out the provisions of this section, including the 
amendments made by this section, to remain avail-
able through December 31, 2022. 
(2) FUNDING FOR EMPLOYEES.—The Secretary 
of Health and Human Services shall provide for the 
transfer to the Centers for Medicare & Medicaid 
Services Program Management Account, from the 
Federal Supplementary Medical Insurance Trust 
Fund under section 1841 of the Social Security Act 
(42 U.S.C. 1395t), of such sums as may be nec-
essary in order to directly hire no more than 2 full- 
time employees to carry out the provisions of this 
section, including the amendments made by this sec-
tion. 
(e) SENSE OF CONGRESS.—It is the sense of Con-
gress that— 
(1) a cost report made by a supplier of ground 
ambulance services with respect to a cost reporting 
period beginning before January 1, 2022, may not 
contain complete and accurate information on 
ground ambulance services furnished during such a 
period by the supplier; and 
(2) the Secretary should take into account only 
the timeliness of such a report made with respect to 
such a period when determining whether to suspend 
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payments to a supplier under section 1834(l) of the 
Social Security Act (42 U.S.C. 1395m(l)). 
SEC. 204. GROUND AMBULANCE SERVICES COST REPORT-
ING STUDY. 
(a) IN GENERAL.—Not later than March 15, 2023, 
and as determined necessary by the Medicare Payment 
Advisory Commission thereafter, such Commission shall 
assess and submit to Congress a report on cost reports 
carried out in accordance with sections 1121(a) and 
1834(l) of the Social Security Act (42 U.S.C. 1320a(a), 
1395m(l)), the adequacy of payments for such services 
made under section 1834(l) of such Act, and geographic 
variations in the cost of providing such services. 
(b) CONTENTS.—The report described in subsection 
(a) shall contain the following: 
(1) An analysis of cost report data submitted in 
accordance with such sections. 
(2) An analysis of any burden on providers and 
suppliers of such services associated with reporting 
such data. 
(3) A recommendation on whether or not cost 
reports of ambulance services made by suppliers or 
a category of suppliers (as specified by the Sec-
retary) of such services, or the ground ambulance 
portion of cost reports made by providers of such 
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services, should be required or modified, taking into 
account the analyses described in paragraphs (1) 
and (2). 
SEC. 205. EXTENSION OF GROUND AMBULANCE SERVICES 
EXTENDERS. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended— 
(1) in paragraph (12)(A), by striking ‘‘2018’’ 
and inserting ‘‘2023’’; and 
(2) in paragraph (13)(A), by striking ‘‘2018’’ 
each place it appears and inserting ‘‘2023’’. 
SEC. 206. EXTENSION OF INCREASED INPATIENT HOSPITAL 
PAYMENT ADJUSTMENT FOR CERTAIN LOW- 
VOLUME HOSPITALS. 
Section 1886(d)(12) of the Social Security Act (42 
U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), in the matter pre-
ceding clause (i), by striking ‘‘and for discharges oc-
curring in fiscal year 2020 and subsequent fiscal 
years’’; 
(2) in subparagraph (C)(i)— 
(A) by striking ‘‘fiscal years 2011 through 
2017’’ each place it appears and inserting ‘‘fis-
cal years 2011 through 2019’’; and 
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(B) by striking ‘‘or portion of fiscal year’’; 
and 
(3) in subparagraph (D)— 
(A) in the heading, by striking ‘‘TEM-
PORARY APPLICABLE PERCENTAGE INCREASE’’ 
and inserting ‘‘APPLICABLE PERCENTAGE IN-
CREASE BEGINNING WITH FISCAL YEAR 2011’’; 
(B) by striking ‘‘fiscal years 2011 through 
2017,’’ and inserting ‘‘fiscal years 2011 
through 2019’’; and 
(C) by striking ‘‘or the portion of fiscal 
year’’ each place it appears. 
SEC. 207. EXTENSION OF THE MEDICARE-DEPENDENT HOS-
PITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend-
ed— 
(1) in clause (i), by striking ‘‘October 1, 2017’’ 
and inserting ‘‘October 1, 2019’’; and 
(2) in clause (ii)(II), by striking ‘‘October 1, 
2017’’ and inserting ‘‘October 1, 2019’’. 
(b) CONFORMING AMENDMENTS.— 
(1) EXTENSION OF TARGET AMOUNT.—Section 
1886(b)(3)(D) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(D)) is amended— 
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(A) in the matter preceding clause (i), by 
striking ‘‘October 1, 2017’’ and inserting ‘‘Oc-
tober 1, 2019’’; and 
(B) in clause (iv), by striking ‘‘through fis-
cal year 2017’’ and inserting ‘‘through fiscal 
year 2019’’. 
(2) PERMITTING HOSPITALS TO DECLINE RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C. 
1395ww note) is amended by striking ‘‘through fis-
cal year 2017’’ and inserting ‘‘through fiscal year 
2019’’. 
SEC. 208. SPECIALIZED MEDICARE ADVANTAGE PLANS FOR 
SPECIAL NEEDS INDIVIDUALS. 
(a) PERMANENT EXTENSION.—Section 1859(f)(1) of 
the Social Security Act (42 U.S.C. 1395w–28(f)(1)) is 
amended by striking ‘‘and for periods before January 1, 
2019’’. 
(b) INCREASED INTEGRATION OF DUAL SNPS.— 
(1) IN GENERAL.—Section 1859(f) of the Social 
Security Act (42 U.S.C. 1395w–28(f)) is amended— 
(A) in paragraph (3), by adding at the end 
the following new subparagraph: 
‘‘(F) The plan meets the requirements ap-
plicable under paragraph (8).’’; and 
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(B) by adding at the end the following new 
paragraph: 
‘‘(8) 
INCREASED
INTEGRATION
OF
DUAL 
SNPS.— 
‘‘(A) DESIGNATED
CONTACT.—The Sec-
retary, acting through the Federal Coordinated 
Health Care Office established under section 
2602 of Public Law 111–148, shall serve as a 
dedicated point of contact for States to address 
misalignments that arise with the integration of 
specialized MA plans for special needs individ-
uals described in subsection (b)(6)(B)(ii) under 
this paragraph and, consistent with such role, 
shall— 
‘‘(i) establish a uniform process for 
disseminating to State Medicaid agencies 
information under this title impacting con-
tracts between such agencies and such 
plans under this subsection; and 
‘‘(ii) establish basic resources for 
States interested in exploring such plans 
as a platform for integration, such as a 
model contract or other tools to achieve 
those goals. 
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