; and (C) with respect to ground ambulance services not described in subparagraph (A) or (B), 2 percent. . (b) Study and report (1) Study The Secretary of Health and Human Services shall conduct a study on how the conversion factor applicable to ground ambulance services under the ambulance fee schedule under section 1834(l) of the Social Security Act ( 42 U.S.C. 1395m(l) ), as adjusted under paragraph (17) of such section (as added by subsection (a)), should be modified, if at all, to take into account the cost of providing services in urban, rural, and super-rural areas. In determining such costs, the Secretary shall use the data collected through the data collection system under paragraph (20) of such section, as added by section 4. (2) Report Not later than January 1, 2022, the Secretary of Health and Human Services shall submit to Congress a report on the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate. 3. Prior authorization for ambulance transports of ESRD beneficiaries (a) In general Section 1834(l) of the Social Security Act ( 42 U.S.C. 1395m(l) ), as amended by section 2, is amended by adding at the end the following new paragraph: (19) Prior authorization of coverage for ambulance transports of ESRD beneficiaries (A) Process (i) In general For applicable ESRD ambulance services furnished on or after January 1, 2019, by a provider of services or an ambulance service provider, the Secretary shall establish and implement a process under which the Secretary shall determine, in advance of furnishing such a service to an individual, whether payment for such service may not be made because such service is not covered or because of the application of section 1862(a)(1). (ii) Denial of payment Subject to subparagraph (B)(ii)(II), no payment shall be made under this part for the service unless the Secretary determines pursuant to such process that the service meets the applicable requirements for coverage.