Title: Comprehensive Operations, Sustainability, and Transport Act of 2017
Policy area: Health

Summary:
Comprehensive Operations, Sustainability, and Transport Act of 2017
This bill modifies Medicare payment rules and reporting requirements with respect to ground-ambulance services.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3729 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 3729

 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 
following 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 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
 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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Comprehensive Operations, 
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 purposes 
                of'';
                    (B) by inserting ``suppliers of ground ambulance 
                services,'' after ``health maintenance 
                organizations,''; and
                    (C) in the matter at the end, by adding the 
                following new sentence: ``Not later than December 31, 
                2019, the Secretary shall modify the uniform reporting 
                system for providers of services with respect to 
                ambulance services to ensure that such system contains 
                information similar (as determined by the Secretary) to 
                information required under the uniform reporting system 
                for suppliers of ground ambulance services.''; and
            (2) by adding at the end the following new subsection:
    ``(d) In the case of a supplier of ground ambulance services that 
furnishes such services for fewer than 20 individuals 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 system established under this section with respect to 
such services.''.
    (b) Suspension of Payment for Ground Ambulance Services; Deeming 
Certain Payments Overpayments.--Section 1834(l) of the Social Security 
Act (42 U.S.C. 1395m(l)) is amended by adding at the end the following 
new paragraph:
            ``(17) Requirement to submit cost report and authority to 
        suspend payments and deem certain payments overpayments for 
        ground ambulance services.--
                    ``(A) In general.--With respect to ground ambulance 
                services furnished by a supplier of such services 
                during cost reporting periods 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 uniform reporting system 
                established under such section for such suppliers and, 
                as may be required by the Secretary, of any of the 
                information described in subparagraph (B).
                    ``(B) Additional information.--The Secretary may, 
                with respect to a supplier of ground ambulance 
                services, require the following information (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 governmental 
                        organization, or another type of entity (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 
                determines that a supplier of ground ambulance services 
                has not made to the Secretary a timely report described 
                in subparagraph (A) with respect 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 overpayments.--
                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 reason of significant 
                hardship (as determined by the Secretary).
                    ``(F) Authority to modify cost reporting elements 
                and enforcement.--Not earlier than January 1, 2023, the 
                Secretary may provide that subparagraph (D) no longer 
                applies to ground ambulance services suppliers or a 
                category of such suppliers after--
                            ``(i) taking into account the 
                        recommendation of the Medicare Payment Advisory 
                        Commission in the most recent report available 
                        to the Secretary submitted under section 3 of 
                        the Ambulance Medicare Budget and Operations 
                        Act of 2017 regarding whether cost reports made 
                        by suppliers or a category of suppliers (as 
                        specified 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 Secretary shall 
                audit reports described in subparagraph (A) submitted 
                with respect to cost reporting periods beginning on or 
                after January 1, 2021.
                    ``(H) Appeals.--The Secretary shall establish a 
                process whereby a supplier of ground ambulance services 
                may appeal a determination described in subparagraph 
                (C) or (D) made with respect to a cost report required 
                to be made by such supplier under subparagraph (A).''.
    (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 section 1121(a) 
                of the Social Security Act (42 U.S.C. 1320a(a)) for 
                suppliers of ground ambulance services and reports 
                required to be made under section 1834(l)(17) of such 
                Act (42 U.S.C. 1395m(l)(17)); and
                    (B) the modification of the uniform reporting 
                systems under such section 1121(a) of such Act for 
                providers of such services and reports required 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 appropriated to the 
        Secretary from the Federal Hospital Insurance Trust Fund under 
        section 1817 of the Social 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 requirement 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 amendments 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 Services Program Management Account, 
        from the Supplemental 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 accordance with sections 1121(a) and 1834(l) of the 
Social Security Act (42 U.S.C. 1320a(a), 1395m(l)) and the adequacy of 
payments for such services made under section 1834(l) of such Act.
    (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 reports 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 EXTENDERS AND PAY-FOR.

    Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) is 
amended--
            (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 beginning on October 
        1, 2013, and ending on September 30, 2018, and by 32 percent 
        for such services furnished on or after October 1, 2018''.
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