,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #cbcf  ,,in ,,the ,,house ,,of  
,,representatives  ,july #ac1 #bjag,mr4 
,nunes 7for himself and ,mr4 ,upton7    
introduced the following bill2 which was
 referred to the ,committee on ,ways and
 ,means1 and in addition to the         
,committee on ,energy and ,commerce1 for
 a period to be subsequently determined 
by the ,speaker1 in each case for       
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
amend titles ,,xi and ,,xviii of the    
,social ,security ,act to improve       
provider and supplier cost reporting of 
ambulance services under the ,medicare  
program1 and for other purposes4  #a4   
,short title ,this ,act may be cited as 
the ,ambulance ,medicare ,budget and    
,operations ,act of #bjag4  #b4 ,ground 
ambulance services cost reporting       
requirement  7a7 ,in general ,section   
#aaba of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acbj;a7 is amended--  7#a7  

in subsection 7a7-- 7,a7 by striking    
,for the purposes of and inserting      
,subject to subsection 7d71 for the     
purposes of2 and  7,b7 by inserting     
providers and suppliers of ground       
ambulance services1 after health        
maintenance organizations12 and  7#b7 by
 adding at the end the following new    
subsection3  7d7 ,in the case of a      
provider or supplier of ground ambulance
 services that furnishes such services  
for fewer than #bj individuals entitled 
to benefits under part ,a and enrolled  
under part ,b in a reporting period 7as 
defined by the ,secretary71 the         
,secretary may modify the requirements  
for inclusion of any information        
specified in subsection 7a7 in reports  
made in accordance with the uniform     
reporting system established under this 
section with respect to such services4  
4  7b7 ,hospital provider agreements    
,section #ahff7;a77#a7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acie;cc7a77#a77 is amended-- 7#a7 in   

subparagraph 7,x71 by striking          
,secretary1 and and inserting           
,secretary12  7#b7 in subparagraph      
7,y77ii77,v71 by striking the period at 
the end and inserting 1 and2 and  7#c7  
by inserting after subparagraph 7,y7 the
 following new subparagraph3  7,z7 in   
the case of a hospital that is a        
provider of ground ambulance services1  
with respect to such services furnished 
for reporting periods 7as defined by the
 ,secretary7 on or after ,january #a1   
#bjbb1 to make reports to the ,secretary
 of information described in section    
#aaba7;a7 in accordance with the uniform
 reporting system established under such
 section for providers and suppliers of 
ground ambulance services4  4  7c7      
,skilled nursing facility provider      
agreements ,section #ahai7;d7 of the    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;d77 is amended by adding at 
the end the following new paragraph3    
7#e7 ,ambulance services cost reporting 
,a skilled nursing facility that        

furnishes ground ambulance services1    
with respect to such services furnished 
on or after ,january #a1 #bjbb1 shall   
make reports to the ,secretary of       
information described in section        
#aaba7;a7 in accordance with the uniform
 reporting system established under such
 section for providers and suppliers of 
ground ambulance services4  4  7d7 ,home
 health agency provider agreements      
,section #ahia7;a7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;bbb7a77 is amended by adding at   
the end the following new paragraph3    
7#g7 ,in the case of an agency that     
furnishes ground ambulance services1    
with respect to such services furnished 
on or after ,january #a1 #bjbb1 the     
agency makes reports to the ,secretary  
of information described in section     
#aaba7;a7 in accordance with the uniform
 reporting system established under such
 section for providers and suppliers of 
ground ambulance services4  4  7e7      
,suspension of payment for ground       

ambulance services ,section #ahcd7l7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciem7l77 is amended by      
adding at the end the following new     
paragraph3  7#ag7 ,authority to suspend 
payments for ground ambulance services  
7,a7 ,in general ,subject to            
subparagraphs 7,c7 and 7,d71 in the case
 that the ,secretary determines that a  
supplier of ground ambulance services   
has not made to the ,secretary complete1
 accurate1 and timely reports of such   
services for reporting periods 7as      
defined by the ,secretary7 with respect 
to a year beginning with #bjbj of       
information described in section        
#aaba7;a7 in accordance with the uniform
 reporting system established under such
 section for providers and suppliers of 
ground ambulance services and1 as       
determined appropriate by the           
,secretary1 of any of the information   
described in subparagraph 7,b71 the     
,secretary may suspend payments made    
under this subsection1 in whole or in   

part1 to such supplier until the        
,secretary determines that such supplier
 has submitted such reports with respect
 to such reporting period4  7,b7        
,additional information ,the ,secretary 
may1 with respect to a supplier of      
ground ambulance services1 require the  
following information 7to be reported to
 the extent practicable under the       
uniform reporting system established    
under section #aaba7;a773  7i7 ,whether 
the supplier is part of an emergency    
services department1 a governmental     
organization1 or another type of entity 
7as described by the ,secretary74  7ii7 
,the number of hours in a week during   
which the supplier is available for     
furnishing ground ambulance services4   
7iii7 ,any ,state regulations regarding 
requirements relating to the stocking of
 ambulances with certain equipment or   
drugs4  7iv7 ,the average number of     
volunteer hours a week used by the      
supplier4  7,c7 ,hardship delay ,the    
,secretary shall establish a process    

whereby a supplier of ground ambulance  
services may request a delay in         
reporting information described in      
subparagraphs 7,a7 and 7,b7 with respect
 to a reporting period for reason of    
significant hardship 7as determined by  
the ,secretary74  7,d7 ,authority to    
modify cost reporting elements and      
enforcement ,not earlier than ,january  
#a1 #bjbc1 the ,secretary may1 after    
taking into account the recommendation  
of the ,medicare ,payment ,advisory     
,commission in the most recent report   
available to the ,secretary submitted   
under section #c of the ,ambulance      
,medicare ,budget and ,operations ,act  
of #bjag regarding whether cost         
reporting of ground ambulance services  
by a supplier or category of suppliers  
7as specified for purposes of the report
 submitted under such section7 should be
 required or modified1 and through      
notice and comment rulemaking1 provide  
that subparagraph 7,a7 no longer applies
 to ground ambulance services suppliers 

or such a category of such suppliers4  4
  7f7 ,stakeholder feedback  7#a7 ,in   
general ,the ,secretary shall implement 
the provisions of this section1         
including the amendments made by this   
section1 through notice and comment     
rulemaking and seek input from          
stakeholders4  7#b7 ,nonapplication of  
,paperwork ,reduction ,act ,chapter #ce 
of title #dd1 ,united ,states ,code1    
shall not apply with respect to notice  
and comment rulemaking carried out under
 paragraph 7#a74  #c4 ,ground ambulance 
services cost reporting study  7a7 ,in  
general ,not later than ,march #ae1     
#bjbb1 and as determined necessary by   
the ,medicare ,payment ,advisory        
,commission thereafter1 such ,commission
 shall assess and submit to ,congress a 
report on ambulance services cost       
reporting carried out in accordance with
 sections #aaba7;a7 and #ahcd7l7 of the 
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a7a71 #aciem7l77 and the adequacy 
of payments for such services made under

 section #ahcd7l7 of such ,act4  7b7    
,contents ,the report described in      
subsection 7a7 shall contain the        
following3 7#a7 ,an analysis of the     
accuracy of cost report data submitted  
in accordance with such sections4  7#b7 
,an analysis of any burden on providers 
and suppliers of such services          
associated with reporting such data4    
7#c7 ,a recommendation on whether or not
 cost reporting of ambulance services by
 providers1 suppliers1 or a category of 
suppliers 7as specified by the          
,secretary7 of such services should be  
required or modified1 taking into       
account the analyses described in       
paragraphs 7#a7 and 7#b74  #d4          
,extension of ground ambulance services 
extenders ,section #ahcd7l7 of the      
,social ,security ,act 7#db4 ,u4,s4,c4  
#aciem7l77 is amended-- 7#a7 in         
paragraph 7#ab77;,a71 by striking #bjah 
and inserting #bjbc2 and  7#b7 in       
paragraph 7#ac77;,a71 by striking #bjah 
each place it appears and inserting     

#bjbc4