial review under section 1869, 1878,
or otherwise, respecting the identification of an area
under this subparagraph.’’.
(2) USE OF DATA.—In order to promptly implement section
1834(l)(12) of the Social Security Act, as added by paragraph
(1), the Secretary may use data furnished by the Comptroller
General of the United States.
(d) TEMPORARY INCREASE FOR GROUND AMBULANCE SERVICES.—
Section 1834(l) (42 U.S.C. 1395m(l)), as amended by subsections
(a), (b), and (c), is amended by adding at the end the following
new paragraph:
‘‘(13) TEMPORARY INCREASE FOR GROUND AMBULANCE SERV-
ICES.—
‘‘(A) IN
GENERAL.—After computing the rates with
respect to ground ambulance services under the other
applicable provisions of this subsection, in the case of such
services furnished on or after July 1, 2004, and before
January 1, 2007, for which the transportation originates
in—
‘‘(i) a rural area described in paragraph (9) or
in a rural census tract described in such paragraph,
the fee schedule established under this section shall
provide that the rate for the service otherwise estab-
lished, after the application of any increase under para-
graphs (11) and (12), shall be increased by 2 percent;
and
‘‘(ii) an area not described in clause (i), the fee
schedule established under this subsection shall pro-
vide that the rate for the service otherwise established,
after the application of any increase under paragraph
(11), shall be increased by 1 percent.
‘‘(B) APPLICATION
OF
INCREASED
PAYMENTS
AFTER
2006.—The increased payments under subparagraph (A)
shall not be taken into account in calculating payments
for services furnished after the period specified in such
subparagraph.’’.
(e) IMPLEMENTATION.—The Secretary may implement the
amendments made by this section, and revise the conversion factor
applicable under section 1834(l) of the Social Security Act (42 U.S.C.
1395m(l)) for purposes of implementing such amendments, on an
interim final basis, or by program instruction.
(f) GAO REPORT
ON COSTS
AND ACCESS.—Not later than
December 31, 2005, the Comptroller General of the United States
shall submit to Congress an initial report on how costs differ among
the types of ambulance providers and on access, supply, and quality
of ambulance services in those regions and States that have a
reduction in payment under the medicare ambulance fee schedule
(under section 1834(l) of the Social Security Act, as amended by
this Act). Not later than December 31, 2007, the Comptroller Gen-
eral shall submit to Congress a final report on such access and
supply.
H. R. 1—216
(g) TECHNICAL AMENDMENTS.—(1) Section 221(c) of BIPA (114
Stat. 2763A–487) is amended by striking ‘‘subsection (b)(2)’’ and
inserting ‘‘subsection (b)(3)’’.
(2) Section 1861(v)(1) (42 U.S.C. 1395x(v)(1)) is amended by
moving subparagraph (U) 4 ems to the left.
SEC. 415. PROVIDING APPROPRIATE COVERAGE OF RURAL AIR AMBU-
LANCE SERVICES.
(a) COVERAGE.—Section 1834(l) (42 U.S.C. 1395m(l)), as
amended by subsections (a), (b), (c), and (d) of section 414, is
amended by adding at the end the following new paragraph:
‘‘(14) PROVIDING
APPROPRIATE
COVERAGE
OF
RURAL
AIR
AMBULANCE SERVICES.—
‘‘(A) IN GENERAL.—The regulations described in section
1861(s)(7) shall provide, to the extent that any ambulance
services (whether ground or air) may be covered under
such section, that a rural air ambulance service (as defined
in subparagraph (C)) is reimbursed under this subsection
at the air ambulance rate if the air ambulance service—
‘‘(i) is reasonable and necessary based on the
health condition of the individual being transported
at or immediately prior to the time of the transport;
and
‘‘(ii) complies with equipment and crew require-
ments established by the Secretary.
‘‘(B) SATISFACTION OF REQUIREMENT OF MEDICALLY NEC-
ESSARY.—The requirement of subparagraph (A)(i) is deemed
to be met for a rural air ambulance service if—
‘‘(i) subject to subparagraph (D), such service is
requested by a physician or other qualified medical
personnel (as specified by the Secretary) who reason-
ably determines or certifies that the individual’s condi-
tion is such that the time needed to transport the
individual by land or the instability of transportation
by land poses a threat to the individual’s survival
or seriously endangers the individual’s health; or
‘‘(ii) such service is furnished pursuant to a pro-
tocol that is established by a State or regional emer-
gency medical service (EMS) agency and recognized
or approved by the Secretary under which the use
of an air ambulance is recommended, if such agency
does not have an ownership interest in the entity fur-
nishing such service.
‘‘(C) RURAL
AIR
AMBULANCE
SERVICE
DEFINED.—For
purposes of this paragraph, the term ‘rural air ambulance
service’ means fixed wing and rotary wing air ambulance
service in which the point of pick up of the individual
occurs in a rural area (as defined in section 1886(d)(2)(D))
or in a rural census tract of a metropolitan statistical
area (as determined under the most recent modification
of the Goldsmith Modification, originally published in the
Federal Register on February 27, 1992 (57 Fed. Reg. 6725)).
‘‘(D) LIMITATION.—
‘‘(i) IN
GENERAL.—Subparagraph (B)(i) shall not
apply if there is a financial or employment relationship
between the person requesting the rural air ambulance
service and the entity furnishing the ambulance
H. R. 1—217
service, or an entity under common ownership with
the entity furnishing the air ambulance service, or
a financial relationship between an immediate family
member of such requester and such an entity.
‘‘(ii) EXCEPTION.—Where a hospital and the entity
furnishing rural air ambulance services are under
common ownership, clause (i) shall not apply to remu-
neration (through employment or other relationship)
by the hospital of the requester or immediate family
member if the remuneration is for provider-based
physician services furnished in a hospital (as described
in section 1887) which are reimbursed under part A
and the amount of the remuneration is unrelated
directly or indirectly to the provision of rural air ambu-
lance services.’’.
(b) CONFORMING AMENDMENT.—Section 1861(s)(7) (42 U.S.C.
1395x(s)(7)) is amended by inserting ‘‘, subject to section
1834(l)(14),’’ after ‘‘but’’.
(c) EFFECTIVE DATE.—The amendments made by this subsection
shall apply to services furnished on or after January 1, 2005.
SEC. 416. TREATMENT OF CERTAIN CLINICAL DIAGNOSTIC LABORA-
TORY TESTS FURNISHED TO HOSPITAL OUTPATIENTS IN
CERTAIN RURAL AREAS.
(a) IN GENERAL.—Notwithstanding subsections (a), (b), and (h)
of section 1833 of the Social Security Act (42 U.S.C. 1395l) and
section 1834(d)(1) of such Act (42 U.S.C. 1395m(d)(1)), in the case
of a clinical diagnostic laboratory test covered under part B of
title XVIII of such Act that is furnished during a cost reporting
period described in subsection (b) by a hospital with fewer than
50 beds that is located in a qualified rural area (identified under
paragraph (12)(B)(iii) of section 1834(l) of the Social Security Act
(42 U.S.C. 1395m(l)), as added by section 414(c)) as part of out-
patient services of the hospital, the amount of payment for such
test shall be 100 percent of the reasonable costs of the hospital
in furnishing such test.
(b) APPLICATION.—A cost reporting period described in this
subsection is a cost reporting period beginning during the 2-year
period beginning on July 1, 2004.
(c) PROVISION AS PART OF OUTPATIENT HOSPITAL SERVICES.—
For purposes of subsection (a), in determining whether clinical
diagnostic laboratory services are furnished as part of outpatient
services of a hospital, the Secretary shall apply the same rules
that are used to determine whether clinical diagnostic laboratory
services are furnished as an outpatient critical access hospital
service under section 1834(g)(4) of the Social Security Act (42 U.S.C.
1395m(g)(4)).
SEC. 417. EXTENSION OF TELEMEDICINE DEMONSTRATION PROJECT.
Section 4207 of the Balanced Budget Act of 1997 (Public Law
105–33) is amended—
(1) in subsection (a)(4), by striking ‘‘4-year’’ and inserting
‘‘8-year’’; and
(2) in subsection (d)(3), by striking ‘‘$30,000,000’’ and
inserting ‘‘$60,000,000’’.