,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #cjba  ,,in ,,the ,,house ,,of  
,,representatives  ,may #bd1 #bjai,mr4  
,la,hood 7for himself and ,ms4 ,sewell  
of ,alabama7 introduced the following   
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committee on ,ways 
and ,means1 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 title ,,xviii of   
the ,social ,security ,act to           
restructure the payment adjustment for  
non-emergency ,,esrd ambulance          
transports under the ,medicare program4 
#a4 ,short title ,this ,act may be cited
 as the ,non-,emergency ,ambulance      
,transportation ,sustainability and     
,accountability ,act of #bjai or the    
,,neatsa ,act4  #b4 ,restructure of     
,medicare payment adjustment for        
non-emergency ,,esrd ambulance          

transports  7a7 ,in general ,section    
#ahcd7l77#ae7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciem7l77#ae77 is  
amended to read as follows3  7#ae7      
,restructure of payment adjustment for  
non-emergency ambulance transports for  
,,esrd beneficiaries  7,a7 ,in general  
,in the case of applicable ambulance    
services1 the fee schedule amount       
otherwise applicable under the preceding
 provisions of this subsection shall be 
reduced as follows3  7i7 ,in the case of
 applicable ambulance services furnished
 during the period beginning on ,october
 #a1 #bjac1 and ending on ,september    
#cj1 #bjai1 reduced by #aj percent4     
7ii7 ,in the case of applicable         
ambulance services furnished during the 
period beginning on ,october #a1 #bjai1 
and ending on ,december #ca1 #bjai1     
reduced by #ae4e percent4  7iii7 ,in the
 case of applicable ambulance services  
furnished during #bjbj or a subsequent  
year-- 7,i7 by a provider or supplier of
 ambulance services that the ,secretary 

has designated under subparagraph 7,c7  
for the year and for which such         
transport originates in an area not     
described in paragraph 7#ac77;,a77i71   
reduced by #bi4e percent2 or  7,,ii7    
that are not described in subclause     
7,i71 reduced by #ae4e percent4  7,b7   
,applicable ambulance services ,in this 
paragraph1 the term applicable ambulance
 services means ambulance services      
consisting of non-emergency basic life  
support services involving transport of 
an individual with end-stage renal      
disease for renal dialysis services 7as 
described in section                    
#ahha7;b77#ad77;,b77 furnished other    
than on an emergency basis by a provider
 of services or a renal dialysis        
facility4  7,c7 ,designation  7i7 ,in   
general ,for #bjbj and each subsequent  
year1 the ,secretary shall designate the
 providers or suppliers of ambulance    
services for which the total payments   
made to the provider or supplier for    
applicable ambulance services furnished 

during the applicable period for the    
year makes up at least #ej percent of   
the total payments made to the provider 
or supplier under this part for all     
ambulance services furnished during such
 applicable period4  7ii7 ,methodology  
,the ,secretary shall1 through notice   
and comment rulemaking1 establish the   
methodology for designating providers   
and suppliers under clause 7i7 for a    
year4 ,under such methodology1 the      
applicable period for a year shall be a 
#ab-month period determined by the      
,secretary that begins and ends prior to
 the beginning of such year4  7iii7     
,timing ,not later than ,november #a of 
each year 7beginning with #bjai71 the   
,secretary shall notify any provider or 
supplier that will be designated under  
clause 7i7 for the subsequent year4     
7iv7 ,targeted review ,the ,secretary   
shall establish a process under which a 
provider or supplier may seek an        
informal review of the designation under
 clause 7i7 with respect to the provider

 or supplier4  7v7 ,public reporting    
,beginning in #bjba1 the ,secretary     
shall1 in an easily understandable      
format1 make available on the ,internet 
website of the ,centers for ,medicare   
,medicaid ,services the following3  7,i7
 ,the total number of claims paid under 
this part for applicable ambulance      
services4  7,,ii7 ,the total number of  
claims paid under this part for         
applicable ambulance services that were 
subject to the payment reduction under  
subparagraph 7,a77iii71 broken out for  
each of subclauses 7,i7 and 7,,ii7 of   
such subparagraph4  7,,iii7 ,the total  
number of providers and suppliers that  
were designated under clause 7i74       
7,,iv7 ,any other data regarding        
applicable ambulance services that the  
,secretary determines appropriate4  4   
7b7 ,,gao study and report  7#a7 ,in    
general ,the ,comptroller ,general of   
the ,united ,states 7in this subsection 
referred to as the ,comptroller         
,general7 shall conduct a study on      

payments under section #ahcd7l7 of the  
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7l77 for applicable ambulance     
services 7as defined in subparagraph    
7,b7 of paragraph 7#ae7 of such section1
 as added by subsection 7a774 ,such     
study shall include an analysis of the  
impact of the amendment made by         
subsection 7a71 including the impact on 
beneficiary access and any steps        
providers and suppliers of ambulance    
services have taken to avoid payment    
reductions under such paragraph 7#ae74  
7#b7 ,report ,not later than ,march #a1 
#bjbc1 the ,comptroller ,general shall  
submit to ,congress a report containing 
the results of the study conducted under
 paragraph 7#a71 together with          
recommendations for such legislation and
 administrative action as the           
,comptroller ,general determines        
appropriate4