NEATSA Act

I 116TH CONGRESS 1ST SESSION H. R. 3021 To amend title XVIII of the Social Security Act to restructure the payment adjustment for non-emergency ESRD ambulance transports under the Medicare program. IN THE HOUSE OF REPRESENTATIVES MAY 24, 2019 Mr. LAHOOD (for himself and Ms. SEWELL of Alabama) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committee on Ways and Means, for a pe- riod to be subsequently determined by the Speaker, in each case for con- sideration of such provisions as fall within the jurisdiction of the com- mittee concerned A BILL To amend title XVIII of the Social Security Act to restruc- ture the payment adjustment for non-emergency ESRD ambulance transports under the Medicare program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Non-Emergency Am- 4 bulance Transportation Sustainability and Accountability 5 Act of 2019’’ or the ‘‘NEATSA Act’’. 6 VerDate Sep 11 2014 00:46 Jun 08, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3021.IH H3021 kjohnson on DSK79L0C42 with BILLS 2 •HR 3021 IH SEC. 2. RESTRUCTURE OF MEDICARE PAYMENT ADJUST- 1 MENT FOR NON-EMERGENCY ESRD AMBU- 2 LANCE TRANSPORTS. 3 (a) IN GENERAL.—Section 1834(l)(15) of the Social 4 Security Act (42 U.S.C. 1395m(l)(15)) is amended to read 5 as follows: 6 ‘‘(15) RESTRUCTURE OF PAYMENT ADJUST- 7 MENT FOR NON-EMERGENCY AMBULANCE TRANS- 8 PORTS FOR ESRD BENEFICIARIES.— 9 ‘‘(A) IN GENERAL.—In the case of applica- 10 ble ambulance services, the fee schedule amount 11 otherwise applicable under the preceding provi- 12 sions of this subsection shall be reduced as fol- 13 lows: 14 ‘‘(i) In the case of applicable ambu- 15 lance services furnished during the period 16 beginning on October 1, 2013, and ending 17 on September 30, 2019, reduced by 10 18 percent. 19 ‘‘(ii) In the case of applicable ambu- 20 lance services furnished during the period 21 beginning on October 1, 2019, and ending 22 on December 31, 2019, reduced by 15.5 23 percent. 24 VerDate Sep 11 2014 00:46 Jun 08, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3021.IH H3021 kjohnson on DSK79L0C42 with BILLS 3 •HR 3021 IH ‘‘(iii) In the case of applicable ambu- 1 lance services furnished during 2020 or a 2 subsequent year— 3 ‘‘(I) by a provider or supplier of 4 ambulance services that the Secretary 5 has designated under subparagraph 6 (C) for the year and for which such 7 transport originates in an area not de- 8 scribed in paragraph (13)(A)(i), re- 9 duced by 29.5 percent; or 10 ‘‘(II) that are not described in 11 subclause (I), reduced by 15.5 per- 12 cent. 13 ‘‘(B) APPLICABLE AMBULANCE SERV- 14 ICES.—In this paragraph, the term ‘applicable 15 ambulance services’ means ambulance services 16 consisting of non-emergency basic life support 17 services involving transport of an individual 18 with end-stage renal disease for renal dialysis 19 services (as described in section 20 1881(b)(14)(B)) furnished other than on an 21 emergency basis by a provider of services or a 22 renal dialysis facility. 23 ‘‘(C) DESIGNATION.— 24 VerDate Sep 11 2014 00:46 Jun 08, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3021.IH H3021 kjohnson on DSK79L0C42 with BILLS 4 •HR 3021 IH ‘‘(i) IN GENERAL.—For 2020 and 1 each subsequent year, the Secretary shall 2 designate the providers or suppliers of am- 3 bulance services for which the total pay- 4 ments made to the provider or supplier for 5 applicable ambulance services furnished 6 during the applicable period for the year 7 makes up at least 50 percent of the total 8 payments made to the provider or supplier 9 under this part for all ambulance services 10 furnished during such applicable period. 11 ‘‘(ii) METHODOLOGY.—The Secretary 12 shall, through notice and comment rule- 13 making, establish the methodology for des- 14 ignating providers and suppliers under 15 clause (i) for a year. Under such method- 16 ology, the applicable period for a year shall 17 be a 12-month period determined by the 18 Secretary that begins and ends prior to the 19 beginning of such year. 20 ‘‘(iii) TIMING.—Not later than No- 21 vember 1 of each year (beginning with 22 2019), the Secretary shall notify any pro- 23 vider or supplier that will be designated 24 under clause (i) for the subsequent year. 25 VerDate Sep 11 2014 00:46 Jun 08, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3021.IH H3021 kjohnson on DSK79L0C42 with BILLS 5 •HR 3021 IH ‘‘(iv) TARGETED REVIEW.—The Sec- 1 retary shall establish a process under 2 which a provider or supplier may seek an 3 informal review of the designation under 4 clause (i) with respect to the provider or 5 supplier. 6 ‘‘(v) PUBLIC REPORTING.—Beginning 7 in 2021, the Secretary shall, in an easily 8 understandable format, make available on 9 the Internet website of the Centers for 10 Medicare & Medicaid Services the fol- 11 lowing: 12 ‘‘(I) The total number of claims 13 paid under this part for applicable 14 ambulance services. 15 ‘‘(II) The total number of claims 16 paid under this part for applicable 17 ambulance services that were subject 18 to the payment reduction under sub- 19 paragraph (A)(iii), broken out for 20 each of subclauses (I) and (II) of such 21 subparagraph. 22 ‘‘(III) The total number of pro- 23 viders and suppliers that were des- 24 ignated under clause (i). 25 VerDate Sep 11 2014 00:46 Jun 08, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3021.IH H3021 kjohnson on DSK79L0C42 with BILLS 6 •HR 3021 IH ‘‘(IV) Any other data regarding 1 applicable ambulance services that the 2 Secretary determines appropriate.’’. 3 (b) GAO STUDY AND REPORT.— 4 (1) IN GENERAL.—The Comptroller General of 5 the United States (in this subsection referred to as 6 the ‘‘Comptroller General’’) shall conduct a study on 7 payments under section 1834(l) of the Social Secu- 8 rity Act (42 U.S.C. 1395m(l)) for applicable ambu- 9 lance services (as defined in subparagraph (B) of 10 paragraph (15) of such section, as added by sub- 11 section (a)). Such study shall include an analysis of 12 the impact of the amendment made by subsection 13 (a), including the impact on beneficiary access and 14 any steps providers and suppliers of ambulance serv- 15 ices have taken to avoid payment reductions under 16 such paragraph (15). 17 (2) REPORT.—Not later than March 1, 2023, 18 the Comptroller General shall submit to Congress a 19 report containing the results of the study conducted 20 under paragraph (1), together with recommenda- 21 tions for such legislation and administrative action 22 as the Comptroller General determines appropriate. 23 Æ VerDate Sep 11 2014 00:46 Jun 08, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H3021.IH H3021 kjohnson on DSK79L0C42 with BILLS