,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #dich  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #ca1 #bjai,ms4
 ,sewell ( ,alabama 7= h]self1 ,mr4     
,nunes1 ,mr4 ,wel*1 ,mr4 ,mull91 & ,mr4 
,blum5au]7 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 to /r5g!n ambulance s]vices     
furni%$ "u "p ,b ( ! ,m$ic>e program4   
#a4 ,%ort title2 table ( cont5ts  7a7   
,%ort title ,?is ,act may be cit$ z !   
,m$ic>e ,ambulance ,access1 ,fraud      
,prev5tion1 & ,re=m ,act ( #bjai4  7b7  
,table ( cont5ts ,! table ( cont5ts =   
?is ,act is z foll[s3  ,sec4 #a4 ,%ort  
title2 table ( cont5ts4 ,title          
,i--,protect ,access to ,high ,quality  
,ambulance ,c>e ,sec4 #aja4 ,re=m to !  
,m$ic>e ambulance fee s*$ule4 ,sec4     

#ajb4 ,national expansion ( prior       
au?orization model = repetitive s*$ul$  
non-em]g5t ambulance transport4 ,title  
,,ii--,r$uce ,adm9i/rative ,burd5s ,to  
,exp& ,pati5t ,c>e ,sec4 #bja4          
,elim9ation ( duplicative pap]work      
requirem5ts 9 ! ,m$ic>e ambulance       
b5efit4 ,title ,,iii--,lev]age          
,ambulance ,s]vices ,to ,protect ,access
 to ,c>e 9 ,rural ,am]ica ,sec4 #cja4   
,protect+ access to ambulance s]vices 9 
rural & l[ population d5sity areas4  ,i 
,protect ,access to ,high ,quality      
,ambulance ,c>e  #aja4 ,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+ at ! end ! foll[+ new 
p>agraph3  7#ah7 ,increase 9 conv]sion  
factor = gr\nd ambulance s]vices ,9 !   
case ( gr\nd ambulance s]vices furni%$  
on or aft] ,janu>y #a1 #bjbj1 = 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#ai7 ,increase 9 mileage rate = gr\nd  
ambulance s]vices ,9 ! case ( gr\nd     
ambulance s]vices furni%$ on or aft]    
,janu>y #a1 #bjbj1 = 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#ah7 ( 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#ag7 ( su* section4  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  #ajb4 ,national  
expansion ( prior au?orization model =  
repetitive s*$ul$ non-em]g5t ambulance  
transport  7a7 ,9 g5]al ,section        
#ahcd7l77#af7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciem7l77#af77 is      
am5d$-- 7#a7 by r$esignat+ subp>agraphs 
7,b7 & 7,c7 z subp>agraphs 7,c7 & 7,d71 
respectively2 &  7#b7 by ins]t+ aft]    
subp>agraph 7,a7 ! foll[+ new           
subp>agraph3  7,b7 ,p]man5t expansion   
7i7 ,if by ,july #a1 #bjai1 ! ,secret>y 
has n already exp&$ to all ,/ates !     
model ( prior au?orization describ$ 9   
p>agraph 7#b7 ( section #eae7;a7 ( !    
,m$ic>e ,access & ,,*ip ,reau?orization 
,act ( #bjae1 by ,janu>y #a1 #bjbj1 !   
,secret>y %all exp& ! prior au?orization
 model to all ,/ates us+ notice & comm5t

 rulemak+1 reg>dless ( :e!r or n !      
expansion meets ! requirem5ts describ$ 9
 p>agraphs 7#a7 ?r\gh 7#c7 ( section    
#aaae;,a7c74  7ii7 ,if ! ,secret>y exp&s
 ! model ( prior au?orization "u ?is    
subp>agraph-- 7,i7 ! prior au?orization 
%all be limit$ to 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 basis2 &  7,,ii7 9   
mak+ ! prior au?orization det]m9ation ) 
respect to a s]vice & individual1 !     
,secret>y %all evaluate ! m$ical        
necessity ( ! s]vice by det]m9+--  7aa7 
:e!r ! individual is unable to get up f 
b$ )\t assi/ance1 unable to ambulate1 & 
unable to sit 9 a *air or :eel*air2     
7bb7 :e!r ! individual has a m$ical     
condition t1 reg>dless ( b$ conf9em5t1  
is su* t transport by ambulance is      
m$ically necess>y2 or  7cc7 :e!r !      
individual meets o!r crit]ia z det]m9$  

appropriate by ! ,secret>y4  4  ,,ii    
,r$uce ,adm9i/rative ,burd5s ,to ,exp&  
,pati5t ,c>e  #bja4 ,elim9ation (       
duplicative pap]work requirem5ts 9 !    
,m$ic>e ambulance b5efit ,section       
#ahcd7l7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem7l771 z am5d$ by       
section #aja1 is fur!r am5d$ by add+ !  
foll[+ new p>agraph3  7#bj7 ,r$uc+      
adm9i/rative burd5 ,no lat] ?an ,july   
#a1 #bjbj-- 7,a7 ,! ,secret>y %all ?r\gh
 notice & comm5t rulemak+ elim9ate !    
foll[+ requirem5ts to r$uce ! burd5 on  
ambulance s]vices provid]s & suppli]s3  
7i7 ,! vehicle section & ! extra        
practice locations = em]g5cy m$ical     
s]vices section ( ! #hee;,b ,ambulance  
,enrollm5t ,=m requir$ "u section       
#dbd4eje ( title #db1 ,code ( ,f$]al    
,regulations 7or successor regulations74
  7ii7 ,! requirem5t t individuals sign 
ambulance s]vice claims "u section      
#dbd4cf ( title #db1 ,code ( ,f$]al     
,regulations 7or successor regulations71
 :5 o!r docum5tation e/abli%+ t !       

individual receiv$ ! ambulance s]vices  
is available4  7,b7 ,n lat] ?an ,july   
#a1 #bjbj1 ! ,secret>y %all ?r\gh notice
 & comm5t rulemak+-- 7i7 require        
ambulance provid]s & suppli]s to update 
! #hee;,b ,ambulance ,enrollm5t ,=m     
requir$ "u section #dbd4eje ( title #db1
 ,code ( ,f$]al ,regulations 7or        
successor regulations71 no m ?an once a 
cal5d> ye>2 &  7ii7 e/abli% a process to
 take into acc\nt inaccuracies 9 ,social
 ,security records or o!r (ficial dea?  
records be=e revok+ bill+ au?ority =    
ambulance provid]s & suppli]s "u section
 #dbd4ece ( title #db1 ,code ( ,f$]al   
,regulations 7or successor regulations74
  4  ,,iii ,lev]age ,ambulance ,s]vices 
,to ,protect ,access to ,c>e 9 ,rural   
,am]ica  #cja4 ,protect+ access to      
ambulance s]vices 9 rural & l[          
population d5sity areas ,section        
#ahcd7l77#ab7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciem7l77#ab77 is am5d$
 by add+ at ! end ! foll[+ new          
subp>agraphs3  7,c7 ,exception = ,rural 

& ,qualifi$ ,rural ,areas ,! ,secret>y  
%all deem an area designat$ z a rural or
 qualifi$ rural area "u ?is p>agraph t  
w\ld o!rwise no long] receive su*       
designation to reta9 its previ\s        
designat$ /atus if !re are #a1jjj or    
few] individuals p] squ>e mile 9 ! area4
  7,d7 ,"r to ,appeal ,rural ,areas &   
,qualifi$ ,rural ,areas ,! ,secret>y    
%all e/abli% an adm9i/rative appeals    
process to all[ ambulance s]vices       
provid]s & suppli]s to seek             
reconsid]ation ( a *ange 9 a ,,zip      
code's /atus z a rural or qualifi$ rural
 area dur+ ! fir/ #ab mon?s aft] !      
,secret>y f9alizes a *ange 9 !          
designation made "u ?is p>agraph4  4