[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 228 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                 S. 228

  To amend title XVIII of the Social Security Act to restructure the 
 payment adjustment for non-emergency ESRD ambulance transports under 
                         the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

             January 25 (legislative day, January 24), 2019

Mr. Cassidy (for himself and Mr. Jones) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to restructure the 
 payment adjustment for non-emergency ESRD ambulance transports under 
                         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.

    This Act may be cited as the ``Non-Emergency Ambulance 
Transportation Sustainability and Accountability (NEATSA) Act of 
2019''.

SEC. 2. RESTRUCTURE OF MEDICARE PAYMENT ADJUSTMENT FOR NON-EMERGENCY 
              ESRD AMBULANCE TRANSPORTS.

    (a) In General.--Section 1834(l)(15) of the Social Security Act (42 
U.S.C. 1395m(l)(15)) is amended to read as follows:
            ``(15) Restructure of payment adjustment for non-emergency 
        ambulance transports for esrd beneficiaries.--
                    ``(A) In general.--In the case of applicable 
                ambulance services, the fee schedule amount otherwise 
                applicable under the preceding provisions of this 
                subsection shall be reduced as follows:
                            ``(i) In the case of applicable ambulance 
                        services furnished during the period beginning 
                        on October 1, 2013, and ending on December 31, 
                        2018, reduced by 10 percent.
                            ``(ii) In the case of applicable ambulance 
                        services furnished during 2019, reduced by 15.5 
                        percent.
                            ``(iii) In the case of applicable ambulance 
                        services furnished during 2020 or a subsequent 
                        year--
                                    ``(I) by a provider or supplier of 
                                ambulance services that the Secretary 
                                has designated under subparagraph (C) 
                                for the year and for which such 
                                transport originates in an area not 
                                described in paragraph (13)(A)(i), 
                                reduced by 29.5 percent; or
                                    ``(II) that are not described in 
                                subclause (I), reduced by 15.5 percent.
                    ``(B) Applicable ambulance services.--In this 
                paragraph, the term `applicable ambulance services' 
                means 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 by a provider of services or a renal dialysis 
                facility.
                    ``(C) Designation.--
                            ``(i) In general.--For 2020 and each 
                        subsequent year, the Secretary shall designate 
                        the providers or suppliers of ambulance 
                        services for which the total payments made to 
                        the provider or supplier for applicable 
                        ambulance services furnished during the 
                        applicable period for the year makes up at 
                        least 50 percent of the total payments made to 
                        the provider or supplier under this part for 
                        all ambulance services furnished during such 
                        applicable period.
                            ``(ii) Methodology.--The Secretary shall, 
                        through notice and comment rulemaking, 
                        establish the methodology for designating 
                        providers and suppliers under clause (i) for a 
                        year. Under such methodology, the applicable 
                        period for a year shall be a 12-month period 
                        determined by the Secretary that begins and 
                        ends prior to the beginning of such year.
                            ``(iii) Timing.--Not later than November 1 
                        of each year (beginning with 2019), the 
                        Secretary shall notify any provider or supplier 
                        that will be designated under clause (i) for 
                        the subsequent year.
                            ``(iv) Targeted review.--The Secretary 
                        shall establish a process under which a 
                        provider or supplier may seek an informal 
                        review of the designation under clause (i) with 
                        respect to the provider or supplier.
                            ``(v) Public reporting.--Beginning in 2021, 
                        the Secretary shall, in an easily 
                        understandable format, make available on the 
                        Internet website of the Centers for Medicare & 
                        Medicaid Services the following:
                                    ``(I) The total number of claims 
                                paid under this part for applicable 
                                ambulance services.
                                    ``(II) The total number of claims 
                                paid under this part for applicable 
                                ambulance services that were subject to 
                                the payment reduction under 
                                subparagraph (A)(iii), broken out for 
                                each of subclauses (I) and (II) of such 
                                subparagraph.
                                    ``(III) The total number of 
                                providers and suppliers that were 
                                designated under clause (i).
                                    ``(IV) Any other data regarding 
                                applicable ambulance services that the 
                                Secretary determines appropriate.''.
    (b) GAO Study and Report.--
            (1) In general.--The Comptroller General of the United 
        States (in this subsection referred to as the ``Comptroller 
        General'') shall conduct a study on payments under section 
        1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) for 
        applicable ambulance services (as defined in subparagraph (B) 
        of paragraph (15) of such section, as added by subsection (a)). 
        Such study shall include an analysis of the impact of the 
        amendment made by subsection (a), including the impact on 
        beneficiary access and any steps providers and suppliers of 
        ambulance services have taken to avoid payment reductions under 
        such paragraph (15).
            (2) Report.--Not later than March 1, 2023, the Comptroller 
        General shall submit to Congress a report containing the 
        results of the study conducted under paragraph (1), together 
        with recommendations for such legislation and administrative 
        action as the Comptroller General determines appropriate.
                                 <all>