[Congressional Record Volume 143, Number 16 (Monday, February 10, 1997)]
[Senate]
[Page S1191]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WELLSTONE:
  S. 292. A bill to amend title XVIII of the Social Security Act to 
provide for coverage of certain ambulance services; to the Committee on 
Finance.


                   the ambulance services act of 1997

 Mr. WELLSTONE. Mr. President, I am pleased to introduce the 
Ambulance Services Act of 1997 today to ensure that Medicare 
beneficiaries are covered for necessary transport for emergency 
treatment.
  I am deeply concerned that Medicare beneficiaries in rural areas have 
a difficult time gaining access to emergency care, and there are 
relatively few hospitals in these areas, and patients must often travel 
a great distance to reach them. The Medicare ambulance transport 
reimbursement regulations have not kept pace with changes in the health 
care system that have occurred as a result of efforts to improve care 
while decreasing the cost of care.
  In many locales, clinics and ambulatory surgery centers staffed by 
physicians have developed the ability to provide routine emergency 
care. The local physicians are often available at the clinic, which has 
facilities and capability for emergency treatment. In fact, patients 
who are transported to the hospital emergency department during the day 
wait longer to see a physician than those at the clinic, as the 
physician must travel from the clinic to the hospital in order to see 
the patient.
  It is often necessary for seniors who are experiencing a medical 
emergency to be transported via an ambulance. Under current regulation, 
seniors who require ambulance transport to an emergency care facility 
must be taken to a hospital. Therefore, the senior is left with a 
difficult choice: be transported to the hospital facility, which may 
take longer and is likely to involve a longer waiting time for 
emergency care, or be transported to a local facility that provides 
emergency care to other citizens, and pay for the ambulance transport 
out of pocket. Neither of these is an optimal choice.
  As the reimbursement policy stands now, patients are required to use 
a more expensive facility when it may not be necessary. It would seem 
that allowing reimbursement for transport to nonhospital facilities 
that provide emergency care could result in fiscal savings in that the 
cost of ambulance transport combined with a clinic visit bill would be 
less than that of ambulance transport and a hospital emergency 
department bill. In addition, it would allow our senior citizens to 
have a health care benefit that is available to other members of the 
community.
  Concerns that might arise about the medical necessity of transporting 
certain patients to a hospital emergency department can and should 
continue to be addressed by local and regional emergency medical 
service systems, based on levels of care that are available in the 
area. These systems set standards and protocols for emergency medical 
service providers and work with the health care community in developing 
protocols for transport and patient care.
  Mr. President, I remain concerned about providing all of our citizens 
with an adequate level of health care. Our seniors need to be able to 
avail themselves of expeditious emergency care, without having to worry 
about how transport for this care will be paid for. The Ambulance 
Services Act of 1997 will go a long way toward this goal.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 292

       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 Services Act of 
     1997''.

     SEC. 2. MEDICARE COVERAGE OF CERTAIN AMBULANCE SERVICES.

       (a) Coverage.--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, in the 
     case of an emergency, the individual is transported to a 
     clinic or to an ambulatory surgical center;''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to items and services provided on or after the 
     date of enactment of this Act.
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