[Congressional Record Volume 147, Number 112 (Friday, August 3, 2001)]
[Senate]
[Pages S8914-S8915]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DAYTON:
  S. 1350. A bill to amend the title XVIII of the Social Security Act 
to provide payment to medicare ambulance suppliers of the full costs of 
providing such services, and for other purposes; to the Committee on 
Finance.
  Mr. DAYTON. Mr. President, today I rise to introduce the Medicare 
Access

[[Page S8915]]

to Ambulance Service Act of 2001. Reliable ambulance service is often a 
matter of life and death. This bill is designed to head off growing 
problems that are putting ambulance providers in Minnesota and across 
the country in financial jeopardy and affecting their ability to 
deliver emergency services to patients.
  The Medicare Access to Ambulance Service Act of 2001 will help 
ambulance providers whose service quality is threatened by inadequate 
Medicare payments and the inappropriate payment denials by Medicare 
claims processors. The continuing difficulties jeopardize the quality 
of care, and ultimately may increase the time it takes to respond to 
emergencies.
  Recently my staff in Minnesota met with ambulance providers and 
Medicare beneficiaries in Hibbing, Duluth, Moorhead, St. Cloud, 
Bemidji, Marshall, and Harmony, Minnesota to listen to their concerns 
over Medicare ambulance service. In every part of the State the stories 
were the same. The biggest concern was Medicare's denial of ambulance 
claims. Medicare has denied claims for such medical emergencies as 
cardiac arrest, heart attack, and stroke. One elderly woman from 
Duluth, Minnesota was so upset with the Medicare process and the year 
it took to get her claim paid, that when she needed an ambulance again 
she called a taxi. This is unacceptable.
  To make matters worse, when Congress enacted the Balanced Budget Act 
of 1997 it required that ambulance payments be moved to a fee schedule 
on a cost-neutral basis. Moving to a fee-schedule makes sense, but not 
on a cost-neutral basis for a system that is already underfunded. The 
proposed fee-schedule is especially unfair to rural areas and will mean 
the end of small ambulance providers in Minnesota and throughout the 
country.
  My bill includes four components to address these problems. First, 
the bill requires that the Medicare fee schedule be based on the 
national average cost of providing the service. Second, the bill 
requires the General Accounting Office to determine a reasonable 
definition for how to identify rural ambulance providers and higher 
payments for rural ambulance services. Third, the bill includes a 
``prudent layperson'' standard for the payment of emergency ambulance 
claims. Simply stated, this provision means that if a reasonable person 
believed an emergency medical problem existed when the ambulance was 
requested then Medicare would pay the claim. Minnesota already leads 
the nation with this successfully implemented standard for all other 
patients, with the exception of those covered by Medicare. And finally, 
the bill requires Medicare to adopt a ``condition coding'' to be used 
by the ambulance provider.
  Medicare beneficiaries deserve more from the health insurance system 
than additional anxiety in an emergency situation for a system into 
which they have paid. When people in Minnesota and across the country 
have an emergency requiring an ambulance, they want to know that they 
will quickly and reliably get the care they need. However, current 
Medicare policies and procedures are putting quality ambulance service 
at risk and are forcing many ambulance providers to struggle to stay in 
business, especially in rural communities. My legislation addresses 
problems that threaten quality ambulance service for patients in 
Minnesota and across the country.
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