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Centers for Medicare&Medicaid Services, HHS §414.615
<br /> (U.S. city average)for the 12-month pe- (b) 2003 Payment. For services fur-
<br /> riod ending with June of the previous nished in CY 2003, payment is based on
<br /> year. 60 percent of the reasonable charge or
<br /> (g) Adjustments. The Secretary mon- reasonable cost, as applicable, plus 40
<br /> itors payment and billing data on an percent of the ambulance fee schedule
<br /> ongoing basis and adjusts the CF and amount. The reasonable charge and
<br /> air ambulance rates as appropriate to reasonable cost portion in CY 2003 is
<br /> reflect actual practices under the fee equal to the supplier's reasonable
<br /> schedule. These rates are not adjusted charge or provider's reasonable cost for
<br /> solely because of changes in the total CY 2002,multiplied by the statutory in-
<br /> number of ambulance transports. flation factor for ambulance services.
<br /> (h) 7'reatment of certain areas for pay- (c) 2004 Payment. For services fur-
<br /> ment for air ambulance services. Any area nished in CY 2004, payment is based on
<br /> that was designated as a rural area for 40 percent of the reasonable charge or
<br /> purposes of making payments under reasonable cost, as applicable, plus 60
<br /> the ambulance fee schedule for air am- percent of the ambulance fee schedule
<br /> bulance services furnished on Decem- amount. The reasonable charge and
<br /> ber 31, 2006, must be treated as a rural reasonable cost portion in CY 2004 is
<br /> area for purposes of making payments equal to the supplier's reasonable
<br /> under the ambulance fee schedule for charge or provider's reasonable cost for
<br /> air ambulance services furnished dur- CY 2003, multiplied by the statutory fin-
<br /> ing the period July 1, 2006 through De- flation factor for ambulance services.
<br /> cember 31,2009. (d) 2005 Payment, For services fur-
<br /> nished in CY 2005, payment is based on
<br /> (67 FR 9132, Feb. 27, 2002, as amended at 68 20 percent of the reasonable charge or
<br /> FR 67693, Dec. 5, 2003; 69 FR 40292, 1uly I, reasonable cost, as applicable, plus 80
<br /> 2004: 71 FR 69787, Dec, 1. 2006; 73 FR 699937, percent of the ambulance fee schedule
<br /> Nov.19,2008;74 FR 62012,Nov.25,2009) amount. The reasonable charge and
<br /> §414.615 Transition to the ambulance reasonable cost portion in CY 2005 is
<br /> fee schedule, equal to the supplier's reasonable
<br /> charge or provider's reasonable cost for
<br /> The fee schedule for ambulance serv- CY 2004, multiplied by the statutory in-
<br /> ices will be phased in over 5 years be- flation factor for ambulance services.
<br /> ginning April 1, 2002. Subject to the (e) 2005 and Beyond Payment. For
<br /> first sentence in §414.6I0(a), payment services furnished in CY 2006 and there-
<br /> for services furnished during the tran- after, the payment is based solely on
<br /> sition period is made based on a cam- the ambulance fee schedule amount.
<br /> bination of the fee schedule payment (f) Updates. The portion of the transi-
<br /> for ambulance services and the amount tion payment that is based on the ex-
<br /> the program would have paid absent isting payment methodology (that is,
<br /> the fee schedule for ambulance serv- the non-fee-schedule portion) is up-
<br /> ices, as follows: dated annually for inflation by a factor
<br /> (a) 2002 Payment. For services fur- equal to the percentage increase in the
<br /> nished in 2002, the payment for the CPI-U (U.S. city average) for the 12-
<br /> service component, the mileage compo- month period ending with June of the
<br /> nent and, if applicable, the supply com- previous year. The CY 2002 inflation
<br /> ponent is based on 80 percent of the update factor used to update the 2001
<br /> reasonable charge for independent sup- payment amounts is applied to the
<br /> pliers or on 80 percent of reasonable annualized (average) payment amounts
<br /> cost for providers, plus 20 percent of for CY 2001, For the period January 1,
<br /> the ambulance fee schedule amount for 2001 through June 30,2001,the inflation
<br /> the service and mileage components. update factor is 2.7 percent. For the pe-
<br /> The reasonable charge or reasonable riod July 1, 2001 through December 31,
<br /> cost portion of payment in CY 2002 is 2001, the inflation update factor is 4.7
<br /> equal to the supplier's reasonable percent. The average for the year is 3.7
<br /> charge allowance or provider's reason- percent. Thus, the annualized (average)
<br /> able cost allowance for CY 2001, multi- CY 2001 payment amounts used to de-
<br /> plied by the statutory inflation factor rive the CY 2002 payment amounts are
<br /> for ambulance services. equivalent to the CY 2001 payment
<br /> 67
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