Sec. 3. Aligning ambulance reimbursement with value-based and high-quality field EMS
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Section 1115A(b)(2) of the Social Security Act ( 42 U.S.C. 1315a(b)(2) ) is amended— in the last sentence of subparagraph (A), by inserting , and shall include the model described in subparagraph
(D)before the period at the end; and by adding at the end the following new subparagraph: The model described in this subparagraph is a demonstration program under title XVIII. Beginning not later than 2 years after the date of the enactment of the Field EMS Modernization and Innovation Act , the CMI shall conduct not less than 10 demonstration projects to— evaluate the implementation and reimbursement of alternative dispositions of field EMS patients, including— transporting individuals by ambulance to alternate destinations when medically appropriate and in the individual's best interests; when medically necessary, evaluating, treating, or referring individuals to other medically appropriate providers; and when medically appropriate, treating individuals through community paramedicine or mobile integrated healthcare services; evaluate the implementation of alternative reimbursement models, including models based on readiness rather than transport or shared savings; and determine whether such alternative dispositions and reimbursement models— improve the safety, effectiveness, timeliness, and efficiency of emergency medical services; and reduce overall utilization and expenditures under title XVIII. The CMI shall ensure that at least one demonstration project under this subparagraph evaluates evidence-based protocols that give guidance on selection of the destination to which individuals are transported. The duration of a demonstration project under this subparagraph shall not exceed 3 years. The Secretary shall conduct or support further research that the Secretary determines to be necessary prior to, or in conjunction with, the demonstration projects under this subparagraph in order to evaluate the implementation of alternative dispositions of, and reimbursement models for transport of, field EMS patients. Not later than 1 year after the completion of all demonstration projects under this subparagraph, the Secretary shall include in the annual report to Congress required under subsection
(g)a report on the results of the projects conducted under this subparagraph, including information about the efficacy of alternative disposition of, and reimbursement models for transport of, field EMS patients. In this subparagraph, the terms community paramedicine , field EMS , mobile integrated healthcare , and readiness shall have the meanings given such terms in section 1291 of the Public Health Service Act. . 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: Not later than 3 years after the date of the enactment of this paragraph, the Secretary shall establish the Field EMS Alternative Delivery Program to establish and promote the utilization of innovative payment models, including the models described in subparagraph (D), on a shared savings and voluntary basis, taking into consideration the results of the evaluation of models under subparagraph
(G)and the demonstration projects conducted under section 1115A(b)(2)(D). To the extent that the Secretary ascertains that an innovative payment model has been sufficiently demonstrated through the private sector or through the Center for Medicare and Medicaid Innovation under section 1115A and does not need to be evaluated under subparagraph (G), the Secretary may establish such innovative payment model on a shared savings and budget neutral basis pursuant to this subparagraph. Providers and suppliers of ground ambulance services may voluntarily opt to utilize innovative payment models under the Field EMS Alternative Delivery Program. Nothing in this subparagraph shall be construed as authorizing the Secretary to require participation in any innovative payment model under the Program. The Secretary shall implement the innovative payment models under this subparagraph in a budget neutral manner such that the cost of implementation of such models shall not exceed the amount that otherwise would have been provided in reimbursement under this title if such models had not been implemented. The following models are described in this clause: Community paramedicine that allows for payment for health care assessment and prevention services, or other care management services. Mobile integrated healthcare services that allow for health care assessment and prevention services, or other care management services within an integrated program of patient care. Alternate patient dispositions regardless of transport to the hospital, including transport to alternate destinations and other patient dispositions such as treating and referring patients to appropriate follow up care. Such alternate dispositions, including alternate destinations and treat and refer dispositions, would be subject to the discretion of the physician medical director responsible for providing medical oversight. The provision of field EMS and reimbursement on a population health basis, such as through global capitation. Prevention-based models, such as injury prevention through home evaluations for fall prevention or infection control. Critical care models, particularly in geographic areas without proximate access to hospital-based critical care, and including a model that enables patient stabilization by critical care transport teams with telemedicine support for maintaining the patient in the patient’s community. Any other innovative shared savings model the Secretary determines relevant pursuant to subparagraph (G). As a condition of participation in the Field EMS Alternative Delivery Program, providers and suppliers of ground ambulance services shall participate in the Ambulance Quality Incentive Program described in paragraph (17). The Secretary shall specify and require appropriate medical oversight with regard to the development, demonstration, and implementation of innovative payment models under this paragraph to ensure high-quality care and patient safety. The Secretary, in consultation with the Assistant Secretary for Preparedness and Response and taking into consideration the recommendations of the National EMS Advisory Council and the Federal Interagency Committee on EMS, shall undertake the development and evaluation of innovative models of field EMS delivery and reimbursement. Not later than 1 year after the date of the enactment of the Field EMS Modernization and Innovation Act , the Secretary shall complete an evaluation of— the provision of and reimbursement for alternative delivery models for medical care through field EMS; and the integration of field EMS patients with other medical providers and facilities as medically appropriate. In completing the evaluation under subclause (I), the Secretary shall consider the following: Alternative dispositions of patients, including— transporting individuals by ambulance to destinations other than a hospital, such as the office of the physician of the individual, an urgent care center, or the facility of another health care provider; when medically necessary, the evaluation, treatment, or referral of individuals to other medically appropriate health care providers; the provision of medical care regardless of the decision to transport, such as reimbursement models based on readiness rather than transport and shared savings; and the provision of health care using patient-centered mobile resources in the out-of-hospital environment, such as community paramedicine and mobile-integrated health care services. Issues related to medical liability and the requirements of section 1867 (commonly referred to as EMTALA ) associated with transport to destinations other than a hospital emergency department. Necessary protections to ensure that patients receive timely and appropriate care in the appropriate setting, including ongoing quality improvement and appropriate physician medical oversight. Whether there are any barriers to providing alternate dispositions to individuals who are not in need of hospital-based care. Other reimbursement related issues that span multiple delivery models including the cost of demonstrated evidence-based care, such as 12-lead electrocardiograms and continuous positive airway pressure, early recognition of time dependent diseases, such as stroke and sepsis, and trauma, and providing high-quality appropriate physician medical oversight. Other issues, as determined by the Secretary, including, when practicable, issues recommended by the Assistant Secretary for Preparedness and Response, the National EMS Advisory Council, and the Federal Interagency Committee on EMS for evaluation under this subparagraph. In this paragraph, the terms community paramedicine , field EMS , medical oversight , and mobile integrated healthcare have the meanings given such terms in section 1291 of the Public Health Service Act. . Section 1834(l) of the Social Security Act ( 42 U.S.C. 1395m(l) ), as amended by subsection (a), is further amended by adding at the end the following new paragraph: Not later than January 1 of the first fiscal year that begins on or after the date that is 3 years after the date of the enactment of this paragraph, the Secretary shall establish an Ambulance Quality Incentive Program under which providers and suppliers of ground ambulance services under this subsection may receive incentive payments from the amount made available under subparagraph
(F)for reporting on the quality measures identified by the Secretary under subparagraph (B). The Secretary shall, by regulation, identify quality measures that have been endorsed by the entity with a contract under section 1890(a). Such measures shall include outcome and patient safety measures and be relevant to the provision of field emergency medical response and mobile medical care. In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. Subject to clause (iv), the Secretary may, by regulation, revise quality measures identified under this paragraph on an annual basis. The Secretary shall publish the quality measures that will apply to a fiscal year not later than January 1 of the preceding fiscal year. Participation in the Ambulance Quality Incentive Program is voluntary for providers and suppliers electing not to participate in the Field EMS Alternative Delivery Program. In carrying out the provisions of this paragraph (including in developing and revising the quality measures identified in subparagraph (B)), the Secretary shall— solicit the input of relevant stakeholders; use the notice and comment procedures provided in section 553 of title 5, United States Code; and take into account prior investments in technology systems to enable participation in the program with minimal additional capital investments. The Secretary shall establish procedures for making data submitted under this paragraph available to the public on the website of the Centers for Medicare & Medicaid Services. Such procedures shall ensure that a supplier or provider has the opportunity to review the data that is to be made public with respect to the supplier or provider prior to such data being made public. The amount available for making payments under this paragraph for any fiscal year shall be equal to the amount of savings for the preceding fiscal year resulting from the Field EMS Alternative Delivery Program described in paragraph (16), as determined by the Secretary. To the extent that funds are available for making payments under this paragraph for a fiscal year, the Secretary shall ensure that— providers and suppliers who participated in the program established under paragraph
(16)in the preceding fiscal year are paid before other providers and suppliers; and providers and suppliers who did not participate in the program established under paragraph
(16)in the preceding fiscal year may only receive payments if there are any funds remaining after the application of subclause (I). .
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Sec. 3
Aligning ambulance reimbursement with value-based and high-quality field EMS
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