SEC. 302. RURAL HEALTH CLINIC IMPROVEMENTS. 
Section 1833(f) of the Social Security Act (42 U.S.C. 
1395l(f)) is amended— 
(1) in paragraph (1), by striking ‘‘, and’’ at the 
end and inserting a semicolon; 
(2) in paragraph (2)— 
(A) by inserting ‘‘(before 2007)’’ after ‘‘in 
a subsequent year’’; and 
(B) by striking the period at the end and 
inserting a semicolon; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(3) in 2007, at $82 per visit; and 
‘‘(4) in a subsequent year, at the limit estab-
lished under this subsection for the previous year in-
creased by the percentage increase in the MEI (as 
so defined) applicable to primary care services (as so 
defined) furnished as of the first day of that year.’’. 
SEC. 303. USE OF MEDICAL CONDITIONS FOR CODING AM-
BULANCE SERVICES. 
Section 1834(l)(7) of the Social Security 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) and 
not later than January 1, 2007, establish a 
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mandatory 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 take 
into account the list of medical conditions devel-
oped in the course of the negotiated rulemaking 
process conducted under paragraph (1).’’. 
SEC. 304. IMPROVEMENT IN PAYMENTS TO RETAIN EMER-
GENCY AND OTHER CAPACITY FOR AMBU-
LANCES IN RURAL AREAS. 
(a) IN GENERAL.—Section 1834(l) of the Social Se-
curity Act (42 U.S.C. 1395m(l)) is amended by adding 
at the end the following new paragraph: 
‘‘(15) ADDITIONAL PAYMENTS FOR PROVIDERS 
FURNISHING
AMBULANCE
SERVICES
IN
RURAL 
AREAS.— 
‘‘(A) IN GENERAL.—In the case of ground 
ambulance services furnished on or after Janu-
ary 1, 2007, for which the transportation origi-
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nates in a rural area (as determined under sub-
paragraph (B)), the Secretary shall provide for 
a percent increase in the base rate of the fee 
schedule for a trip identified under this sub-
section. 
‘‘(B) IDENTIFICATION OF RURAL AREAS.— 
The Secretary, in consultation with the Office 
of Rural Health Policy, shall use the Rural- 
Urban Commuting Areas (RUCA) coding sys-
tem, adopted by that Office, to designate rural 
areas for the purposes of this paragraph. A 
rural area is any area in RUCA levels 2 
through 10 and any unclassified area. 
‘‘(C) TIERING
OF
RURAL
AREAS.—The 
Secretary shall designate 4 tiers of rural areas, 
using a ZIP Code population-based method-
ology generated by the RUCA coding system, as 
follows: 
‘‘(i) TIER 1.—A rural area that is a 
high metropolitan commuting area, in 
which 30 percent or more of the com-
muting flow is to an urban area, as des-
ignated by the Bureau of the Census 
(RUCA level 2). 
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