I
107TH CONGRESS
1ST SESSION
H. R. 3109
To amend the title XVIII of the Social Security Act to provide payment
to Medicare ambulance suppliers of the full costs of providing such
services, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 12, 2001
Mr. HOUGHTON (for himself, Mr. ALLEN, Mr. ENGLISH, Mr. MCNULTY, Mr.
WALSH, Mr. LAFALCE, Mr. KOLBE, Mr. KIND, Mr. SWEENEY, Mr.
MOORE, Mrs. EMERSON, Mr. POMEROY, Mr. MCHUGH, Mr. TAYLOR of
Mississippi, Mr. SMITH of New Jersey, Mr. FROST, Mr. BOEHLERT, Mr.
HINCHEY, Mr. FRELINGHUYSEN, Mr. PALLONE, Mrs. ROUKEMA, Mr.
BORSKI, Mr. SAXTON, Mrs. MINK of Hawaii, Mr. REYNOLDS, Mr.
CAPUANO, Mr. FERGUSON, Mr. THOMPSON of California, Mr. KILDEE,
Mr. ANDREWS, Mr. STUPAK, Mr. OBERSTAR, Ms. SLAUGHTER, Mr.
MENENDEZ, Mr. TRAFICANT, Mr. BALDACCI, Mr. ROSS, and Mr. BROWN
of Ohio) 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 the title XVIII of the Social Security Act to
provide payment to Medicare ambulance suppliers of the
full costs of providing such services, and for other pur-
poses.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
ICES.—In the case of any ambulance serv-
ice furnished under this part in 2003 or
any subsequent year, the Secretary shall
set the payment rates under the fee sched-
ule for such service at amounts equal to
the payment rate under the fee schedule
for that service furnished during the pre-
vious year, increased by the percentage in-
crease in the Consumer Price Index for all
urban consumers (United States city aver-
age) for the 12-month period ending with
June of the previous year.
‘‘(B) ADJUSTMENT IN RURAL RATES.—For
years beginning with 2004, the Secretary, after
taking into consideration the recommendations
contained in the report submitted under section
221(b)(3) the Medicare, Medicaid, and SCHIP
Benefits Improvements and Protection Act of
2000, shall adjust the fee schedule payment
rates that would otherwise apply under this
subsection for ambulance services provided in
low density rural areas based on the increased
cost (if any) of providing such services in such
areas.’’.
(2) 
CONFORMING
AMENDMENT.—Section
221(c) of the Medicare, Medicaid, and SCHIP Bene-
fits Improvement and Protection Act of 2000 (114
Stat. 2763A–487), as enacted into law by section
1(a)(6) of Public Law 106–554, is repealed.
(3) TECHNICAL AMENDMENT.—
(A) IN GENERAL.—Paragraph (8) of sec-
tion 1834(l) of the Social Security Act (42
U.S.C. 1395m(l)), as added by section 221(a)
of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (114
Stat. 2763A–487), as enacted into law by sec-
tion 1(a)(6) of Public Law 106–554, is redesig-
nated as paragraph (9).
(B) EFFECTIVE
DATE.—The amendment
made by subparagraph (A) shall take effect as
if included in the enactment of such section
221(a).
(b) USE OF MEDICAL CONDITIONS FOR CODING AM-
BULANCE SERVICES.—Section 1834(l)(7) of the Social Se-
curity Act (42 U.S.C. 1395m(l)(7)) is amended to read
as follows:
‘‘(7) CODING SYSTEM.—
‘‘(A) IN GENERAL.—The Secretary shall,
in accordance with section 1173(c)(1)(B), es-
tablish a system or systems for the coding of
claims for ambulance services for which pay-
ment is made under this subsection, including a
code set specifying the medical condition of the
individual who is transported and the level of
service that is appropriate for the transpor-
tation of an individual with that medical condi-
tion.
‘‘(B) MEDICAL CONDITIONS.—The code set
established under subparagraph (A) shall—
‘‘(i) take into account the list of med-
ical conditions developed in the course of
the negotiated rulemaking process con-
ducted under paragraph (1); and
‘‘(ii) notwithstanding any other provi-
sion of law, be adopted as a standard code
set under section 1173(c).’’.
SEC. 3. PRUDENT LAYPERSON STANDARD FOR EMERGENCY
AMBULANCE SERVICES UNDER MEDICARE
AND MEDICAID.
(a) AMBULANCE SERVICES FOR MEDICARE FEE-FOR-
SERVICE BENEFICIARIES.—Section 1861(s)(7) of the So-
cial Security Act (42 U.S.C. 1395x(s)(7)) is amended by
inserting before the semicolon at the end the following:
‘‘, except that such regulations shall not fail to treat am-
bulance services as medical and other health services solely
because the ultimate diagnosis of the individual receiving
the ambulance services results in the conclusion that am-
bulance services were not necessary, as long as the request
for ambulance services is made after the sudden onset of
a medical condition that would be classified as an emer-
gency 
medical 
condition 
(as 
defined 
in 
section
1852(d)(3)(B)).’’.
(b) AMBULANCE SERVICES FOR MEDICARE+CHOICE
ENROLLEES.—Section 1852(d)(3)(A) of the Social Secu-
rity Act (42 U.S.C. 1395w–22(d)(3)(A)) is amended by
inserting ‘‘(including the services described in section
1861(s)(7))’’ after ‘‘outpatient services’’ in the matter
preceding clause (i).
(c) AMBULANCE SERVICES IN MEDICAID MANAGED
CARE PLANS.—Section 1932(b)(2)(B) of the Social Secu-
rity Act (42 U.S.C. 1396u–2(b)(2)(B)) is amended by in-
serting ‘‘(including the services described in section
1861(s)(7) (if covered by the State plan))’’ after ‘‘out-
patient services’’ in the matter preceding clause (i).
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to services provided
on and after the date of enactment of the Act.
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