[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2858 Introduced in Senate (IS)]
106th CONGRESS
2d Session
S. 2858
To amend title XVIII of the Social Security Act to ensure adequate
payment rates for ambulance services, to apply a prudent layperson
standard to the determination of medical necessity for emergency
ambulance services, and to recognize the additional costs of providing
ambulance services in rural areas.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 13, 2000
Mr. Grams 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 ensure adequate
payment rates for ambulance services, to apply a prudent layperson
standard to the determination of medical necessity for emergency
ambulance services, and to recognize the additional costs of providing
ambulance services in rural areas.
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 Access to Ambulance
Services Act of 2000''.
SEC. 2. PAYMENT RATES.
(a) 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) Ground and air ambulance payment rates.--
Subject to the succeeding provisions of this paragraph,
in establishing such fee schedule, the Secretary
shall--
``(i) set the payment rates provided under
the fee schedule for ground ambulance services
furnished under this part during 2001 at a rate
based on the average costs (as determined by
the Secretary based on a study performed by an
independent research organization of such
costs, adjusted for inflation if necessary)
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 service
levels to be determined based on the rule
negotiated in accordance with paragraph (1);
and
``(ii) set the payment amounts provided
under the fee schedule for all ambulance
services furnished in 2002 and each subsequent
year at amounts equal to the payment amounts
under the fee schedule for services 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) Study and report on the costs of rural
ambulance services.--
``(i) Study.--The Secretary, in
consultation with the Office of Rural Health
Policy, shall conduct a study of the means by
which rural areas with low population densities
can be identified for the purpose of
designating areas in which the cost of
providing ambulance services would be expected
to be higher than similar services provided in
more heavily populated areas because of low
usage. Such study shall also include an
analysis of the additional costs of providing
ambulance services in areas designated under
the previous sentence.
``(ii) Report.--Not later than June 30,
2001, the Secretary shall submit to Congress a
report on the results of the study conducted
under this section, together with a regulation
based on that study which adjusts the fee
schedule payment rates for ambulance services
provided in low density rural areas based on
the increased cost of providing such services
in such areas.
``(iii) Implementation of regulation.--The
regulation submitted under clause (ii) shall
become effective not later than January 1,
2002.
``(C) Interim payments for rural ground ambulance
services.--Notwithstanding subparagraph (A)(i) of this
paragraph, until such time as the fee schedule
established under this subsection is modified by the
regulation under subparagraph (B), the amount of
payment under this subsection for ground ambulance
services provided in a rural area (as defined in
section 1886(d)(2)(D)) shall be the greater of--
``(i) the amount determined under the fee
schedule established under this subsection
(without regard to any phase-in established
pursuant to paragraph (2)(E)); or
``(ii) the amount that would have been paid
for such service if the amendments made by
section 4531(b) of the Balanced Budget Act of
1997 had not been enacted;
as adjusted for inflation pursuant to subparagraph
(A)(ii). For purposes of this subparagraph, an
ambulance trip shall be considered to have been
provided in a rural area only if the transportation of
the patient originated in a rural area.''.
(b) Conforming Amendments.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(1) in subparagraph (R)--
(A) by inserting ``except as provided in
subparagraph (T),'' before ``with respect''; and
(B) by striking ``and'' at the end; and
(2) in subparagraph (S), by striking the semicolon at the
end and inserting ``, and (T) with respect to ambulance
services described in section 1834(l)(3)(C), the amount paid
shall be 80 percent of the lesser of the actual charge for the
services or the amount determined under such section;''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to services provided on and after January 1, 2001.
SEC. 3. PRUDENT LAYPERSON STANDARD FOR EMERGENCY AMBULANCE SERVICES.
(a) In General.--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 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 is manifested
by symptoms of such sufficient severity, including severe pain, that a
prudent layperson, who possesses an average knowledge of health and
medicine, could reasonably expect to result, without immediate medical
attention, in--
``(A) placing the individual's health in serious
jeopardy;
``(B) serious impairment to the individual's bodily
functions; or
``(C) serious dysfunction of any bodily organ or
part of the individual;''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to services provided on and after the date of enactment of
this Act.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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