; and (ii) with respect to air ambulances services furnished by a supplier or provider of air ambulances services during 2020, unless the provider or supplier submits to the Secretary cost data in accordance with paragraph (17)(A) and quality data in accordance with paragraph (17)(D) for such year. (19) Rebasing air ambulance base rate The Secretary shall, through rulemaking, provide for an update to the base rate of the fee schedule established under this subsection for air ambulance services, which shall be applied beginning with air ambulance services furnished during 2021, so that such rate reflects the actual costs of providing air ambulance services, consistent with cost data submitted under paragraph (17)(A). In carrying out the previous sentence, the Secretary shall ensure that the aggregate data, methodology, and rationale applied for determining the updated base rate shall be made publicly available through rulemaking. The preceding sentence shall not be applied in a budget neutral manner. (20) Value-based purchasing program (A) In general The Secretary shall establish an air ambulance services value-based purchasing program (in this paragraph referred to as the Program ). Under the Program, the Secretary shall— (i) for a performance period (as defined in subparagraph (F)) with respect to a payment year (beginning with 2024), determine the performance of each provider or supplier of air ambulance services, with respect to each quality measure described in paragraph (17)(E); (ii) for each such performance period, establish performance benchmarks in accordance with subparagraph (B)