I 
114TH CONGRESS 
1ST SESSION 
H. R. 817 
To suspend the implementation of zip code reclassifications for Medicare 
payment for ambulance services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 9, 2015 
Mr. NUNES (for himself, Mr. BOUSTANY, Mr. THOMPSON of California, Mr. 
LAMALFA, Mr. KELLY of Pennsylvania, Mr. VALADAO, Mr. COOK, and 
Mr. DEFAZIO) 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 suspend the implementation of zip code reclassifications 
for Medicare payment for ambulance services, 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 ‘‘Fairness in Ambulance 
Reimbursement Act of 2015’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) The Centers for Medicare & Medicaid Serv-
ices in both its proposed and final calendar year 
2015 physician fee schedule rules made adjustments 
to the geographic area designations used to calculate 
payments for ambulance providers and suppliers and 
misidentified the number of zip code designations 
that would be impacted by the change. 
(2) On July 11, 2014, the Centers for Medicare 
& Medicaid Services published a proposal (79 FR 
40375) informing the public that no zip codes in the 
State of California, only two zip codes in the State 
of Louisiana, and only one zip code in the State of 
Texas would be changed based on the Office of Man-
agement and Budget’s revised delineations and up-
dated Rural-Urban Commuting Area codes. 
(3) After publication of the zip code proposal, 
the public had 60 days to submit comments, per the 
requirements of the Administration Procedures Act. 
(4) On November 13, 2014, the Centers for 
Medicare & Medicaid Services published a final regu-
lation (79 FR 67748) informing the public, for the 
first time, that 3.45 percent of zip codes (or 94 zip 
codes) in the State of California, 13.67 percent of 
zip codes (or 101 zip codes) in the State of Lou-
isiana, 5.96 percent of zip codes (or 155 zip codes) 
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in the State of Texas, and 7.1 percent of zip codes 
(or 35 zip codes) in the State of Oregon would 
change based on the Office of Management and 
Budget’s revised delineations of the Rural-Urban 
Commuting Area codes. 
(5) This change from the data that was pub-
lished in the proposed rule to the data that was pub-
lished in the final rule did not afford the public 
proper notice and comment and therefore is an ap-
parent violation of the Administration Procedures 
Act. 
(6) Further, the corrected final list of zip code 
changes was not posted until December 4, 2014, less 
than a month before the new policy was imple-
mented on January 1, 2015, giving ambulance pro-
viders and suppliers insufficient time to prepare for 
the change in reimbursement. 
(7) The Centers for Medicare & Medicaid Serv-
ices also did not provide an impact analysis or cer-
tification determining whether there is a significant 
economic impact on small entities, as required by 
law. 
(8) These changes will result in nearly 9 per-
cent cut in reimbursement under the Medicare pro-
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gram for transports originating in areas losing rural 
status. 
SEC. 3. SUSPENSION OF IMPLEMENTATION OF RURAL TO 
URBAN ZIP CODE RECLASSIFICATIONS FOR 
MEDICARE PAYMENT FOR AMBULANCE SERV-
ICES. 
(a) SUSPENSION OF RURAL TO URBAN ZIP CODE 
RECLASSIFICATIONS.—Not later than July 1, 2015, the 
Secretary of Health and Human Services shall issue a no-
tice suspending through December 31, 2015, the imple-
mentation of the reclassification of rural to urban zip 
codes for payment for ambulance services under the fee 
schedule under section 1834(l) of the Social Security Act 
(42 U.S.C. 1395m(l)), as contained in the final rule pub-
lished by the Centers for Medicare & Medicaid Services 
in the Federal Register on November 13, 2014 (76 Fed. 
Reg. 67744 through 67750). The Secretary shall ensure, 
subject to subsection (d)(1), that claims for payment 
under the fee schedule under section 1834(l) of the Social 
Security Act (42 U.S.C. 1395m(l)) for ambulance services 
furnished during 2015 (beginning on July 1, 2015) are 
paid as if the reclassification of rural to urban zip codes 
applied under such final rule were the classification of zip 
codes applied the day before the effective date of such final 
rule. 
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(b) RECLASSIFICATIONS PURSUANT TO NOTICE AND 
COMMENT RULEMAKING.—Not later than November 1, 
2015, the Secretary of Health and Human Services shall, 
through notice and comment rulemaking, reclassify rural 
to urban zip codes for payment under the fee schedule 
under section 1834(l) of the Social Security Act (42 
U.S.C. 1395m(l)) for ambulance services furnished on or 
after January 1, 2016, taking into account the revised ge-
ographic delineations of the Office of Management and 
Budget, as described in the February 28, 2013 Office of 
Management and Budget Bulletin No. 13–01. 
(c) TREATMENT OF 2015 CLAIMS; BUDGET NEU-
TRALITY.— 
(1) TREATMENT OF 2015 CLAIMS.—Nothing in 
this section, or the amendment made by this section, 
shall be construed as instructing the Secretary of 
Health and Human Services to re-process any claims 
for payment under the fee schedule under section 
1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) for ambulance services furnished during 
2015. 
(2) BUDGET NEUTRALITY.— 
(A) DETERMINING AFFECT OF 2015 SUS-
PENSION.—The 
Secretary 
of 
Health 
and 
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Human Services shall estimate the amount, if 
any, by which— 
(i) the aggregate amount of payments 
under the fee schedule under section 
1834(l) of the Social Security Act (42 
U.S.C. 1395m(l)) for ambulance services 
furnished during 2015 after application of 
subsection (a), exceeds 
(ii) the aggregate amount of payments 
that would have been made under such fee 
schedule for such services furnished during 
such year if subsection (a) had not been 
enacted. 
(B) ADJUSTMENTS IN 2016.—If the Sec-
retary estimates the amount under clause (i) of 
subparagraph (A) exceeds the amount described 
in clause (ii) of such subparagraph, the Sec-
retary shall, through notice and comment rule-
making, adjust payments under the fee schedule 
under section 1834(l) of the Social Security Act 
(42 U.S.C. 1395m(l)) for ambulance services 
(other than air ambulance services) furnished 
during 2016 such that the total amount of such 
adjustments is equal to the amount by which 
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the amount described in such clause (i) exceeds 
the amount described in such clause (ii). 
Æ 
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