,,ii  #aae? ,,congress  #a/ ,session    
,s4 #ifg  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,april #bg1 #bjag,ms4  
,/ab5[ 7= h]self1 ,mr4 ,rob]ts1 ,mr4    
,leahy1 ,ms4 ,coll9s1 & ,mr4 ,s*um]7    
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$ic>e 
,ambulance ,access1 ,fraud ,prev5tion1 &
 ,re=m ,act ( #bjag4  7b7 ,table (      
cont5ts ,! table ( cont5ts ( ?is ,act is
 z foll[s3 ,sec4 #a4 ,%ort title4 ,sec4 
#b4 ,re=m to ! ,m$ic>e ambulance fee    
s*$ule4 ,sec4 #c4 ,prior au?orization = 
ambulance transports ( ,,esrd           
b5efici>ies4 ,sec4 #d4 ,requir+ provid]s
 ( s]vices & ambulance s]vice provid]s  
to submit co/ data & o!r in=mation )    
respect to ambulance s]vices4 ,sec4 #e4 

,treatm5t ( ambulance s]vice provid]s4  
#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#ag7 ,increase 9       
conv]sion factor = gr\nd ambulance      
s]vices ,9 ! case ( gr\nd ambulance     
s]vices furni%$ on or aft] ,janu>y #a1  
#bjah1 = 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#ah7 ,increase 9 mileage rate = gr\nd  
ambulance s]vices ,9 ! case ( gr\nd     
ambulance s]vices furni%$ on or aft]    
,janu>y #a1 #bjah1 = 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#ag7 ( 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#bj7 ( su* section1 z add$ by 
section #d4  7#b7 ,report ,n lat] ?an   
,janu>y #a1 #bjbb1 ! ,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#ai7 ,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 #bjai1 by
 a provid] ( s]vices or an ambulance    
s]vice 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 ! provid] ( s]vices or    
ambulance s]vice 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      
s]vice provid] ,9 ?is p>agraph1 ! t]m   
ambulance s]vice provid] means an entity
 t furni%es ambulance s]vices 7z        
describ$ 9 section #ahfa7s77#g77 & is n 
a provid] ( s]vices 7z def9$ section    
#ahfa7u774  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 #bjah1 ! ,secret>y %all 
make ! aspects ( ! process "u ?is       
p>agraph available to ! public4  4  7b7 
,ref]5ces to ambulance s]vice provid]s  
,section #ahcd7l7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7l77 is       

am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ a
 suppli] or provid] & ins]t+ an         
ambulance s]vice provid] 7z def9$ 9     
p>agraph 7#ai77;,e77 or "u arrangem5t ) 
an ambulance s]vice provid] or by a     
provid]2  7#b7 9 p>agraph 7#h71 9 !     
matt] foll[+ subp>agraph 7,b71 by /rik+ 
suppli] ( ambulance s]vices & ins]t+    
ambulance s]vice provid] 7z def9$ 9     
p>agraph 7#ai77;,e772  7#c7 9 p>agraph  
7#i71 9 ! head+1 by ins]t+ provid]s (   
s]vices & ambulance s]vice aft] rural2  
7#d7 9 p>agraph 7#ab71 9 ! head+1 by    
ins]t+ provid]s ( s]vices & ambulance   
s]vice aft] rural2 &  7#e7 9 ea* (      
subp>agraphs 7,b77ii7 & 7,d77ii7 (      
p>agraph 7#ad71 by /rik+ entity & ins]t+
 provid] ( s]vices or ambulance s]vice  
provid] 7z def9$ 9 p>agraph 7#ai77;,e774
  #d4 ,requir+ provid]s ( s]vices &     
ambulance s]vice provid]s to submit co/ 
data & o!r in=mation ) respect to       
ambulance s]vices ,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#bj7 ,submission ( co/ data 
& o!r in=mation  7,a7 ,developm5t ( data
 collection sy/em  7i7 ,9 g5]al ,!      
,secret>y %all develop a data collection
 sy/em = ! submission by provid]s (     
s]vices & ambulance s]vice provid]s 7z  
def9$ 9 p>agraph 7#ai77;,e77 ( data on  
co/1 rev5ue1 & utilization ) respect to 
ambulance s]vices1 & o!r in=mation      
det]m9$ appropriate by ! ,secret>y4 ,su*
 sy/em %all enable provid]s ( s]vices & 
ambulance s]vice provid]s to submit to !
 ,secret>y in=mation--  7,i7 ne$$ to    
evaluate ! appropriat5ess ( paym5t rates
 "u ?is subsection2  7,,ii7 on !        
utilization ( capital equipm5t &        
ambulance capacity2 &  7,,iii7 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 
7ii7 ,collection ( co/ data in=mation ,=
 purposes ( collect+ ! co/ data         
in=mation describ$ 9 subp>agraph        

7,b77iv71 ! ,secret>y %all use ! sampl+ 
me?odology describ$ 9 subp>agraph       
7,b77ii74  7,b7 ,specification ( data   
collection sy/em  7i7 ,9 g5]al ,n lat]  
?an #ij days aft] ! date ( enactm5t (   
?is p>agraph1 ! ,secret>y %all specify !
 data collection sy/em develop$ "u      
subp>agraph 7,a71 :i* %all consi/ ( !   
basic data collection describ$ 9 clause 
7iii7 & ! co/ data in=mation describ$ 9 
clause 7iv71 & ! "t p]iod = :i* !       
report+ ( su* data is requir$ "u ?is    
p>agraph4  7ii7 ,selection ( provid]s ( 
s]vices & ambulance s]vice provid]s     
requir$ to submit co/ data in=mation    
7,i7 ,9 g5]al ,subject to subp>agraph   
7,d77ii71 ! ,secret>y %all det]m9e a    
/ati/ically appropriate sample (        
provid]s ( s]vices & ambulance s]vice   
provid]s bas$ ^u ! organizational       
designation ( ! provid] ( s]vices or    
ambulance s]vice provid] z describ$ 9   
clause 7iii77,i7 to submit co/ data     
in=mation "u clause 7iv7 = ea* p]iod =  
:i* ! report+ ( su* data is requir$1 z  

specifi$ "u clause 7i74  7,,ii7         
,implem5tation ,9 det]m9+ an appropriate
 sample ( provid]s ( s]vices & ambulance
 s]vice provid]s "u subclause 7,i71 !   
,secret>y %all promulgate an int]im f9al
 rule & %all accept & consid] public    
comm5ts on ! int]im f9al rule = #cj days
 aft] ! date ( publication ( su* int]im 
f9al rule4  7,,iii7 ,notification (     
provid]s ( s]vices & ambulance s]vice   
provid]s select$ ,n lat] ?an #ahj days  
aft] ! date on :i* ! ,secret>y has      
complet$ ! basic data collection "u     
clause 7iii71 ! ,secret>y %all provide  
notice to ^? provid]s ( s]vices &       
ambulance s]vice provid]s select$ "u ?is
 clause to submit co/ data in=mation "u 
clause 7iv74  7iii7 ,basic data         
collection ,! ,secret>y %all require    
provid]s ( s]vices & ambulance s]vice   
provid]s to submit in=mation "u ! data  
collection sy/em "u ?is p>agraph1 su* z 
! foll[+ ) respect to ! provid] (       
s]vices or ambulance s]vice provid]1 n  
lat] ?an ! date t is #abj days aft] !   

date on :i* ! ,secret>y specifies su*   
data collection sy/em "u clause 7i71 & n
 less (t5 ?an once e #e ye>s !reaft]3   
7,i7 ,! organizational designation ( !  
provid] ( s]vices or ambulance s]vice   
provid] z a gov]nm5t ambulance au?ority1
 indep5d5t ambulance company1 public    
safety or fire dep>tm5t-bas$            
organization1 hospital-bas$             
organization1 or o!r type (             
organization4  7,,ii7 ,! p]c5tage (     
volunte] em]g5cy m$ical te*nician labor 
! provid] ( s]vices or ambulance s]vice 
provid] relies on4  7,,iii7 ,! volume ( 
ambulance s]vices furni%$ p] ye>4       
7,,iv7 ,! p]c5tage ( em]g5cy &          
non-em]g5cy s]vices furni%$ "u ?is title
 p] ye>4  7,v7 ,! av]age duration (     
transports4  7,,vi7 ,:e!r ! provid] (   
s]vices or ambulance s]vice provid] has 
a sole s\rce contract & ! p]c5tage ( !  
activity provid$ "u t contract4  7,,vii7
 ,:e!r ! provid] ( s]vices or ambulance 
s]vice provid] is requir$ to pay fees to
 ! local jurisdiction to subsidize      

em]g5cy & o!r s]vices z a requirem5t (  
do+ bus9ess4  7,,viii7 ,! p]c5tage (    
transports t are urban1 rural1 or 9 a   
l[-population d5sity area describ$ 9    
p>agraph 7#ab71 z det]m9$ by !          
,secret>y4  7,,ix7 ,o!r data elem5ts t !
 ,secret>y1 9 consultation ) /akehold]s1
 det]m9es appropriate4  7iv7 ,co/ data  
in=mation ,! ,secret>y %all require ^?  
provid]s ( s]vices & ambulance s]vice   
provid]s select$ "u clause 7ii7 to      
submit "u ! data collection sy/em "u ?is
 p>agraph = ea* p]iod = :i* ! report+ ( 
su* data is requir$1 z specifi$ "u      
clause 7i71 data on co/1 rev5ue1 &      
utilization1 su* z--  7,i7 data on total
 rev5ue1 includ+ rev5ues "u ?is title1  
subscription programs1 ,m$icaid1 o!r    
heal? c>e plans & self-pay1 public      
fund+1 fundrais+ & donations1           
uncomp5sat$ c>e1 & write-(fs2 &  7,,ii7 
data on total co/ includ+ labor co/s    
7paid & volunte]71 op]at+ co/s1         
adm9i/rative co/s1 vehicle & fleet co/s1
 communications co/s1 equipm5t &        

supplies 7includ+ drugs71 ma9t5ance1    
build+ & facility co/s1 adm9i/rative    
co/s1 local jurisdiction co/s1 ! co/ (  
read9ess1 & c5tral (fice adm9i/ration   
co/s4  7,c7 ,p5alty = failure to report 
co/ data in=mation  7i7 ,9 g5]al ,beg9n+
 on ,janu>y #a1 #bjba1 subject to clause
 7ii71 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 a provid] ( s]vices or     
ambulance s]vice provid] :o--  7,i7 is  
id5tifi$ "u subp>agraph 7,b77ii7 or     
7,d77ii7 z be+ requir$ to submit        
in=mation "u subp>agraph 7,b77iv7 or    
7,d77ii71 respectively2 &  7,,ii7 does n
 submit su* in=mation 9 a timely mann] =
 ! p]iod specifi$ "u subp>agraph 7,b77i7
 or 7,d77ii71 respectively4  7ii7       
,exception ,! ,secret>y may susp5d !    
paym5t r$uction "u clause 7i7 ) respect 
to a p]iod 9 ! ev5t ( a natural disa/]1 
bankruptcy1 or o!r simil> situation t ! 
,secret>y det]m9es int]f]$ ) ability ( !
 provid] ( s]vices or ambulance s]vice  

provid] to submit su* in=mation 9 a     
timely mann] = ! specifi$ p]iod4  7,d7  
,ongo+ co/ data collection  7i7         
,revision ( data collection sy/em ,!    
,secret>y may1 z appropriate1           
p]iodically revise ! data collection    
sy/em "u ?is p>agraph4  7ii7 ,subsequ5t 
co/ 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] #bjbj 7b n m frequ5tly ?an once e  
#c ye>s71 require provid]s ( s]vices &  
ambulance s]vice provid]s to submit     
in=mation describ$ 9 subp>agraph        
7,b77iv7 = a p]iod ! ,secret>y det]m9es 
appropriate4 ,! p5alty describ$ 9       
subp>agraph 7,c7 %all apply to ea* su*  
subsequ5t data collection p]iod 9       
accordance ) su* subp>agraph4  7,,ii7   
,sample ,= ea* p]iod describ$ 9         
subclause 7,i71 ! ,secret>y %all det]m9e
 a /ati/ically appropriate sample (     
provid]s ( s]vices & ambulance s]vices  
provid]s to submit in=mation "u ! data  

collection sy/em = ! p]iod4 ,9 det]m9+  
:i* provid]s ( s]vices & ambulance      
s]vice provid]s w\ld be requir$ to      
submit in=mation = su* p]iod1 !         
,secret>y may n require a provid] (     
s]vices or ambulance s]vice provid] :o  
has already submitt$ in=mation = a      
previ\s p]iod to submit in=mation = a   
subsequ5t p]iod unless all ( ! provid]s 
( s]vices & ambulance s]vice provid]s t 
! ,secret>y det]m9es are ( ! same type z
 su* provid] ( s]vices or ambulance     
s]vice provid] h ei!r submitt$ in=mation
 or be5 p5aliz$ "u subp>agraph 7,c7 =   
fail+ to d s 9 a timely mann]4  7,e7    
,consultation ,! ,secret>y %all consult 
) /akehold]s 9 c>ry+ out ! developm5t ( 
! data collection 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 ,adm9i/ration ,*apt]   
#ce ( title #dd1 ,unit$ ,/ates ,code1   

%all n apply to ! collection ( in=mation
 requir$ "u ?is p>agraph4  7,g7         
,limitations on review ,!re %all be no  
adm9i/rative or judicial review "u      
section #ahfi1 section #ahgh1 or o!rwise
 ( ! data collection sy/em "u ?is       
p>agraph1 ! det]m9ation ( provid]s (    
s]vices & ambulance s]vice provid]s     
requir$ to submit in=mation "u ! data   
collection sy/em1 or ! application ( !  
p5alty = failure to report in=mation "u 
subp>agraph 7,c74  7,h7 ,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$4  4  #e4 ,treatm5t ( ambulance   
s]vice provid]s  7a7 ,9 g5]al ,section  
#ahcd ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciem7l771 z am5d$ by section

 #d1 is am5d$ by add+ at ! end ! foll[+ 
new p>agraph3  7#ba7 ,treatm5t (        
ambulance s]vice provid]s z provid]s (  
s]vices = c]ta9 purposes  7,a7 ,provid] 
,reimbursem5t ,review ,bo>d ,= purposes 
( section #ahgh1 an ambulance s]vice    
provid] 7z def9$ 9 p>agraph 7#ai77;,e77 
%all be treat$ z a provid] ( s]vices4   
7,b7 ,e/abli%m5t ( conditions (         
p>ticipation ,an ambulance s]vice       
provid]-- 7i7 = purposes ( section      
#ahfe7;a77#a71 %all be treat$ z a       
provid] entity2 &  7ii7 %all be requir$ 
to meet su* requirem5ts = p>ticipation  
"u ?is title z ! ,secret>y %all e/abli% 
by regulation4  7,c7 ,use ( bill+ codes 
,an ambulance s]vice provid] may1 =     
purposes ( ?is title1 use bill+ codes   
e/abli%$ = provid]s ( s]vices1 if su*   
use is consi/5t ) applicable ,f$]al1    
,/ate1 or local scope ( practice        
requirem5ts4  4  7b7 ,effective date ,! 
am5dm5t made ?is section %all take      
effect on ,janu>y #a1 #bjah1 & %all     
apply to an ambulance s]vice provid] on 

or aft] su* date4