IB 
Union Calendar No. 356 
115TH CONGRESS 
1ST SESSION H. R. 3729 
[Report No. 115–481, Part I] 
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 
DECEMBER 21, 2017 
Additional sponsors: Mr. CURBELO of Florida, Ms. JENKINS of Kansas, and 
Mr. PETERSON 
DECEMBER 21, 2017 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
DECEMBER 21, 2017 
The Committee on Energy and Commerce discharged; committed to the Com-
mittee of the Whole House on the State of the Union and ordered to be 
printed 
[For text of introduced bill, see copy of bill as introduced on September 11, 2017] 
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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. 
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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’’. 
SEC. 2. GROUND AMBULANCE SERVICES COST REPORTING 
REQUIREMENT. 
(a) IN GENERAL.—Section 1121 of the Social Security 
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 pur-
poses of’’; 
(B) by inserting ‘‘suppliers of ground am-
bulance services,’’ after ‘‘health maintenance or-
ganizations,’’; and 
(C) in the matter following paragraph (5), 
by adding the following new sentence: ‘‘Not later 
than December 31, 2019, the Secretary shall 
modify the uniform reporting system for pro-
viders of services with respect to ambulance serv-
ices to ensure that such system contains informa-
tion similar (as determined by the Secretary) to 
information required under the uniform report-
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ing system for suppliers of ground ambulance 
services.’’; 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 indi-
viduals entitled to benefits under part A of title XVIII 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 systems established under this section 
with respect to such services.’’. 
(b) SUSPENSION OF PAYMENT FOR GROUND AMBU-
LANCE SERVICES; DEEMING CERTAIN PAYMENTS OVERPAY-
MENTS.—Section 1834(l) of the Social Security Act (42 
U.S.C. 1395m(l)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(17) REQUIREMENT TO SUBMIT COST REPORT 
AND AUTHORITY TO SUSPEND PAYMENTS AND DEEM 
CERTAIN PAYMENTS OVERPAYMENTS FOR GROUND AM-
BULANCE SERVICES.— 
‘‘(A) IN GENERAL.—With respect to ground 
ambulance services furnished by a supplier of 
such services during cost reporting periods (as 
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defined in subparagraph (I)) beginning on or 
after January 1, 2020, such supplier shall make 
reports to the Secretary of information described 
in section 1121(a) in accordance with the uni-
form reporting system established under such sec-
tion for such suppliers and, as may be required 
by the Secretary, of any of the information de-
scribed in subparagraph (B). 
‘‘(B) ADDITIONAL INFORMATION.—The Sec-
retary may, with respect to a supplier of ground 
ambulance services, require the following infor-
mation (to be reported to the extent practicable 
under the uniform reporting system established 
under section 1121(a) for such suppliers): 
‘‘(i) Whether the supplier is part of an 
emergency services department, a govern-
mental organization, or another type of en-
tity (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 volunteer 
hours a week used by the supplier. 
‘‘(C) SUSPENSION OF PAYMENT.—Subject to 
subparagraph (E), in the case that the Secretary 
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determines that a supplier of ground ambulance 
services has not made to the Secretary a timely 
report described in subparagraph (A) with re-
spect to a cost reporting period beginning on or 
after January 1, 2020, and before 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 report. 
‘‘(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, accurate, 
and timely report described in subparagraph (A) 
with respect to a cost reporting period 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 overpayments. 
‘‘(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 
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reason of significant hardship (as determined by 
the Secretary). 
‘‘(F) AUTHORITY TO MODIFY COST REPORT-
ING ELEMENTS AND ENFORCEMENT.—Not earlier 
than January 1, 2023, the Secretary may pro-
vide that subparagraph (D) no longer applies to 
ground ambulance services suppliers or a cat-
egory of such suppliers after— 
‘‘(i) taking into account the rec-
ommendation of the Medicare Payment Ad-
visory Commission in the most recent report 
available to the Secretary submitted under 
section 3 of the Comprehensive Operations, 
Sustainability, and Transport Act of 2017 
regarding 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) made with respect to cost reporting 
periods beginning on or after January 1, 2021. 
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‘‘(H) APPEALS.—The Secretary shall estab-
lish a process whereby a supplier of ground am-
bulance services may appeal a determination de-
scribed in subparagraph (C) or (D) made with 
respect to a cost report required to be made by 
such supplier under subparagraph (A). 
‘‘(I) DEFINITION.—In this paragraph, the 
term ‘cost reporting period’ means, with respect 
to a year, the 12-month period beginning on 
January 1 of such year.’’. 
(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 REDUCTION 
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 sec-
tion 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 
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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 
Act for providers of such services and reports re-
quired 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 amend-
ments made by this section, to remain available 
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 Serv-
ices Program Management Account, from the Federal 
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Supplementary Medical 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 
directly 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 Congress 
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 
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accordance with sections 1121(a) and 1834(l) of the Social 
Security Act (42 U.S.C. 1320a(a), 1395m(l)), the adequacy 
of payments for such services made under section 1834(l) 
of such Act, and the extent to which state mandates may 
create geographic variations in the cost of providing such 
services. 
(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 re-
ports of ambulance services made by suppliers or a 
category of suppliers (as specified by the Secretary) 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— 
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(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 
(3) in paragraph (15), by striking ‘‘on or after 
October 1, 2013’’ and inserting ‘‘during the period be-
ginning on October 1, 2013, and ending on September 
30, 2018, and by 32 percent for such services fur-
nished on or after October 1, 2018’’. 
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Union Calendar No. 356 
115TH CONGRESS 
1ST SESSION 
H. R. 3729 
[Report No. 115–481, Part I] 
A BILL 
To amend titles XI and XVIII of the Social Secu-
rity Act to facilitate provider and supplier cost 
reporting of ambulance services under the Medi-
care program, and for other purposes. 
DECEMBER 21, 2017 
Reported from the Committee on Ways and Means with 
an amendment 
DECEMBER 21, 2017 
The Committee on Energy and Commerce discharged; 
committed to the Committee of the Whole House on 
the State of the Union and ordered to be printed 
VerDate Sep 11 2014 
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