S. 1108Senate109th Congress (2005-2007)In Committee

Rural Access to Emergency Services Act of 2005

Introduced May 24, 2005

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SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance.

May 24, 2005

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SenateIntro Referral

Introduced in Senate

May 24, 2005

SenateIntro Referral

Sponsor introductory remarks on measure. (CR S5852-5853)

May 24, 2005

SenateIntro Referral

Read twice and referred to the Committee on Finance.

May 24, 2005

Floor Debate

5 members

What members said about S. 1108 on the floor

4 Republicans1 Democrat
Orrin G. Hatch
Sen. Orrin G. HatchR-UT · May 24, 2005

Mr. President, I rise today to introduce the Oil Shale and Tar Sands Development Act of 2005. In doing so, I would like to thank Senator Robert Bennett and Senator Wayne Allard for cosponsoring this…

John McCain
Sen. John McCainR-AZ · May 24, 2005

Mr. President, I am joined today by Senator Stevens in introducing the Clean Sports Act of 2005. The chairman of the House Government Reform Committee, Congressman Davis, and the ranking member of…

Max Baucus
Sen. Max BaucusD-MT · May 24, 2005

Mr. President, I am pleased to join Senator Grassley, and our other colleagues, in introducing legislation to make the Section 529 enhancements enacted in 2001 permanent. In 2001, it was the Senate,…

Lisa Murkowski
Sen. Lisa MurkowskiR-AK · May 24, 2005

Mr. President, I rise to introduce a bill that will help increase the amount of food donations going to American Indians and Alaska Natives nationwide. I am pleased to have Mr. Johnson join me in…

Chuck Grassley
Sen. Chuck GrassleyR-IA · May 24, 2005

Mr. President, over the past three decades, prescription medicines have assumed a central and critical role in treating health care conditions. Every year, researchers make new discoveries that help…

Bill Text

Latest available legislative text

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Introduced in SenateIssued May 24, 2005
        [Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1108 Introduced in Senate (IS)]

109th CONGRESS
1st Session
S. 1108

To amend title XVIII of the Social Security Act to make improvements to
payments to ambulance providers in rural areas, and for other purposes.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

May 24, 2005

Mr. Conrad (for himself, Mr. Roberts, Mr. Harkin, and Mr. Nelson of
Nebraska) introduced the following bill; which was read twice and
referred to the Committee on Finance

_______________________________________________________________________

A BILL

To amend title XVIII of the Social Security Act to make improvements to
payments to ambulance providers in rural areas, and for other purposes.

Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Rural Access to Emergency Services
Act of 2005''.

SEC. 2. COST-BASED CRITICAL ACCESS HOSPITAL AMBULANCE SERVICES CHANGES.

(a) In General.--Section 1834(l)(8) of the Social Security Act (42
U.S.C. 1395m(l)(8)) is amended--
(1) in subparagraph (B)--
(A) by striking ``owned and''; and
(B) by inserting ``(including when such services
are provided by the entity under an arrangement with
the hospital)'' after ``hospital''; and
(2) by striking the comma at the end of subparagraph (B)
and all that follows and inserting a period.
(b) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2006.

SEC. 3. PROVIDING APPROPRIATE COVERAGE OF RURAL GROUND AMBULANCE
SERVICES.

(a) Coverage.--Section 1834(l) of the Social Security Act (42
U.S.C. 1395m(l)) is amended by adding at the end the following new
paragraph:
``(15) Providing appropriate coverage of rural ground
ambulance services.--
``(A) In general.--The regulations described in
section 1861(s)(7) shall provide, to the extent that
any ambulance services (whether ground or air) may be
covered under such section, that a rural ground
ambulance service (as defined in subparagraph (C)) is
reimbursed under this subsection at the ground
ambulance rate if the ground ambulance service--
``(i) is reasonable and necessary based on
the health condition of the individual being
transported at or immediately prior to the time
of the transport; and
``(ii) complies with equipment and crew
requirements established by the Secretary.
``(B) Prudent layperson standard as satisfaction of
requirement of medically necessary.--The requirement of
subparagraph (A)(i) is deemed to be met for a rural
ground ambulance service if the request for such
ambulance service is made after the sudden onset of a
medical condition that would be classified as an
emergency medical condition under section
1852(d)(3)(B)).
``(C) Rural ground ambulance service defined.--For
purposes of this paragraph, the term `rural ground
ambulance service' means a ground ambulance service in
which the point of pick up of the individual occurs in
a rural area identified by the Secretary under
paragraph (16)(B).''.
(b) Conforming Amendment.--Section 1861(s)(7) of such Act (42
U.S.C. 1395x(s)(7)) is amended by striking ``section 1834(l)(14)'' and
inserting ``paragraphs (14) and (15) of section 1834(l)''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2006.

SEC. 4. IMPROVEMENT IN PAYMENTS TO RETAIN EMERGENCY AND OTHER CAPACITY
FOR AMBULANCES IN RURAL AREAS.

(a) In General.--Section 1834(l) of the Social Security Act (42
U.S.C. 1395m(l)), as amended by section 3(a), is amended by adding at
the end the following new paragraph:
``(16) Additional payments for providers furnishing
ambulance services in rural areas.--
``(A) In general.--In the case of ground ambulance
services furnished on or after January 1, 2006, for
which the transportation originates in a rural area (as
determined under subparagraph (B)), the Secretary shall
provide for a percent increase in the base rate of the
fee schedule for a trip identified under this
subsection.
``(B) Identification of rural areas.--The
Secretary, in consultation with the Office of Rural
Health Policy, shall use the Rural-Urban Commuting
Areas (RUCA) coding system, adopted by that Office, to
designate rural areas for the purposes of this
paragraph. A rural area is any area in RUCA levels 2
through 10 and any unclassified area.
``(C) Tiering of rural areas.--The Secretary shall
designate 4 tiers of rural areas, using a ZIP Code
population-based methodology generated by the RUCA
coding system, as follows:
``(i) Tier 1.--A rural area that is a high
metropolitan commuting area, in which 30
percent or more of the commuting flow is to an
urban area, as designated by the Bureau of the
Census (RUCA level 2).
``(ii) Tier 2.--A rural area that is a low
metropolitan commuting area, in which less than
30 percent of the commuting flow is to an urban
area or to a large town, as designated by the
Bureau of the Census (RUCA levels 3-6).
``(iii) Tier 3.--A rural area that is a
small town core, as designated by the Bureau of
the Census, in which no significant portion of
the commuting flow is to an area of population
greater than 10,000 people (RUCA levels 7-9).
``(iv) Tier 4.--A rural area in which there
is no dominant commuting flow (RUCA level 10)
and any unclassified area.
The Secretary shall consult with the Office of Rural
Health Policy not less often than every 2 years to
update the designation of rural areas in accordance
with any changes that are made to the RUCA system.
``(D) Payment adjustments for trips in rural
areas.--The Secretary shall adjust the payment rate
under this section for ambulance trips that originate
in each of the tiers established in subparagraph (C)
according to the national average cost of full-cost
providers for providing ambulance services in each such
tier.''.
(b) Review of Payments for Rural Ambulance Services and Report to
Congress.--
(1) Review.--Not later than July 1, 2008, the Secretary of
Health and Human Services shall review the system for adjusting
payments for rural ambulance services under section 1834(l)(16)
of the Social Security Act, as added by subsection (a), to
determine the adequacy and appropriateness of such adjustments.
In conducting such review, the Secretary shall consult with
providers and suppliers affected by such adjustments and with
representatives of the ambulance industry generally to
determine--
(A) whether such adjustments adequately cover the
additional costs incurred in serving areas of low
population density; and
(B) whether the tiered structure for making such
adjustments appropriately reflects the difference in
costs of providing services in different types of rural
areas.
(2) Report.--Not later than January 1, 2009, the Secretary
shall submit to Congress a report on the review conducted under
paragraph (1) together with any recommendations for revision to
the systems for adjusting payments for ambulance services in
rural areas that the Secretary of Health and Human Services
determines appropriate.
(c) Conforming Amendments.--(1) Section 1834(l) of the Social
Security Act (42 U.S.C. 1395m(l)), as amended by subsection (a), is
amended by adding at the end the following new paragraph:
``(17) Designation of rural areas for mileage payment
purposes.--In establishing any differential in the amount of
payment for mileage between rural and urban areas in the fee
schedule established under paragraph (1), the Secretary shall,
in the case of ambulance services furnished on or after January
1, 2006, identify rural areas in the same manner as provided in
paragraph (16)(B).''.
(2) Section 1834(l)(12)(A) of such Act (42 U.S.C. 1395m(l)(12)(A))
is amended by striking ``January 1, 2010'' and inserting ``January 1,
2006''.
(3) Section 1834(l)(13)(A)(i) of such Act (42 U.S.C.
1395m(l)(13)(A)(i)) is amended by inserting ``(or in the case of such
services furnished in 2006, in a rural area identified by the Secretary
under paragraph (16)(B))'' after ``such paragraph''.

SEC. 5. EXPANDING THE WORK OF MEDICARE QUALITY IMPROVEMENT
ORGANIZATIONS TO INCLUDE AMBULANCE PROVIDERS.

(a) Application to Ambulance Providers.--Section 1154(a)(1) of the
Social Security Act (42 U.S.C. 1320c-3(a)(1)) is amended by inserting
``(including ambulance providers)'' after ``noninstitutional
providers'' in the matter preceding subparagraph (A).
(b) Effective Date.--The amendment made by this section shall apply
on and after October 1, 2006.

SEC. 6. INCLUDING AMBULANCE PROVIDERS IN THE DEFINITION OF HEALTH CARE
PROVIDER FOR PURPOSES OF THE UNIVERSAL SERVICE FUND.

(a) In General.--Section 254(h)(7)(B) of the Communications Act of
1934 (47 U.S.C. 254(h)(7)(B)) is amended--
(1) in clause (vi), by striking ``and'' at the end;
(2) by redesignating clause (vii) as clause (viii);
(3) in clause (viii), as so redesignated, by striking
``(vi)'' and inserting ``(vii)''; and
(4) by inserting after clause (vi) the following new
clause:
``(vii) ambulance providers; and''.
(b) Effective Date.--The amendments made by this section shall take
effect on January 1, 2006.

SEC. 7. EMERGENCY MEDICAL SERVICES DEMONSTRATION PROJECT.

(a) In General.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary''), acting
through the Office of Rural Health Policy, shall award grants
to States to encourage such States to make improvements to
their emergency medical services (in this section referred to
as ``EMS'') systems.
(2) Administration requirement.--In order to be eligible
for a grant under this section, a State shall administer the
project jointly through the State EMS office and the State
rural health office. Either such office may be the lead office
for the project.
(3) Number of grants.--The Secretary shall award 3 grants
under this section.
(4) Maximum amount.--The Secretary shall not award a grant
under this section in an amount which exceeds $5,000,000.
(5) Duration.--The Secretary shall award grants under this
section for a period not to exceed 3 years.
(b) Target.--A State that receives a grant under this section
shall, in determining how to allocate the assistance received through
such grant--
(1) target such assistance to geographic areas that
complete community EMS assessments and informed self-
determination processes; and
(2) consider progress toward E-911 and WE-911 system
capability.
(c) Use of Funds.--Subject to subsection (b), a State that receives
a grant under this section may use assistance received through such
grant for the following:
(1) To integrate the State EMS systems with the State and
local health care delivery system, including through exploring
opportunities for expanded EMS scopes of practice and piloting
EMS-based rural community health services.
(2) To explore alternative rural EMS funding mechanisms
with State insurance authorities.
(3) To form rural and frontier EMS operational or service-
contracting networks.
(4) To analyze rural and frontier workforce recruitment and
retention efforts and to develop statewide plans for
improvement of such efforts.
(5) To deliver a rural EMS leadership and management
training model which includes EMS leadership, grant writing,
data collection, research, governing board structure, and
management of volunteers.
(6) To establish at least one full-time position of State
EMS medical director (or an equivalent position).
(7) To develop flexible models for providing EMS training
and continuing education to rural and frontier areas and to
develop bridge training between EMS providers and the nursing
or other allied health professions.
(8) To develop State and regional stockpiling and sharing
of expensive training devices, such as mannequins and patient
simulators.
(9) To develop and distribute, in partnership with public
health agencies, data-driven public information resources to
local EMS providers.
(10) To conduct comprehensive State EMS communications
needs assessments.
(11) To plan, integrate, and regulate, at the State level,
aeromedical, critical care transport and other statewide or
region wide systems of specialty care and transportation.
(12) To consider the evolving role of telehealth resources
and their application to EMS patient management and medical
oversight.
(13) To implement the National EMS Information System.
(14) To link and integrate, at all levels, EMS data systems
with other relevant health information systems, such as systems
relating to traffic crash data and other crash data, public
health surveillance, the medical examiner, hospital discharge
data, and emergency department data, and including the Centers
for Disease Control and Prevention surveillance monitoring
systems.
(d) Application.--
(1) In general.--Each State desiring a grant under this
section shall submit an application to the Secretary at such
time, in such manner, and accompanied by such information as
the Secretary may reasonably require.
(2) Contents.--Each application submitted pursuant to
paragraph (1) shall--
(A) describe the activities for which assistance
under this section is sought;
(B) provide assurances to the Secretary that no law
exists in the State that would prohibit EMS personnel
from practicing in non-ambulance settings; and
(C) provide such additional assurances as the
Secretary determines to be essential to ensure
compliance with the requirements of this section.
(e) Authorization of Appropriations.--There is authorized to be
appropriated $15,000,000 to carry out this section. Not more than 10
percent of amounts received under a grant awarded under this section
may be used for administrative expenses.
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