,,ii  #aahth ,,congress  #b;d ,session  
,s4 #edjj  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #ba1 
#bjbd,mr4 ,manchin 7for himself and ,ms4
 ,collins7 introduced the following     
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,to amend title ,,xi of the ,social   
,security ,act to require the ,center   
for ,medicare and ,medicaid ,innovation 
to test an emergency medical services   
treatment-in-place model under the      
,medicare program4  #a4 ,short title    
,this ,act may be cited as the          
,improving ,access to ,emergency        
,medical ,services ,act4  #b4 ,requiring
 the ,center for ,medicare and ,medicaid
 ,innovation to test an emergency       
medical services treatment-in-place     
model under the ,medicare program  7a7  
,in general ,section #aaae;,a of the    
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7 is amended-- 7#a7 in subsection
 7b77#b7-- 7,a7 in subparagraph 7,a71 in
 the third sentence1 by inserting 1 and 

shall include the model described in    
subparagraph 7,b77xxviii7 before the    
period at the end2 and  7,b7 in         
subparagraph 7,b71 by adding at the end 
the following new clause3  7xxviii7 ,the
 ,emergency ,medical ,services          
,treatment-in-,place ,model described in
 subsection 7h74  2 and  7#b7 by adding 
at the end the following new subsection3
  7h7 ,emergency ,medical ,services     
,treatment-in-,place ,model  7#a7 ,in   
general ,for purposes of subsection     
7b77#b77;,b77xxviii71 the ,emergency    
,medical ,services ,treatment-in-,place 
,model described in this subsection is a
 model under which payment is made under
 part ,b of title ,,xviii for treatment 
services furnished to an individual     
enrolled under such part by a provider  
or supplier of ground ambulance services
 7as described in section #ahcd7l77 when
 such services-- 7,a7 are not associated
 with a corresponding transport payable 
under such section2  7,b7 are so        
furnished in response to an emergency   

medical call 7as specified by the       
,secretary7 made with respect to such   
individual2 and  7,c7 are so furnished  
in accordance with ,state and local     
protocols 7which may include online     
medical direction74  7#b7 ,payment ,the 
,secretary shall set payment rates for  
services furnished under the model      
described in paragraph 7#a7 in a manner 
that aligns such payments with the      
payments that would have been made for  
such services had such services resulted
 in a transport payable under section   
#ahcd7l74  7#c7 ,duration ,the model    
described in paragraph 7#a7 shall be    
carried out for a period of #e years4  4
  7b7 ,report ,not later than #d years  
after the date on which the ,emergency  
,medical ,services ,treatment-in-,place 
,model 7as described in section         
#aaae;,a7h7 of the ,social ,security    
,act1 as added by subsection 7a77 is    
implemented1 the ,comptroller ,general  
of the ,united ,states shall submit to  
the ,committee on ,ways and ,means of   

the ,house of ,representatives and the  
,committee on ,finance of the ,senate a 
report that1 taking into account        
stakeholder input-- 7#a7 analyzes       
various aspects of ,medicare            
beneficiaries' access to emergency      
medical services1 including an          
evaluation of the impact of such model  
on beneficiary outcomes1 resource       
utilization1 and overall health care    
system efficiency2  7#b7 compares       
beneficiary outcomes under such model   
with beneficiary outcomes using         
traditional emergency transportation2   
7#c7 assesses the impact of regional    
variations and demographics on          
beneficiary access to emergency medical 
services2  7#d7 identifies best         
practices and potential challenges in   
implementing such model2 and  7#e7      
includes recommendations for improving  
emergency medical services4