SEC. 414. PAYMENT FOR RURAL AND URBAN AMBULANCE SERVICES.
(a) PHASE-IN PROVIDING FLOOR USING BLEND OF
FEE SCHEDULE AND REGIONAL FEE SCHEDULES- Section 1834(l) (42 U.S.C. 1395m(l))
is amended--
(1) in paragraph (2)(E), by inserting
`consistent with paragraph (11)' after `in an efficient and fair manner';
and
(2) by redesignating paragraph (8),
as added by section 221(a) of BIPA (114 Stat. 2763A-486), as paragraph (9);
and
(3) by adding at the end the following
new paragraph:
`(10) PHASE-IN PROVIDING FLOOR USING BLEND OF FEE SCHEDULE AND REGIONAL
FEE SCHEDULES- In carrying out the phase-in under paragraph (2)(E) for each
level of ground service furnished in a year, the portion of the payment
amount that is based on the fee schedule shall be the greater of the amount
determined under such fee schedule (without regard to this paragraph) or the
following blended rate of the fee schedule under paragraph (1) and of a
regional fee schedule for the region involved:
`(A) For 2004 (for services furnished on or after July 1, 2004), the
blended rate shall be based 20 percent on the fee schedule under paragraph
(1) and 80 percent on the regional fee schedule.
`(B) For 2005, the blended rate shall be based 40 percent on the fee
schedule under paragraph (1) and 60 percent on the regional fee
schedule.
`(C) For 2006, the blended rate shall be based 60 percent on the fee
schedule under paragraph (1) and 40 percent on the regional fee
schedule.
`(D) For 2007, 2008, and 2009, the blended rate shall be based 80
percent on the fee schedule under paragraph (1) and 20 percent on the
regional fee schedule.
`(E) For 2010 and each succeeding year, the blended rate shall be
based 100 percent on the fee schedule under paragraph (1).
For purposes of this paragraph, the Secretary shall establish a regional
fee schedule for each of the nine census divisions (referred to in section
1886(d)(2)) using the methodology (used in establishing the fee schedule
under paragraph (1)) to calculate a regional conversion factor and a
regional mileage payment rate and using the same payment adjustments and the
same relative value units as used in the fee schedule under such
paragraph.'.
(b) ADJUSTMENT IN PAYMENT FOR CERTAIN LONG
TRIPS- Section 1834(l), as amended by subsection (a), is amended by adding at
the end the following new paragraph:
`(11) ADJUSTMENT IN PAYMENT FOR CERTAIN LONG TRIPS- In the case of
ground ambulance services furnished on or after July 1, 2004, and before
January 1, 2009, regardless of where the transportation originates, the fee
schedule established under this subsection shall provide that, with respect
to the payment rate for mileage for a trip above 50 miles the per mile rate
otherwise established shall be increased by 1/4 of the payment per mile
otherwise applicable to miles in excess of 50 miles in such trip.'.
(c) IMPROVEMENT IN PAYMENTS TO RETAIN EMERGENCY
CAPACITY FOR AMBULANCE SERVICES IN RURAL AREAS-
(1) IN GENERAL- Section 1834(l) (42
U.S.C. 1395m(l)), as amended by subsections (a) and (b), is amended by adding
at the end the following new paragraph:
`(12) ASSISTANCE FOR RURAL PROVIDERS FURNISHING SERVICES IN LOW
POPULATION DENSITY AREAS-
`(A) IN GENERAL- In the case of ground ambulance services furnished on
or after July 1, 2004, and before January 1, 2010, for which the
transportation originates in a qualified rural area (identified under
subparagraph (B)(iii)), the Secretary shall provide for a percent increase
in the base rate of the fee schedule for a trip established under this
subsection. In establishing such percent increase, the Secretary shall
estimate the average cost per trip for such services (not taking into
account mileage) in the lowest quartile as compared to the average cost
per trip for such services (not taking into account mileage) in the
highest quartile of all rural county populations.
`(B) IDENTIFICATION OF QUALIFIED RURAL AREAS-
`(i) DETERMINATION OF POPULATION DENSITY IN AREA- Based upon data
from the United States decennial census for the year 2000, the Secretary
shall determine, for each rural area, the population density for that
area.
`(ii) RANKING OF AREAS- The Secretary shall rank each such area
based on such population density.
`(iii) IDENTIFICATION OF QUALIFIED RURAL AREAS- The Secretary shall
identify those areas (in subparagraph (A) referred to as `qualified
rural areas') with the lowest population densities that represent, if
each such area were weighted by the population of such area (as used in
computing such population densities), an aggregate total of 25 percent
of the total of the population of all such areas.
`(iv) RURAL AREA- For purposes of this paragraph, the term `rural
area' has the meaning given such term in section 1886(d)(2)(D). If
feasible, the Secretary shall treat a rural census tract of a
metropolitan statistical area (as determined under the most recent
modification of the Goldsmith Modification, originally published in the
Federal Register on February 27, 1992 (57 Fed. Reg. 6725) as a rural
area for purposes of this paragraph.
`(v) JUDICIAL REVIEW- There shall be no administrative or judicial
review under section 1869, 1878, or otherwise, respecting the
identification of an area under this subparagraph.'.
(2) USE OF DATA- In order to promptly
implement section 1834(l)(12) of the Social Security Act, as added by paragraph
(1), the Secretary may use data furnished by the Comptroller General of the
United States.
(d) TEMPORARY INCREASE FOR GROUND AMBULANCE
SERVICES- Section 1834(l) (42 U.S.C. 1395m(l)), as amended by subsections (a),
(b), and (c), is amended by adding at the end the following new paragraph:
`(13) TEMPORARY INCREASE FOR GROUND AMBULANCE SERVICES-
`(A) IN GENERAL- After computing the rates with respect to ground
ambulance services under the other applicable provisions of this
subsection, in the case of such services furnished on or after July 1,
2004, and before January 1, 2007, for which the transportation originates
in--
`(i) a rural area described in paragraph (9) or in a rural census
tract described in such paragraph, the fee schedule established under
this section shall provide that the rate for the service otherwise
established, after the application of any increase under paragraphs (11)
and (12), shall be increased by 2 percent; and
`(ii) an area not described in clause (i), the fee schedule
established under this subsection shall provide that the rate for the
service otherwise established, after the application of any increase
under paragraph (11), shall be increased by 1 percent.
`(B) APPLICATION OF INCREASED PAYMENTS AFTER 2006- The increased
payments under subparagraph (A) shall not be taken into account in
calculating payments for services furnished after the period specified in
such subparagraph.'.
(e) IMPLEMENTATION- The Secretary may implement
the amendments made by this section, and revise the conversion factor applicable
under section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) for purposes
of implementing such amendments, on an interim final basis, or by program instruction.
(f) GAO REPORT ON COSTS AND ACCESS- Not later
than December 31, 2005, the Comptroller General of the United States shall submit
to Congress an initial report on how costs differ among the types of ambulance
providers and on access, supply, and quality of ambulance services in those
regions and States that have a reduction in payment under the medicare ambulance
fee schedule (under section 1834(l) of the Social Security Act, as amended by
this Act). Not later than December 31, 2007, the Comptroller General shall submit
to Congress a final report on such access and supply.
(g) TECHNICAL AMENDMENTS- (1)
Section 221(c) of BIPA (114 Stat. 2763A-487) is amended by striking `subsection
(b)(2)' and inserting `subsection (b)(3)'.
(2) Section 1861(v)(1) (42 U.S.C. 1395x(v)(1))
is amended by moving subparagraph (U) 4 ems to the left.
