[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5153 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5153

  To amend title XVIII of the Social Security Act to ensure adequate 
  payment rates for ambulance services, to apply a prudent layperson 
   standard to the determination of medical necessity for emergency 
ambulance services, and to recognize the additional costs of providing 
                   ambulance services in rural areas.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 12, 2000

   Mr. Houghton (for himself, Mr. Minge, Mr. Stupak, and Mrs. Kelly) 
 introduced the following bill; which was referred to the Committee on 
  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 ensure adequate 
  payment rates for ambulance services, to apply a prudent layperson 
   standard to the determination of medical necessity for emergency 
ambulance services, and to recognize the additional costs of providing 
                   ambulance services in rural areas.

    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 ``Medicare Access to Ambulance 
Services Act of 2000''.

SEC. 2. PAYMENT RATES.

    (a) In General.--Section 1834(l)(3) of the Social Security Act (42 
U.S.C. 1395m(l)(3)) is amended to read as follows:
            ``(3) Payment rates.--
                    ``(A) Ground and air ambulance payment rates.--
                Subject to the succeeding provisions of this paragraph, 
                in establishing such fee schedule, the Secretary 
                shall--
                            ``(i) set the payment rates provided under 
                        the fee schedule for ground ambulance services 
                        furnished under this part during 2001 at a rate 
                        based on the average costs (as determined by 
                        the Secretary based on a study performed by an 
                        independent research organization of such 
                        costs, adjusted for inflation if necessary) 
                        incurred by full cost ambulance suppliers in 
                        providing nonemergency basic life support 
                        ambulance services covered under this title, 
                        with adjustments to the rates for other service 
                        levels to be determined based on the rule 
                        negotiated in accordance with paragraph (1); 
                        and
                            ``(ii) set the payment amounts provided 
                        under the fee schedule for all ambulance 
                        services furnished in 2002 and each subsequent 
                        year at amounts equal to the payment amounts 
                        under the fee schedule for services furnished 
                        during the previous year, increased by the 
                        percentage increase in the Consumer Price Index 
                        for all urban consumers (United States city 
                        average) for the 12-month period ending with 
                        June of the previous year.
                    ``(B) Study and report on the costs of rural 
                ambulance services.--
                            ``(i) Study.--The Secretary, in 
                        consultation with the Office of Rural Health 
                        Policy, shall conduct a study of the means by 
                        which rural areas with low population densities 
                        can be identified for the purpose of 
                        designating areas in which the cost of 
                        providing ambulance services would be expected 
                        to be higher than similar services provided in 
                        more heavily populated areas because of low 
                        usage. Such study shall also include an 
analysis of the additional costs of providing ambulance services in 
areas designated under the previous sentence.
                            ``(ii) Report.--Not later than June 30, 
                        2001, the Secretary shall submit to Congress a 
                        report on the results of the study conducted 
                        under this section, together with a regulation 
                        based on that study which adjusts the fee 
                        schedule payment rates for ambulance services 
                        provided in low density rural areas based on 
                        the increased cost of providing such services 
                        in such areas.
                            ``(iii) Implementation of regulation.--The 
                        regulation submitted under clause (ii) shall 
                        become effective not later than January 1, 
                        2002.
                    ``(C) Interim payments for rural ground ambulance 
                services.--Notwithstanding subparagraph (A)(i) of this 
                paragraph, until such time as the fee schedule 
                established under this subsection is modified by the 
                regulation under subparagraph (B), the amount of 
                payment under this subsection for ground ambulance 
                services provided in a rural area (as defined in 
                section 1886(d)(2)(D)) shall be the greater of--
                            ``(i) the amount determined under the fee 
                        schedule established under this subsection 
                        (without regard to any phase-in established 
                        pursuant to paragraph (2)(E)); or
                            ``(ii) the amount that would have been paid 
                        for such service if the amendments made by 
                        section 4531(b) of the Balanced Budget Act of 
                        1997 had not been enacted;
                as adjusted for inflation pursuant to subparagraph 
                (A)(ii). For purposes of this subparagraph, an 
                ambulance trip shall be considered to have been 
                provided in a rural area only if the transportation of 
                the patient originated in a rural area.''.
    (b) Conforming Amendments.--Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
            (1) in subparagraph (R)--
                    (A) by inserting ``except as provided in 
                subparagraph (T),'' before ``with respect''; and
                    (B) by striking ``and'' at the end; and
            (2) in subparagraph (S), by striking the semicolon at the 
        end and inserting ``, and (T) with respect to ambulance 
        services described in section 1834(l)(3)(C), the amount paid 
        shall be 80 percent of the lesser of the actual charge for the 
        services or the amount determined under such section;''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to services provided on and after January 1, 2001.

SEC. 3. PRUDENT LAYPERSON STANDARD FOR EMERGENCY AMBULANCE SERVICES.

    (a) In General.--Section 1861(s)(7) of the Social Security Act (42 
U.S.C. 1395x(s)(7)) is amended by striking ``regulations;'' and 
inserting ``regulations, except that such regulations shall not fail to 
treat ambulance services as medical and other health services solely 
because the ultimate diagnosis of the individual receiving the 
ambulance services results in the conclusion that ambulance services 
were not necessary, as long as the request for ambulance services is 
made after the sudden onset of a medical condition that is manifested 
by symptoms of such sufficient severity, including severe pain, that a 
prudent layperson, who possesses an average knowledge of health and 
medicine, could reasonably expect to result, without immediate medical 
attention, in--
                    ``(A) placing the individual's health in serious 
                jeopardy;
                    ``(B) serious impairment to the individual's bodily 
                functions; or
                    ``(C) serious dysfunction of any bodily organ or 
                part of the individual;''.
    (b) Effective Date.--The amendment made by this section shall apply 
with respect to services provided on and after the date of enactment of 
this Act.
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