PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2223 (2) The relationship of such payment amounts to the direct and indirect costs of providing ambulance services. Such rela- tionship shall be examined separately— (A)(i) for tax-subsidized, municipally-owned and operated services, (ii) for volunteer services, (iii) for private, for-profit services, and (iv) for hospital-owned services, and (B) for different levels (such as basic life support and advanced life support) of such services. (3) How such payment amounts compare to the payment amounts made for ambulance services under medicaid plans under title XDC of such Act. (b) REPORT. —By not later than one year after the date of the enactment of this Act, the Secretary shall submit a report to Congress on the results of the study conducted under subsection (a) and shall include in the report such recommendations for changes in medicare payment policy with respect to ambulance services as may be needed to ensure access by medicare beneficiaries to quality ambulance services in metropolitan and rural areas. SEC 6137. PROPAC S'iTJDY OF PAYMENTS FOR SERVICES IN HOSPITAL 42 USC 1395Z OUTPATIENT DEPARTMENTS. "°^ (a) IN GENERAL. —The Prospective Payment Assessment Commis- sion shall conduct a study on payment under title XVm of the Social Security Act for hospital outpatient services. Such study shall include an examination of— (1) the sources of growth in spending for hospital outpatient services; (2) the differences between the costs of delivering services in a hospital outpatient department as opposed to providing similar services in other appropriate settings (including ambulatory surgery centers and physician offices); (3) the effects on outpatient hospital costs of the step-down method used to allocate hospital capital between inpatient and outpatient departments and the extent to which hospital out- patient costs were affected by the implementation of the prospective payment system of payment for inpatient hospital services and by increased review of such services by peer review organizations; and (4) alternative methods for reimbursing hospitals for services in outpatient departments under the medicare pix^am, includ- ing prospective payment methods, fee schedules, and such other meljiods as the (Commission may consider appropriate. (b) REPORTS.— (1) By not later than July 1, 1990, the Commission shall submit a report to Congress on the study conducted under subsection (a) with respect to the portions of the study described in paragraphs (1), (2), and (3) of such subsection, and shall include in the report such recommendations as the Commission deems appro- priate. (2) By not later than March 1, 1991, the Commission shall submit a report to Congress on the study conducted under subsection (a) with respect to the portion of the study described in paragraph (4) of such subsection, and shall include in the report such recommenda- tions as the Commission deems appropriate.
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