I 
115TH CONGRESS 
1ST SESSION H. R. 3378 
To amend title XVIII of the Social Security Act to require reporting of 
certain data by providers and suppliers of air ambulance services for 
purposes of reforming reimbursements for such services under the Medi-
care program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 25, 2017 
Mrs. WALORSKI (for herself, Ms. DELBENE, Mr. JOHNSON of Ohio, Mr. RUIZ, 
and Mr. SESSIONS) introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Com-
mittee 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 title XVIII of the Social Security Act to require 
reporting of certain data by providers and suppliers of 
air ambulance services for purposes of reforming reim-
bursements for such services under the Medicare pro-
gram, 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 ‘‘Ensuring Access to 
Air Ambulance Services Act of 2017’’. 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
SEC. 2. AIR AMBULANCE DATA REPORTING PROGRAM AND 
VALUE-BASED PURCHASING PROGRAM. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended— 
(1) in paragraph (3)(B), by striking ‘‘subpara-
graph (C)’’ and inserting ‘‘subparagraph (C) and 
paragraphs (17) and (20)’’; 
(2) in paragraph (3)(C), by inserting ‘‘(other 
than 2018)’’ after ‘‘each subsequent year’’; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(17) AIR AMBULANCE DATA REPORTING PRO-
GRAM.— 
‘‘(A) SUBMISSION OF COST DATA.—With 
respect to 2019 and each subsequent year, each 
supplier or provider of air ambulance services 
shall submit to the Secretary data specified 
under subparagraph (B) for air ambulance 
services furnished by such provider or supplier 
during such year. Such data shall be submitted 
in a form and manner, and on an annual basis, 
as specified by the Secretary for purposes of 
this subparagraph. 
‘‘(B) COST DATA.—For purposes of report-
ing data for air ambulance services furnished 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
during a year, the data described in this sub-
paragraph are cost data on the following: 
‘‘(i) Maintenance of aircrafts. 
‘‘(ii) Medical supplies and equipment. 
‘‘(iii) Fuel. 
‘‘(iv) Employee expenses. 
‘‘(v) Recurring training relating to 
aviation, maintenance, communication, and 
clinical. 
‘‘(vi) Rent and utilities. 
‘‘(vii) Communications. 
‘‘(viii) Travel. 
‘‘(ix) Hull and aviation liability insur-
ance, life insurance, and professional mal-
practice insurance. 
‘‘(x) Marketing. 
‘‘(xi) Supplies and equipment. 
‘‘(xii) Overhead support. 
‘‘(xiii) Aircraft ownership expenses. 
‘‘(xiv) Depreciation. 
‘‘(xv) Safety enhancement capital 
costs. 
‘‘(xvi) Safety enhancement recurring 
costs. 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
‘‘(C) CONSULTATION RELATING TO COST 
REPORTS.—For purposes of this paragraph, the 
Secretary shall consult with suppliers and pro-
viders of air ambulance services to develop a 
cost reporting instrument and further define 
the data specified under subparagraph (B) 
through instructions. 
‘‘(D) SUBMISSION
OF
QUALITY
DATA.— 
With respect to 2020 and each subsequent year, 
each supplier or provider of air ambulance serv-
ices shall submit to the Secretary data specified 
under subparagraph (E) for air ambulance 
services furnished by such supplier or provider 
during such year. Such data shall be submitted 
in a form and manner, and on an annual basis, 
as specified by the Secretary for purposes of 
this subparagraph. 
‘‘(E) QUALITY DATA.—For purposes of re-
porting data for air ambulance services fur-
nished during a year, the data described in this 
subparagraph are quality data on the following 
measures: 
‘‘(i) Mechanical ventilator use in pa-
tients with advanced airways. 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
‘‘(ii) Interpretation of 12-lead electro-
cardiogram documented on patient care 
record for those transported with primary 
cardiac diagnoses. 
‘‘(iii) Continuous waveform capnogra-
phy for mechanically ventilated patients. 
‘‘(iv) Advanced airway established 
without newly developed hypoxia or hypo-
tension. 
‘‘(v) Tracheal intubation verified with 
capnography and direct visualization, chest 
radiograph, or symmetric breath sounds. 
‘‘(F) CONSEQUENCE FOR NOT REPORTING 
QUALITY
DATA
FOR
VALUE-BASED
PUR-
CHASING.— 
‘‘(i) IN
GENERAL.—With respect to 
ambulance services furnished by a provider 
or supplier of air ambulance services dur-
ing a payment year (beginning with 2024), 
if such provider or supplier does not sub-
mit to the Secretary data specified under 
subparagraph (E) for the performance pe-
riod for such year (as defined in paragraph 
(20)(F)), the Secretary shall provide for a 
percent reduction of 10 percent to the per-
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
centage increase determined under para-
graph (3)(B), after application of para-
graphs (3)(C) and (19) for such payment 
year. 
‘‘(ii) APPLICATION.—The reduction 
under clause (i) shall apply only with re-
spect to the year involved and the Sec-
retary shall not take into account such in-
crease in computing the payment amount 
under the fee schedule under this sub-
section for a subsequent year. 
‘‘(iii) DISTRIBUTION.—For purposes 
of paragraph (20)(D)(iii)(III), of the total 
amount of reductions pursuant to clause 
(i) for a payment year— 
‘‘(I) 50 percent of such reduc-
tions shall be made available for pur-
poses of performance payments under 
paragraph (20) for such payment 
year; and 
‘‘(II) 50 percent shall be trans-
ferred to the Federal Hospital Insur-
ance Trust Fund under section 1817. 
‘‘(G) DATA DISCLOSURES.—The Secretary 
shall provide, with respect to data submitted 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
under subparagraph (D) by a supplier or pro-
vider of air ambulance services— 
‘‘(i) with respect to 2020, on a con-
fidential basis to such supplier or provider, 
information with respect to such data and 
year, including a comparison of the results 
of such data submitted by such supplier or 
provider to the national average, with re-
spect to such data reported; and 
‘‘(ii) with respect to a subsequent 
year, for the public disclosure of such in-
formation with respect to such subsequent 
year, including the comparison described in 
clause (i) of such data with respect to such 
subsequent year. 
‘‘(H) REPORTS.— 
‘‘(i) BY SECRETARY.—Not later than 
July 1, 2021, subject to clause (iii), the 
Secretary shall submit to Congress a re-
port on the data described in subpara-
graphs (B) and (E) submitted to the Sec-
retary. 
‘‘(ii) BY COMPTROLLER GENERAL.— 
Not later than July 1, 2021, subject to 
clause (iii), the Comptroller General of the 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
United States shall submit to Congress a 
report on the data described in subpara-
graph (B) and subparagraph (E) sub-
mitted under this paragraph. Such report 
shall include an analysis of cost variation 
to providers and supplier of air ambulance 
services by geography and provider or sup-
plier status and a recommendation on the 
adequate amount of reimbursement under 
this title to providers and suppliers of air 
ambulance services for furnishing such 
services that would reflect operational costs 
of such providers and suppliers and pre-
serve access to critical air medical services 
and such other recommendations as the 
Comptroller General deems appropriate. 
‘‘(iii) LIMITATION.—The reports sub-
mitted under subclauses (i) and (ii) shall 
not include any information that the Sec-
retary or Comptroller General, respectively, 
determines is proprietary. 
‘‘(18) TEMPORARY INCREASE IN PAYMENT FOR 
AIR AMBULANCE SERVICES.— 
‘‘(A) INCREASE.— 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
‘‘(i) IN
GENERAL.—Subject to sub-
paragraph (B), in the case of air ambu-
lance services— 
‘‘(I) furnished during 2018, the 
Secretary shall provide for a percent 
increase of 12 percent in the base rate 
of the fee schedule established under 
this subsection for such air ambulance 
services; and 
‘‘(II) furnished during 2019 and 
2020, the Secretary shall provide for 
a percent increase of 20 percent in 
the base rate of the fee schedule es-
tablished under this subsection for 
such air ambulance services. 
‘‘(ii) 
APPLICATION.—The 
increase 
under clause (i) shall apply only with re-
spect to the year involved and the Sec-
retary shall not take into account such in-
crease in computing the payment amount 
under the fee schedule under this sub-
section for a subsequent year. 
‘‘(B) NO INCREASE FOR PROVIDERS AND 
SUPPLIERS THAT DO NOT REPORT DATA.—The 
Secretary shall not provide for the percent in-
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
crease under subparagraph (A) in the base rate 
of the fee schedule established under this sub-
section— 
‘‘(i) with respect to air ambulances 
services furnished by a supplier or provider 
of air ambulances services during 2019, 
unless the provider or supplier submits to 
the Secretary cost data in accordance with 
paragraph (17)(A) for such year; and 
‘‘(ii) with respect to air ambulances 
services furnished by a supplier or provider 
of air ambulances services during 2020, 
unless the provider or supplier submits to 
the Secretary cost data in accordance with 
paragraph (17)(A) and quality data in ac-
cordance with paragraph (17)(D) for such 
year. 
‘‘(19) 
REBASING
AIR
AMBULANCE
BASE 
RATE.—The Secretary shall, through rulemaking, 
provide for an update to the base rate of the fee 
schedule established under this subsection for air 
ambulance services, which shall be applied beginning 
with air ambulance services furnished during 2021, 
so that such rate reflects the actual costs of pro-
viding air ambulance services, consistent with cost 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
data submitted under paragraph (17)(A). In car-
rying out the previous sentence, the Secretary shall 
ensure that the aggregate data, methodology, and 
rationale applied for determining the updated base 
rate shall be made publicly available through rule-
making. The preceding sentence shall not be applied 
in a budget neutral manner. 
‘‘(20) VALUE-BASED PURCHASING PROGRAM.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish an air ambulance services value-based 
purchasing program (in this paragraph referred 
to as the ‘Program’). Under the Program, the 
Secretary shall— 
‘‘(i) for a performance period (as de-
fined in subparagraph (F)) with respect to 
a payment year (beginning with 2024), de-
termine the performance of each provider 
or supplier of air ambulance services, with 
respect to each quality measure described 
in paragraph (17)(E); 
‘‘(ii) for each such performance pe-
riod, establish performance benchmarks in 
accordance with subparagraph (B); 
‘‘(iii) for each such performance pe-
riod and each quality measure described in 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
paragraph (17)(E), establish a perform-
ance score for each provider or supplier of 
air ambulance services, that is determined 
by measuring the performance of such pro-
vider or supplier described in clause (i), 
with respect to each quality measure de-
scribed in such clause, against the per-
formance benchmark established under 
subparagraph (B) for such quality meas-
ure; 
‘‘(iv) for each such performance pe-
riod and provider or supplier of air ambu-
lance services, determine a composite per-
formance quality score, in accordance with 
subparagraph (C); 
‘‘(v) for each such performance pe-
riod, rank each provider or supplier of air 
ambulance services, based on the composite 
performance quality score of such provider 
or supplier for such period (as determined 
under subparagraph (C)), in order from 
highest to lowest; and 
‘‘(vi) for each such payment year 
specify a performance payment percentage 
point adjustment, in accordance with sub-
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
paragraph (D)(ii), for each provider or 
supplier of air ambulance services to be ap-
plied under subparagraph (D)(i). 
‘‘(B) 
PERFORMANCE
BENCHMARKS.— 
Under the Program, for each performance pe-
riod with respect to a payment year (beginning 
with payment year 2024), the Secretary shall 
establish a nationwide performance benchmark 
for each quality measure described in para-
graph (17)(E). Such a benchmark, with respect 
to such a quality measure, shall be the average 
of the performance scores for all such providers 
and suppliers for such measure. 
‘‘(C) COMPOSITE PERFORMANCE QUALITY 
SCORES.—Under the Program, for each per-
formance period with respect to a payment year 
(beginning with payment year 2024), the Sec-
retary shall determine a composite performance 
quality score for each provider or supplier of air 
ambulance services, based on the cumulative 
performance scores determined under subpara-
graph (A)(iii) for such provider or supplier and 
performance period. For purposes of ranking 
under subparagraph (A)(v), a provider or sup-
plier of air ambulance services who does not 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
submit required data to determine performance 
under this paragraph for a performance period 
for a year shall be treated as receiving a com-
posite performance quality score of zero under 
this subparagraph for such period and shall be 
ranked accordingly under subparagraph (A)(v). 
‘‘(D) PERFORMANCE PAYMENT.— 
‘‘(i) IN
GENERAL.—With respect to 
ambulance services furnished by a provider 
or supplier of air ambulance services dur-
ing a payment year (beginning with 2024), 
the Secretary shall apply a performance 
payment percentage point adjustment to 
the percentage increase determined under 
paragraph (3)(B), after application of 
paragraphs (3)(C), (17)(F), and (19) and 
subparagraph (E) for a payment year (be-
ginning with 2024). 
‘‘(ii) PERFORMANCE
PAYMENT
PER-
CENTAGE POINT ADJUSTMENT.—The Sec-
retary shall, in accordance with clause (iii), 
specify a performance payment percentage 
point adjustment for a provider or supplier 
of air ambulance services for a payment 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
year (beginning with 2024) which may in-
clude a zero percentage. 
‘‘(iii) REQUIREMENTS.—In specifying 
the performance payment percentage point 
adjustment for a provider or supplier of air 
ambulance services for a payment year 
under clause (i), the Secretary shall ensure 
that— 
‘‘(I) such adjustment is based on 
the ranking of the provider or supplier 
under subparagraph (A)(v) for the 
performance period for such payment 
year; 
‘‘(II) the application of all such 
adjustments in such fiscal year results 
in an appropriate distribution of per-
formance payment incentives applied 
under this paragraph such that— 
‘‘(aa) providers and sup-
pliers of air ambulance services 
with the highest rankings under 
subparagraph (A)(v) receive the 
highest payment increases under 
clause (i); and 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
‘‘(bb) providers and sup-
pliers of air ambulance services 
with the lowest rankings under 
subparagraph (A)(v) receive the 
lowest payment increases under 
clause (i), which may include 
zero; and 
‘‘(III) the total amount of in-
creases in payment under this sub-
section for all providers and suppliers 
of air ambulance services, pursuant to 
this subparagraph, in such payment 
year shall be equal to the sum of the 
total amount, as estimated by the Sec-
retary, of the reductions to payments 
under this subsection for such pay-
ment year pursuant to subparagraph 
(E) and the total amount, as esti-
mated by the Secretary, of the reduc-
tions 
made 
under 
paragraph 
(17)(F)(i) and made available under 
paragraph (17)(F)(iii)(I) for purposes 
of performance payments under this 
paragraph for such payment year. 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS
‘‘(E) FUNDING FOR PERFORMANCE INCEN-
TIVE ADJUSTMENTS.— 
‘‘(i) IN
GENERAL.—With respect to 
air ambulance services furnished by a sup-
plier or provider of air ambulance services 
during 2024 or a subsequent year, the Sec-
retary shall, after determining the percent-
age increase under paragraph (3)(B), and 
after application of paragraphs (3)(C), 
(17), and (19), shall reduce such percent-
age increase for payments under the fee 
schedule under this subsection otherwise 
applicable to such provider or supplier for 
services furnished by such provider or sup-
plier during such year by the applicable 
percent (as defined in clause (ii)). The Sec-
retary shall make such reductions for all 
providers and suppliers of air ambulance 
services in the year involved, regardless of 
whether or not the provider or supplier has 
been determined by the Secretary to have 
earned a performance payment percentage 
point adjustment under subparagraph (D) 
for such year. 
VerDate Sep 11 2014 
02:42 Aug 03, 2017
Jkt 069200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H3378.IH
H3378
lotter on DSKBCFDHB2PROD with BILLS