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108th CONGRESS
1st Session
H. R. 1301
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 HOUSE OF REPRESENTATIVES
March 17, 2003
Mr. Houghton (for himself, Mr. Allen, Mr. Boehlert, Mr. Pomeroy, Mr.
Ramstad, Mr. Taylor of Mississippi, Mr. Quinn, Mr. Hinchey, Mr.
English, Ms. Corrine Brown of Florida, Mr. McHugh, Mr. Moore, Mr.
Upton, Mr. McNulty, Mr. Kennedy of Minnesota, Mr. Kildee, Mr. Simmons,
Mr. Frank of Massachusetts, Mr. Reynolds, Mr. Dicks, Mrs. Emerson, Mr.
Payne, Mr. Walsh, Mr. Frost, Mr. Murtha, Mr. Ross, Mr. Kind, Mr. Olver,
Ms. McCollum, and Mr. Schiff) 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 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 2003''.
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 paragraph
(2)(E), in establishing such fee schedule, the
following rules shall apply:
``(i) Payment rates in 2004.--
``(I) Ground ambulance services.--
In the case of ground ambulance
services furnished under this part in
2004, 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 2004, 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
2005 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) Effective date.--The amendments made by this subsection
shall apply to payment for ambulance services furnished on or
after January 1, 2004.
(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) and not later
than December 31, 2003, 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).''.
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