PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 451 (1) PAYMENT IN ACCORDANCE WITH FEE SCHEDULE. —Section 1833(a)(1) (42 U.S.C. 13951(a)(1)), 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: "(1) ESTABLISHMENT OF FEE SCHEDULE FOR AMBULANCE SERV- ICES. — "(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 dif- ferences; "(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; and "(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.
�
