(b) REVIEW OF PAYMENTS FOR RURAL AMBULANCE 
SERVICES AND REPORT TO CONGRESS.— 
(1) REVIEW.—Not later than July 1, 2008, the 
Secretary of Health and Human Services shall re-
view the system for adjusting payments for rural 
ambulance services under section 1834(l)(16) of the 
Social Security Act, as added by subsection (a), to 
determine the adequacy and appropriateness of such 
adjustments. In conducting such review, the Sec-
retary shall consult with providers and suppliers af-
fected by such adjustments and with representatives 
of the ambulance industry generally to determine— 
(A) whether such adjustments adequately 
cover the additional costs incurred in serving 
areas of low population density; and 
(B) whether the tiered structure for mak-
ing such adjustments appropriately reflects the 
difference in costs of providing services in dif-
ferent types of rural areas. 
(2) REPORT.—Not later than January 1, 2009, 
the Secretary shall submit to Congress a report on 
the review conducted under paragraph (1) together 
with any recommendations for revision to the sys-
tems for adjusting payments for ambulance services
in rural areas that the Secretary of Health and 
Human Services determines appropriate. 
(c) 
CONFORMING
AMENDMENTS.—(1) 
Section 
1834(l) of the Social Security Act (42 U.S.C. 1395m(l)), 
as amended by subsection (a), is amended by adding at 
the end the following new paragraph: 
‘‘(17) DESIGNATION
OF
RURAL
AREAS
FOR 
MILEAGE PAYMENT PURPOSES.—In establishing any 
differential in the amount of payment for mileage 
between rural and urban areas in the fee schedule 
established under paragraph (1), the Secretary shall, 
in the case of ambulance services furnished on or 
after January 1, 2006, identify rural areas in the 
same manner as provided in paragraph (16)(B).’’. 
(2) Section 1834(l)(12)(A) of such Act (42 U.S.C. 
1395m(l)(12)(A)) is amended by striking ‘‘January 1, 
2010’’ and inserting ‘‘January 1, 2006’’. 
(3) Section 1834(l)(13)(A)(i) of such Act (42 U.S.C. 
1395m(l)(13)(A)(i)) is amended by inserting ‘‘(or in the 
case of such services furnished in 2006, in a rural area 
identified by the Secretary under paragraph (16)(B))’’ 
after ‘‘such paragraph’’.
SEC. 5. EXPANDING THE WORK OF MEDICARE QUALITY IM-
PROVEMENT ORGANIZATIONS TO INCLUDE 
AMBULANCE PROVIDERS. 
(a) APPLICATION TO AMBULANCE PROVIDERS.—Sec-
tion 1154(a)(1) of the Social Security Act (42 U.S.C. 
1320c–3(a)(1)) is amended by inserting ‘‘(including am-
bulance providers)’’ after ‘‘noninstitutional providers’’ in 
the matter preceding subparagraph (A). 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply on and after October 1, 2006. 
SEC. 6. INCLUDING AMBULANCE PROVIDERS IN THE DEFI-
NITION OF HEALTH CARE PROVIDER FOR 
PURPOSES 
OF 
THE 
UNIVERSAL 
SERVICE 
FUND. 
(a) IN GENERAL.—Section 254(h)(7)(B) of the Com-
munications Act of 1934 (47 U.S.C. 254(h)(7)(B)) is 
amended— 
(1) in clause (vi), by striking ‘‘and’’ at the end; 
(2) by redesignating clause (vii) as clause (viii); 
(3) in clause (viii), as so redesignated, by strik-
ing ‘‘(vi)’’ and inserting ‘‘(vii)’’; and 
(4) by inserting after clause (vi) the following 
new clause: 
‘‘(vii) ambulance providers; and’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2006.
SEC. 7. EMERGENCY MEDICAL SERVICES DEMONSTRATION 
PROJECT. 
(a) IN GENERAL.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’), acting through the Office of Rural 
Health Policy, shall award grants to States to en-
courage such States to make improvements to their 
emergency medical services (in this section referred 
to as ‘‘EMS’’) systems. 
(2) ADMINISTRATION REQUIREMENT.—In order 
to be eligible for a grant under this section, a State 
shall administer the project jointly through the State 
EMS office and the State rural health office. Either 
such office may be the lead office for the project. 
(3) NUMBER OF GRANTS.—The Secretary shall 
award 3 grants under this section. 
(4) MAXIMUM
AMOUNT.—The Secretary shall 
not award a grant under this section in an amount 
which exceeds $5,000,000. 
(5) DURATION.—The Secretary shall award 
grants under this section for a period not to exceed 
3 years. 
(b) TARGET.—A State that receives a grant under 
this section shall, in determining how to allocate the as-
sistance received through such grant—
(1) target such assistance to geographic areas 
that complete community EMS assessments and in-
formed self-determination processes; and 
(2) consider progress toward E–911 and WE– 
911 system capability. 
(c) USE OF FUNDS.—Subject to subsection (b), a 
State that receives a grant under this section may use as-
sistance received through such grant for the following: 
(1) To integrate the State EMS systems with 
the State and local health care delivery system, in-
cluding through exploring opportunities for ex-
panded EMS scopes of practice and piloting EMS- 
based rural community health services. 
(2) To explore alternative rural EMS funding 
mechanisms with State insurance authorities. 
(3) To form rural and frontier EMS operational 
or service-contracting networks. 
(4) To analyze rural and frontier workforce re-
cruitment and retention efforts and to develop state-
wide plans for improvement of such efforts. 
(5) To deliver a rural EMS leadership and 
management training model which includes EMS 
leadership, grant writing, data collection, research, 
governing board structure, and management of vol-
unteers.
(6) To establish at least one full-time position 
of State EMS medical director (or an equivalent po-
sition). 
(7) To develop flexible models for providing 
EMS training and continuing education to rural and 
frontier areas and to develop bridge training between 
EMS providers and the nursing or other allied 
health professions. 
(8) To develop State and regional stockpiling 
and sharing of expensive training devices, such as 
mannequins and patient simulators. 
(9) To develop and distribute, in partnership 
with public health agencies, data-driven public infor-
mation resources to local EMS providers. 
(10) To conduct comprehensive State EMS 
communications needs assessments. 
(11) To plan, integrate, and regulate, at the 
State level, aeromedical, critical care transport and 
other statewide or region wide systems of specialty 
care and transportation. 
(12) To consider the evolving role of telehealth 
resources and their application to EMS patient man-
agement and medical oversight. 
(13) To implement the National EMS Informa-
tion System.
(14) To link and integrate, at all levels, EMS 
data systems with other relevant health information 
systems, such as systems relating to traffic crash 
data and other crash data, public health surveil-
lance, the medical examiner, hospital discharge data, 
and emergency department data, and including the 
Centers for Disease Control and Prevention surveil-
lance monitoring systems. 
(d) APPLICATION.— 
(1) IN GENERAL.—Each State desiring a grant 
under this section shall submit an application to the 
Secretary at such time, in such manner, and accom-
panied by such information as the Secretary may 
reasonably require. 
(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
(A) describe the activities for which assist-
ance under this section is sought; 
(B) provide assurances to the Secretary 
that no law exists in the State that would pro-
hibit EMS personnel from practicing in non- 
ambulance settings; and 
(C) provide such additional assurances as 
the Secretary determines to be essential to en-
sure compliance with the requirements of this 
section. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated $15,000,000 to carry out 
this section. Not more than 10 percent of amounts re-
ceived under a grant awarded under this section may be 
used for administrative expenses. 
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