,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #cbcf  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #ac1 #bjag,mr4  
,nunes 7= himself & ,mr4 ,upton7        
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means1 & 9    
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d titles ,,xi & ,,xviii 
( ! ,social ,security ,act to improve   
provid] & suppli] co/ report+ (         
ambulance s]vices "u ! ,m$ic>e program1 
& = o!r purposes4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,ambulance ,m$ic>e 
,budget & ,op]ations ,act ( #bjag4  #b4 
,gr\nd ambulance s]vices co/ report+    
requirem5t  7a7 ,9 g5]al ,section #aaba 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acbj;a7 is am5d$--  7#a7 9   
subsection 7a7-- 7,a7 by /rik+ ,= !     
purposes ( & ins]t+ ,subject to         
subsection 7d71 = ! purposes (2 &  7,b7 

by ins]t+ provid]s & suppli]s ( gr\nd   
ambulance s]vices1 aft] heal? ma9t5ance 
organizations12 &  7#b7 by add+ at ! end
 ! foll[+ new subsection3  7d7 ,9 ! case
 ( a provid] or suppli] ( gr\nd         
ambulance s]vices t furni%es su* s]vices
 = few] ?an #bj individuals entitl$ to  
b5efits "u "p ,a & enroll$ "u "p ,b 9 a 
report+ p]iod 7z def9$ by ! ,secret>y71 
! ,secret>y may modify ! requirem5ts =  
inclusion ( any in=mation specifi$ 9    
subsection 7a7 9 reports made 9         
accordance ) ! uni=m report+ sy/em      
e/abli%$ "u ?is section ) respect to su*
 s]vices4  4  7b7 ,hospital provid]     
agreem5ts ,section #ahff7;a77#a7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7a77#a77 is am5d$-- 7#a7 9      
subp>agraph 7,x71 by /rik+ ,secret>y1 & 
& ins]t+ ,secret>y12  7#b7 9 subp>agraph
 7,y77ii77,v71 by /rik+ ! p]iod at ! end
 & ins]t+ 1 &2 &  7#c7 by ins]t+ aft]   
subp>agraph 7,y7 ! foll[+ new           
subp>agraph3  7,z7 9 ! case ( a hospital
 t is a provid] ( gr\nd ambulance       

s]vices1 ) respect to su* s]vices       
furni%$ = report+ p]iods 7z def9$ by !  
,secret>y7 on or aft] ,janu>y #a1 #bjbb1
 to make reports to ! ,secret>y (       
in=mation describ$ 9 section #aaba7;a7 9
 accordance ) ! uni=m report+ sy/em     
e/abli%$ "u su* section = provid]s &    
suppli]s ( gr\nd ambulance s]vices4  4  
7c7 ,skill$ nurs+ facility provid]      
agreem5ts ,section #ahai7;d7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acie;i-#c7;d77 is am5d$ by add+ at !   
end ! foll[+ new p>agraph3  7#e7        
,ambulance s]vices co/ report+ ,a skill$
 nurs+ facility t furni%es gr\nd        
ambulance s]vices1 ) respect to su*     
s]vices furni%$ on or aft] ,janu>y #a1  
#bjbb1 %all make reports to ! ,secret>y 
( in=mation describ$ 9 section #aaba7;a7
 9 accordance ) ! uni=m report+ sy/em   
e/abli%$ "u su* section = provid]s &    
suppli]s ( gr\nd ambulance s]vices4  4  
7d7 ,home heal? ag5cy provid] agreem5ts 
,section #ahia7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;bbb7a77 is   

am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#g7 ,9 ! case ( an ag5cy t  
furni%es gr\nd ambulance s]vices1 )     
respect to su* s]vices furni%$ on or    
aft] ,janu>y #a1 #bjbb1 ! ag5cy makes   
reports to ! ,secret>y ( in=mation      
describ$ 9 section #aaba7;a7 9          
accordance ) ! uni=m report+ sy/em      
e/abli%$ "u su* section = provid]s &    
suppli]s ( gr\nd ambulance s]vices4  4  
7e7 ,susp5sion ( paym5t = gr\nd         
ambulance s]vices ,section #ahcd7l7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7l77 is am5d$ by add+ at ! end !  
foll[+ new p>agraph3  7#ag7 ,au?ority to
 susp5d paym5ts = gr\nd ambulance       
s]vices  7,a7 ,9 g5]al ,subject to      
subp>agraphs 7,c7 & 7,d71 9 ! case t !  
,secret>y det]m9es t a suppli] ( gr\nd  
ambulance s]vices has n made to !       
,secret>y complete1 accurate1 & timely  
reports ( su* s]vices = report+ p]iods  
7z def9$ by ! ,secret>y7 ) respect to a 
ye> beg9n+ ) #bjbj ( in=mation describ$ 
9 section #aaba7;a7 9 accordance ) !    

uni=m report+ sy/em e/abli%$ "u su*     
section = provid]s & suppli]s ( gr\nd   
ambulance s]vices &1 z det]m9$          
appropriate by ! ,secret>y1 ( any ( !   
in=mation describ$ 9 subp>agraph 7,b71 !
 ,secret>y may susp5d paym5ts made "u   
?is subsection1 9 :ole or 9 "p1 to su*  
suppli] until ! ,secret>y det]m9es t su*
 suppli] has submitt$ su* reports )     
respect to su* report+ p]iod4  7,b7     
,additional in=mation ,! ,secret>y may1 
) respect to a suppli] ( gr\nd ambulance
 s]vices1 require ! foll[+ in=mation 7to
 be report$ to ! ext5t practicable "u ! 
uni=m report+ sy/em e/abli%$ "u section 
#aaba7;a773  7i7 ,:e!r ! suppli] is "p (
 an em]g5cy s]vices dep>tm5t1 a         
gov]nm5tal organization1 or ano!r type (
 entity 7z describ$ by ! ,secret>y74    
7ii7 ,! numb] ( h\rs 9 a week dur+ :i* !
 suppli] is available = furni%+ gr\nd   
ambulance s]vices4  7iii7 ,any ,/ate    
regulations reg>d+ requirem5ts relat+ to
 ! /ock+ ( ambulances ) c]ta9 equipm5t  
or drugs4  7iv7 ,! av]age numb] (       

volunte] h\rs a week us$ by ! suppli]4  
7,c7 ,h>d%ip delay ,! ,secret>y %all    
e/abli% a process :]eby a suppli] (     
gr\nd ambulance s]vices may reque/ a    
delay 9 report+ in=mation describ$ 9    
subp>agraphs 7,a7 & 7,b7 ) respect to a 
report+ p]iod = reason ( significant    
h>d%ip 7z det]m9$ by ! ,secret>y74  7,d7
 ,au?ority to modify co/ report+ elem5ts
 & en=cem5t ,n e>li] ?an ,janu>y #a1    
#bjbc1 ! ,secret>y may1 aft] tak+ into  
acc\nt ! recomm5dation ( ! ,m$ic>e      
,paym5t ,advisory ,commission 9 ! mo/   
rec5t report available to ! ,secret>y   
submitt$ "u section #c ( ! ,ambulance   
,m$ic>e ,budget & ,op]ations ,act (     
#bjag reg>d+ :e!r co/ report+ ( gr\nd   
ambulance s]vices by a suppli] or       
category ( suppli]s 7z specifi$ =       
purposes ( ! report submitt$ "u su*     
section7 %\ld be requir$ or modifi$1 &  
?r\gh notice & comm5t rulemak+1 provide 
t subp>agraph 7,a7 no long] applies to  
gr\nd ambulance s]vices suppli]s or su* 
a category ( su* suppli]s4  4  7f7      

,/akehold] fe$back  7#a7 ,9 g5]al ,!    
,secret>y %all implem5t ! provisions (  
?is section1 includ+ ! am5dm5ts made by 
?is section1 ?r\gh notice & comm5t      
rulemak+ & seek input f /akehold]s4     
7#b7 ,nonapplication ( ,pap]work        
,r$uction ,act ,*apt] #ce ( title #dd1  
,unit$ ,/ates ,code1 %all n apply )     
respect to notice & comm5t rulemak+     
c>ri$ out "u p>agraph 7#a74  #c4 ,gr\nd 
ambulance s]vices co/ report+ /udy  7a7 
,9 g5]al ,n lat] ?an ,m>* #ae1 #bjbb1 & 
z det]m9$ necess>y by ! ,m$ic>e ,paym5t 
,advisory ,commission !reaft]1 su*      
,commission %all assess & submit to     
,congress a report on ambulance s]vices 
co/ report+ c>ri$ out 9 accordance )    
sections #aaba7;a7 & #ahcd7l7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a7a71 #aciem7l77 & ! adequacy (   
paym5ts = su* s]vices made "u section   
#ahcd7l7 ( su* ,act4  7b7 ,cont5ts ,!   
report describ$ 9 subsection 7a7 %all   
conta9 ! foll[+3 7#a7 ,an analysis ( !  
accuracy ( co/ report data submitt$ 9   

accordance ) su* sections4  7#b7 ,an    
analysis ( any burd5 on provid]s &      
suppli]s ( su* s]vices associat$ )      
report+ su* data4  7#c7 ,a recomm5dation
 on :e!r or n co/ report+ ( ambulance   
s]vices by provid]s1 suppli]s1 or a     
category ( suppli]s 7z specifi$ by !    
,secret>y7 ( su* s]vices %\ld be requir$
 or modifi$1 tak+ into acc\nt ! analyses
 describ$ 9 p>agraphs 7#a7 & 7#b74  #d4 
,ext5sion ( gr\nd ambulance s]vices     
ext5d]s ,section #ahcd7l7 ( ! ,social   
,security ,act 7#db4 ,u4,s4,c4          
#aciem7l77 is am5d$-- 7#a7 9 p>agraph   
7#ab77;,a71 by /rik+ #bjah & ins]t+     
#bjbc2 &  7#b7 9 p>agraph 7#ac77;,a71 by
 /rik+ #bjah ea* place x appe>s & ins]t+
 #bjbc4