,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #cjba  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #bd1 #bjai,mr4   
,la,hood 7= himself & ,ms4 ,sewell (    
,alabama7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = 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 title      
,,xviii ( ! ,social ,security ,act to   
re/ructure ! paym5t adju/m5t =          
non-em]g5cy ,,esrd ambulance transports 
"u ! ,m$ic>e program4  #a4 ,%ort title  
,?is ,act may be cit$ z ! ,non-,em]g5cy 
,ambulance ,transportation ,su/a9ability
 & ,acc\ntability ,act ( #bjai or !     
,,neatsa ,act4  #b4 ,re/ructure (       
,m$ic>e paym5t adju/m5t = non-em]g5cy   
,,esrd ambulance transports  7a7 ,9     
g5]al ,section #ahcd7l77#ae7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciem7l77#ae77 is am5d$ to read z      

foll[s3  7#ae7 ,re/ructure ( paym5t     
adju/m5t = non-em]g5cy ambulance        
transports = ,,esrd b5efici>ies  7,a7 ,9
 g5]al ,9 ! case ( applicable ambulance 
s]vices1 ! fee s*$ule am\nt o!rwise     
applicable "u ! prec$+ provisions ( ?is 
subsection %all be r$uc$ z foll[s3  7i7 
,9 ! case ( applicable ambulance s]vices
 furni%$ dur+ ! p]iod beg9n+ on ,octob] 
#a1 #bjac1 & end+ on ,septemb] #cj1     
#bjai1 r$uc$ by #aj p]c5t4  7ii7 ,9 !   
case ( applicable ambulance s]vices     
furni%$ dur+ ! p]iod beg9n+ on ,octob]  
#a1 #bjai1 & end+ on ,decemb] #ca1      
#bjai1 r$uc$ by #ae4e p]c5t4  7iii7 ,9 !
 case ( applicable ambulance s]vices    
furni%$ dur+ #bjbj or a subsequ5t ye>-- 
7,i7 by a provid] or suppli] ( ambulance
 s]vices t ! ,secret>y has designat$ "u 
subp>agraph 7,c7 = ! ye> & = :i* su*    
transport orig9ates 9 an area n describ$
 9 p>agraph 7#ac77;,a77i71 r$uc$ by     
#bi4e p]c5t2 or  7,,ii7 t are n describ$
 9 subclause 7,i71 r$uc$ by #ae4e p]c5t4
  7,b7 ,applicable ambulance s]vices ,9 

?is p>agraph1 ! t]m applicable 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 basis by a provid] ( 
s]vices or a r5al dialysis facility4    
7,c7 ,designation  7i7 ,9 g5]al ,= #bjbj
 & ea* subsequ5t ye>1 ! ,secret>y %all  
designate ! provid]s or suppli]s (      
ambulance s]vices = :i* ! total paym5ts 
made to ! provid] or suppli] =          
applicable ambulance s]vices furni%$    
dur+ ! applicable p]iod = ! ye> makes up
 at lea/ #ej p]c5t ( ! total paym5ts    
made to ! provid] or suppli] "u ?is "p =
 all ambulance s]vices furni%$ dur+ su* 
applicable p]iod4  7ii7 ,me?odology ,!  
,secret>y %all1 ?r\gh notice & comm5t   
rulemak+1 e/abli% ! me?odology =        
designat+ provid]s & suppli]s "u clause 
7i7 = a ye>4 ,"u su* me?odology1 !      
applicable p]iod = a ye> %all be a      

#ab-mon? p]iod det]m9$ by ! ,secret>y t 
beg9s & ends prior to ! beg9n+ ( su*    
ye>4  7iii7 ,tim+ ,n lat] ?an ,novemb]  
#a ( ea* ye> 7beg9n+ ) #bjai71 !        
,secret>y %all notify any provid] or    
suppli] t w be designat$ "u clause 7i7 =
 ! subsequ5t ye>4  7iv7 ,t>get$ review  
,! ,secret>y %all e/abli% a process "u  
:i* a provid] or suppli] may seek an    
in=mal review ( ! designation "u clause 
7i7 ) respect to ! provid] or suppli]4  
7v7 ,public report+ ,beg9n+ 9 #bjba1 !  
,secret>y %all1 9 an easily und]/&able  
=mat1 make available on ! ,int]net      
website ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices ! foll[+3  7,i7 ,! total numb] 
( claims paid "u ?is "p = applicable    
ambulance s]vices4  7,,ii7 ,! total     
numb] ( claims paid "u ?is "p =         
applicable ambulance s]vices t 7 subject
 to ! paym5t r$uction "u subp>agraph    
7,a77iii71 brok5 out = ea* ( subclauses 
7,i7 & 7,,ii7 ( su* subp>agraph4        
7,,iii7 ,! total numb] ( provid]s &     
suppli]s t 7 designat$ "u clause 7i74   

7,,iv7 ,any o!r data reg>d+ applicable  
ambulance s]vices t ! ,secret>y det]m9es
 appropriate4  4  7b7 ,,gao /udy &      
report  7#a7 ,9 g5]al ,! ,comptroll]    
,g5]al ( ! ,unit$ ,/ates 79 ?is         
subsection ref]r$ to z ! ,comptroll]    
,g5]al7 %all conduct a /udy on paym5ts  
"u section #ahcd7l7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #aciem7l77
 = applicable ambulance s]vices 7z def9$
 9 subp>agraph 7,b7 ( p>agraph 7#ae7 (  
su* section1 z add$ by subsection 7a774 
,su* /udy %all include an analysis ( !  
impact ( ! am5dm5t made by subsection   
7a71 includ+ ! impact on b5efici>y      
access & any /eps provid]s & suppli]s ( 
ambulance s]vices h tak5 to avoid paym5t
 r$uctions "u su* p>agraph 7#ae74  7#b7 
,report ,n lat] ?an ,m>* #a1 #bjbc1 !   
,comptroll] ,g5]al %all submit to       
,congress a report conta9+ ! results ( !
 /udy conduct$ "u p>agraph 7#a71 toge!r 
) recomm5dations = su* legislation &    
adm9i/rative action z ! ,comptroll]     
,g5]al det]m9es appropriate4