,,ii  #aae? ,,congress  #a/ ,session    
,s4 #baba  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #ad1 #bjag,mr4
 ,hell] 7= himself1 ,mr4 ,b5net1 & ,mr4 
,g>dn]7 introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
require report+ ( c]ta9 data by provid]s
 & suppli]s ( air ambulance s]vices =   
purposes ( re=m+ reimbursem5ts = su*    
s]vices "u ! ,m$ic>e program1 & = o!r   
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,ensur+ ,access to ,air    
,ambulance ,s]vices ,act ( #bjag4  #b4  
,air ambulance data report+ program &   
value-bas$ pur*as+ program ,section     
#ahcd7l7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem7l77 is am5d$--  7#a7 9
 p>agraph 7#c77;,b71 by /rik+           
subp>agraph 7,c7 & ins]t+ subp>agraph   
7,c7 & p>agraphs 7#ag7 & 7#bj72  7#b7 9 
p>agraph 7#c77;,c71 by ins]t+ 7o!r ?an  
#bjah7 aft] ea* subsequ5t ye>2 &  7#c7  
by add+ at ! end ! foll[+ new p>agraphs3

  7#ag7 ,air ,ambulance ,data ,report+  
,program  7,a7 ,submission ( co/ data ,)
 respect to #bjai & ea* subsequ5t ye>1  
ea* suppli] or provid] ( air ambulance  
s]vices %all submit to ! ,secret>y data 
specifi$ "u subp>agraph 7,b7 = air      
ambulance s]vices furni%$ by su* provid]
 or suppli] dur+ su* ye>4 ,su* data %all
 be submitt$ 9 a =m & mann]1 & on an    
annual basis1 z specifi$ by ! ,secret>y 
= purposes ( ?is subp>agraph4  7,b7 ,co/
 data ,= purposes ( report+ data = air  
ambulance s]vices furni%$ dur+ a ye>1 ! 
data describ$ 9 ?is subp>agraph are co/ 
data on ! foll[+3  7i7 ,ma9t5ance (     
aircrafts4  7ii7 ,m$ical supplies &     
equipm5t4  7iii7 ,fuel4  7iv7 ,employee 
exp5ses4  7v7 ,recurr+ tra9+ relat+ to  
aviation1 ma9t5ance1 communication1 &   
cl9ical4  7vi7 ,r5t & utilities4  7vii7 
,communications4  7viii7 ,travel4  7ix7 
,hull & aviation liability insurance1   
life insurance1 & pr(essional           
malpractice insurance4  7x7 ,m>ket+4    
7xi7 ,supplies & equipm5t4  7xii7       

,ov]head support4  7xiii7 ,aircraft     
own]%ip exp5ses4  7xiv7 ,depreciation4  
7xv7 ,safety enhancem5t capital co/s4   
7xvi7 ,safety enhancem5t recurr+ co/s4  
7,c7 ,consultation relat+ to co/ reports
 ,= purposes ( ?is p>agraph1 ! ,secret>y
 %all consult ) suppli]s & provid]s (   
air ambulance s]vices to develop a co/  
report+ in/rum5t & fur!r def9e ! data   
specifi$ "u subp>agraph 7,b7 ?r\gh      
in/ructions4  7,d7 ,submission ( quality
 data ,) respect to #bjbj & ea*         
subsequ5t ye>1 ea* suppli] or provid] ( 
air ambulance s]vices %all submit to !  
,secret>y data specifi$ "u subp>agraph  
7,e7 = air ambulance s]vices furni%$ by 
su* suppli] or provid] dur+ su* ye>4    
,su* data %all be submitt$ 9 a =m &     
mann]1 & on an annual basis1 z specifi$ 
by ! ,secret>y = purposes ( ?is         
subp>agraph4  7,e7 ,quality data ,=     
purposes ( report+ data = air ambulance 
s]vices furni%$ dur+ a ye>1 ! data      
describ$ 9 ?is subp>agraph are quality  
data on ! foll[+ measures3  7i7         

,me*anical v5tilator use 9 pati5ts )    
advanc$ airways4  7ii7 ,int]pretation ( 
#ab-lead electroc>diogram docum5t$ on   
pati5t c>e record = ^? transport$ )     
prim>y c>diac diagnoses4  7iii7         
,cont9u\s wave=m capnography =          
me*anically v5tilat$ pati5ts4  7iv7     
,advanc$ airway e/abli%$ )\t newly      
develop$ hypoxia or hypot5sion4  7v7    
,tra*eal intubation v]ifi$ ) capnography
 & direct visualization1 *e/ radiograph1
 or symmetric brea? s\nds4  7,f7        
,consequ5ce = n report+ quality data =  
value-bas$ pur*as+  7i7 ,9 g5]al ,)     
respect to ambulance s]vices furni%$ by 
a provid] or suppli] ( air ambulance    
s]vices dur+ a paym5t ye> 7beg9n+ )     
#bjbd71 if su* provid] or suppli] does n
 submit to ! ,secret>y data specifi$ "u 
subp>agraph 7,e7 = ! p]=mance p]iod =   
su* ye> 7z def9$ 9 p>agraph 7#bj77;,f771
 ! ,secret>y %all provide = a p]c5t     
r$uction ( #aj p]c5t to ! p]c5tage      
increase det]m9$ "u p>agraph 7#c77;,b71 
aft] application ( p>agraphs 7#c77;,c7 &

 7#ai7 = su* paym5t ye>4  7ii7          
,application ,! r$uction "u clause 7i7  
%all apply only ) respect to ! ye>      
involv$ & ! ,secret>y %all n take into  
acc\nt su* increase 9 comput+ ! paym5t  
am\nt "u ! fee s*$ule "u ?is subsection 
= a subsequ5t ye>4  7iii7 ,di/ribution  
,= purposes ( p>agraph                  
7#bj77;,d77iii77,,iii71 ( ! total am\nt 
( r$uctions pursuant to clause 7i7 = a  
paym5t ye>--  7,i7 #ej p]c5t ( su*      
r$uctions %all be made available =      
purposes ( p]=mance paym5ts "u p>agraph 
7#bj7 = su* paym5t ye>2 &  7,,ii7 #ej   
p]c5t %all be transf]r$ to ! ,f$]al     
,hospital ,insurance ,tru/ ,fund "u     
section #ahag4  7,g7 ,data disclosures  
,! ,secret>y %all provide1 ) respect to 
data submitt$ "u subp>agraph 7,d7 by a  
suppli] or provid] ( air ambulance      
s]vices--  7i7 ) respect to #bjbj1 on a 
confid5tial basis to su* suppli] or     
provid]1 in=mation ) respect to su* data
 & ye>1 includ+ a comp>ison ( ! results 
( su* data submitt$ by su* suppli] or   

provid] to ! national av]age1 ) respect 
to su* data report$2 &  7ii7 ) respect  
to a subsequ5t ye>1 = ! public          
disclosure ( su* in=mation ) respect to 
su* subsequ5t ye>1 includ+ ! comp>ison  
describ$ 9 clause 7i7 ( su* data )      
respect to su* subsequ5t ye>4  7,h7     
,reports  7i7 ,by ,secret>y ,n lat] ?an 
,july #a1 #bjba1 subject to clause      
7iii71 ! ,secret>y %all submit to       
,congress a report on ! data describ$ 9 
subp>agraphs 7,b7 & 7,e7 submitt$ to !  
,secret>y4  7ii7 ,by ,comptroll] ,g5]al 
,n lat] ?an ,july #a1 #bjba1 subject to 
clause 7iii71 ! ,comptroll] ,g5]al ( !  
,unit$ ,/ates %all submit to ,congress a
 report on ! data describ$ 9 subp>agraph
 7,b7 & subp>agraph 7,e7 submitt$ "u ?is
 p>agraph4 ,su* report %all include an  
analysis ( co/ v>iation to provid]s &   
suppli] ( air ambulance s]vices by      
geography & provid] or suppli] /atus & a
 recomm5dation on ! adequate am\nt (    
reimbursem5t "u ?is title to provid]s & 
suppli]s ( air ambulance s]vices =      

furni%+ su* s]vices t w\ld reflect      
op]ational co/s ( su* provid]s &        
suppli]s & pres]ve access to critical   
air m$ical s]vices & su* o!r            
recomm5dations z ! ,comptroll] ,g5]al   
deems appropriate4  7iii7 ,limitation ,!
 reports submitt$ "u subclauses 7i7 &   
7ii7 %all n include any in=mation t !   
,secret>y or ,comptroll] ,g5]al1        
respectively1 det]m9es is propriet>y4   
7#ah7 ,tempor>y increase 9 paym5t = air 
ambulance s]vices  7,a7 ,increase  7i7  
,9 g5]al ,subject to subp>agraph 7,b71 9
 ! case ( air ambulance s]vices-- 7,i7  
furni%$ dur+ #bjah1 ! ,secret>y %all    
provide = a p]c5t increase ( #ab p]c5t 9
 ! base rate ( ! fee s*$ule e/abli%$ "u 
?is subsection = su* air ambulance      
s]vices2 &  7,,ii7 furni%$ dur+ #bjai & 
#bjbj1 ! ,secret>y %all provide = a     
p]c5t increase ( #bj p]c5t 9 ! base rate
 ( ! fee s*$ule e/abli%$ "u ?is         
subsection = su* air ambulance s]vices4 
7ii7 ,application ,! increase "u clause 
7i7 %all apply only ) respect to ! ye>  

involv$ & ! ,secret>y %all n take into  
acc\nt su* increase 9 comput+ ! paym5t  
am\nt "u ! fee s*$ule "u ?is subsection 
= a subsequ5t ye>4  7,b7 ,no increase = 
provid]s & suppli]s t d n report data ,!
 ,secret>y %all n provide = ! p]c5t     
increase "u subp>agraph 7,a7 9 ! base   
rate ( ! fee s*$ule e/abli%$ "u ?is     
subsection--  7i7 ) respect to air      
ambulances s]vices furni%$ by a suppli] 
or provid] ( air ambulances s]vices dur+
 #bjai1 unless ! provid] or suppli]     
submits to ! ,secret>y co/ data 9       
accordance ) p>agraph 7#ag77;,a7 = su*  
ye>2 &  7ii7 ) respect to air ambulances
 s]vices furni%$ by a suppli] or provid]
 ( air ambulances s]vices dur+ #bjbj1   
unless ! provid] or suppli] submits to !
 ,secret>y co/ data 9 accordance )      
p>agraph 7#ag77;,a7 & quality data 9    
accordance ) p>agraph 7#ag77;,d7 = su*  
ye>4  7#ai7 ,rebas+ air ambulance base  
rate ,! ,secret>y %all1 ?r\gh rulemak+1 
provide = an update to ! base rate ( !  
fee s*$ule e/abli%$ "u ?is subsection = 

air ambulance s]vices1 :i* %all be      
appli$ beg9n+ ) air ambulance s]vices   
furni%$ dur+ #bjba1 s t su* rate        
reflects ! actual co/s ( provid+ air    
ambulance s]vices1 consi/5t ) co/ data  
submitt$ "u p>agraph 7#ag77;,a74 ,9     
c>ry+ out ! previ\s s5t5ce1 ! ,secret>y 
%all ensure t ! aggregate data1         
me?odology1 & rationale appli$ = det]m9+
 ! updat$ base rate %all be made        
publicly available ?r\gh rulemak+4 ,!   
prec$+ s5t5ce %all n be appli$ 9 a      
budget neutral mann]4  7#bj7 ,value-bas$
 pur*as+ program  7,a7 ,9 g5]al ,!      
,secret>y %all e/abli% an air ambulance 
s]vices value-bas$ pur*as+ program 79   
?is p>agraph ref]r$ to z ! ,program74   
,"u ! ,program1 ! ,secret>y %all--  7i7 
= a p]=mance p]iod 7z def9$ 9           
subp>agraph 7,f77 ) respect to a paym5t 
ye> 7beg9n+ ) #bjbd71 det]m9e ! p]=mance
 ( ea* provid] or suppli] ( air         
ambulance s]vices1 ) respect to ea*     
quality measure describ$ 9 p>agraph     
7#ag77;,e72  7ii7 = ea* su* p]=mance    

p]iod1 e/abli% p]=mance b5*m>ks 9       
accordance ) subp>agraph 7,b72  7iii7 = 
ea* su* p]=mance p]iod & ea* quality    
measure describ$ 9 p>agraph 7#ag77;,e71 
e/abli% a p]=mance score = ea* provid]  
or suppli] ( air ambulance s]vices1 t is
 det]m9$ by measur+ ! p]=mance ( su*    
provid] or suppli] describ$ 9 clause    
7i71 ) respect to ea* quality measure   
describ$ 9 su* clause1 aga9/ ! p]=mance 
b5*m>k e/abli%$ "u subp>agraph 7,b7 =   
su* quality measure2  7iv7 = ea* su*    
p]=mance p]iod & provid] or suppli] (   
air ambulance s]vices1 det]m9e a        
composite p]=mance quality score1 9     
accordance ) subp>agraph 7,c72  7v7 =   
ea* su* p]=mance p]iod1 rank ea* provid]
 or suppli] ( air ambulance s]vices1    
bas$ on ! composite p]=mance quality    
score ( su* provid] or suppli] = su*    
p]iod 7z det]m9$ "u subp>agraph 7,c771 9
 ord] f highe/ to l[e/2 &  7vi7 = ea*   
su* paym5t ye> specify a p]=mance paym5t
 p]c5tage po9t adju/m5t1 9 accordance ) 
subp>agraph 7,d77ii71 = ea* provid] or  

suppli] ( air ambulance s]vices to be   
appli$ "u subp>agraph 7,d77i74  7,b7    
,p]=mance ,b5*m>ks ,"u ! ,program1 = ea*
 p]=mance p]iod ) respect to a paym5t   
ye> 7beg9n+ ) paym5t ye> #bjbd71 !      
,secret>y %all e/abli% a nationwide     
p]=mance b5*m>k = ea* quality measure   
describ$ 9 p>agraph 7#ag77;,e74 ,su* a  
b5*m>k1 ) respect to su* a quality      
measure1 %all be ! av]age ( ! p]=mance  
scores = all su* provid]s & suppli]s =  
su* measure4  7,c7 ,composite p]=mance  
quality scores ,"u ! ,program1 = ea*    
p]=mance p]iod ) respect to a paym5t ye>
 7beg9n+ ) paym5t ye> #bjbd71 !         
,secret>y %all det]m9e a composite      
p]=mance quality score = ea* provid] or 
suppli] ( air ambulance s]vices1 bas$ on
 ! cumulative p]=mance scores det]m9$ "u
 subp>agraph 7,a77iii7 = su* provid] or 
suppli] & p]=mance p]iod4 ,= purposes ( 
rank+ "u subp>agraph 7,a77v71 a provid] 
or suppli] ( air ambulance s]vices :o   
does n submit requir$ data to det]m9e   
p]=mance "u ?is p>agraph = a p]=mance   

p]iod = a ye> %all be treat$ z receiv+ a
 composite p]=mance quality score ( z]o 
"u ?is subp>agraph = su* p]iod & %all be
 rank$ accord+ly "u subp>agraph 7,a77v74
  7,d7 ,p]=mance paym5t  7i7 ,9 g5]al ,)
 respect to ambulance s]vices furni%$ by
 a provid] or suppli] ( air ambulance   
s]vices dur+ a paym5t ye> 7beg9n+ )     
#bjbd71 ! ,secret>y %all apply a        
p]=mance paym5t p]c5tage po9t adju/m5t  
to ! p]c5tage increase det]m9$ "u       
p>agraph 7#c77;,b71 aft] application (  
p>agraphs 7#c77;,c71 7#ag77;,f71 & 7#ai7
 & subp>agraph 7,e7 = a paym5t ye>      
7beg9n+ ) #bjbd74  7ii7 ,p]=mance paym5t
 p]c5tage po9t adju/m5t ,! ,secret>y    
%all1 9 accordance ) clause 7iii71      
specify a p]=mance paym5t p]c5tage po9t 
adju/m5t = a provid] or suppli] ( air   
ambulance s]vices = a paym5t ye> 7beg9n+
 ) #bjbd7 :i* may include a z]o         
p]c5tage4  7iii7 ,requirem5ts ,9        
specify+ ! p]=mance paym5t p]c5tage po9t
 adju/m5t = a provid] or suppli] ( air  
ambulance s]vices = a paym5t ye> "u     

clause 7i71 ! ,secret>y %all ensure t-- 
7,i7 su* adju/m5t is bas$ on ! rank+ ( !
 provid] or suppli] "u subp>agraph      
7,a77v7 = ! p]=mance p]iod = su* paym5t 
ye>2  7,,ii7 ! application ( all su*    
adju/m5ts 9 su* fiscal ye> results 9 an 
appropriate di/ribution ( p]=mance      
paym5t inc5tives appli$ "u ?is p>agraph 
su* t--  7aa7 provid]s & suppli]s ( air 
ambulance s]vices ) ! highe/ rank+s "u  
subp>agraph 7,a77v7 receive ! highe/    
paym5t increases "u clause 7i72 &  7bb7 
provid]s & suppli]s ( air ambulance     
s]vices ) ! l[e/ rank+s "u subp>agraph  
7,a77v7 receive ! l[e/ paym5t increases 
"u clause 7i71 :i* may include z]o2 &   
7,,iii7 ! total am\nt ( increases 9     
paym5t "u ?is subsection = all provid]s 
& suppli]s ( air ambulance s]vices1     
pursuant to ?is subp>agraph1 9 su*      
paym5t ye> %all be equal to ! sum ( !   
total am\nt1 z e/imat$ by ! ,secret>y1 (
 ! r$uctions to paym5ts "u ?is          
subsection = su* paym5t ye> pursuant to 
subp>agraph 7,e7 & ! total am\nt1 z     

e/imat$ by ! ,secret>y1 ( ! r$uctions   
made "u p>agraph 7#ag77;,f77i7 & made   
available "u p>agraph                   
7#ag77;,f77iii77,i7 = purposes (        
p]=mance paym5ts "u ?is p>agraph = su*  
paym5t ye>4  7,e7 ,fund+ = p]=mance     
inc5tive adju/m5ts  7i7 ,9 g5]al ,)     
respect to air ambulance s]vices furni%$
 by a suppli] or provid] ( air ambulance
 s]vices dur+ #bjbd or a subsequ5t ye>1 
! ,secret>y1 aft] det]m9+ ! p]c5tage    
increase "u p>agraph 7#c77;,b71 & aft]  
application ( p>agraphs 7#c77;,c71      
7#ag71 & 7#ai71 %all r$uce su* p]c5tage 
increase = paym5ts "u ! fee s*$ule "u   
?is subsection o!rwise applicable to su*
 provid] or suppli] = s]vices furni%$ by
 su* provid] or suppli] dur+ su* ye> by 
! applicable p]c5t 7z def9$ 9 clause    
7ii774 ,! ,secret>y %all make su*       
r$uctions = all provid]s & suppli]s (   
air ambulance s]vices 9 ! ye> involv$1  
reg>dless ( :e!r or n ! provid] or      
suppli] has be5 det]m9$ by ! ,secret>y  
to h e>n$ a p]=mance paym5t p]c5tage    

po9t adju/m5t "u subp>agraph 7,d7 = su* 
ye>4  7ii7 ,applicable p]c5t ,= purposes
 ( clause 7i71 ! t]m applicable p]c5t   
means1 ) respect to #bjbd & succe$+     
ye>s1 #b p]c5t4  7,f7 ,p]=mance p]iod ,=
 purposes ( ?is p>agraph1 ! t]m p]=mance
 p]iod means1 ) respect to a paym5t ye>1
 ! previ\s ye> 7or1 if specifi$ by !    
,secret>y1 portion or portions ( su*    
previ\s ye>74  4