I 
116TH CONGRESS 
1ST SESSION H. R. 3021 
To amend title XVIII of the Social Security Act to restructure the payment 
adjustment for non-emergency ESRD ambulance transports under the 
Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 24, 2019 
Mr. LAHOOD (for himself and Ms. SEWELL of Alabama) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to restruc-
ture the payment adjustment for non-emergency ESRD 
ambulance transports 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 ‘‘Non-Emergency Am-
bulance Transportation Sustainability and Accountability 
Act of 2019’’ or the ‘‘NEATSA Act’’. 
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SEC. 2. RESTRUCTURE OF MEDICARE PAYMENT ADJUST-
MENT FOR NON-EMERGENCY ESRD AMBU-
LANCE TRANSPORTS. 
(a) IN GENERAL.—Section 1834(l)(15) of the Social 
Security Act (42 U.S.C. 1395m(l)(15)) is amended to read 
as follows: 
‘‘(15) RESTRUCTURE
OF
PAYMENT
ADJUST-
MENT
FOR
NON-EMERGENCY
AMBULANCE
TRANS-
PORTS FOR ESRD BENEFICIARIES.— 
‘‘(A) IN GENERAL.—In the case of applica-
ble ambulance services, the fee schedule amount 
otherwise applicable under the preceding provi-
sions of this subsection shall be reduced as fol-
lows: 
‘‘(i) In the case of applicable ambu-
lance services furnished during the period 
beginning on October 1, 2013, and ending 
on September 30, 2019, reduced by 10 
percent. 
‘‘(ii) In the case of applicable ambu-
lance services furnished during the period 
beginning on October 1, 2019, and ending 
on December 31, 2019, reduced by 15.5 
percent. 
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‘‘(iii) In the case of applicable ambu-
lance services furnished during 2020 or a 
subsequent year— 
‘‘(I) by a provider or supplier of 
ambulance services that the Secretary 
has designated under subparagraph 
(C) for the year and for which such 
transport originates in an area not de-
scribed in paragraph (13)(A)(i), re-
duced by 29.5 percent; or 
‘‘(II) that are not described in 
subclause (I), reduced by 15.5 per-
cent. 
‘‘(B) 
APPLICABLE
AMBULANCE
SERV-
ICES.—In this paragraph, the term ‘applicable 
ambulance services’ means ambulance 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 
1881(b)(14)(B)) furnished other than on an 
emergency basis by a provider of services or a 
renal dialysis facility. 
‘‘(C) DESIGNATION.— 
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‘‘(i) IN
GENERAL.—For 2020 and 
each subsequent year, the Secretary shall 
designate the providers or suppliers of am-
bulance services for which the total pay-
ments made to the provider or supplier for 
applicable ambulance services furnished 
during the applicable period for the year 
makes up at least 50 percent of the total 
payments made to the provider or supplier 
under this part for all ambulance services 
furnished during such applicable period. 
‘‘(ii) METHODOLOGY.—The Secretary 
shall, through notice and comment rule-
making, establish the methodology for des-
ignating providers and suppliers under 
clause (i) for a year. Under such method-
ology, the applicable period for a year shall 
be a 12-month period determined by the 
Secretary that begins and ends prior to the 
beginning of such year. 
‘‘(iii) TIMING.—Not later than No-
vember 1 of each year (beginning with 
2019), the Secretary shall notify any pro-
vider or supplier that will be designated 
under clause (i) for the subsequent year. 
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‘‘(iv) TARGETED REVIEW.—The Sec-
retary shall establish a process under 
which a provider or supplier may seek an 
informal review of the designation under 
clause (i) with respect to the provider or 
supplier. 
‘‘(v) PUBLIC REPORTING.—Beginning 
in 2021, the Secretary shall, in an easily 
understandable format, make available on 
the Internet website of the Centers for 
Medicare & Medicaid Services the fol-
lowing: 
‘‘(I) The total number of claims 
paid under this part for applicable 
ambulance services. 
‘‘(II) The total number of claims 
paid under this part for applicable 
ambulance services that were subject 
to the payment reduction under sub-
paragraph (A)(iii), broken out for 
each of subclauses (I) and (II) of such 
subparagraph. 
‘‘(III) The total number of pro-
viders and suppliers that were des-
ignated under clause (i). 
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‘‘(IV) Any other data regarding 
applicable ambulance services that the 
Secretary determines appropriate.’’. 
(b) GAO STUDY AND REPORT.— 
(1) IN GENERAL.—The Comptroller General of 
the United States (in this subsection referred to as 
the ‘‘Comptroller General’’) shall conduct a study on 
payments under section 1834(l) of the Social Secu-
rity Act (42 U.S.C. 1395m(l)) for applicable ambu-
lance services (as defined in subparagraph (B) of 
paragraph (15) of such section, as added by sub-
section (a)). Such study shall include an analysis of 
the impact of the amendment made by subsection 
(a), including the impact on beneficiary access and 
any steps providers and suppliers of ambulance serv-
ices have taken to avoid payment reductions under 
such paragraph (15). 
(2) REPORT.—Not later than March 1, 2023, 
the Comptroller General shall submit to Congress a 
report containing the results of the study conducted 
under paragraph (1), together with recommenda-
tions for such legislation and administrative action 
as the Comptroller General determines appropriate. 
Æ 
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