I 
118TH CONGRESS 
1ST SESSION H. R. 3691 
To amend title XVIII of the Social Security Act to revise payment for 
air ambulance services under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 25, 2023 
Mr. ESTES (for himself and Ms. DELBENE) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently 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 revise 
payment for air ambulance services under the Medicare 
program. 
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 ‘‘Protecting Air Ambu-
lance Services for Americans Act of 2023’’. 
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SEC. 2. IMPROVEMENTS TO MEDICARE PAYMENT SYSTEM 
FOR AIR AMBULANCE SERVICES. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended by adding at the end the following 
new paragraph: 
‘‘(18) IMPROVEMENTS TO MEDICARE PAYMENT 
SYSTEM FOR AIR AMBULANCE SERVICES.— 
‘‘(A) IN GENERAL.—The Secretary may re-
vise the fee schedule otherwise established 
under this subsection for air ambulance services 
based on data described in subparagraph (B) 
and data collected under subparagraph (C). 
‘‘(B) DATA DESCRIBED.—For purposes of 
subparagraph (A), the data described in this 
subparagraph is data collected pursuant to the 
provisions of, and amendments made by, section 
106 of division BB of the Consolidated Appro-
priations Act, 2021 (Public Law 116–260). 
‘‘(C) ADDITIONAL
DATA
COLLECTION.— 
The Secretary shall require, once every 3 years, 
providers of services and suppliers furnishing 
air ambulance services to submit to the Sec-
retary— 
‘‘(i) data relating to the fixed and op-
erating costs per air ambulance base at-
tributable to furnishing air ambulance 
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services to individuals enrolled under this 
part and data relating to the utilization of 
such services by such individuals; 
‘‘(ii) data relating to the revenue ob-
tained by such providers and suppliers 
under this part attributable to the fur-
nishing of such services; and 
‘‘(iii) any other information deter-
mined appropriate by the Secretary. 
‘‘(D) CONSULTATION.—In the case that 
the Secretary elects to revise the fee schedule 
for air ambulance services under subparagraph 
(A), the Secretary shall consider stakeholder 
input in a process that is transparent and ap-
propriately considers data described in subpara-
graph (B) and data collected under subpara-
graph (C).’’. 
SEC. 3. GAO STUDY ON EMERGENCY AIR AMBULANCE 
COSTS. 
Not later than 1 year after the date on which data 
begins to be collected pursuant to the provisions of, and 
amendments made by, section 106 of division BB of the 
Consolidated Appropriations Act, 2021 (Public Law 116– 
260), the Comptroller General of the United States shall 
submit to the Committee on Finance of the Senate and 
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the Committee on Ways and Means and the Committee 
on Energy and Commerce of the House of Representa-
tives, a report detailing— 
(1) the average annual operating costs per air 
ambulance base; 
(2) the average cost per transport by air ambu-
lance; 
(3) the payor mix for air ambulance services; 
(4) the adequacy of Medicare payments for 
such services; 
(5) geographic variations in the cost of fur-
nishing such services; and 
(6) recommendations on improving the fee 
schedule under section 1834(l) of the Social Security 
Act (42 U.S.C. 1395m(l)) for air ambulance serv-
ices. 
Æ 
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