To amend title XVIII of the Social Security Act to ensure appropriate payments for ambulance services under the Medicare program.

To amend title XVIII of the Social Security Act to ensure appropriate payments for ambulance services 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.

SEC. 2. Ambulance services payments.

(1) in paragraph (1)—

(A) by inserting “, for years before 2027,” after “under this part through”; and

(B) by inserting “(and for each year, beginning with 2027, by regulation)” after “title 5, United States Code,”;

(2) in paragraph (2)(D), by inserting “and, beginning for 2028, in accordance with paragraph (18), determine and apply updated payment amounts (as defined in subparagraph (A)(ii) of such paragraph) and the adjustments described in such paragraph” after “and other relevant factors”;

(3) in paragraph (3)—

(A) in subparagraph (B)—

(i) by inserting “(before 2028)” after “each subsequent year”; and

(ii) by striking “and” after the semicolon;

(B) in subparagraph (C)—

(i) by inserting “(before 2028)” after “each subsequent year”; and

(ii) by striking the period at the end and inserting a semicolon; and

(C) by inserting at the end the following:

“(D) for services furnished in 2028, substitute the updated payment amounts (as defined in paragraph (18)(A)(ii)) for such services as the payment amounts provided under the fee schedule for such services; and

“(E) set the payment amounts provided under the fee schedule for services furnished in 2029 and each subsequent year at amounts equal to the payment amounts under the fee schedule for services furnished during the previous year, updated by the adjustments or increase applicable to such year in accordance with clause (ii) or (iii), respectively, of paragraph (18)(B).”;

(4) in paragraph (4), by inserting “including for purposes of carrying out the provisions of paragraph (18),” after “under this subsection,”;

(5) in paragraph (15), by striking “the preceding provisions of” after “amount otherwise applicable under”;

(6) in paragraph (17)—

(A) in subparagraph (D)—

(i) in clause (i)—

(I) by inserting “(or, in the case of a provider or supplier of air ambulance services, beginning January 1 of the year subsequent to the first year for which such providers and suppliers are required to submit information pursuant to subparagraph (E)(ii)(II)),” after “Beginning January 1, 2022,”;

(II) by redesignating subclauses (I) and (II) as items (aa) and (bb), respectively, and moving the margin of each such item, as redesignated, 2 ems to the right;

(III) by striking “(as defined in clause (ii)) to a provider or supplier of ground ambulance services” and inserting “ “(as defined in clause (ii))—

“(I) to a provider or supplier of ground ambulance services”;

(IV) by striking at the end the period and inserting “; and”; and

(V) by adding at the end the following new subclause:

“(II) to a provider or supplier of air ambulance services that—

“(aa) is required to submit information for a year determined by the Secretary under subparagraph (E)(ii)(II); and

“(bb) does not sufficiently submit such information, as determined by the Secretary.”;

(ii) in clause (ii)—

(I) by inserting “or a provider or supplier of air ambulance services” after “with respect to a provider or supplier of ground ambulance services”;

(II) by striking “made a determination under clause (i)(II)” and inserting “ “made—

“(I) in the case of a provider or supplier of ground ambulance services, a determination under clause (i)(I)(bb)”;

(III) by striking at the end the period and inserting “; or”; and

(IV) by adding at the end the following new subclause:

“(II) in the case of a provider or supplier of air ambulance services, a determination under clause (i)(II)(bb) that the provider or supplier of air ambulance services failed to sufficiently submit information as described in clause (i)(II)(aa).”;

(iii) in clause (iii)—

(I) by inserting “of ground ambulance services or a provider or supplier of air ambulance services” after “may exempt a provider or supplier”; and

(II) by inserting “or provider or supplier of air ambulance services, respectively,” after “ability of the provider or supplier of ground ambulance services”; and

(iv) in clause (iv), by inserting “or air ambulance services” after “ground ambulance services”;

(B) in subparagraph (E)—

(i) in clause (ii)—

(I) by striking “shall require” and inserting “ “shall—

“(I) require”;

(II) by striking at the end the period and inserting “; and”; and

(III) by adding at the end the following new subclause:

“(II) require providers and suppliers of air ambulance services to submit, in such form and manner and at such time as specified by the Secretary in accordance with clause (iii), information described in section 106(a)(2) of the No Surprises Act for years after the last NSA reporting year (as defined in clause (iv)) as the Secretary determines appropriate, but in no case less often than once every 3 years.”; and

(ii) by adding at the end the following new clauses:

“(iii) APPLICATION TO AIR AMBULANCE SERVICES.—In carrying out clause (ii)(II), the Secretary—

“(I) may, as the Secretary determines appropriate, use the data collection system under subparagraph (A) to provide for a single process for the submission of information under this paragraph, including information described in such clause with respect to providers and suppliers of air ambulance services; and

“(II) shall, to the greatest extent practicable, align the years for which information is required to be submitted under such clause with the years for which information is required to be submitted under clause (ii)(I).

“(iv) LAST NSA REPORTING YEAR.—For purposes of clause (ii)(II), the term ‘last NSA reporting year’ means the year with respect to which information is required to be submitted under section 106(a)(1)(B) of the No Surprises Act.”; and

(C) in subparagraph (F)(i), by striking “thereafter,, such” and inserting “thereafter, such”; and

(7) by adding at the end the following:

“(18) UPDATING FEE SCHEDULE TO REFLECT MOST RECENTLY AVAILABLE DATA.—

“(A) INITIAL REVIEW AND REVISIONS.—

“(i) IN GENERAL.—To improve the valuation of ground ambulance services and air ambulance services under this subsection the Secretary shall review the relative value units, conversion factor, air ambulance base rates, and the mileage rates applied under the fee schedule under this subsection and shall, by regulation and taking into account the information required under subparagraph (C), make such adjustments as are necessary to ensure that such relative value units, conversion factor, base rates, and mileage rates that are applied under the fee schedule for 2028 with respect to ground ambulance services and with respect to air ambulance services, as applicable, reflect the costs (including labor-related costs and costs related to uncompensated care), expenses, and resources used in furnishing the respective ambulance service.

“(ii) UPDATED PAYMENT AMOUNTS DEFINED.—For purposes of this subsection, the term ‘updated payment amounts’ means the payment amounts determined, with application of the adjustments pursuant to clause (i), under the fee schedule under this subsection for 2028.

“(B) ONGOING REVIEW AND ADJUSTMENTS.—

“(i) TRIENNIAL REVIEW.—For each data-based adjustment year (as defined in clause (iv)), with respect to ground ambulance services and with respect to air ambulance services, the Secretary shall review the relative value units, conversion factor, air ambulance base rates, and the mileage rates (or any successor to or replacement for such units, factor, or rates, including under any payment methodology developed pursuant to this subsection that is different from the methodology in effect as of the date of enactment of this paragraph), as applicable to the respective services, established under the fee schedule under this subsection.

“(ii) TRIENNIAL ADJUSTMENTS BASED ON UPDATED FACTORS AND DATA.—For determining payment amounts under the fee schedule under this subsection for ground ambulance services and air ambulance services furnished during a data-based adjustment year, the Secretary shall, based on the review under clause (i) with respect to such year and taking into account the information required under subparagraph (C), by regulation adjust the number of relative value units, conversion factor, air ambulance base rates, mileage rates (or any successor to or replacement for such units, factor, or rates, including under any payment methodology developed pursuant to this subsection that is different from the methodology in effect as of the date of enactment of this paragraph), or any combination thereof, as applicable to the respective services, to take into account changes in medical practice, changes in technology, the addition of new services, new data on relative value components, new cost data (including on labor-related costs and costs related to uncompensated care), and other relevant information and factors. The Secretary shall publish in the Federal Register an explanation of the basis for such adjustments made for a data-based adjustment year.

“(iii) ADJUSTMENTS FOR YEARS THAT ARE NOT DATA-BASED ADJUSTMENT YEARS.—Beginning with 2029, with respect to a year that is not a data-based adjustment year, for determining the payment amounts under the fee schedule under this subsection for ground ambulance services and air ambulance services furnished during such year, such payment amounts for such services furnished during such year shall be computed by increasing the payment amounts determined under this subsection for such services furnished during the previous year by the percentage increase in the consumer price index for all urban consumers (U.S. city average) for the 12-month period ending with June of the previous year.

“(iv) DATA-BASED ADJUSTMENT YEAR DEFINED.—For purposes of this subparagraph, the term ‘data-based adjustment year’ means 2031 and each third year thereafter.

“(C) USE OF INFORMATION.—For purposes of subparagraph (A) and clauses (i) and (ii) of subparagraph (B), the Secretary shall use the most recently available data related to ground ambulance services and air ambulance services for which payment is made under the fee schedule under this subsection, including (as applicable to the respective services) information collected or obtained pursuant to paragraph (17), information collected or obtained pursuant to section 106 of the No Surprises Act, and such other information specified by the Secretary on costs (including labor-related costs and costs related to uncompensated care), expenses, and resources directly or indirectly related to furnishing such respective services. In applying the previous sentence with respect to air ambulance services, in the case that information collected or obtained pursuant to section 106 of the No Surprises Act is not available, the Secretary shall instead use such other comparable information (as identified by the Secretary in consultation with the organizations described in paragraph (4)) on such costs, expenses, and resources related to furnishing air ambulance services.

“(19) STAKEHOLDER CONSULTATION FOR CONTINUED ASSESSMENT FOR MODIFICATIONS TO IMPROVE FEE SCHEDULE.—Not later than December 31, 2028, the Secretary shall convene experts and stakeholders, including organizations described in paragraph (4), to assess the fee schedule applied under this subsection for ground ambulance services and for air ambulance services and the adequacy of payments for such respective services under such fee schedule and to submit, not later than July 1, 2029, to the Secretary and Congress recommendations for modifications to such fee schedule, including the payment methodology under the fee schedule, to improve the valuation of such respective services under this subsection.”.