I
107TH CONGRESS
1ST SESSION
H. R. 3545
To amend title XVIII of the Social Security Act to increase by 20 percent
the payment under the Medicare Program for ambulance services fur-
nished to Medicare beneficiaries in rural areas, to determine rural areas
based on population density, and to require the use of recent data
in determining payment adjustments.
IN THE HOUSE OF REPRESENTATIVES
DECEMBER 19, 2001
Mr. MURTHA introduced the following bill; which was referred to the Com-
mittee on Energy and 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 committee concerned
A BILL
To amend title XVIII of the Social Security Act to increase
by 20 percent the payment under the Medicare Program
for ambulance services furnished to Medicare bene-
ficiaries in rural areas, to determine rural areas based
on population density, and to require the use of recent
data in determining payment adjustments.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Rural Ambulance Service Improvement Act of
2001’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Payment increases for rural ambulance services.
Sec. 3. Basing rural areas on population density by postal zip codes.
Sec. 4. Requiring use of recent data for calculation of budget neutrality adjust-
ment.
Sec. 5. Exemption of ambulance suppliers from certain provider designation
rules.
Sec. 6. Calculation of separate rates for ground and air ambulance services.
SEC. 2. PAYMENT INCREASES FOR RURAL AMBULANCE
SERVICES.
(a) 20 PERCENT INCREASE.—Section 1834(l) of the
Social Security Act (42 U.S.C. 1395m(l)), as amended by
sections 205(a) and 221(a) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000
(114 Stat. 2763A–482, 486), as enacted into law by sec-
tion 1(a)(6) of Public Law 106–554, is amended—
(1) by redesignating paragraph (8), as added by
such section 221(a), as paragraph (9), and
(2) by inserting after that paragraph the fol-
lowing new paragraph:
‘‘(10) INCREASE FOR RURAL AMBULANCE SERV-
ICES.—Effective for ambulance services furnished on
or after January 1, 2002, for which the transpor-
tation originates in a rural area or tract to which
mileage for a trip above 17 miles, and up to 50
miles, shall be increased’’; and
(6) by inserting before such subparagraph (B)
the following new subparagraph:
‘‘(A) for ambulance services furnished on
or after January 1, 2002, the payment rate
otherwise established for mileage for the first
17 miles of a trip transporting a patient shall
be increased by $7.50 per mile; and’’.
(c) NONAPPLICATION
OF INITIAL BUDGET NEU-
TRALITY
PROVISIONS.—The 
provisions 
of 
section
1834(l)(3)(A) of the Social Security Act (42 U.S.C.
1395m(l)(3)(A)) do not apply with respect to the amend-
ments made by this section.
SEC. 3. BASING RURAL AREAS ON POPULATION DENSITY
BY POSTAL ZIP CODES.
(a) IN GENERAL.—Section 1834(l) of the Social Se-
curity Act (42 U.S.C. 1395m(l)) is amended in paragraph
(9), as so redesignated by section 2(a)(1), by striking ‘‘(as
defined in section 1886(d)(2)(D))’’ and all that follows
through ‘‘(57 Fed. Reg. 6725))’’ and inserting ‘‘(as deter-
mined under an area classification system established by
the Secretary that is based on population density within
postal zip code areas)’’.
(b) EFFECTIVE DATE.—The Secretary of Health and
Human Services shall establish the classification system
described in the amendment made by subsection (a) by
not later than 1 year after the date of the enactment of
this Act. Such amendment shall apply to services fur-
nished on or after such date, not later than 30 days after
the establishment of such system, as the Secretary shall
provide by regulation.
SEC. 4. REQUIRING USE OF RECENT DATA FOR CALCULA-
TION OF BUDGET NEUTRALITY ADJUSTMENT.
(a) IN GENERAL.—Section 1834(l)(3) of the Social
Security Act (42 U.S.C. 1395m(l)(3)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (A);
(2) by redesignating subparagraph (B) as sub-
paragraph (C); and
(3) by inserting after subparagraph (A) the fol-
lowing new subparagraph:
‘‘(B) in making the determination under
subparagraph (A), use data from the most re-
cent year for which such data are available, but
may not use data from a year that preceded the
two-year period ending on the date of the im-
plementation of the fee schedule under this sub-
section; and’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to ambulance services furnished
on or after January 1, 2003.
SEC. 5. EXEMPTION OF AMBULANCE SUPPLIERS FROM
CERTAIN PROVIDER DESIGNATION RULES.
In applying the regulation for requirements for deter-
mination that a facility or organization has provider-based
status under section 413.65 of title 42 of the Code of Fed-
eral Regulations, the Secretary of Health and Human
Services shall not apply the regulation with respect to am-
bulance services.
SEC. 6. CALCULATION OF SEPARATE RATES FOR GROUND
AND AIR AMBULANCE SERVICES.
(a) IN GENERAL.—Section 1861(v)(1)(U) of the So-
cial Security Act (42 U.S.C. 1395x(v)(1)(U)) is amended
by adding at the end the following: ‘‘In carrying out the
first sentence, upon request of a hospital, the Secretary
shall determine and apply separately the reasonable costs
of ground and air ambulance services.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to ambulance services furnished
on or after the date of the enactment of this Act.
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