(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Reform to the Medicare ambulance fee schedule. 
Sec. 3. Prior authorization for ambulance transports of ESRD beneficiaries. 
Sec. 4. Requiring ambulance providers to submit cost and other information. 
SEC. 2. REFORM TO THE MEDICARE AMBULANCE FEE 
SCHEDULE. 
(a) IN GENERAL.—Section 1834(l) of the Social Se-
curity Act (42 U.S.C. 1395m(l)) is amended by adding 
the following new paragraphs: 
‘‘(16) INCREASE IN CONVERSION FACTOR FOR 
GROUND
AMBULANCE
SERVICES.—In the case of 
ground ambulance services furnished on or after 
April 1, 2015, for purposes of determining the fee 
schedule amount for such services under this sub-
section, the conversion factor otherwise applicable to 
such services shall be increased by— 
‘‘(A) with respect to ground ambulance 
services for which the transportation originates 
in a qualified rural area, as identified using the 
methodology 
described 
in 
paragraph 
(12)(B)(iii), 25.6 percent; 
‘‘(B) with respect to ground ambulance 
services not described in subparagraph (A) and 
for which the transportation originates in a 
rural area described under paragraph (9) or in 
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a rural census tract described in such para-
graph, 3 percent; and 
‘‘(C) with respect to ground ambulance 
services not described in subparagraph (A) or 
(B), 2 percent. 
‘‘(17) INCREASE
IN
MILEAGE
RATE
FOR 
GROUND
AMBULANCE
SERVICES.—In the case of 
ground ambulance services furnished on or after 
April 1, 2015, for purposes of determining the fee 
schedule amount for such services under this sub-
section, the payment rate for mileage otherwise ap-
plicable to such services shall be increased by— 
‘‘(A) with respect to ground ambulance 
services for which the transportation originates 
in a qualified rural area, as identified using the 
methodology 
described 
in 
paragraph 
(12)(B)(iii), 3 percent; 
‘‘(B) with respect to ground ambulance 
services not described in subparagraph (A) and 
for which the transportation originates in a 
rural area described under paragraph (9) or in 
a rural census tract described in such para-
graph, 3 percent; and 
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‘‘(C) with respect to ground ambulance 
services not described in subparagraph (A) or 
(B), 2 percent.’’. 
(b) STUDY AND REPORT.— 
(1) STUDY.—The Secretary of Health and 
Human Services shall conduct a study on how the 
conversion factor applicable to ground ambulance 
services under the ambulance fee schedule under sec-
tion 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)), as adjusted under paragraph (16) of 
such section (as added by subsection (a)), should be 
modified, if at all, to take into account the cost of 
providing services in urban, rural, and super-rural 
areas. In determining such costs, the Secretary shall 
use the data collected through the data collection 
system under paragraph (18) of such section, as 
added by section 4. 
(2) REPORT.—Not later than January 1, 2020, 
the Secretary of Health and Human Services shall 
submit to Congress a report on the study conducted 
under paragraph (1), together with recommenda-
tions for such legislation and administrative action 
as the Secretary determines appropriate. 
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SEC. 3. PRIOR AUTHORIZATION FOR AMBULANCE TRANS-
PORTS OF ESRD BENEFICIARIES. 
(a) IN GENERAL.—Section 1834(l) of the Social Se-
curity Act (42 U.S.C. 1395m(l)), as amended by section 
2, is amended by adding at the end the following new 
paragraph: 
‘‘(18) PRIOR
AUTHORIZATION
OF
COVERAGE 
FOR
AMBULANCE
TRANSPORTS
OF
ESRD
BENE-
FICIARIES.— 
‘‘(A) PROCESS.— 
‘‘(i) IN
GENERAL.—For applicable 
ESRD ambulance services furnished on or 
after January 1, 2017, by an applicable 
ambulance provider, the Secretary shall es-
tablish and implement a process under 
which the Secretary shall determine, in ad-
vance of furnishing such a service to an in-
dividual, whether payment for such service 
may not be made because such service is 
not covered or because of the application of 
section 1862(a)(1). 
‘‘(ii) DENIAL OF PAYMENT.—Subject 
to subparagraph (B)(ii)(II), no payment 
shall be made under this part for the serv-
ice unless the Secretary determines pursu-
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ant to such process that the service meets 
the applicable requirements for coverage. 
‘‘(B) ELEMENTS OF PROCESS.—The proc-
ess described in subparagraph (A) shall include 
the following elements: 
‘‘(i) In order to obtain a prior author-
ization, the applicable ambulance provider 
shall submit— 
‘‘(I) a valid physician certifi-
cation statement (PCS) for non-emer-
gency ambulance transport; and 
‘‘(II) any other documentation 
determined appropriate by the Sec-
retary. 
‘‘(ii)(I) The Secretary shall respond to 
a prior authorization request within 7 busi-
ness days of receiving the request. 
‘‘(II) If the Secretary does not make 
a prior authorization determination within 
7 business days of the date of the Sec-
retary’s receipt of medical documentation 
needed to make such determination, sub-
paragraph (A)(ii) shall not apply. 
‘‘(iii) In making the determination 
under subparagraph (A) with respect to a 
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service and individual, the Secretary shall 
evaluate the medical necessity of the serv-
ice by determining— 
‘‘(I) whether the individual is un-
able to get up from bed without as-
sistance, unable to ambulate, and un-
able to sit in a chair or wheelchair; 
‘‘(II) whether the individual has 
a medical condition that, regardless of 
bed confinement, is such that trans-
port by ambulance is medically nec-
essary; or 
‘‘(III) whether the individual 
meets other criteria as determined ap-
propriate by the Secretary. 
‘‘(iv) If the prior authorization re-
quest is approved, such request shall be 
retroactive to the date on which such re-
quest was received. 
‘‘(v) An approved prior authorization 
shall be valid for a 60-day period. The Sec-
retary may provide for an extension of 
such period if the Secretary determines 
such an extension is appropriate. 
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‘‘(vi) An approved prior authorization 
shall be deemed to constitute medical ne-
cessity but shall not eliminate the docu-
mentation requirements necessary to sup-
port a claim for the transport. 
‘‘(vii) Other elements determined ap-
propriate by the Secretary. 
‘‘(C) RELIANCE
UPON
CONTRACTORS.— 
The Secretary may rely upon contractors to im-
plement the requirements of this paragraph. 
The contractor’s compensation shall be limited 
to a demonstration that it has reduced the 
number of non-emergency basic life support 
services involving individuals with end-stage 
renal disease for renal dialysis services (as de-
scribed in section 1881(b)(14)(B)) furnished 
other than on an emergency basis. 
‘‘(D) 
APPLICABLE
ESRD
AMBULANCE 
SERVICES.—In this paragraph, the term ‘appli-
cable ESRD ambulance services’ means ambu-
lance services consisting of non-emergency basic 
life support services involving transport of an 
individual with end-stage renal disease for renal 
dialysis services (as described in section 
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1881(b)(14)(B)) furnished other than on an 
emergency basis. 
‘‘(E) AMBULANCE PROVIDER; APPLICABLE 
AMBULANCE
PROVIDER
DEFINED.—In 
this 
paragraph: 
‘‘(i) 
AMBULANCE
PROVIDER.—The 
term ‘ambulance provider’ means a pro-
vider of services (as defined in section 
1861(u)) or other entity that furnishes am-
bulance services under this title. 
‘‘(ii) APPLICABLE
AMBULANCE
PRO-
VIDER.—The term ‘applicable ambulance 
provider’ means an ambulance provider 
(other than an ambulance provider who is 
a provider of services (as defined in such 
section)). 
‘‘(F) IMPLEMENTATION.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the Secretary may carry out this para-
graph through program instruction or oth-
erwise. 
‘‘(ii) SUFFICIENT
NOTICE
TO
PRE-
PARE.—Not later than June 30, 2016, the 
Secretary shall make the aspects of the 
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process under this paragraph available to 
the public.’’. 
(b) CONFORMING AMENDMENTS.—Section 1834(l) of 
the Social Security Act (42 U.S.C. 1395m(l)) is amend-
ed— 
(1) in paragraph (1), by striking ‘‘a supplier or 
provider or under arrangement with a provider’’ and 
inserting ‘‘an ambulance provider (as defined in 
paragraph (18)(E)(i)) or under arrangement with an 
ambulance provider’’; 
(2) in paragraph (8), in the matter following 
subparagraph (B), by striking ‘‘provider or supplier 
of ambulance services’’ and inserting ‘‘ambulance 
provider (as defined in paragraph (18)(E)(i))’’; and 
(3) in paragraph (9), in the heading, by insert-
ing ‘‘AMBULANCE’’ after ‘‘RURAL’’; 
(4) in paragraph (12), in the heading, by in-
serting ‘‘AMBULANCE’’ after ‘‘RURAL’’; and 
(5) in each of subparagraphs (B)(ii) and (D)(ii) 
of paragraph (14), by striking ‘‘entity’’ and inserting 
‘‘ambulance provider (as defined in paragraph 
(18)(E)(i))’’. 
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SEC. 4. REQUIRING AMBULANCE PROVIDERS TO SUBMIT 
COST AND OTHER INFORMATION. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)), as amended by section 3, is amended by adding 
at the end the following new paragraph: 
‘‘(19) SUBMISSION OF COST AND OTHER INFOR-
MATION.— 
‘‘(A) DEVELOPMENT OF DATA COLLECTION 
SYSTEM.—The Secretary shall develop a data 
collection system (which may include use of a 
cost survey and standardized definitions) for 
ambulance providers to collect cost, revenue, 
utilization, and other information determined 
appropriate by the Secretary. Such system shall 
be designed to submit information— 
‘‘(i) needed to evaluate the appro-
priateness of payment rates under this 
subsection; 
‘‘(ii) on the utilization of capital 
equipment and ambulance capacity; and 
‘‘(iii) on different types of ambulance 
services furnished in different geographic 
locations, including rural areas and low 
population density areas described in para-
graph (12). 
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‘‘(B) SPECIFICATION
OF
DATA
COLLEC-
TION SYSTEM.— 
‘‘(i) IN
GENERAL.—Not later than 
July 1, 2016, the Secretary shall— 
‘‘(I) specify the data collection 
system under subparagraph (A) and 
the time period during which such 
data is required to be submitted; and 
‘‘(II) identify the ambulance pro-
viders who would be required to sub-
mit the information under such data 
collection system. 
‘‘(ii) RESPONDENTS.—Subject to sub-
paragraph (D)(ii), the Secretary shall de-
termine an appropriate sample of ambu-
lance providers to submit information 
under the data collection system for each 
period for which reporting of data is re-
quired. 
‘‘(C) PENALTY FOR FAILURE TO REPORT 
COST
AND
OTHER
INFORMATION.—Beginning 
on July 1, 2017, a 5-percent reduction to pay-
ments under this part shall be made for a 1- 
year prospective period specified by the Sec-
retary to an ambulance provider who— 
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