,,ii  #aad? ,,congress  #a/ ,session    
,s4 #cgg  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #d1 #bjae,mr4 
,s*um] 7= himself1 ,mr4 ,rob]ts1 ,mr4   
,leahy1 & ,ms4 ,coll9s7 introduc$ !     
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xviii ( ! ,social      
,security ,act to increase access to    
ambulance s]vices "u ! ,m$ic>e program &
 to re=m paym5ts = su* s]vices "u su*   
program1 & = o!r purposes4  #a4 ,%ort   
title  7a7 ,%ort title ,?is ,act may be 
cit$ z ! ,m$ic>e ,ambulance ,access1    
,fraud ,prev5tion1 & ,re=m ,act ( #bjae4
  7b7 ,table ( cont5ts ,! table (       
cont5ts ( ?is ,act is z foll[s3 ,sec4   
#a4 ,%ort title4,sec4 #b4 ,re=m to !    
,m$ic>e ambulance fee s*$ule4,sec4 #c4  
,prior au?orization = ambulance         
transports ( ,,esrd b5efici>ies4,sec4   
#d4 ,requir+ ambulance provid]s to      
submit co/ & o!r in=mation4  #b4 ,re=m  
to ! ,m$ic>e ambulance fee s*$ule  7a7  
,9 g5]al ,section #ahcd7l7 ( ! ,social  

,security ,act 7#db ,u4,s4,c4 #aciem7l77
 is am5d$ by add+ ! foll[+ new          
p>agraphs3  7#af7 ,increase 9 conv]sion 
factor = gr\nd ambulance s]vices ,9 !   
case ( gr\nd ambulance s]vices furni%$  
on or aft] ,april #a1 #bjae1 = purposes 
( det]m9+ ! fee s*$ule am\nt = su*      
s]vices "u ?is subsection1 ! conv]sion  
factor o!rwise applicable to su* s]vices
 %all be increas$ by-- 7,a7 ) respect to
 gr\nd ambulance s]vices = :i* !        
transportation orig9ates 9 a qualifi$   
rural area1 z id5tifi$ us+ ! me?odology 
describ$ 9 p>agraph 7#ab77;,b77iii71    
#be4f p]c5t2  7,b7 ) respect to gr\nd   
ambulance s]vices n describ$ 9          
subp>agraph 7,a7 & = :i* !              
transportation orig9ates 9 a rural area 
describ$ "u p>agraph 7#i7 or 9 a rural  
c5sus tract describ$ 9 su* p>agraph1 #c 
p]c5t2 &  7,c7 ) respect to gr\nd       
ambulance s]vices n describ$ 9          
subp>agraph 7,a7 or 7,b71 #b p]c5t4     
7#ag7 ,increase 9 mileage rate = gr\nd  
ambulance s]vices ,9 ! case ( gr\nd     

ambulance s]vices furni%$ on or aft]    
,april #a1 #bjae1 = purposes ( det]m9+ !
 fee s*$ule am\nt = su* s]vices "u ?is  
subsection1 ! paym5t rate = mileage     
o!rwise applicable to su* s]vices %all  
be increas$ by-- 7,a7 ) respect to gr\nd
 ambulance s]vices = :i* !              
transportation orig9ates 9 a qualifi$   
rural area1 z id5tifi$ us+ ! me?odology 
describ$ 9 p>agraph 7#ab77;,b77iii71 #c 
p]c5t2  7,b7 ) respect to gr\nd         
ambulance s]vices n describ$ 9          
subp>agraph 7,a7 & = :i* !              
transportation orig9ates 9 a rural area 
describ$ "u p>agraph 7#i7 or 9 a rural  
c5sus tract describ$ 9 su* p>agraph1 #c 
p]c5t2 &  7,c7 ) respect to gr\nd       
ambulance s]vices n describ$ 9          
subp>agraph 7,a7 or 7,b71 #b p]c5t4  4  
7b7 ,/udy & report  7#a7 ,/udy ,!       
,secret>y ( ,heal? & ,human ,s]vices    
%all conduct a /udy on h[ ! conv]sion   
factor applicable to gr\nd ambulance    
s]vices "u ! ambulance fee s*$ule "u    
section #ahcd7l7 ( ! ,social ,security  

,act 7#db ,u4,s4,c4 #aciem7l771 z adju/$
 "u p>agraph 7#af7 ( su* section 7z add$
 by subsection 7a771 %\ld be modifi$1 if
 at all1 to take into acc\nt ! co/ (    
provid+ s]vices 9 urban1 rural1 &       
sup]-rural areas4 ,9 det]m9+ su* co/s1 !
 ,secret>y %all use ! data collect$     
?r\gh ! data collection sy/em "u        
p>agraph 7#ah7 ( su* section1 z add$ by 
section #d4  7#b7 ,report ,n lat] ?an   
,janu>y #a1 #bjbj1 ! ,secret>y ( ,heal? 
& ,human ,s]vices %all submit to        
,congress a report on ! /udy conduct$ "u
 p>agraph 7#a71 toge!r ) recomm5dations 
= su* legislation & adm9i/rative action 
z ! ,secret>y det]m9es appropriate4  #c4
 ,prior au?orization = ambulance        
transports ( ,,esrd b5efici>ies  7a7 ,9 
g5]al ,section #ahcd7l7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciem7l771 z am5d$ by section #b1 is   
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#ah7 ,prior au?orization (  
cov]age = ambulance transports ( ,,esrd 
b5efici>ies  7,a7 ,process  7i7 ,9 g5]al

 ,= applicable ,,esrd ambulance s]vices 
furni%$ on or aft] ,janu>y #a1 #bjag1 by
 an applicable ambulance provid]1 !     
,secret>y %all e/abli% & implem5t a     
process "u :i* ! ,secret>y %all det]m9e1
 9 advance ( furni%+ su* a s]vice to an 
individual1 :e!r paym5t = su* s]vice may
 n be made because su* s]vice is n cov]$
 or because ( ! application ( section   
#ahfb7;a77#a74  7ii7 ,d5ial ( paym5t    
,subject to subp>agraph 7,b77ii77,,ii71 
no paym5t %all be made "u ?is "p = !    
s]vice unless ! ,secret>y det]m9es      
pursuant to su* process t ! s]vice meets
 ! applicable requirem5ts = cov]age4    
7,b7 ,elem5ts ( process ,! process      
describ$ 9 subp>agraph 7,a7 %all include
 ! foll[+ elem5ts3 7i7 ,9 ord] to obta9 
a prior au?orization1 ! applicable      
ambulance provid] %all submit-- 7,i7 a  
valid physician c]tification /atem5t    
7,,pcs7 = non-em]g5cy ambulance         
transport2 &  7,,ii7 any o!r            
docum5tation det]m9$ appropriate by !   
,secret>y4  7ii7 7,i7 ,! ,secret>y %all 

respond to a prior au?orization reque/  
)9 #g bus9ess days ( receiv+ ! reque/4  
7,,ii7 ,if ! ,secret>y does n make a    
prior au?orization det]m9ation )9 #g    
bus9ess days ( ! date ( ! ,secret>y's   
receipt ( m$ical docum5tation ne$$ to   
make su* det]m9ation1 subp>agraph       
7,a77ii7 %all n apply4  7iii7 ,9 mak+ ! 
det]m9ation "u subp>agraph 7,a7 )       
respect to a s]vice & individual1 !     
,secret>y %all evaluate ! m$ical        
necessity ( ! s]vice by det]m9+-- 7,i7  
:e!r ! individual is unable to get up f 
b$ )\t assi/ance1 unable to ambulate1 & 
unable to sit 9 a *air or :eel*air2     
7,,ii7 :e!r ! individual has a m$ical   
condition t1 reg>dless ( b$ conf9em5t1  
is su* t transport by ambulance is      
m$ically necess>y2 or  7,,iii7 :e!r !   
individual meets o!r crit]ia z det]m9$  
appropriate by ! ,secret>y4  7iv7 ,if ! 
prior au?orization reque/ is approv$1   
su* reque/ %all be retroactive to ! date
 on :i* su* reque/ 0 receiv$4  7v7 ,an  
approv$ prior au?orization %all be valid

 = a #fj-;day p]iod4 ,! ,secret>y may   
provide = an ext5sion ( su* p]iod if !  
,secret>y det]m9es su* an ext5sion is   
appropriate4  7vi7 ,an approv$ prior    
au?orization %all be deem$ to con/itute 
m$ical necessity b %all n elim9ate !    
docum5tation requirem5ts necess>y to    
support a claim = ! transport4  7vii7   
,o!r elem5ts det]m9$ appropriate by !   
,secret>y4  7,c7 ,reliance ^u           
contractors ,! ,secret>y may rely ^u    
contractors to implem5t ! requirem5ts ( 
?is p>agraph4 ,! contractor's           
comp5sation %all be limit$ to a         
demon/ration t x has r$uc$ ! numb] (    
non-em]g5cy basic life support s]vices  
involv+ individuals ) end-/age r5al     
disease = r5al dialysis s]vices 7z      
describ$ 9 section #ahha7;b77#ad77;,b77 
furni%$ o!r ?an on an em]g5cy basis4    
7,d7 ,applicable ,,esrd ambulance       
s]vices ,9 ?is p>agraph1 ! t]m          
applicable ,,esrd ambulance s]vices     
means ambulance s]vices consi/+ (       
non-em]g5cy basic life support s]vices  

involv+ transport ( an individual )     
end-/age r5al disease = r5al dialysis   
s]vices 7z describ$ 9 section           
#ahha7;b77#ad77;,b77 furni%$ o!r ?an on 
an em]g5cy basis4  7,e7 ,ambulance      
provid]2 applicable ambulance provid]   
def9$ ,9 ?is p>agraph3 7i7 ,ambulance   
provid] ,! t]m ambulance provid] means a
 provid] ( s]vices 7z def9$ 9 section   
#ahfa7u77 or o!r entity t furni%es      
ambulance s]vices "u ?is title4  7ii7   
,applicable ambulance provid] ,! t]m    
applicable ambulance provid] means an   
ambulance provid] 7o!r ?an an ambulance 
provid] :o is a provid] ( s]vices 7z    
def9$ 9 su* section774  7,f7            
,implem5tation  7i7 ,9 g5]al ,subject to
 clause 7ii71 ! ,secret>y may c>ry out  
?is p>agraph ?r\gh program in/ruction or
 o!rwise4  7ii7 ,suffici5t notice to    
prep>e ,n lat] ?an ,june #cj1 #bjaf1 !  
,secret>y %all make ! aspects ( !       
process "u ?is p>agraph available to !  
public4  4  7b7 ,con=m+ am5dm5ts        
,section #ahcd7l7 ( ! ,social ,security 

,act 7#db ,u4,s4,c4 #aciem7l77 is       
am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ a
 suppli] or provid] or "u arrangem5t ) a
 provid] & ins]t+ an ambulance provid]  
7z def9$ 9 p>agraph 7#ah77;,e77i77 or "u
 arrangem5t ) an ambulance provid]2     
7#b7 9 p>agraph 7#h71 9 ! matt] foll[+  
subp>agraph 7,b71 by /rik+ provid] or   
suppli] ( ambulance s]vices & ins]t+    
ambulance provid] 7z def9$ 9 p>agraph   
7#ah77;,e77i772  7#c7 9 p>agraph 7#i71 9
 ! head+1 by ins]t+ ambulance aft]      
rural2  7#d7 9 p>agraph 7#ab71 9 !      
head+1 by ins]t+ ambulance aft] rural2 &
  7#e7 9 ea* ( subp>agraphs 7,b77ii7 &  
7,d77ii7 ( p>agraph 7#ad71 by /rik+     
entity & ins]t+ ambulance provid] 7z    
def9$ 9 p>agraph 7#ah77;,e77i774  #d4   
,requir+ ambulance provid]s to submit   
co/ & o!r in=mation ,section #ahcd7l7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciem7l771 z am5d$ by section #c1 is   
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#ai7 ,submission ( co/ & o!r
 in=mation  7,a7 ,developm5t ( data     

collection sy/em ,! ,secret>y %all      
develop a data collection sy/em 7:i* may
 include use ( a co/ survey & /&>diz$   
def9itions7 = ambulance provid]s to     
collect co/1 rev5ue1 utilization1 & o!r 
in=mation det]m9$ appropriate by !      
,secret>y4 ,su* sy/em %all be design$ to
 submit in=mation-- 7i7 ne$$ to evaluate
 ! appropriat5ess ( paym5t rates "u ?is 
subsection2  7ii7 on ! utilization (    
capital equipm5t & ambulance capacity2 &
  7iii7 on diff]5t types ( ambulance    
s]vices furni%$ 9 diff]5t geographic    
locations1 includ+ rural areas & l[     
population d5sity areas describ$ 9      
p>agraph 7#ab74  7,b7 ,specification (  
data collection sy/em  7i7 ,9 g5]al ,n  
lat] ?an ,july #a1 #bjaf1 ! ,secret>y   
%all-- 7,i7 specify ! data collection   
sy/em "u subp>agraph 7,a7 & ! "t p]iod  
dur+ :i* su* data is requir$ to be      
submitt$2 &  7,,ii7 id5tify ! ambulance 
provid]s :o w\ld be requir$ to submit ! 
in=mation "u su* data collection sy/em4 
7ii7 ,respond5ts ,subject to subp>agraph

 7,d77ii71 ! ,secret>y %all det]m9e an  
appropriate sample ( ambulance provid]s 
to submit in=mation "u ! data collection
 sy/em = ea* p]iod = :i* report+ ( data 
is requir$4  7,c7 ,p5alty = failure to  
report co/ & o!r in=mation ,beg9n+ on   
,july #a1 #bjag1 a #e-p]c5t r$uction to 
paym5ts "u ?is "p %all be made = a      
#a-ye> prospective p]iod specifi$ by !  
,secret>y to an ambulance provid] :o--  
7i7 is id5tifi$ "u subp>agraph          
7,b77i77,,ii7 or 7,d77ii7 z be+ requir$ 
to submit ! in=mation "u ! data         
collection sy/em2 &  7ii7 does n submit 
su* in=mation dur+ ! p]iod specifi$ "u  
subp>agraph 7,b77i77,i74  7,d7 ,ongo+   
data collection  7i7 ,revision ( data   
collection sy/em ,! ,secret>y may1 z    
det]m9$ appropriate1 p]iodically revise 
! data collection sy/em4  7ii7          
,subsequ5t data collection  7,i7 ,9     
g5]al ,9 ord] to cont9ue to evaluate !  
appropriat5ess ( paym5t rates "u ?is    
subsection1 ! ,secret>y %all1 = ye>s    
aft] #bjag 7b n less (t5 ?an once e #c  

ye>s71 require ambulance provid]s to    
submit in=mation = a p]iod ! ,secret>y  
det]m9es appropriate4 ,! p5alty describ$
 9 subp>agraph 7,c7 %all apply to su*   
subsequ5t data collection p]iods4       
7,,ii7 ,sample ,= ea* p]iod describ$ 9  
subclause 7,i71 ! ,secret>y %all det]m9e
 an appropriate sample ( ambulance      
provid]s to submit in=mation "u ! data  
collection sy/em = su* p]iod4 ,9 det]m9+
 :i* ambulance provid]s w\ld be requir$ 
to submit in=mation = su* p]iod1 !      
,secret>y may n require an ambulance    
provid] :o has already submitt$         
in=mation = a previ\s p]iod to submit   
in=mation = a subsequ5t p]iod unless all
 ( ! ambulance provid]s :o ! ,secret>y  
det]m9es are ! same type z su* ambulance
 provid] h ei!r submitt$ in=mation or   
be5 p5aliz$ "u subp>agraph 7,c7 = n do+ 
s4  7,e7 ,consultation ,! ,secret>y %all
 consult ) /akehold]s 9 c>ry+ out !     
developm5t ( ! sy/em & collection (     
in=mation "u ?is p>agraph1 includ+ !    
activities describ$ 9 subp>agraphs 7,a7 

& 7,d74 ,su* consultation %all include !
 use ( reque/s = in=mation & o!r        
me*anisms det]m9$ appropriate by !      
,secret>y4  7,f7 ,def9ition ( ambulance 
provid] ,9 ?is p>agraph1 ! t]m ambulance
 provid] has ! mean+ giv5 su* t]m 9     
p>agraph 7#ah77;,e77i74  7,g7           
,adm9i/ration ,*apt] #ce ( title #dd1   
,unit$ ,/ates ,code1 %all n apply to !  
collection ( in=mation requir$ "u ?is   
subsection4  7,h7 ,limitations on review
 ,!re %all be no adm9i/rative or        
judicial review "u section #ahfi1       
section #ahgh1 or o!rwise ( ! data      
collection sy/em or id5tification (     
respond5ts "u ?is p>agraph4  7,i7 ,fund+
 = implem5tation ,= purposes ( c>ry+ out
 subp>agraph 7,a71 ! ,secret>y %all     
provide = ! transf]1 f ! ,f$]al         
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u section #ahda1 ( #a1jjj1jjj to 
! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices   
,program ,managem5t ,acc\nt = fiscal ye>
 #bjaf4 ,am\nts transf]r$ "u ?is        
subp>agraph %all rema9 available until  

exp5d$4  4