I 
108TH CONGRESS 
1ST SESSION H. R. 1301
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 
MARCH 17, 2003
Mr. HOUGHTON (for himself, Mr. ALLEN, Mr. BOEHLERT, Mr. POMEROY, Mr. 
RAMSTAD, Mr. TAYLOR of Mississippi, Mr. QUINN, Mr. HINCHEY, Mr. 
ENGLISH, Ms. CORRINE BROWN of Florida, Mr. MCHUGH, Mr. MOORE, 
Mr. UPTON, Mr. MCNULTY, Mr. KENNEDY of Minnesota, Mr. KILDEE, 
Mr. SIMMONS, Mr. FRANK of Massachusetts, Mr. REYNOLDS, Mr. DICKS, 
Mrs. EMERSON, Mr. PAYNE, Mr. WALSH, Mr. FROST, Mr. MURTHA, Mr. 
ROSS, Mr. KIND, Mr. OLVER, Ms. MCCOLLUM, and Mr. SCHIFF) intro-
duced 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 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,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Ambulance 
Payment Reform Act of 2003’’. 
SEC. 2. AMBULANCE PAYMENT RATES. 
(a) PAYMENT RATES.—
(1) IN
GENERAL.—Section 1834(l)(3) of the 
Social Security Act (42 U.S.C. 1395m(l)(3)) is 
amended to read as follows: 
‘‘(3) PAYMENT RATES.—
‘‘(A) IN GENERAL.—Subject to any adjust-
ment under subparagraph (B) and paragraph 
(9) and the full payment of a national mileage 
rate pursuant to paragraph (2)(E), in estab-
lishing such fee schedule, the following rules 
shall apply: 
‘‘(i) PAYMENT RATES IN 2004.—
‘‘(I) GROUND AMBULANCE SERV-
ICES.—In the case of ground ambu-
lance services furnished under this 
part in 2004, the Secretary shall set 
the payment rates under the fee 
schedule for such services at a rate 
based on the average costs (as deter-
mined by the Secretary on the basis of 
the most recent and reliable informa-
tion available) incurred by full cost
ambulance suppliers in providing non-
emergency basic life support ambu-
lance services covered under this title, 
with adjustments to the rates for 
other ground ambulance service levels 
to be determined based on the rule es-
tablished under paragraph (1). For 
the purposes of the preceding sen-
tence, the term ‘full cost ambulance 
supplier’ means a supplier for which 
volunteers or other unpaid staff com-
prise less than 20 percent of the sup-
plier’s total staff and which receives 
less than 20 percent of space and 
other capital assets free of charge. 
‘‘(II) OTHER AMBULANCE SERV-
ICES.—In the case of ambulance serv-
ices not described in subclause (I) 
that are furnished under this part in 
2004, the Secretary shall set the pay-
ment rates under the fee schedule for 
such services based on the rule estab-
lished under paragraph (1). 
‘‘(ii) PAYMENT
RATES
IN
SUBSE-
QUENT YEARS FOR ALL AMBULANCE SERV-
ICES.—In the case of any ambulance serv-
ice furnished under this part in 2005 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) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to payment for ambu-
lance services furnished on or after January 1, 
2004. 
(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) and 
not later than December 31, 2003, establish a 
system or systems for the coding of claims for 
ambulance services for which payment is made 
under this subsection, including a code set 
specifying the medical condition of the indi-
vidual who is transported and the level of serv-
ice that is appropriate for the transportation of 
an individual with that medical condition.