Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4938 To amend title XVIII to strengthen ambulance services furnished under part B of the Medicare program. IN THE HOUSE OF REPRESENTATIVES OCTOBER 31, 2019 Ms. SEWELL of Alabama (for herself, Mr. NUNES, Mr. WELCH, Mr. MULLIN, and Mr. BLUMENAUER) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Com- mittee on Ways and Means, for a period to be subsequently determined by the Speaker, 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 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; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Medicare Ambulance Access, Fraud Prevention, and Re- 5 form Act of 2019’’. 6 (b) TABLE OF CONTENTS.—The table of contents for 7 this Act is as follows: 8 VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 4938 IH Sec. 1. Short title; table of contents. TITLE I—PROTECT ACCESS TO HIGH QUALITY AMBULANCE CARE Sec. 101. Reform to the Medicare ambulance fee schedule. Sec. 102. National expansion of prior authorization model for repetitive sched- uled non-emergent ambulance transport. TITLE II—REDUCE ADMINISTRATIVE BURDENS TO EXPAND PATIENT CARE Sec. 201. Elimination of duplicative paperwork requirements in the Medicare ambulance benefit. TITLE III—LEVERAGE AMBULANCE SERVICES TO PROTECT ACCESS TO CARE IN RURAL AMERICA Sec. 301. Protecting access to ambulance services in rural and low population density areas. TITLE I—PROTECT ACCESS TO 1 HIGH QUALITY AMBULANCE 2 CARE 3 SEC. 101. REFORM TO THE MEDICARE AMBULANCE FEE 4 SCHEDULE. 5 (a) IN GENERAL.—Section 1834(l) of the Social Se- 6 curity Act (42 U.S.C. 1395m(l)) is amended by adding 7 at the end the following new paragraph: 8 ‘‘(18) INCREASE IN CONVERSION FACTOR FOR 9 GROUND AMBULANCE SERVICES.—In the case of 10 ground ambulance services furnished on or after 11 January 1, 2020, for purposes of determining the 12 fee schedule amount for such services under this 13 subsection, the conversion factor otherwise applica- 14 ble to such services shall be increased by— 15 ‘‘(A) with respect to ground ambulance 16 services for which the transportation originates 17 VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 4938 IH in a qualified rural area, as identified using the 1 methodology described in paragraph 2 (12)(B)(iii), 25.6 percent; 3 ‘‘(B) with respect to ground ambulance 4 services not described in subparagraph (A) and 5 for which the transportation originates in a 6 rural area described under paragraph (9) or in 7 a rural census tract described in such para- 8 graph, 3 percent; and 9 ‘‘(C) with respect to ground ambulance 10 services not described in subparagraph (A) or 11 (B), 2 percent. 12 ‘‘(19) INCREASE IN MILEAGE RATE FOR 13 GROUND AMBULANCE SERVICES.—In the case of 14 ground ambulance services furnished on or after 15 January 1, 2020, for purposes of determining the 16 fee schedule amount for such services under this 17 subsection, the payment rate for mileage otherwise 18 applicable to such services shall be increased by— 19 ‘‘(A) with respect to ground ambulance 20 services for which the transportation originates 21 in a qualified rural area, as identified using the 22 methodology described in paragraph 23 (12)(B)(iii), 3 percent; 24 VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 4938 IH ‘‘(B) with respect to ground ambulance 1 services not described in subparagraph (A) and 2 for which the transportation originates in a 3 rural area described under paragraph (9) or in 4 a rural census tract described in such para- 5 graph, 3 percent; and 6 ‘‘(C) with respect to ground ambulance 7 services not described in subparagraph (A) or 8 (B), 2 percent.’’. 9 (b) STUDY AND REPORT.— 10 (1) STUDY.—The Secretary of Health and 11 Human Services shall conduct a study on how the 12 conversion factor applicable to ground ambulance 13 services under the ambulance fee schedule under sec- 14 tion 1834(l) of the Social Security Act (42 U.S.C. 15 1395m(l)), as adjusted under paragraph (18) of 16 such section (as added by subsection (a)), should be 17 modified, if at all, to take into account the cost of 18 providing services in urban, rural, and super-rural 19 areas. In determining such costs, the Secretary shall 20 use the data collected through the data collection 21 system under paragraph (17) of such section. 22 (2) REPORT.—Not later than January 1, 2022, 23 the Secretary of Health and Human Services shall 24 submit to Congress a report on the study conducted 25 VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 4938 IH under paragraph (1), together with recommenda- 1 tions for such legislation and administrative action 2 as the Secretary determines appropriate. 3 SEC. 102. NATIONAL EXPANSION OF PRIOR AUTHORIZA- 4 TION MODEL FOR REPETITIVE SCHEDULED 5 NON-EMERGENT AMBULANCE TRANSPORT. 6 (a) IN GENERAL.—Section 1834(l)(16) of the Social 7 Security Act (42 U.S.C. 1395m(l)(16)) is amended— 8 (1) by redesignating subparagraphs (B) and 9 (C) as subparagraphs (C) and (D), respectively; and 10 (2) by inserting after subparagraph (A) the fol- 11 lowing new subparagraph: 12 ‘‘(B) PERMANENT EXPANSION.— 13 ‘‘(i) If by July 1, 2019, the Secretary 14 has not already expanded to all States the 15 model of prior authorization described in 16 paragraph (2) of section 515(a) of the 17 Medicare Access and CHIP Reauthoriza- 18 tion Act of 2015, by January 1, 2020, the 19 Secretary shall expand the prior authoriza- 20 tion model to all States using notice and 21 comment rulemaking, regardless of wheth- 22 er or not the expansion meets the require- 23 ments described in paragraphs (1) through 24 (3) of section 1115A(c). 25 VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 4938 IH ‘‘(ii) If the Secretary expands the 1 model of prior authorization under this 2 subparagraph— 3 ‘‘(I) the prior authorization shall 4 be limited to ambulance services con- 5 sisting of non-emergency basic life 6 support services involving transport of 7 an individual with end-stage renal dis- 8 ease for renal dialysis services (as de- 9 scribed in section 1881(b)(14)(B)) 10 furnished other than on an emergency 11 basis; and 12 ‘‘(II) in making the prior author- 13 ization determination with respect to 14 a service and individual, the Secretary 15 shall evaluate the medical necessity of 16 the service by determining— 17 ‘‘(aa) whether the individual 18 is unable to get up from bed 19 without assistance, unable to am- 20 bulate, and unable to sit in a 21 chair or wheelchair; 22 ‘‘(bb) whether the individual 23 has a medical condition that, re- 24 gardless of bed confinement, is 25 VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 4938 IH such that transport by ambulance 1 is medically necessary; or 2 ‘‘(cc) whether the individual 3 meets other criteria as deter- 4 mined appropriate by the Sec- 5 retary.’’. 6 TITLE II—REDUCE ADMINISTRA- 7 TIVE BURDENS TO EXPAND 8 PATIENT CARE 9 SEC. 201. ELIMINATION OF DUPLICATIVE PAPERWORK RE- 10 QUIREMENTS IN THE MEDICARE AMBULANCE 11 BENEFIT. 12 Section 1834(l) of the Social Security Act (42 U.S.C. 13 1395m(l)), as amended by section 101, is further amended 14 by adding the following new paragraph: 15 ‘‘(20) REDUCING ADMINISTRATIVE BURDEN.— 16 No later than July 1, 2020— 17 ‘‘(A) The Secretary shall through notice 18 and comment rulemaking eliminate the fol- 19 lowing requirements to reduce the burden on 20 ambulance services providers and suppliers: 21 ‘‘(i) The vehicle section and the 22 ‘extra’ practice locations for emergency 23 medical services section of the 855B Am- 24 bulance Enrollment Form required under 25 VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 4938 IH section 424.505 of title 42, Code of Fed- 1 eral Regulations (or successor regulations). 2 ‘‘(ii) The requirement that individuals 3 sign ambulance service claims under sec- 4 tion 424.36 of title 42, Code of Federal 5 Regulations (or successor regulations), 6 when other documentation establishing 7 that the individual received the ambulance 8 services is available. 9 ‘‘(B) Not later than July 1, 2020, the Sec- 10 retary shall through notice and comment rule- 11 making— 12 ‘‘(i) require ambulance providers and 13 suppliers to update the 855B Ambulance 14 Enrollment Form required under section 15 424.505 of title 42, Code of Federal Regu- 16 lations (or successor regulations), no more 17 than once a calendar year; and 18 ‘‘(ii) establish a process to take into 19 account inaccuracies in Social Security 20 records or other official death records be- 21 fore revoking billing authority for ambu- 22 lance providers and suppliers under section 23 424.535 of title 42, Code of Federal Regu- 24 lations (or successor regulations).’’. 25 VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 4938 IH TITLE III—LEVERAGE AMBU- 1 LANCE SERVICES TO PRO- 2 TECT ACCESS TO CARE IN 3 RURAL AMERICA 4 SEC. 301. PROTECTING ACCESS TO AMBULANCE SERVICES 5 IN RURAL AND LOW POPULATION DENSITY 6 AREAS. 7 Section 1834(l)(12) of the Social Security Act (42 8 U.S.C. 1395m(l)(12)) is amended by adding at the end 9 the following new subparagraphs: 10 ‘‘(C) EXCEPTION FOR RURAL AND QUALI- 11 FIED RURAL AREAS.—The Secretary shall deem 12 an area designated as a rural or qualified rural 13 area under this paragraph that would otherwise 14 no longer receive such designation to retain its 15 previous designated status if there are 1,000 or 16 fewer individuals per square mile in the area. 17 ‘‘(D) RIGHT TO APPEAL RURAL AREAS 18 AND QUALIFIED RURAL AREAS.—The Secretary 19 shall establish an administrative appeals proc- 20 ess to allow ambulance services providers and 21 suppliers to seek reconsideration of a change in 22 a ZIP code’s status as a rural or qualified rural 23 area during the first 12 months after the Sec- 24 VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 4938 IH retary finalizes a change in the designation 1 made under this paragraph.’’. 2 Æ VerDate Sep 11 2014 19:03 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H4938.IH H4938 pamtmann on DSKBC07HB2PROD with BILLS