I 
114TH CONGRESS 
1ST SESSION 
H. R. 822 
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 
FEBRUARY 10, 2015 
Mr. SESSIONS (for himself, Mr. MEEKS, Mr. YOUNG of Indiana, and Mr. 
JOHNSON of Ohio) introduced 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 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. FINDINGS. 
The Congress finds the following: 
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(1) Air medical critical care transport is an es-
sential component of the healthcare system. 
(2) The presence of air medical services in rural 
areas provides tens of millions of rural Americans 
with access to critical care within an hour of injury. 
(3) As an emergency responder, air medical 
providers must maintain readiness 24 hours a day 
and 7 days a week. 
(4) Air medical providers transport all emergent 
patients for which they are dispatched regardless of 
insurance status or ability to pay. 
(5) The air ambulance fee schedule under the 
Medicare program was first implemented in 2002 
and developed through negotiated rulemaking, which 
required the new fee schedule to be created in a 
budget neutral manner. As such, the Medicare air 
ambulance fee schedule has never reflected true 
costs. 
(6) Since the implementation of the air ambu-
lance fee schedule under the Medicare program, re-
imbursements have only been adjusted by infla-
tionary updates averaging 2.2 percent a year. 
(7) Operational readiness and safety enhance-
ment costs have grown at a far faster rate than the 
Medicare inflationary updates, creating a funda-
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mental imbalance within the air ambulance fee 
schedule. 
(8) It is imperative that balance be restored to 
the air ambulance fee schedule to preserve access to 
timely care for tens of millions of Americans. 
SEC. 2. AIR AMBULANCE DATA REPORTING 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 
paragraph (16)’’; and 
(2) by adding at the end the following new 
paragraphs: 
‘‘(16) AIR AMBULANCE DATA REPORTING PRO-
GRAM.— 
‘‘(A) REDUCTION IN UPDATE FOR FAILURE 
TO REPORT.— 
‘‘(i) IN
GENERAL.—With respect to 
air ambulance services furnished by a sup-
plier or provider of air ambulance services 
during 2017 or any subsequent year, in the 
case the supplier or provider does not sub-
mit data to the Secretary in accordance 
with subparagraph (C) with respect to 
such year, after determining the percent-
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age increase under paragraph (3)(B), and 
after application of paragraph (3)(C), the 
Secretary shall reduce such percentage in-
crease for payments under the fee schedule 
under this subsection during such year by 
2.0 percentage points. 
‘‘(ii) SPECIAL RULE.—The application 
of this subparagraph may result in such 
percentage increase being less than 0.0 for 
a year, and may result in payment rates 
under the fee schedule under this sub-
section for a year being less than such pay-
ment rates for the preceding year. 
‘‘(B) 
NONCUMULATIVE
APPLICATION.— 
Any reduction under subparagraph (A) shall 
apply only with respect to the year involved and 
the Secretary shall not take into account such 
reduction in computing the payment amount 
under the fee schedule under this subsection for 
a subsequent year. 
‘‘(C) SUBMISSION
OF
DATA.—For 2017 
and each subsequent year, for purposes of this 
paragraph, each supplier or provider of air am-
bulance services shall submit to the Secretary 
data specified under subparagraph (D) for the 
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‘‘(xiii) Aircraft ownership expenses. 
‘‘(xiv) Safety enhancement capital 
costs. 
‘‘(xv) Safety enhancement recurring 
costs. 
‘‘(E) VOLUNTARY REPORTING ON QUALITY 
MEASURES.—Not later than January 1, 2018, 
the Secretary shall select no less than two qual-
ity measures with respect to which providers 
and suppliers of air ambulance services may 
voluntarily submit to the Secretary data. In se-
lecting such measures, the Secretary shall con-
sider the following: 
‘‘(i) Ventilator use in patients with 
advanced airways. 
‘‘(ii) Blood glucose check for altered 
mental status. 
‘‘(iii) Waveform capnography for ven-
tilated patients. 
‘‘(iv) First attempt tracheal tube suc-
cess. 
‘‘(v) DASH 1A-definitive airway sans 
hypoxia/hypotension on first attempt. 
‘‘(vi) Verification of tracheal tube 
placement. 
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‘‘(vii) Medication errors on transport. 
‘‘(viii) Rapid sequence intubation pro-
tocol compliance. 
‘‘(ix) Unplanned dislodgements of 
therapeutic devices. 
‘‘(x) Rate of serious reportable events. 
‘‘(xi) Medical equipment failure. 
‘‘(F) REPORTS.— 
‘‘(i) BY SECRETARY.—Not later than 
July 1, 2019, subject to clause (iii), the 
Secretary shall submit to Congress a re-
port on the data described in subparagraph 
(E) submitted to the Secretary. 
‘‘(ii) BY COMPTROLLER GENERAL.— 
Not later than July 1, 2019, subject to 
clause (iii), the Comptroller General of the 
United States shall submit to Congress a 
report on the data described in subpara-
graph (D) and subparagraph (E) sub-
mitted under this paragraph. Such report 
shall include a recommendation on the ade-
quate amount of reimbursement under this 
title to providers and suppliers of air am-
bulance services for furnishing such serv-
ices that would reflect operational costs of 
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such providers and suppliers and preserve 
access to critical air medical services and 
such other recommendations as the Comp-
troller 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. 
‘‘(17) INCREASE IN PAYMENT FOR AIR AMBU-
LANCE
SERVICES.—In the case of air ambulance 
services furnished on or after January 1, 2016, and 
before January 1, 2020, the Secretary shall provide 
for a percent increase in the base rate of the fee 
schedule established under this subsection— 
‘‘(A) during 2016, by 20 percent; and 
‘‘(B) during 2017 through 2019, by 5 per-
cent.’’. 
Æ 
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