I 
115TH CONGRESS 
1ST SESSION H. R. 3729 
To amend titles XI and XVIII of the Social Security Act to facilitate provider 
and supplier cost reporting of ambulance services under the Medicare 
program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 11, 2017 
Mr. NUNES (for himself and Ms. SEWELL of Alabama) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend titles XI and XVIII of the Social Security Act 
to facilitate provider and supplier cost reporting of ambu-
lance services under the Medicare program, and for other 
purposes. 
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 ‘‘Comprehensive Oper-
ations, Sustainability, and Transport Act of 2017’’. 
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SEC. 2. GROUND AMBULANCE SERVICES COST REPORTING 
REQUIREMENT. 
(a) IN GENERAL.—Section 1121 of the Social Secu-
rity Act (42 U.S.C. 1320a) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘For the purposes of’’ and 
inserting ‘‘Subject to subsection (d), for the 
purposes of’’; 
(B) by inserting ‘‘suppliers of ground am-
bulance services,’’ after ‘‘health maintenance or-
ganizations,’’; and 
(C) in the matter at the end, by adding the 
following new sentence: ‘‘Not later than Decem-
ber 31, 2019, the Secretary shall modify the 
uniform reporting system for providers of serv-
ices with respect to ambulance services to en-
sure that such system contains information 
similar (as determined by the Secretary) to in-
formation required under the uniform reporting 
system for suppliers of ground ambulance serv-
ices.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(d) In the case of a supplier of ground ambulance 
services that furnishes such services for fewer than 20 in-
dividuals entitled to benefits under part A of title XVIII 
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and enrolled under part B of such title in a cost reporting 
period (as defined by the Secretary), the Secretary may 
modify the requirements for inclusion of any information 
specified in subsection (a) in reports made in accordance 
with the uniform reporting system established under this 
section with respect to such services.’’. 
(b) SUSPENSION OF PAYMENT FOR GROUND AMBU-
LANCE SERVICES; DEEMING CERTAIN PAYMENTS OVER-
PAYMENTS.—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: 
‘‘(17) REQUIREMENT TO SUBMIT COST REPORT 
AND AUTHORITY TO SUSPEND PAYMENTS AND DEEM 
CERTAIN PAYMENTS OVERPAYMENTS FOR GROUND 
AMBULANCE SERVICES.— 
‘‘(A) 
IN
GENERAL.—With 
respect 
to 
ground ambulance services furnished by a sup-
plier of such services during cost reporting peri-
ods beginning on or after January 1, 2020, 
such supplier shall make reports to the Sec-
retary of information described in section 
1121(a) in accordance with the uniform report-
ing system established under such section for 
such suppliers and, as may be required by the 
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Secretary, of any of the information described 
in subparagraph (B). 
‘‘(B) 
ADDITIONAL
INFORMATION.—The 
Secretary may, with respect to a supplier of 
ground ambulance services, require the fol-
lowing information (to be reported to the extent 
practicable under the uniform reporting system 
established under section 1121(a) for such sup-
pliers): 
‘‘(i) Whether the supplier is part of 
an emergency services department, a gov-
ernmental organization, or another type of 
entity (as described by the Secretary). 
‘‘(ii) The number of hours in a week 
during which the supplier is available for 
furnishing ground ambulance services. 
‘‘(iii) The average number of volun-
teer hours a week used by the supplier. 
‘‘(C) SUSPENSION OF PAYMENT.—Subject 
to subparagraph (E), in the case that the Sec-
retary determines that a supplier of ground am-
bulance services has not made to the Secretary 
a timely report described in subparagraph (A) 
with respect to a cost reporting period begin-
ning on or after January 1, 2020, and before 
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January 1, 2022, the Secretary may suspend 
payments made under this subsection, in whole 
or in part, to such supplier until the Secretary 
finds that such supplier has made such a re-
port. 
‘‘(D) DEEMING CERTAIN PAYMENTS OVER-
PAYMENTS.—Subject to subparagraphs (E) and 
(F), in the case that the Secretary determines 
that a supplier of ground ambulance services 
has not made to the Secretary a complete, accu-
rate, and timely report described in subpara-
graph (A) with respect to a cost reporting pe-
riod beginning on or after January 1, 2022, the 
Secretary may deem payments made under this 
subsection to such supplier for such period to 
be overpayments and recoup such overpay-
ments. 
‘‘(E) HARDSHIP
DELAY.—The Secretary 
shall establish a process whereby a supplier of 
ground ambulance services may request a delay 
in making a report described in subparagraph 
(A) with respect to a cost reporting period for 
reason of significant hardship (as determined 
by the Secretary). 
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‘‘(F) AUTHORITY
TO
MODIFY
COST
RE-
PORTING ELEMENTS AND ENFORCEMENT.—Not 
earlier than January 1, 2023, the Secretary 
may provide that subparagraph (D) no longer 
applies to ground ambulance services suppliers 
or a category of such suppliers after— 
‘‘(i) taking into account the rec-
ommendation of the Medicare Payment 
Advisory Commission in the most recent 
report available to the Secretary submitted 
under section 3 of the Ambulance Medicare 
Budget and Operations Act of 2017 re-
garding whether cost reports made by sup-
pliers or a category of suppliers (as speci-
fied for purposes of the report submitted 
under such section) should be required or 
modified; and 
‘‘(ii) undertaking notice and comment 
rulemaking. 
‘‘(G) AUDIT OF COST REPORTS.—The Sec-
retary shall audit reports described in subpara-
graph (A) submitted with respect to cost re-
porting periods beginning on or after January 
1, 2021. 
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‘‘(H) APPEALS.—The Secretary shall es-
tablish a process whereby a supplier of ground 
ambulance services may appeal a determination 
described in subparagraph (C) or (D) made 
with respect to a cost report required to be 
made by such supplier under subparagraph 
(A).’’. 
(c) STAKEHOLDER FEEDBACK.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall implement the provisions of 
this section, including the amendments made by this 
section, through notice and comment rulemaking 
and seek input from stakeholders. 
(2) NONAPPLICATION OF PAPERWORK REDUC-
TION ACT.—Chapter 35 of title 44, United States 
Code, shall not apply with respect to— 
(A) the development and implementation of 
the uniform reporting system required under 
section 1121(a) of the Social Security Act (42 
U.S.C. 1320a(a)) for suppliers of ground ambu-
lance services and reports required to be made 
under section 1834(l)(17) of such Act (42 
U.S.C. 1395m(l)(17)); and 
(B) the modification of the uniform report-
ing systems under such section 1121(a) of such 
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Act for providers of such services and reports 
required 
to 
be 
made 
under 
section 
1861(v)(1)(F) 
of 
such 
Act 
(42 
U.S.C. 
1395x(v)(1)(F)). 
(d) IMPLEMENTATION RESOURCES.— 
(1) IN
GENERAL.—There are hereby appro-
priated to the Secretary from the Federal Hospital 
Insurance Trust Fund under section 1817 of the So-
cial Security Act (42 U.S.C. 1395i) $8,000,000 and 
from the Federal Supplementary Medical Insurance 
Trust Fund under section 1841 of such Act (42 
U.S.C. 1395t) $92,000,000 (of which not less than 
$10,000,000 shall be used to fulfill the auditing re-
quirement under section 1834(l)(17)(G) of such Act, 
as added by subsection (b) of this section) to carry 
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 
Supplemental Insurance Trust Fund under section 
1841 of the Social Security Act (42 U.S.C. 1395t), 
of such sums as may be necessary in order to di-
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rectly hire no more than 2 full-time employees to 
carry out the provisions of this section, including the 
amendments made by this section. 
(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 
payments to a supplier under section 1834(l) of the 
Social Security Act (42 U.S.C. 1395m(l)). 
SEC. 3. GROUND AMBULANCE SERVICES COST REPORTING 
STUDY. 
(a) IN GENERAL.—Not later than March 15, 2022, 
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), 
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1395m(l)) and the adequacy of payments for such services 
made under section 1834(l) of such Act. 
(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 
services, should be required or modified, taking into 
account the analyses described in paragraphs (1) 
and (2). 
SEC. 4. EXTENSION OF GROUND AMBULANCE SERVICES EX-
TENDERS AND PAY-FOR. 
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’’; 
(2) in paragraph (13)(A), by striking ‘‘2018’’ 
each place it appears and inserting ‘‘2023’’; and 
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(3) in paragraph (15), by striking ‘‘on or after 
October 1, 2013’’ and inserting ‘‘during the period 
beginning on October 1, 2013, and ending on Sep-
tember 30, 2018, and by 32 percent for such serv-
ices furnished on or after October 1, 2018’’. 
Æ 
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