Amends SSA titles XVIII (Medicare) (including part C (Medicare+Choice) of the Medicare program) and XIX (Medicaid) to establish a prudent layperson standard for justification of emergency ambulance services under Medicare and Medicaid.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1350 Introduced in Senate (IS)]
107th CONGRESS
1st Session
S. 1350
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.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
August 3, 2001
Mr. Dayton introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
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.
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 ``Medicare Ambulance Payment Reform
Act of 2001''.
SEC. 2. AMBULANCE PAYMENT RATES.
(a) Payment Rates.--
(1) In general.--Section 1834(l)(3) of the Social Security
Act (42 U.S.C. 1395m(l)(3)) is amended to read as follows:
``(3) Payment rates.--
``(A) In general.--Subject to any adjustment under
subparagraph (B) and paragraph (9) and the full payment
of a national mileage rate pursuant to subparagraph
(2)(E), in establishing such fee schedule, the
following rules shall apply:
``(i) Payment rates in 2002.--
``(I) Ground ambulance services.--
In the case of ground ambulance
services furnished under this part in
2002, the Secretary shall set the
payment rates under the fee schedule
for such services at a rate based on
the average costs (as determined by the
Secretary on the basis of the most
recent and reliable information
available) incurred by full cost
ambulance suppliers in providing
nonemergency basic life support
ambulance services covered under this
title, with adjustments to the rates
for other ground ambulance service
levels to be determined based on the
rule established under paragraph (1).
For the purposes of the preceding
sentence, the term `full cost ambulance
supplier' means a supplier for which
volunteers or other unpaid staff
comprise less than 20 percent of the
supplier's total staff and which
receives less than 20 percent of space
and other capital assets free of
charge.
``(II) Other ambulance services.--
In the case of ambulance services not
described in subclause (I) that are
furnished under this part in 2002, the
Secretary shall set the payment rates
under the fee schedule for such
services based on the rule established
under paragraph (1).
``(ii) Payment rates in subsequent years
for all ambulance services.--In the case of any
ambulance service furnished under this part in
2003 or any subsequent year, the Secretary
shall set the payment rates under the fee
schedule for such service at amounts equal to
the payment rate under the fee schedule for
that service furnished during the previous
year, increased by the percentage increase in
the Consumer Price Index for all urban
consumers (United States city average) for the
12-month period ending with June of the
previous year.
``(B) Adjustment in rural rates.--For years
beginning with 2004, the Secretary, after taking into
consideration the recommendations contained in the
report submitted under section 221(b)(3) the Medicare,
Medicaid, and SCHIP Benefits Improvements and
Protection Act of 2000, shall adjust the fee schedule
payment rates that would otherwise apply under this
subsection for ambulance services provided in low
density rural areas based on the increased cost (if
any) of providing such services in such areas.''.
(2) Conforming amendment.--Section 221(c) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of
2000 (114 Stat. 2763A-487), as enacted into law by section
1(a)(6) of Public Law 106-554, is repealed.
(3) Technical amendment.--
(A) In general.--Paragraph (8) of section 1834(l)
of the Social Security Act (42 U.S.C. 1395m(l)), as
added by section 221(a) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000
(114 Stat. 2763A-487), as enacted into law by section
1(a)(6) of Public Law 106-554, is redesignated as
paragraph (9).
(B) Effective date.--The amendment made by
subparagraph (A) shall take effect as if included in
the enactment of such section 221(a).
(b) Use of Medical Conditions for Coding Ambulance Services.--
Section 1834(l)(7) of the Social Security Act (42 U.S.C. 1395m(l)(7))
is amended to read as follows:
``(7) Coding system.--
``(A) In general.--The Secretary shall, in
accordance with section 1173(c)(1)(B), establish a
system or systems for the coding of claims for
ambulance services for which payment is made under this
subsection, including a code set specifying the medical
condition of the individual who is transported and the
level of service that is appropriate for the
transportation of an individual with that medical
condition.
``(B) Medical conditions.--The code set established
under subparagraph (A) shall--
``(i) take into account the list of medical
conditions developed in the course of the
negotiated rulemaking process conducted under
paragraph (1); and
``(ii) notwithstanding any other provision
of law, be adopted as a standard code set under
section 1173(c).''.
SEC. 3. PRUDENT LAYPERSON STANDARD FOR EMERGENCY AMBULANCE SERVICES
UNDER MEDICARE AND MEDICAID.
(a) Ambulance Services for Medicare Fee-For-Service
Beneficiaries.--Section 1861(s)(7) of the Social Security Act (42
U.S.C. 1395x(s)(7)) is amended by inserting before the semicolon at the
end the following: ``, except that such regulations shall not fail to
treat ambulance services as medical and other health services solely
because the ultimate diagnosis of the individual receiving the
ambulance services results in the conclusion that ambulance services
were not necessary, as long as the request for ambulance services is
made after the sudden onset of a medical condition that would be
classified as an emergency medical condition (as defined in section
1852(d)(3)(B)).''.
(b) Ambulance Services for Medicare+Choice Enrollees.--Section
1852(d)(3)(A) of the Social Security Act (42 U.S.C. 1395w-22(d)(3)(A))
is amended by inserting ``(including the services described in section
1861(s)(7))'' after ``outpatient services'' in the matter preceding
clause (i).
(c) Ambulance Services in Medicaid Managed Care Plans.--Section
1932(b)(2)(B) of the Social Security Act (42 U.S.C. 1396u-2(b)(2)(B))
is amended by inserting ``(including the services described in section
1861(s)(7) (if covered by the State plan))'' after ``outpatient
services'' in the matter preceding clause (i).
(d) Effective Date.--The amendments made by this section shall
apply with respect to services provided on and after the date of
enactment of the Act.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S8914-8915)
Read twice and referred to the Committee on Finance.
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