Air Ambulance Quality and Accountability Act
This bill amends title XVIII (Medicare) of the Social Security Act to modify standards and payment for air-ambulance services under the Medicare Program.
The Department of Health and Human Services (HHS) shall establish minimum standards that must be met by air-ambulance suppliers and providers as a condition of their participation in Medicare. These standards must address: (1) scope of practice, training, and clinical capability; (2) medical equipment and vehicle attributes; (3) documentation; (4) medical direction and oversight; (5) reporting of specified events; (6) patient safety and infection control; (7) clinical quality-management and performance-improvement programs; and (8) particular populations. An air-ambulance provider or supplier that is accredited by an HHS-approved organization shall be deemed to be in compliance with these standards.
HHS must establish an air-ambulance quality-reporting and performance program under which Medicare payment is determined according to a specified performance-based formula. Performance measures shall address patient safety, clinical quality, and over-triage.
An air-ambulance provider or supplier must, subject to suspension of payment under Medicare, annually submit specified cost data to HHS.
The Medicare Payment Advisory Commission shall report to Congress on whether changes should be made with regard to reimbursement of air-ambulance providers and suppliers under Medicare.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3780 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 3780
To amend title XVIII of the Social Security Act to provide under the
Medicare program for conditions of participation, reporting
requirements, and a quality program with respect to air ambulance
services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 14, 2017
Mr. Hudson (for himself, Mr. Kennedy, Ms. Jenkins of Kansas, and Mr.
Kind) 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 under the
Medicare program for conditions of participation, reporting
requirements, and a quality program with respect to air ambulance
services.
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 ``Air Ambulance Quality and
Accountability Act''.
SEC. 2. FINDINGS.
Congress finds as follows:
(1) Patient access to high quality and essential air
ambulance services can mean the difference between life and
death and quality of survival for patients.
(2) Medicare should assure beneficiaries of high quality
air ambulance services and patient safety.
(3) Medicare has no requirements related to quality
measurement and reporting, adherence to relevant standards as a
condition of participating in Medicare, and robust cost
reporting.
(4) Medicare currently reimburses all suppliers and
providers of air ambulance services the same, regardless of
clinical capability or investment in aviation safety that
exceeds requirements of the Federal Aviation Administration.
(5) A subset of patients requiring air transport are so
critically ill or injured as to require an advanced level of
clinical capability to address unstable and life-threatening
medical conditions that may develop or deteriorate during
transport. The costs of providing care to such patients should
be reported to enable the Congress to assess the sufficiency
and appropriateness of reimbursement for these most vulnerable
patients.
(6) There remain many geographic areas of the nation with
limited access to air ambulance services due to low volume of
patients in geographically isolated and very rural areas.
(7) Medicare and Medicaid payment should be adequate to
protect and promote access to air ambulance services that are
capable of meeting the clinical needs of the most critically
ill and injured patients, allow necessary investments in
transport safety, and enable transport to the appropriate
medical center to receive them.
(8) An evaluation of Medicare payment policy is warranted
to assess and secure recommendations about payment adequacy for
air ambulance providers and suppliers and the realistic costs
of providing this life-saving transport services.
(9) Mandatory cost reporting is necessary for air ambulance
services providers receiving Medicare reimbursement to ensure
fair and adequate reimbursement and allow appropriate access.
(10) Such reporting should also capture essential data with
regard to access, cost, utilization, quality and variation of
such services to enable more specifically narrowly tailoring
payments commensurate with higher costs actually incurred such
as those treating the most critically ill and injured,
investing in higher cost aviation safety and airframes, and
serving patients in the most geographically isolated areas.
SEC. 3. STANDARDS FOR AIR AMBULANCE PROVIDERS AND SUPPLIERS.
(a) Minimum Standards.--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:
``(17) Minimum standards for air ambulance providers and
suppliers.--
``(A) In general.--Not later than 2 years after the
date of the enactment of this paragraph, the Secretary
shall, in consultation with relevant stakeholders,
establish minimum standards which air ambulance
suppliers and providers would be required to satisfy as
a condition of participation under this title.
``(B) Air ambulance minimum standards.--In
establishing the minimum standards under subparagraph
(A), the Secretary shall include at least minimum
standards with respect to the following:
``(i) Scope of practice, training and
clinical capability of medical personnel
relevant to medical condition of patients
transported.
``(ii) Medical equipment (such as patient
monitoring, respiratory and hemodynamic and
other relevant patient support equipment),
devices, technology and formularies.
``(iii) Vehicle attributes to support
needed care, including configuration and
conditions of medical environment, electrical
supply in air ambulance and other related
equipment.
``(iv) Documentation standards, such as
patient care records, timeline of care and
transport, history of present illness and
assessments, and documentation specific to
diagnostic and therapeutic procedures.
``(v) Medical direction and physician
medical oversight, such as credentials of such
physicians.
``(vi) Reporting of always events, such as
care coordination and transition, pain
management, preventing ventilator acquired
pneumonia or invasive line or wound infections.
``(vii) Reporting of never events, such as
loss of oxygen, delivery of a baby during
transport, patient death or disability due to
vehicle failure or crash, transport to
unintended destination, dropping a patient or
allowing a fall during movement of patient,
failure to communicate time of arrival,
hypoglycemia, and medication errors.
``(viii) Patient safety and infection
control.
``(ix) Physician directed clinical quality
management and clinical performance improvement
programs including quality assurance,
utilization review, outcomes, proficiency
measures and patient safety.
``(x) Standards relevant to particular
populations, such as those on balloon pumps or
ECMO.
``(C) Deemed status.--Air ambulance providers and
suppliers that are accredited by an accreditation
organization approved by the Secretary as having
standards that meet or exceed the Secretary's standards
for such providers shall be deemed to be in compliance
with the minimum requirements required pursuant to this
paragraph.''.
SEC. 4. AIR AMBULANCE COST REPORTING PROGRAM.
Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)), as
amended by section 3, is further amended by adding at the end the
following new paragraph:
``(18) Air ambulance cost reporting program.--
``(A) In general.--For the first year beginning at
least 12 months after the date of the enactment of this
paragraph and each subsequent year, an air ambulance
provider or supplier of air ambulance services shall
submit to the Secretary (in a form and manner and at
such time as specified by the Secretary) data described
in subparagraph (B) for the reporting period (as
specified by the Secretary) for such year.
``(B) Cost data.--For purposes of reporting data
under this for air ambulance services furnished with
respect to a year, the data described in this
subparagraph are cost data specified by the Secretary
relating to the following:
``(i) Geographic location factors,
including mileage and number of providers in
the service area.
``(ii) Capital and operational costs, such
as the type of aircraft, including fixed wing
aircraft, rotary wing aircraft--single or twin
engine, instrumented flight or visual flight.
``(iii) Maintenance of aircraft, including
avionics, communications equipment, fuel, and
general repairs.
``(iv) Maintenance of equipment, including
specialty clinical equipment.
``(v) Medical supplies.
``(vi) Employee expenses, including
salaries and insurance (life, health, and
liability).
``(vii) Building expenses, including rent
and maintenance.
``(viii) Any other costs as specified by
the Secretary, in consultation with the
Secretary of Transportation, as needed to be
included under this subparagraph for purposes
of informing the report and evaluation under
section 6 of the Air Ambulance Quality and
Accountability Act or for purposes of enabling
Congress to make appropriate determinations
about payment under this section to air
ambulance providers and suppliers.
The Secretary, in consultation with providers and
suppliers of air ambulance services, shall periodically
update, as determined necessary by the Secretary, the
cost data specified pursuant to this subparagraph.
``(C) Suspension of payment for failure to
report.--
``(i) In general.--With respect to air
ambulance services furnished by a supplier or
provider of air ambulance services during the
second year beginning at least 12 months after
the date of the enactment of this paragraph or
any subsequent year, in the case that the
supplier or provider does not submit data to
the Secretary in accordance with subparagraph
(A) for the reporting period applicable to such
year (which shall be during the previous year),
the Secretary shall suspend payments under the
fee schedule under this subsection for air
ambulance services furnished by such supplier
or provider during such year until such
supplier or provider submits such data in
accordance with such subparagraph.
``(ii) Treatment of new medicare suppliers
and providers of air ambulance services.--In
the case of a supplier or provider of air
ambulance services that first becomes a
Medicare enrolled supplier or provider of air
ambulance services during the reporting period
applicable to a year with respect to which
clause (i) applies (and had not previously
submitted claims under this title such as a
person or entity or under a different billing
number or tax identifier), such supplier or
provider shall not be subject to clause (i)
until the subsequent year and with respect to
data required to be submitted for the reporting
period applicable to such subsequent year.''.
SEC. 5. AIR AMBULANCE QUALITY REPORTING PROGRAM.
Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)), as
amended by sections 3 and 4, is further amended by adding at the end
the following new paragraph:
``(19) Air ambulance quality reporting program.--
``(A) Payment based on performance.--
``(i) In general.--The Secretary shall
establish an air ambulance quality reporting
and performance program under which--
``(I) with respect to air ambulance
services furnished by a supplier or
provider of air ambulance services
during the first consequence year,
second consequence year, or third
consequence year, in the case that the
supplier or provider does not submit a
report, with respect to the performance
period for such year, in accordance
with subparagraph (C), after
determining the percentage increase
under paragraph (3)(B), and after
application of paragraphs (3)(C) and
(18), the Secretary shall reduce such
percentage increase for payments under
the fee schedule under this subsection
during such year by 2 percentage
points; and
``(II) with respect to air
ambulance services furnished by a
supplier or provider of air ambulance
services during a consequence year
after the third consequence year, the
Secretary applies a percentage point
adjustment to the percentage increase
determined under paragraph (3)(B),
after application of paragraphs (3)(C)
and (18), in a manner that provides for
differential payment to a supplier or
provider of air ambulance services
based upon the quality of care
furnished (as determined under
subparagraph (B)) during a performance
period with respect to such consequence
year (with such percentage point
adjustment ranging from an increase of
5 percentage points for such services
furnished in a consequence year by such
a provider or supplier with the highest
demonstrated performance in the
performance period for such year to a
decrease of 5 percentage points for
such services furnished in the
consequence year by such a provider or
supplier with the lowest demonstrated
performance for the performance period
for such year).
``(ii) Special rule.--The application of
this subparagraph may result in such percentage
increase being less than 0.0 for a year, and
may result in payment rates under the fee
schedule under this subsection for a year being
less than such payment rates for the preceding
year.
``(iii) Noncumulative application.--Any
adjustment under this subparagraph shall apply
only with respect to the year involved and the
Secretary shall not take into account such
adjustment in computing the payment amount
under the fee schedule under this subsection
for a subsequent year.
``(iv) Treatment of new medicare suppliers
and providers of air ambulance services.--In
the case of a supplier or provider of air
ambulance services that first becomes a
Medicare enrolled supplier or provider of air
ambulance services during the performance
period for a consequence year (and had not
previously submitted claims under this title
such as a person or entity or under a different
billing number or tax identifier), the
adjustment under clause (i) shall not apply to
such supplier or provider until the subsequent
consequence year and performance period for
such subsequent consequence year.
``(B) Determining performance.--
``(i) In general.--Under the air ambulance
quality reporting and performance program, the
performance of a provider or supplier of air
ambulance services with respect to a
performance period with respect to a
consequence year after the third consequence
year shall be determined as specified by the
Secretary based on data required under
subparagraph (C) to be submitted (in a form and
manner and at such time as specified by the
Secretary) by the provider or supplier for such
performance period for the consequence year.
``(ii) Treatment of non-reporters.--Under
the air ambulance quality reporting and
performance program, for purposes of
subparagraph (A), any provider or supplier of
air ambulance services who does not submit data
required under subparagraph (C) to submitted
for a performance period with respect to a
consequence year after the third consequence
year, shall be treated as if such provider or
supplier had the lowest demonstrated
performance for the performance period for such
year.
``(C) Reporting.--
``(i) In general.--For purposes of this
paragraph for years beginning with the first
consequence year, an air ambulance provider or
supplier shall submit to the Secretary a
report, with respect to the performance period
for such year, on--
``(I) the measures described in
subparagraph (D)(i);
``(II) in the case of a consequence
year before the fourth consequence
year--
``(aa) at least 2 of the
measures described in
subparagraph (D)(ii)(I); and
``(bb) at least 2 of the
measures established under
subparagraph (D)(iii)(I); and
``(III) in the case of a
consequence year beginning with the
fourth consequence year--
``(aa) at least 4 of the
measures described in
subparagraph (D)(ii)(II); and
``(bb) at least 4 of the
measures established under
subparagraph (D)(iii)(II).
``(ii) Availability of data.--The Secretary
shall establish procedures for making data
submitted under clause (i) available to the
public. Such procedures shall ensure that--
``(I) data submitted under clause
(i) for the first consequence year
shall not be made public; and
``(II) an air ambulance provider or
supplier has the opportunity to review
the data that is to be made public with
respect to the air ambulance provider
or supplier prior to such data being
made public.
``(D) Measures.--In establishing the quality
program under subparagraph (A), the following shall
apply:
``(i) Over-triage.--The Secretary shall
provide for the application of a measure with
respect to over-triage in mode of
transportation.
``(ii) Patient safety measures.--The
Secretary shall, in consultation with providers
and suppliers of air ambulance services,
establish--
``(I) with respect to a performance
period with respect to a consequence
year before the fourth consequence
year, at least 3 patient safety
measures for providers and suppliers of
air ambulance services; and
``(II) with respect to a
performance period with respect to a
consequence year beginning with the
fourth consequence year, at least 6
patient safety measures for providers
and suppliers of air ambulance
services.
``(iii) Clinical quality measures.--The
Secretary shall, in consultation with providers
and suppliers of air ambulance services,
establish--
``(I) with respect to a performance
period with respect to a consequence
year before the fourth consequence
year, at least 3 clinical quality
measures for providers and suppliers of
air ambulance services; and
``(II) with respect to a
performance period with respect to a
consequence year beginning with the
fourth consequence year, at least 6
clinical quality measures for providers
and suppliers of air ambulance
services.
``(iv) Updates.--The Secretary, in
consultation with providers and suppliers of
air ambulance services, shall periodically
update, as determined necessary by the
Secretary, the measures to be applied pursuant
to this subparagraph.
``(E) Definitions.--For purposes of this paragraph:
``(i) The term `consequence year' means a
year beginning with the 5th year starting at
least 12 months after the date of the enactment
of this paragraph. The terms `first consequence
year', second consequence year, and third
consequence year mean such 5th year starting at
least 12 months after such date of enactment,
the 6th year starting at least 12 months after
such date of enactment, and the 7th year
starting at least 12 months after such date of
enactment, respectively.
``(ii) The term `performance period' means,
with respect to a consequence year, such period
as specified by the Secretary.''.
SEC. 6. MEDPAC STUDY ON ACCESS, QUALITY, COSTS, AND REIMBURSEMENT.
(a) Evaluation.--Not later than three years after December 31 of
the first year to which paragraph (18) of section 1834(l) of the Social
Security Act, as added by section 4, applies, the Medicare Payment
Advisory Commission shall submit to Congress a report containing an
evaluation of the costs of air providers and suppliers. Such evaluation
shall--
(1) be derived from the cost and other data submitted under
such paragraph (18) of such section 1834(l); and
(2) differentiate as appropriate to recognize variation or
higher costs related to--
(A) aviation instrument flight control;
(B) provision of care to critically ill or injured
patients;
(C) the provision of services in geographically
isolated areas; and
(D) the provision of care to uninsured individuals.
(b) Recommendations.--As part of the report submitted under
subsection (a), the Medicare Payment Advisory Commission shall provide
recommendations on whether changes should be made with regard to
reimbursement of air ambulance providers and suppliers under title
XVIII of the Social Security Act based upon the data submitted under
paragraph (18) of section 1834(l) of the Social Security Act, as added
by section 4, taking into consideration variables affecting payment
adequacy under such title for and its impact on Medicare beneficiaries,
including--
(1) whether payment under such title is sufficient to
ensure access to air ambulance services or should be altered,
including whether payment should be higher for air ambulance
providers and suppliers--
(A) with higher levels of clinical capability to
serve the most critically ill and injured patients; and
(B) that utilize advanced and expense avionics such
as Instrument Flight Rules;
(2) whether uncompensated care borne by air ambulance
providers and suppliers impedes access;
(3) the degree to which there is variation in the
utilization of air ambulance services on a per capita and per
transport basis, including whether the undersupply or
oversupply of helicopters or fixed wing aircraft in a
geographic region affects access and the volume and adequacy of
payments under such title with regard to such utilization;
(4) the degree to which membership programs are utilized by
air ambulance providers and suppliers to sustain their
operations, and if revenue from membership programs is used to
reduce their costs or provide capital funding, and whether such
programs are beneficial to Medicare beneficiaries;
(5) the degree of subsidization that occurs from private
insurers or hospitals sponsoring air ambulance providers or
suppliers to cover inadequate payments under title XVIII or XIX
of the Social Security Act and enable reasonable profitability;
(6) the ratio of charges to Medicare reimbursement and the
impact on beneficiary cost sharing of cost, utilization, and
variation in air ambulance services;
(7) appropriate financial or other incentives for the
utilization of ground critical care transport where medically
appropriate;
(8) the degree to which a quality reporting and performance
program based upon patient safety measures and clinical quality
measures should be used in determining a value based payment
model for suppliers and providers of air ambulance service; and
(9) any other information deemed relevant and appropriate
by the Medicare Payment Advisory Commission for the purposes of
providing such recommendations.
<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 Subcommittee on Health.
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