,,ib  ,union ,cal5d> ,no4 #cef  #aae?   
,,congress  #a/ ,session  ,h4 ,r4 #cgbi 
,report ,no4 #aae-dha1 ,"p ,i  ,,9 ,,!  
,,h\se ,,( ,,repres5tatives  ,septemb]  
#aa1 #bjag ,mr4 ,nunes 7= himself & ,ms4
 ,sewell ( ,alabama7 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$  ,decemb] #ba1 #bjag 
,additional sponsors3 ,mr4 ,curbelo (   
,florida1 ,ms4 ,j5k9s ( ,kansas1 & ,mr4 
,pet]son  ,decemb] #ba1 #bjag ,report$ f
 ! ,committee on ,ways & ,means ) an    
am5dm5t ,/rike out all aft] ! enact+    
clause & ins]t ! "p pr9t$ 9 italic      
,decemb] #ba1 #bjag ,! ,committee on    
,en]gy & ,comm]ce dis*>g$2 committ$ to !
 ,committee ( ! ,:ole ,h\se on ! ,/ate (
 ! ,union & ord]$ to be pr9t$ ,= text ( 
introduc$ bill1 see copy ( bill z       
introduc$ on ,septemb] #aa1 #bjag  ,a   

,,bill  ,to am5d titles ,,xi & ,,xviii (
 ! ,social ,security ,act to facilitate 
provid] & suppli] co/ report+ (         
ambulance s]vices "u ! ,m$ic>e program1 
& = o!r purposes4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,compreh5sive      
,op]ations1 ,su/a9ability1 & ,transport 
,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$--  7#a7 9 subsection 7a7-- 7,a7
 by /rik+ ,= ! purposes ( & ins]t+      
,subject to subsection 7d71 = ! purposes
 (2  7,b7 by ins]t+ suppli]s ( gr\nd    
ambulance s]vices1 aft] heal? ma9t5ance 
organizations12 &  7,c7 9 ! matt] foll[+
 p>agraph 7#e71 by add+ ! foll[+ new    
s5t5ce3 ,n lat] ?an ,decemb] #ca1 #bjai1
 ! ,secret>y %all modify ! uni=m report+
 sy/em = provid]s ( s]vices ) respect to
 ambulance s]vices to ensure t su* sy/em
 conta9s in=mation simil> 7z det]m9$ by 
! ,secret>y7 to in=mation requir$ "u !  
uni=m report+ sy/em = suppli]s ( gr\nd  

ambulance s]vices42 &  7#b7 by add+ at !
 end ! foll[+ new subsection3  7d7 ,9 ! 
case ( a suppli] ( gr\nd ambulance      
s]vices t furni%es su* s]vices = few]   
?an #bj individuals entitl$ to b5efits  
"u "p ,a ( title ,,xviii & enroll$ "u "p
 ,b ( su* title 9 a co/ 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/ems e/abli%$ "u ?is section )
 respect to su* s]vices4  4  7b7        
,susp5sion ( paym5t = gr\nd ambulance   
s]vices2 deem+ c]ta9 paym5ts ov]paym5ts 
,section #ahcd7l7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7l77 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#ag7 ,requirem5t to submit co/ report &
 au?ority to susp5d paym5ts & deem c]ta9
 paym5ts ov]paym5ts = gr\nd ambulance   
s]vices  7,a7 ,9 g5]al ,) respect to    
gr\nd ambulance s]vices furni%$ by a    
suppli] ( su* s]vices dur+ co/ report+  
p]iods 7z def9$ 9 subp>agraph 7,i77     

beg9n+ on or aft] ,janu>y #a1 #bjbj1 su*
 suppli] %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 = 
su* suppli]s &1 z may be requir$ by !   
,secret>y1 ( any ( ! in=mation describ$ 
9 subp>agraph 7,b74  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;a7 = su* suppli]s73  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 
,! av]age numb] ( volunte] h\rs a week  
us$ by ! suppli]4  7,c7 ,susp5sion (    
paym5t ,subject to subp>agraph 7,e71 9 !
 case t ! ,secret>y det]m9es t a suppli]
 ( gr\nd ambulance s]vices has n made to

 ! ,secret>y a timely report describ$ 9 
subp>agraph 7,a7 ) respect to a co/     
report+ p]iod beg9n+ on or aft] ,janu>y 
#a1 #bjbj1 & be=e ,janu>y #a1 #bjbb1 !  
,secret>y may susp5d paym5ts made "u ?is
 subsection1 9 :ole or 9 "p1 to su*     
suppli] until ! ,secret>y f9ds t su*    
suppli] has made su* a report4  7,d7    
,deem+ c]ta9 paym5ts ov]paym5ts ,subject
 to subp>agraphs 7,e7 & 7,f71 9 ! case t
 ! ,secret>y det]m9es t a suppli] (     
gr\nd ambulance s]vices has n made to ! 
,secret>y a complete1 accurate1 & timely
 report describ$ 9 subp>agraph 7,a7 )   
respect to a co/ report+ p]iod beg9n+ on
 or aft] ,janu>y #a1 #bjbb1 ! ,secret>y 
may deem paym5ts made "u ?is subsection 
to su* suppli] = su* p]iod to be        
ov]paym5ts & rec\p su* ov]paym5ts4  7,e7
 ,h>d%ip delay ,! ,secret>y %all e/abli%
 a process :]eby a suppli] ( gr\nd      
ambulance s]vices may reque/ a delay 9  
mak+ a report describ$ 9 subp>agraph    
7,a7 ) respect to a co/ report+ p]iod = 
reason ( significant h>d%ip 7z det]m9$  

by ! ,secret>y74  7,f7 ,au?ority to     
modify co/ report+ elem5ts & en=cem5t ,n
 e>li] ?an ,janu>y #a1 #bjbc1 !         
,secret>y may provide t subp>agraph 7,d7
 no long] applies to gr\nd ambulance    
s]vices suppli]s or a category ( su*    
suppli]s aft]--  7i7 tak+ into acc\nt ! 
recomm5dation ( ! ,m$ic>e ,paym5t       
,advisory ,commission 9 ! mo/ rec5t     
report available to ! ,secret>y submitt$
 "u section #c ( ! ,compreh5sive        
,op]ations1 ,su/a9ability1 & ,transport 
,act ( #bjag reg>d+ :e!r co/ reports    
made by suppli]s or a category (        
suppli]s 7z specifi$ = purposes ( !     
report submitt$ "u su* section7 %\ld be 
requir$ or modifi$2 &  7ii7 und]tak+    
notice & comm5t rulemak+4  7,g7 ,audit (
 co/ reports ,! ,secret>y %all audit    
reports describ$ 9 subp>agraph 7,a7 made
 ) respect to co/ report+ p]iods beg9n+ 
on or aft] ,janu>y #a1 #bjba4  7,h7     
,appeals ,! ,secret>y %all e/abli% a    
process :]eby a suppli] ( gr\nd         
ambulance s]vices may appeal a          

det]m9ation describ$ 9 subp>agraph 7,c7 
or 7,d7 made ) respect to a co/ report  
requir$ to be made by su* suppli] "u    
subp>agraph 7,a74  7,i7 ,def9ition ,9   
?is p>agraph1 ! t]m co/ report+ p]iod   
means1 ) respect to a ye>1 ! #ab-mon?   
p]iod beg9n+ on ,janu>y #a ( su* ye>4  4
  7c7 ,/akehold] fe$back  7#a7 ,9 g5]al 
,! ,secret>y ( ,heal? & ,human ,s]vices 
%all implem5t ! provisions ( ?is        
section1 includ+ ! am5dm5ts made by ?is 
section1 ?r\gh notice & comm5t rulemak+ 
& seek input f /akehold]s4  7#b7        
,nonapplication ( ,pap]work ,r$uction   
,act ,*apt] #ce ( title #dd1 ,unit$     
,/ates ,code1 %all n apply ) respect    
to-- 7,a7 ! developm5t & implem5tation (
 ! uni=m report+ sy/em requir$ "u       
section #aaba7;a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acbj;a7a77 =       
suppli]s ( gr\nd ambulance s]vices &    
reports requir$ to be made "u section   
#ahcd7l77#ag7 ( su* ,act 7#db ,u4,s4,c4 
#aciem7l77#ag772 &  7,b7 ! modification 
( ! uni=m report+ sy/ems "u su* section 

#aaba7;a7 ( su* ,act = provid]s ( su*   
s]vices & reports requir$ to be made "u 
section #ahfa7v77#a77;,f7 ( su* ,act    
7#db ,u4,s4,c4 #aciex7v77#a77;,f774  7d7
 ,implem5tation res\rces  7#a7 ,9 g5]al 
,!re are h]eby appropriat$ to !         
,secret>y f ! ,f$]al ,hospital          
,insurance ,tru/ ,fund "u section #ahag 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i7 #h1jjj1jjj & f !     
,f$]al ,supplem5t>y ,m$ical ,insurance  
,tru/ ,fund "u section #ahda ( su* ,act 
7#db ,u4,s4,c4 #aciet7 #ib1jjj1jjj 7(   
:i* n less ?an #aj1jjj1jjj %all be us$  
to fulfill ! audit+ requirem5t "u       
section #ahcd7l77#ag77;,g7 ( su* ,act1 z
 add$ by subsection 7b7 ( ?is section7  
to c>ry out ! provisions ( ?is section1 
includ+ ! am5dm5ts made by ?is section1 
to rema9 available ?r\gh ,decemb] #ca1  
#bjbb4  7#b7 ,fund+ = employees ,!      
,secret>y ( ,heal? & ,human ,s]vices    
%all provide = ! transf] to ! ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices ,program     
,managem5t ,acc\nt1 f ! ,f$]al          

,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u section #ahda ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #aciet71 (
 su* sums z may be necess>y 9 ord] to   
directly hire no m ?an #b full-"t       
employees to c>ry out ! provisions ( ?is
 section1 includ+ ! am5dm5ts made by ?is
 section4  7e7 ,s5se ( ,congress ,x is !
 s5se ( ,congress t-- 7#a7 a co/ report 
made by a suppli] ( gr\nd ambulance     
s]vices ) respect to a co/ report+ p]iod
 beg9n+ be=e ,janu>y #a1 #bjbb1 may n   
conta9 complete & accurate in=mation on 
gr\nd ambulance s]vices furni%$ dur+ su*
 a p]iod by ! suppli]2 &  7#b7 !        
,secret>y %\ld take into acc\nt only !  
timel9ess ( su* a report made ) respect 
to su* a p]iod :5 det]m9+ :e!r to susp5d
 paym5ts to a suppli] "u section        
#ahcd7l7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem7l774  #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 co/ reports c>ri$ 
out 9 accordance ) sections #aaba7;a7 & 
#ahcd7l7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acbj;a7a71 #aciem7l771 !    
adequacy ( paym5ts = su* s]vices made "u
 section #ahcd7l7 ( su* ,act1 & ! ext5t 
to :i* /ate m&ates may create geographic
 v>iations 9 ! co/ ( provid+ su*        
s]vices4  7b7 ,cont5ts ,! report        
describ$ 9 subsection 7a7 %all conta9 ! 
foll[+3 7#a7 ,an analysis ( 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/ reports (
 ambulance s]vices made by suppli]s or a
 category ( suppli]s 7z specifi$ by !   
,secret>y7 ( su* s]vices1 or ! gr\nd    
ambulance portion ( co/ reports made by 
provid]s ( su* s]vices1 %\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 & pay-= ,section #ahcd7l7 ( !   
,social ,security ,act 7#db4 ,u4,s4,c4  
#aciem7l77 is am5d$-- 7#a7 9 p>agraph   
7#ab77;,a71 by /rik+ #bjah & ins]t+     
#bjbc2  7#b7 9 p>agraph 7#ac77;,a71 by  
/rik+ #bjah ea* place x appe>s & ins]t+ 
#bjbc2 &  7#c7 9 p>agraph 7#ae71 by     
/rik+ on or aft] ,octob] #a1 #bjac &    
ins]t+ dur+ ! p]iod beg9n+ on ,octob]   
#a1 #bjac1 & end+ on ,septemb] #cj1     
#bjah1 & by #cb p]c5t = su* s]vices     
furni%$ on or aft] ,octob] #a1 #bjah4   
,decemb] #ba1 #bjag ,report$ f !        
,committee on ,ways & ,means ) an       
amendment,december #ba1 #bjag,!         
,committee on ,en]gy & ,comm]ce dis*>g$2
 committ$ to ! ,committee ( ! ,:ole     
,h\se on ! ,/ate ( ! ,union & ord]$ to  
be pr9t$