Medicare Ambulance Payment Reform and Rural Equity Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) revise ambulance payment rates; and (2) provide additional payments for providers furnishing ambulance services in rural areas.
Directs the Secretary of Health and Human Services to review the system for adjusting payments for rural ambulance services to determine their adequacy and appropriateness.
Amends SSA title XVIII with respect to a Secretary-specified uniform coding system identifying furnished ambulance services for purposes of a fee schedule. Directs the Secretary to establish a system or systems for the coding of claims for ambulance services for which payment is made, 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. Requires the code set to take into account the list of medical conditions developed in the course of the negotiated rulemaking process. (Current law authorizes the Secretary to require the claim for any ambulance services to include a code (or codes) under a uniform coding system specified by the Secretary, but does not require the establishment of such a coding system.)
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2014 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 2014
To amend title XVIII of the Social Security Act to provide payments to
Medicare ambulance suppliers of the full cost or furnishing such
services, to provide payments to rural ambulance providers and
suppliers to account for the cost of serving areas with low population
density, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 28, 2005
Mr. Reynolds (for himself, Mr. Allen, Mr. Pickering, Mr. Oberstar, Mr.
Taylor of Mississippi, Mr. Dicks, Mr. Reyes, Mr. Payne, Mr. McNulty,
Mr. Hinchey, Mr. Platts, Mr. Kolbe, Mr. McHugh, Mr. Boustany, Mr.
Kildee, Mr. Davis of Alabama, Mr. Renzi, and Mr. Holden) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide payments to
Medicare ambulance suppliers of the full cost or furnishing such
services, to provide payments to rural ambulance providers and
suppliers to account for the cost of serving areas with low population
density, 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
and Rural Equity Act of 2005''.
SEC. 2. AMBULANCE PAYMENT RATES.
(a) Payment Rates.--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.--Subject to any adjustment under
subparagraph (B) and paragraph (13) and the full payment of a
national mileage rate pursuant to paragraph (2)(E), the
Secretary shall modify the fee schedule established under
paragraph (1) as follows:
``(A) Payment rates in 2006.--
``(i) Ground ambulance services.--In the
case of ground ambulance services furnished
under this part in 2006, 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 2006, the Secretary shall set the
payment rates under the fee schedule for such
services based on the rule established under
paragraph (1).
``(B) Payment rates in subsequent years for all
ambulance services.--In the case of any ambulance
service furnished under this part in 2007 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) Conforming Amendment.--(1) 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.
(2) The amendment made by paragraph (1) shall take effect on
January 1, 2006, and shall apply to payments for ambulance services
furnished on or after such date.
SEC. 3. IMPROVEMENT IN PAYMENTS TO RETAIN EMERGENCY AND OTHER CAPACITY
FOR AMBULANCES IN RURAL AREAS.
(a) In General.--Section 1834(l) of the Social Security Act (42
U.S.C. 1395m(l)) is amended by adding at the end the following new
paragraph:
``(15) Additional payments for providers furnishing
ambulances services in rural areas.--
``(A) In general.--In the case of ground ambulance
services furnished on or after January 1, 2006, for
which the transportation originates in a rural area (as
determined under subparagraph (B)), the Secretary shall
provide for a percent increase in the base rate of the
fee schedule for a trip identified under this
subsection.
``(B) Identification of rural areas.--The
Secretary, in consultation with the Office of Rural
Health Policy, shall use the Rural-Urban Commuting
Areas (RUCA) coding system, adopted by that Office, to
designate rural areas for the purposes of this
paragraph. A rural area is any area in RUCA level 2
through 10 and any unclassified area.
``(C) Tiering of rural areas.--The Secretary shall
designate 4 tiers of rural areas, using a zip code
population-based methodology generated by the RUCA
coding system, as follows:
``(i) Tier 1.--A rural area that is a high
metropolitan commuting area, in which 30
percent or more of the commuting flow is to an
urban area, as designated by the Bureau of the
Census (RUCA level 2).
``(ii) Tier 2.--A rural area that is a low
metropolitan commuting area, in which less than
30 percent of the commuting flow is to an urban
area or to a large town, as designated by the
Bureau of the Census (RUCA levels 3-6).
``(iii) Tier 3.--A rural area that is a
small town core, as designated by the Bureau of
the Census, in which no significant portion of
the commuting flow is to an area of population
greater than 10,000 people (RUCA levels 7-9).
``(iv) Tier 4.--A rural area in which there
is no dominant commuting flow (RUCA level 10)
and any unclassified area.
The Secretary shall consult with the Office of Rural
Health Policy not less often than every 2 years to
update the designation of rural areas in accordance
with any changes that are made to the RUCA system.
``(D) Payment adjustments for trips in rural
areas.--The Secretary shall adjust the payment rate
under this section for ambulance trips that originate
in each of the tiers established in subparagraph (C).
The adjustment shall be a percentage increase in the
base payment rate as follows:
``(i) Tier 1.--5.5 percent.
``(ii) Tier 2.--11 percent.
``(iii) Tier 3.--16.5 percent.
``(iv) Tier 4.--22 percent.''.
(b) Review of Payments for Rural Ambulance Services and Report to
Congress.--
(1) Review.--Not later than July 1, 2008, the Secretary of
Health and Human Services shall review the system for adjusting
payments for rural ambulance services under section 1834(l)(15)
of the Social Security Act (42 U.S.C. 1395m(l)(15)), as added
by subsection (a), to determine the adequacy and
appropriateness of such adjustments. In conducting such review
the Secretary shall consult with providers and suppliers
affected by such adjustments and with representatives of the
ambulance industry generally to determine--
(A) whether such adjustments adequately cover the
additional costs incurred in serving areas of low
population density; and
(B) whether the tiered structure for making such
adjustments appropriately reflects the difference in
costs of providing services in different types of rural
areas.
(2) Report.--Not later than January 1, 2009, the Secretary
shall submit to Congress a report setting forth the results of
such review and any recommendations for revision to the systems
for adjusting payments for ambulance services in rural areas.
(c) Conforming Amendments.--(1) Section 1834(l) of the Social
Security Act (42 U.S.C. 1395m(l)), as amended by subsection (a), is
further amended by adding at the end the following new paragraph:
``(16) Designation of rural areas for mileage payment
purposes.--In establishing any differential in the amount of
payment for mileage between rural and urban areas in the fee
schedule established under paragraph (1), the Secretary shall
identify rural areas in the same manner as provided in
paragraph (15)(B).''.
(2) Section 1834(l)(12)(A) of the Social Security Act (42 U.S.C.
1395m(l)(12)(A)) is amended by striking ``January 1, 2010'' and
inserting ``January 1, 2006''.
(3) Section 1834(l)(13)(A)(i) of the Social Security Act (42 U.S.C.
1395m(l)(13)(A)(i)) is amended by inserting ``(or in the case of such
services furnished in 2006, in a rural area identified by the Secretary
under paragraph (15)(B))'' after ``such paragraph''.
SEC. 4. 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) and not later
than January 1, 2006, establish a mandatory 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 take into account the list
of medical conditions developed in the course of the
negotiated rulemaking process conducted under paragraph
(1).''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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