,i #aafth ,,congress #ast ,session ,h4 ,r4 #dich ,,in ,,the ,,house ,,of ,,representatives ,october #ca1 #bjai,ms4 ,sewell of ,alabama 7for herself1 ,mr4 ,nunes1 ,mr4 ,welch1 ,mr4 ,mullin1 and ,mr4 ,blumenauer7 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 to strengthen ambulance services furnished under part ,b of the ,medicare program4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,medicare ,ambulance ,access1 ,fraud ,prevention1 and ,reform ,act of #bjai4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,title ,i--,protect ,access to ,high ,quality ,ambulance ,care ,sec4 #aja4 ,reform to the ,medicare ambulance fee schedule4 ,sec4 #ajb4 ,national expansion of prior authorization model for repetitive scheduled non-emergent ambulance transport4 ,title ,,ii--,reduce ,administrative ,burdens ,to ,expand ,patient ,care ,sec4 #bja4 ,elimination of duplicative paperwork requirements in the ,medicare ambulance benefit4 ,title ,,iii--,leverage ,ambulance ,services ,to ,protect ,access to ,care in ,rural ,america ,sec4 #cja4 ,protecting access to ambulance services in rural and low population density areas4 ,i ,protect ,access to ,high ,quality ,ambulance ,care #aja4 ,reform to the ,medicare ambulance fee schedule 7a7 ,in general ,section #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77 is amended by adding at the end the following new paragraph3 7#ah7 ,increase in conversion factor for ground ambulance services ,in the case of ground ambulance services furnished on or after ,january #a1 #bjbj1 for purposes of determining the fee schedule amount for such services under this subsection1 the conversion factor otherwise applicable to such services shall be increased by-- 7,a7 with respect to ground ambulance services for which the transportation originates in a qualified rural area1 as identified using the methodology described in paragraph 7#ab77;,b77iii71 #be4f percent2 7,b7 with respect to ground ambulance services not described in subparagraph 7,a7 and for which the transportation originates in a rural area described under paragraph 7#i7 or in a rural census tract described in such paragraph1 #c percent2 and 7,c7 with respect to ground ambulance services not described in subparagraph 7,a7 or 7,b71 #b percent4 7#ai7 ,increase in mileage rate for ground ambulance services ,in the case of ground ambulance services furnished on or after ,january #a1 #bjbj1 for purposes of determining the fee schedule amount for such services under this subsection1 the payment rate for mileage otherwise applicable to such services shall be increased by-- 7,a7 with respect to ground ambulance services for which the transportation originates in a qualified rural area1 as identified using the methodology described in paragraph 7#ab77;,b77iii71 #c percent2 7,b7 with respect to ground ambulance services not described in subparagraph 7,a7 and for which the transportation originates in a rural area described under paragraph 7#i7 or in a rural census tract described in such paragraph1 #c percent2 and 7,c7 with respect to ground ambulance services not described in subparagraph 7,a7 or 7,b71 #b percent4 4 7b7 ,study and report 7#a7 ,study ,the ,secretary of ,health and ,human ,services shall conduct a study on how the conversion factor applicable to ground ambulance services under the ambulance fee schedule under section #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l771 as adjusted under paragraph 7#ah7 of such section 7as added by subsection 7a771 should be modified1 if at all1 to take into account the cost of providing services in urban1 rural1 and super-rural areas4 ,in determining such costs1 the ,secretary shall use the data collected through the data collection system under paragraph 7#ag7 of such section4 7#b7 ,report ,not later than ,january #a1 #bjbb1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report on the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 #ajb4 ,national expansion of prior authorization model for repetitive scheduled non-emergent ambulance transport 7a7 ,in general ,section #ahcd7l77#af7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#af77 is amended-- 7#a7 by redesignating subparagraphs 7,b7 and 7,c7 as subparagraphs 7,c7 and 7,d71 respectively2 and 7#b7 by inserting after subparagraph 7,a7 the following new subparagraph3 7,b7 ,permanent expansion 7i7 ,if by ,july #a1 #bjai1 the ,secretary has not already expanded to all ,states the model of prior authorization described in paragraph 7#b7 of section #eae7;a7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae1 by ,january #a1 #bjbj1 the ,secretary shall expand the prior authorization model to all ,states using notice and comment rulemaking1 regardless of whether or not the expansion meets the requirements described in paragraphs 7#a7 through 7#c7 of section #aaae;,a7c74 7ii7 ,if the ,secretary expands the model of prior authorization under this subparagraph-- 7,i7 the prior authorization shall be limited to 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 basis2 and 7,,ii7 in making the prior authorization determination with respect to a service and individual1 the ,secretary shall evaluate the medical necessity of the service by determining-- 7aa7 whether the individual is unable to get up from bed without assistance1 unable to ambulate1 and unable to sit in a chair or wheelchair2 7bb7 whether the individual has a medical condition that1 regardless of bed confinement1 is such that transport by ambulance is medically necessary2 or 7cc7 whether the individual meets other criteria as determined appropriate by the ,secretary4 4 ,,ii ,reduce ,administrative ,burdens ,to ,expand ,patient ,care #bja4 ,elimination of duplicative paperwork requirements in the ,medicare ambulance benefit ,section #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l771 as amended by section #aja1 is further amended by adding the following new paragraph3 7#bj7 ,reducing administrative burden ,no later than ,july #a1 #bjbj-- 7,a7 ,the ,secretary shall through notice and comment rulemaking eliminate the following requirements to reduce the burden on ambulance services providers and suppliers3 7i7 ,the vehicle section and the extra practice locations for emergency medical services section of the #hee;,b ,ambulance ,enrollment ,form required under section #dbd4eje of title #db1 ,code of ,federal ,regulations 7or successor regulations74 7ii7 ,the requirement that individuals sign ambulance service claims under section #dbd4cf of title #db1 ,code of ,federal ,regulations 7or successor regulations71 when other documentation establishing that the individual received the ambulance services is available4 7,b7 ,not later than ,july #a1 #bjbj1 the ,secretary shall through notice and comment rulemaking-- 7i7 require ambulance providers and suppliers to update the #hee;,b ,ambulance ,enrollment ,form required under section #dbd4eje of title #db1 ,code of ,federal ,regulations 7or successor regulations71 no more than once a calendar year2 and 7ii7 establish a process to take into account inaccuracies in ,social ,security records or other official death records before revoking billing authority for ambulance providers and suppliers under section #dbd4ece of title #db1 ,code of ,federal ,regulations 7or successor regulations74 4 ,,iii ,leverage ,ambulance ,services ,to ,protect ,access to ,care in ,rural ,america #cja4 ,protecting access to ambulance services in rural and low population density areas ,section #ahcd7l77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#ab77 is amended by adding at the end the following new subparagraphs3 7,c7 ,exception for ,rural and ,qualified ,rural ,areas ,the ,secretary shall deem an area designated as a rural or qualified rural area under this paragraph that would otherwise no longer receive such designation to retain its previous designated status if there are #a1jjj or fewer individuals per square mile in the area4 7,d7 ,right to ,appeal ,rural ,areas and ,qualified ,rural ,areas ,the ,secretary shall establish an administrative appeals process to allow ambulance services providers and suppliers to seek reconsideration of a change in a ,,zip code's status as a rural or qualified rural area during the first #ab months after the ,secretary finalizes a change in the designation made under this paragraph4 4