,,ii #aadth ,,congress #ast ,session ,s4 #aadi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #cj1 #bjae,mr4 ,vitter 7for himself1 ,mr4 ,bennet1 ,mr4 ,gardner1 and ,mr4 ,scott7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to require reporting of certain data by providers and suppliers of air ambulance services for purposes of reforming reimbursements for such services under the ,medicare program1 and for other purposes4 #a4 ,findings ,the ,congress finds the following3 7#a7 ,air medical critical care transport is an essential component of the healthcare system4 7#b7 ,the presence of air medical services in rural areas provides tens of millions of rural ,americans with access to critical care within an hour of injury4 7#c7 ,as an emergency responder1 air medical providers must maintain readiness #bd hours a day and #g days a week4 7#d7 ,air medical providers transport all emergent patients for which they are dispatched regardless of insurance status or ability to pay4 7#e7 ,the air ambulance fee schedule under the ,medicare program was first implemented in #bjjb and developed through negotiated rulemaking1 which required the new fee schedule to be created in a budget neutral manner4 ,as such1 the ,medicare air ambulance fee schedule has never reflected true costs4 7#f7 ,since the implementation of the air ambulance fee schedule under the ,medicare program1 reimbursements have only been adjusted by inflationary updates averaging #b4b percent a year4 7#g7 ,operational readiness and safety enhancement costs have grown at a far faster rate than the ,medicare inflationary updates1 creating a fundamental imbalance within the air ambulance fee schedule4 7#h7 ,it is imperative that balance be restored to the air ambulance fee schedule to preserve access to timely care for tens of millions of ,americans4 #b4 ,air ,ambulance ,data ,reporting ,program ,section #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77 is amended-- 7#a7 in paragraph 7#c77;,b71 by striking subparagraph 7,c7 and inserting subparagraph 7,c7 and paragraph 7#af72 and 7#b7 by adding at the end the following new paragraphs3 7#af7 ,air ,ambulance ,data ,reporting ,program 7,a7 ,reduction in update for failure to report 7i7 ,in general ,with respect to air ambulance services furnished by a supplier or provider of air ambulance services during #bjag or any subsequent year1 in the case the supplier or provider does not submit data to the ,secretary in accordance with subparagraph 7,c7 with respect to such year1 after determining the percentage increase under paragraph 7#c77;,b71 and after application of paragraph 7#c77;,c71 the ,secretary shall reduce such percentage increase for payments under the fee schedule under this subsection during such year by #b4j percentage points4 7ii7 ,special rule ,the application of this subparagraph may result in such percentage increase being less than #j4j for a year1 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 year4 7,b7 ,noncumulative application ,any reduction under subparagraph 7,a7 shall apply only with respect to the year involved and the ,secretary shall not take into account such reduction in computing the payment amount under the fee schedule under this subsection for a subsequent year4 7,c7 ,submission of data ,for #bjag and each subsequent year1 for purposes of this paragraph1 each supplier or provider of air ambulance services shall submit to the ,secretary data specified under subparagraph 7,d7 for the reporting period 7specified by the ,secretary7 for the year4 ,such data shall be submitted in a form and manner1 and at a time1 specified by the ,secretary for purposes of this subparagraph4 7,d7 ,data ,for purposes of reporting data for air ambulance services furnished during a year1 the data described in this subparagraph are cost data on the following3 7i7 ,maintenance of aircrafts4 7ii7 ,medical supplies4 7iii7 ,fuel4 7iv7 ,employee expenses4 7v7 ,recurring training relating to aviation1 maintenance1 communication1 and clinical4 7vi7 ,rent and utilities4 7vii7 ,communications4 7viii7 ,travel4 7ix7 ,hull and aviation liability insurance1 life insurance1 and professional malpractice insurance4 7x7 ,marketing4 7xi7 ,supplies4 7xii7 ,overhead support4 7xiii7 ,aircraft ownership expenses4 7xiv7 ,safety enhancement capital costs4 7xv7 ,safety enhancement recurring costs4 7,e7 ,voluntary reporting on quality measures ,not later than ,january #a1 #bjah1 the ,secretary shall select no less than two quality measures with respect to which providers and suppliers of air ambulance services may voluntarily submit to the ,secretary data4 ,in selecting such measures1 the ,secretary shall consider the following3 7i7 ,ventilator use in patients with advanced airways4 7ii7 ,blood glucose check for altered mental status4 7iii7 ,waveform capnography for ventilated patients4 7iv7 ,first attempt tracheal tube success4 7v7 ,,dash #a;,a-definitive airway sans hypoxia_/hypotension on first attempt4 7vi7 ,verification of tracheal tube placement4 7vii7 ,medication errors on transport4 7viii7 ,rapid sequence intubation protocol compliance4 7ix7 ,unplanned dislodgements of therapeutic devices4 7x7 ,rate of serious reportable events4 7xi7 ,medical equipment failure4 7,f7 ,reports 7i7 ,by ,secretary ,not later than ,july #a1 #bjai1 subject to clause 7iii71 the ,secretary shall submit to ,congress a report on the data described in subparagraph 7,e7 submitted to the ,secretary4 7ii7 ,by ,comptroller ,general ,not later than ,july #a1 #bjai1 subject to clause 7iii71 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the data described in subparagraph 7,d7 and subparagraph 7,e7 submitted under this paragraph4 ,such report shall include a recommendation on the adequate amount of reimbursement under this title to providers and suppliers of air ambulance services for furnishing such services that would reflect operational costs of such providers and suppliers and preserve access to critical air medical services and such other recommendations as the ,comptroller ,general deems appropriate4 7iii7 ,limitation ,the reports submitted under subclauses 7i7 and 7ii7 shall not include any information that the ,secretary or ,comptroller ,general1 respectively1 determines is proprietary4 7#ag7 ,increase in payment for air ambulance services 7,a7 ,in general ,subject to subparagraph 7,b71 ,in the case of air ambulance services furnished on or after ,january #a1 #bjag1 and before ,january #a1 #bjba1 the ,secretary shall provide for a percent increase in the base rate of the fee schedule established under this subsection-- 7i7 during #bjag1 by #bj percent2 and 7ii7 during #bjah through #bjbj1 by #e percent4 7,b7 ,adjustment to ensure budget neutrality ,for #bjag through #bjbj1 the ,secretary shall adjust the percentages described in clauses 7i7 and 7ii7 of subparagraph1 by either increasing or reducing 7but in no case below zero7 such percentages1 to ensure that the increased expenditures under this part by reason of subparagraph 7,a7 are equal to the reduced expenditures under this part by reason of paragraph 7#af74 4