[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3236 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 3236

  To amend titles XI and XVIII of the Social Security Act to improve 
 provider and supplier cost reporting of ambulance services under the 
               Medicare program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 13, 2017

 Mr. Nunes (for himself and Mr. Upton) 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 improve 
 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 ``Ambulance Medicare Budget and 
Operations 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''; and
                    (B) by inserting ``providers and suppliers of 
                ground ambulance services,'' after ``health maintenance 
                organizations,''; and
            (2) by adding at the end the following new subsection:
    ``(d) In the case of a provider or supplier of ground ambulance 
services that furnishes such services for fewer than 20 individuals 
entitled to benefits under part A and enrolled under part B in a 
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) Hospital Provider Agreements.--Section 1866(a)(1) of the Social 
Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
            (1) in subparagraph (X), by striking ``Secretary, and'' and 
        inserting ``Secretary,'';
            (2) in subparagraph (Y)(ii)(V), by striking the period at 
        the end and inserting ``, and''; and
            (3) by inserting after subparagraph (Y) the following new 
        subparagraph:
            ``(Z) in the case of a hospital that is a provider of 
        ground ambulance services, with respect to such services 
        furnished for reporting periods (as defined by the Secretary) 
        on or after January 1, 2022, to make reports to the Secretary 
        of information described in section 1121(a) in accordance with 
        the uniform reporting system established under such section for 
        providers and suppliers of ground ambulance services.''.
    (c) Skilled Nursing Facility Provider Agreements.--Section 1819(d) 
of the Social Security Act (42 U.S.C. 1395i-3(d)) is amended by adding 
at the end the following new paragraph:
            ``(5) Ambulance services cost reporting.--A skilled nursing 
        facility that furnishes ground ambulance services, with respect 
        to such services furnished on or after January 1, 2022, 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 providers and suppliers of 
        ground ambulance services.''.
    (d) Home Health Agency Provider Agreements.--Section 1891(a) of the 
Social Security Act (42 U.S.C. 1395bbb(a)) is amended by adding at the 
end the following new paragraph:
            ``(7) In the case of an agency that furnishes ground 
        ambulance services, with respect to such services furnished on 
        or after January 1, 2022, the agency makes reports to the 
        Secretary of information described in section 1121(a) in 
        accordance with the uniform reporting system established under 
        such section for providers and suppliers of ground ambulance 
        services.''.
    (e) Suspension of Payment for Ground Ambulance Services.--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) Authority to suspend payments for ground ambulance 
        services.--
                    ``(A) In general.--Subject to subparagraphs (C) and 
                (D), in the case that the Secretary determines that a 
                supplier of ground ambulance services has not made to 
                the Secretary complete, accurate, and timely reports of 
                such services for reporting periods (as defined by the 
                Secretary) with respect to a year beginning with 2020 
                of information described in section 1121(a) in 
                accordance with the uniform reporting system 
                established under such section for providers and 
                suppliers of ground ambulance services and, as 
                determined appropriate by the Secretary, of any of the 
                information described in subparagraph (B), the 
                Secretary may suspend payments made under this 
                subsection, in whole or in part, to such supplier until 
                the Secretary determines that such supplier has 
                submitted such reports with respect to such reporting 
                period.
                    ``(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)):
                            ``(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) Any State regulations regarding 
                        requirements relating to the stocking of 
                        ambulances with certain equipment or drugs.
                            ``(iv) The average number of volunteer 
                        hours a week used by the supplier.
                    ``(C) Hardship delay.--The Secretary shall 
                establish a process whereby a supplier of ground 
                ambulance services may request a delay in reporting 
                information described in subparagraphs (A) and (B) with 
                respect to a reporting period for reason of significant 
                hardship (as determined by the Secretary).
                    ``(D) Authority to modify cost reporting elements 
                and enforcement.--Not earlier than January 1, 2023, the 
                Secretary may, after 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 reporting of ground ambulance services by 
                a supplier or category of suppliers (as specified for 
                purposes of the report submitted under such section) 
                should be required or modified, and through notice and 
                comment rulemaking, provide that subparagraph (A) no 
                longer applies to ground ambulance services suppliers 
                or such a category of such suppliers.''.
    (f) Stakeholder Feedback.--
            (1) In general.--The Secretary 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 notice and comment rulemaking carried out under paragraph 
        (1).

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 ambulance 
services cost reporting 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 the accuracy 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 reporting of 
        ambulance services by providers, suppliers, or a category of 
        suppliers (as specified by the Secretary) 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.

    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''; and
            (2) in paragraph (13)(A), by striking ``2018'' each place 
        it appears and inserting ``2023''.
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