Title: Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2019
Policy area: Health

Summary:
Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2019
This bill establishes a series of requirements relating to coverage of ground ambulance services under Medicare.
Specifically, the Centers for Medicare & Medicaid Services (CMS) must continue to designate an area as a rural or qualified rural area that is eligible for increased payment under Medicare, even if the area would otherwise no longer qualify for such designation, if the area has a specified population density. The CMS must also establish an administrative process to allow ambulance service providers to appeal a change in an area's designation.
The bill also requires the CMS to (1) expand to all states a prior authorization model for repetitive scheduled nonemergent ambulance transport, in accordance with specified limitations, if such an expansion has not already occurred by a certain date; (2) increase payment rates for ground ambulance services; and (3) eliminate certain administrative requirements for such services.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4938 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 4938

 To amend title XVIII to strengthen ambulance services furnished under 
                    part B of the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 31, 2019

 Ms. Sewell of Alabama (for herself, Mr. Nunes, Mr. Welch, Mr. Mullin, 
 and Mr. Blumenauer) 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 to strengthen ambulance services furnished under 
                    part B of the Medicare program.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Ambulance 
Access, Fraud Prevention, and Reform Act of 2019''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
         TITLE I--PROTECT ACCESS TO HIGH QUALITY AMBULANCE CARE

Sec. 101. Reform to the Medicare ambulance fee schedule.
Sec. 102. National expansion of prior authorization model for 
                            repetitive scheduled non-emergent ambulance 
                            transport.
     TITLE II--REDUCE ADMINISTRATIVE BURDENS TO EXPAND PATIENT CARE

Sec. 201. Elimination of duplicative paperwork requirements in the 
                            Medicare ambulance benefit.
  TITLE III--LEVERAGE AMBULANCE SERVICES TO PROTECT ACCESS TO CARE IN 
                             RURAL AMERICA

Sec. 301. Protecting access to ambulance services in rural and low 
                            population density areas.

         TITLE I--PROTECT ACCESS TO HIGH QUALITY AMBULANCE CARE

SEC. 101. REFORM TO THE MEDICARE AMBULANCE FEE SCHEDULE.

    (a) In General.--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:
            ``(18) Increase in conversion factor for ground ambulance 
        services.--In the case of ground ambulance services furnished 
        on or after January 1, 2020, for purposes of determining the 
        fee schedule amount for such services under this subsection, 
        the conversion factor otherwise applicable to such services 
        shall be increased by--
                    ``(A) with respect to ground ambulance services for 
                which the transportation originates in a qualified 
                rural area, as identified using the methodology 
                described in paragraph (12)(B)(iii), 25.6 percent;
                    ``(B) with respect to ground ambulance services not 
                described in subparagraph (A) and for which the 
                transportation originates in a rural area described 
                under paragraph (9) or in a rural census tract 
                described in such paragraph, 3 percent; and
                    ``(C) with respect to ground ambulance services not 
                described in subparagraph (A) or (B), 2 percent.
            ``(19) Increase in mileage rate for ground ambulance 
        services.--In the case of ground ambulance services furnished 
        on or after January 1, 2020, for purposes of determining the 
        fee schedule amount for such services under this subsection, 
        the payment rate for mileage otherwise applicable to such 
        services shall be increased by--
                    ``(A) with respect to ground ambulance services for 
                which the transportation originates in a qualified 
                rural area, as identified using the methodology 
                described in paragraph (12)(B)(iii), 3 percent;
                    ``(B) with respect to ground ambulance services not 
                described in subparagraph (A) and for which the 
                transportation originates in a rural area described 
                under paragraph (9) or in a rural census tract 
                described in such paragraph, 3 percent; and
                    ``(C) with respect to ground ambulance services not 
                described in subparagraph (A) or (B), 2 percent.''.
    (b) Study and Report.--
            (1) Study.--The Secretary of Health and Human Services 
        shall conduct a study on how the conversion factor applicable 
        to ground ambulance services under the ambulance fee schedule 
        under section 1834(l) of the Social Security Act (42 U.S.C. 
        1395m(l)), as adjusted under paragraph (18) of such section (as 
        added by subsection (a)), should be modified, if at all, to 
        take into account the cost of providing services in urban, 
        rural, and super-rural areas. In determining such costs, the 
        Secretary shall use the data collected through the data 
        collection system under paragraph (17) of such section.
            (2) Report.--Not later than January 1, 2022, the Secretary 
        of Health and Human Services shall submit to Congress a report 
        on the study conducted under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines appropriate.

SEC. 102. NATIONAL EXPANSION OF PRIOR AUTHORIZATION MODEL FOR 
              REPETITIVE SCHEDULED NON-EMERGENT AMBULANCE TRANSPORT.

    (a) In General.--Section 1834(l)(16) of the Social Security Act (42 
U.S.C. 1395m(l)(16)) is amended--
            (1) by redesignating subparagraphs (B) and (C) as 
        subparagraphs (C) and (D), respectively; and
            (2) by inserting after subparagraph (A) the following new 
        subparagraph:
                    ``(B) Permanent expansion.--
                            ``(i) If by July 1, 2019, the Secretary has 
                        not already expanded to all States the model of 
                        prior authorization described in paragraph (2) 
                        of section 515(a) of the Medicare Access and 
                        CHIP Reauthorization Act of 2015, by January 1, 
                        2020, the Secretary shall expand the prior 
                        authorization model to all States using notice 
                        and comment rulemaking, regardless of whether 
                        or not the expansion meets the requirements 
                        described in paragraphs (1) through (3) of 
                        section 1115A(c).
                            ``(ii) If the Secretary expands the model 
                        of prior authorization under this 
                        subparagraph--
                                    ``(I) the prior authorization shall 
                                be limited to ambulance services 
                                consisting of non-emergency basic life 
                                support services involving transport of 
                                an individual with end-stage renal 
                                disease for renal dialysis services (as 
                                described in section 1881(b)(14)(B)) 
                                furnished other than on an emergency 
                                basis; and
                                    ``(II) in making the prior 
                                authorization determination with 
                                respect to a service and individual, 
                                the Secretary shall evaluate the 
                                medical necessity of the service by 
                                determining--
                                            ``(aa) whether the 
                                        individual is unable to get up 
                                        from bed without assistance, 
                                        unable to ambulate, and unable 
                                        to sit in a chair or 
                                        wheelchair;
                                            ``(bb) whether the 
                                        individual has a medical 
                                        condition that, regardless of 
                                        bed confinement, is such that 
                                        transport by ambulance is 
                                        medically necessary; or
                                            ``(cc) whether the 
                                        individual meets other criteria 
                                        as determined appropriate by 
                                        the Secretary.''.

     TITLE II--REDUCE ADMINISTRATIVE BURDENS TO EXPAND PATIENT CARE

SEC. 201. ELIMINATION OF DUPLICATIVE PAPERWORK REQUIREMENTS IN THE 
              MEDICARE AMBULANCE BENEFIT.

    Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)), as 
amended by section 101, is further amended by adding the following new 
paragraph:
            ``(20) Reducing administrative burden.--No later than July 
        1, 2020--
                    ``(A) The Secretary shall through notice and 
                comment rulemaking eliminate the following requirements 
                to reduce the burden on ambulance services providers 
                and suppliers:
                            ``(i) The vehicle section and the `extra' 
                        practice locations for emergency medical 
                        services section of the 855B Ambulance 
                        Enrollment Form required under section 424.505 
                        of title 42, Code of Federal Regulations (or 
                        successor regulations).
                            ``(ii) The requirement that individuals 
                        sign ambulance service claims under section 
                        424.36 of title 42, Code of Federal Regulations 
                        (or successor regulations), when other 
                        documentation establishing that the individual 
                        received the ambulance services is available.
                    ``(B) Not later than July 1, 2020, the Secretary 
                shall through notice and comment rulemaking--
                            ``(i) require ambulance providers and 
                        suppliers to update the 855B Ambulance 
                        Enrollment Form required under section 424.505 
                        of title 42, Code of Federal Regulations (or 
                        successor regulations), no more than once a 
                        calendar year; and
                            ``(ii) establish a process to take into 
                        account inaccuracies in Social Security records 
                        or other official death records before revoking 
                        billing authority for ambulance providers and 
                        suppliers under section 424.535 of title 42, 
                        Code of Federal Regulations (or successor 
                        regulations).''.

  TITLE III--LEVERAGE AMBULANCE SERVICES TO PROTECT ACCESS TO CARE IN 
                             RURAL AMERICA

SEC. 301. PROTECTING ACCESS TO AMBULANCE SERVICES IN RURAL AND LOW 
              POPULATION DENSITY AREAS.

    Section 1834(l)(12) of the Social Security Act (42 U.S.C. 
1395m(l)(12)) is amended by adding at the end the following new 
subparagraphs:
                    ``(C) Exception for rural and qualified rural 
                areas.--The Secretary shall deem an area designated as 
                a rural or qualified rural area under this paragraph 
                that would otherwise no longer receive such designation 
                to retain its previous designated status if there are 
                1,000 or fewer individuals per square mile in the area.
                    ``(D) Right to appeal rural areas and qualified 
                rural areas.--The Secretary shall establish an 
                administrative appeals process to allow ambulance 
                services providers and suppliers to seek 
                reconsideration of a change in a ZIP code's status as a 
                rural or qualified rural area during the first 12 
                months after the Secretary finalizes a change in the 
                designation made under this paragraph.''.
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