S.Amdt. 1098

1. Rewrites section 426

   Replaces

   In S. 1 · Reported to Senate

   SEC. 426. INCREASE FOR GROUND AMBULANCE SERVICES[struck: FURNISHED IN A RURAL AREA].

   Section 1834(l) (42 U.S.C. 1395m(l)), as amended by section 405(b)(2), is amended by adding at the end the following new [struck: paragraph][inserted: paragraphs]:

   "(10) Temporary increase for ground ambulance services[struck: furnished in a rural area].--

   "(A) In general.--Notwithstanding any other provision of this subsection, in the case of ground ambulance services furnished on or after January 1, [struck: 2005][inserted: 2004], and before January 1, [struck: 2008, for which ][inserted: 2007, ]the [struck: transportation originates in a rural area described in paragraph (9) or in a rural census tract described in such paragraph, the ]fee schedule established under this section, with respect to both the payment rate for service and the payment rate for mileage, shall provide that such rates otherwise established, [struck: after application of any increase under such paragraph, ]shall be increased by [struck: 5][inserted: 21.5] percent.

   Struck: "(B) Application of increased payments after 2007.--The increased payments under subparagraph (A) shall not be taken into account in calculating payments for services furnished on or after the period specified in such subparagraph.".

   Inserted: "(B) Additional increase for services furnished in a rural area.--Notwithstanding any other provision of this subsection, in the case of ground ambulance services furnished on or after January 1, 2004, and before January 1, 2007, for which the transportation originates in a rural area described in subparagraph (C), the fee schedule established under this section, with respect to both the payment rate for service and the payment rate for mileage, shall provide that such rates otherwise established, shall be increased by the higher of either 20 percent of the rate determined after the application of subparagraph (C), in addition to the increase provided under subparagraph (A).

   Inserted: "(C) Determination of rural areas based on population density within postal zip codes.--With respect to ground ambulance services described in subparagraph (B), during the period described in that subparagraph, paragraph (9) shall be applied by substituting '(as determined under an area classification system established by the Secretary that is based on population density within postal zip code areas)' for '(as defined in section 1886(d)(2)(D)) or in 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))'. Not later than December 31, 2003, the Secretary, taking into account the recommendations contained in the report submitted under section 221(b)(3) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, shall implement the increase in payment required under subparagraph (B) and shall establish the classification system required by the application of this subparagraph. The Secretary shall provide such increased payment for services furnished on or after the earlier of 30 days after the establishment of such classification system or December 31, 2003.

   Inserted: "(D) Application of increased payments after 2007.--The increased payments under subparagraphs (A) and (B) shall not be taken into account in calculating payments for services furnished on or after the period specified in such subparagraph.

   Inserted: "(11) Conversion factor adjustments.--The Secretary shall not adjust downward the conversion factor in any year because of an evaluation of the prior year conversion factor.".

   Inserted: SEC. 426A. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.

   Inserted: (a) Technical Amendment Concerning Secretary's Authority to Make Conditional Payment When Certain Primary Plans Do Not Pay Promptly.--

   Inserted: (1) In general.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is amended--

   Inserted: (A) in subparagraph (A)(ii), by striking "promptly (as determined in accordance with regulations)";

   Inserted: (B) in subparagraph (B)--

   Inserted: (i) by redesignating clauses (i) through (iii) as clauses (ii) through (iv), respectively; and

   Inserted: (ii) by inserting before clause (ii), as so redesignated, the following new clause:

   Inserted: "(i) Authority to make conditional payment.--The Secretary may make payment under this title with respect to an item or service if a primary plan described in subparagraph (A)(ii) has not made or cannot reasonably be expected to make payment with respect to such item or service promptly (as determined in accordance with regulations). Any such payment by the Secretary shall be conditioned on reimbursement to the appropriate Trust Fund in accordance with the succeeding provisions of this subsection.".

   Show 10 more inserted paragraphsShow less

   Inserted: (2) Effective date.--The amendments made by paragraph (1) shall be effective as if included in the enactment of title III of the Medicare and Medicaid Budget Reconciliation Amendments of 1984 (Public Law 98-369).

   Inserted: (b) Clarifying Amendments to Conditional Payment Provisions.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further amended--

   Inserted: (1) in subparagraph (A), in the matter following clause (ii), by inserting the following sentence at the end: "An entity that engages in a business, trade, or profession shall be deemed to have a self-insured plan if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part.";

   Inserted: (2) in subparagraph (B)(ii), as redesignated by subsection (a)(2)(B)--

   Inserted: (A) by striking the first sentence and inserting the following: "A primary plan, and an entity that receives payment from a primary plan, shall reimburse the appropriate Trust Fund for any payment made by the Secretary under this title with respect to an item or service if it is demonstrated that such primary plan has or had a responsibility to make payment with respect to such item or service. A primary plan's responsibility for such payment may be demonstrated by a judgment, a payment conditioned upon the recipient's compromise, waiver, or release (whether or not there is a determination or admission of liability) of payment for items or services included in a claim against the primary plan or the primary plan's insured, or by other means."; and

   Inserted: (B) in the final sentence, by striking "on the date such notice or other information is received" and inserting "on the date notice of, or information related to, a primary plan's responsibility for such payment or other information is received"; and

   Inserted: (3) in subparagraph (B)(iii), as redesignated by subsection (a)(2)(B), by striking the first sentence and inserting the following: "In order to recover payment made under this title for an item or service, the United States may bring an action against any or all entities that are or were required or responsible (directly, as an insurer or self-insurer, as a third-party administrator, as an employer that sponsors or contributes to a group health plan, or large group health plan, or otherwise) to make payment with respect to the same item or service (or any portion thereof) under a primary plan. The United States may, in accordance with paragraph (3)(A) collect double damages against any such entity. In addition, the United States may recover under this clause from any entity that has received payment from a primary plan or from the proceeds of a primary plan's payment to any entity.".

   Inserted: (c) Clerical Amendments.--Section 1862(b) (42 U.S.C. 1395y(b)) is amended--

   Inserted: (1) in paragraph (1)(A), by moving the indentation of clauses (ii) through (v) 2 ems to the left; and

   Inserted: (2) in paragraph (3)(A), by striking "such" before "paragraphs".

   Original wording

   Strike section 426 and insert the following:

Read automatically from the Congressional Record. Check the original before relying on it.

As printed