PAYMENTS FOR AMBULANCE SERVICES.

SEC. 4531. PAYMENTS FOR AMBULANCE SERVICES. (a) Interim Reductions.— (1) Payments determined on reasonable cost basis.—Section 1861(v)(1) (42 U.S.C. 1395x(v)(1)), as amended by section 4451, is amended by adding at the end the following new subparagraph: “(U) In determining the reasonable cost of ambulance services (as described in subsection (s)(7)) provided during fiscal year 1998, during fiscal year 1999, and during so much of fiscal year 2000 as precedes January 1, 2000, the Secretary shall not recognize the costs per trip in excess of costs recognized as reasonable for ambulance services provided on a per trip basis during the previous fiscal year (after application of this subparagraph), increased by the percentage increase in the consumer price index for all urban consumers (U.S. city average) as estimated by the Secretary for the 12-month period ending with the midpoint of the fiscal year involved reduced by 1.0 percentage point. For ambulance services provided after June 30, 1998, the Secretary may provide that claims for such services must include a code (or codes) under a uniform coding system specified by the Secretary that identifies the services furnished.”. (2) Payments determined on reasonable charge basis.—Section 1842(b) (42 U.S.C. 1395u(b)) is amended by adding at the end the following new paragraph: “(19) For purposes of section 1833(a)(1), the reasonable charge for ambulance services (as described in section 1861(s)(7)) provided during calendar year 1998 and calendar year 1999 may not exceed the reasonable charge for such services provided during the previous calendar year (after application of this paragraph), increased by the percentage increase in the consumer price index for all urban consumers (U.S. city average) as estimated by the Secretary for the 12-month period ending with the midpoint of the year involved reduced by 1.0 percentage point.”. (b) Establishment of Prospective Fee Schedule.—111 STAT. 451 (1) Payment in accordance with fee schedule.—Section 1833(a)(1) (42 U.S.C. 13951(a)(D), as amended by section 4315(b), is amended— (A) by striking “and (Q)” and inserting “(Q)”; and (B) by striking the semicolon at the end and inserting the following: “, and (R) with respect to ambulance service, the amounts paid shall be 80 percent of the lesser of the actual charge for the services or the amount determined by a fee schedule established by the Secretary under section 1834(1);”. (2) Establishment of schedule.—Section 1834 (42 U.S.C. 1395m), as amended by section 4541, is amended by adding at the end the following new subsection: “(l) Establishment of Fee Schedule for Ambulance Services.— “(1) In general.—The Secretary shall establish a fee schedule for payment for ambulance services whether provided directly by a supplier or provider or under arrangement with a provider under this part through a negotiated rulemaking process described in title 5, United States Code, and in accordance with the requirements of this subsection. “(2) Considerations.—In establishing such fee schedule, the Secretary shall— “(A) establish mechanisms to control increases in expenditures for ambulance services under this part; “(B) establish definitions for ambulance services which link payments to the type of services provided; “(C) consider appropriate regional and operational differences; “(D) consider adjustments to payment rates to account for inflation and other relevant factors; and “(E) phase in the application of the payment rates under the fee schedule in an efficient and fair manner. “(3) Savings.—In establishing such fee schedule, the Secretary shall— “(A) ensure that the aggregate amount of payments made for ambulance services under this part during 2000 does not exceed the aggregate amount of payments which would have been made for such services under this part during such year if the amendments made by section 4531(a) of the Balanced Budget Act of 1997 continued in effect, except that in making such determination the Secretary shall assume an update in such payments for 2002 equal to percentage increase in the consumer price index for all urban consumers (U.S. city average) for the 12-month period ending with June of the previous year reduced in the case of 2001 and 2002 by 1.0 percentage points; and111 STAT. 452 “(B) set the payment amounts provided under the fee schedule for services furnished in 2001 and each subsequent year at amounts equal to the payment amounts under the fee schedule for services furnished during the previous year, increased by the percentage increase in the consumer price index for all urban consumers (U.S. city average) for the 12-month period ending with June of the previous year reduced in the case of 2001 and 2002 by 1.0 percentage points. “(4) Consultation.—In establishing the fee schedule for ambulance services under this subsection, the Secretary shall consult with various national organizations representing individuals and entities who furnish and regulate ambulance services and share with such organizations relevant data in establishing such schedule. “(5) Limitation on review.—There shall be no administrative or judicial review under section 1869 or otherwise of the amounts established under the fee schedule for ambulance services under this subsection, including matters described in paragraph (2). “(6) Restraint on billing.—The provisions of subparagraphs (A) and (B) of section 1842(b)(18) shall apply to ambulance services for which payment is made under this subsection in the same manner as they apply to services provided by a practitioner described in section 1842(b)(18)(C). “(7) Coding system.—The Secretary may require the claim for any services for which the amount of payment is determined under this subsection to include a code (or codes) under a uniform coding system specified by the Secretary that identifies the services furnished.”. (3) Effective date.—The amendments made by this subsection shall apply to services furnished on or after January 1, 2000. (c) Authorizing Payment for Paramedic Intercept Service Providers in Rural Communities.—In promulgating regulations to carry out section 1861(s)(7) of the Social Security Act (42 U.S.C. 1395x(s)(7)) with respect to the coverage of ambulance service, the Secretary of Health and Human Services may include coverage of advanced life support services (in this subsection referred to as “ALS intercept services”) provided by a paramedic intercept service provider in a rural area if the following conditions are met: (1) The ALS intercept services are provided under a contract with one or more volunteer ambulance services and are medically necessary based on the health condition of the individual being transported. (2) The volunteer ambulance service involved— (A) is certified as qualified to provide ambulance service for purposes of such section, (B) provides only basic life support services at the time of the intercept, and (C) is prohibited by State law from billing for any services. (3) The entity supplying the ALS intercept services— (A) is certified as qualified to provide such services under the medicare program under title XVIII of the Social Security Act, and (B) bills all recipients who receive ALS intercept services from the entity, regardless of whether or not such recipients are medicare beneficiaries.111 STAT. 453