Medicare ambulance payment updates

Full Title:
RESCUE Act of 2026

Summary#

This bill changes how Medicare sets and updates payments for ambulance services, covering both ground and air ambulances. It requires the agency that runs Medicare (the Secretary of Health and Human Services) to use recent cost data to set new payment amounts for 2028 and to review and adjust payments regularly after that. The stated goal is to make payment rates better reflect providers’ costs, including labor and uncompensated care.

Key changes:

  • Main change: Directs a full review and adjustment of the ambulance fee schedule so 2028 payment amounts reflect recent costs for ground and air ambulance services.
  • Regular updates: Requires data-based adjustments every three years (starting 2031) and CPI-based increases in non-data years (starting 2029).
  • Air ambulance reporting: Extends reporting requirements similar to the No Surprises Act to air ambulance providers and allows consequences if they fail to submit required data.
  • Data use: Requires the Secretary to use most recent cost and related data (including No Surprises Act data when available) when setting rates.
  • Stakeholder review: Requires the Secretary to convene experts by the end of 2028 and report recommendations for fee-schedule changes to Congress by July 1, 2029.

What it means for you#

  • Medicare patients: The bill does not change Medicare eligibility or benefits. It could change the amounts Medicare pays to ambulance providers. That may affect which services providers accept, but the bill does not directly change patient cost-sharing rules.
  • Ambulance providers (ground and air): Providers will face new reporting rules. Air ambulance companies must submit information similar to what the No Surprises Act requires, at least once every three years. Providers who do not “sufficiently submit” information may face the same kinds of consequences that apply now to ground providers (the bill allows the Secretary to make such determinations).
  • Medicare (CMS administrators): CMS must review and revise payment rates, develop or adapt data collection systems, write rules, and publish explanations of adjustments. CMS must also convene experts and deliver recommendations to Congress.
  • Hospitals and emergency services: If Medicare increases payments to better match costs, some ambulance services that previously found Medicare payments inadequate may be more financially stable. The bill does not change hospital payments.
  • Insurers and other payers: The bill changes only Medicare rules. It does not directly change private insurer payment rules. However, public payment changes can influence private negotiations indirectly.

What is unclear: The bill does not specify exact dollar changes, how “sufficient” reporting is defined, or the exact penalties that will apply if air providers fail to report. It also leaves details of the data sources and methods to the Secretary’s future rulemaking.

Expenses#

No publicly available information.

Possible cost-related effects the bill could cause (inferred from the text):

  • This could mean higher Medicare spending if the 2028 review increases payment rates to match provider costs.
  • The Centers for Medicare & Medicaid Services (CMS) may have increased administrative costs to collect and analyze data, run rulemaking, and convene stakeholder meetings.
  • Ambulance providers (especially air providers) may face compliance costs to prepare and submit regular reports.
  • If Medicare payments rise, there could be offsetting reductions in providers’ uncompensated care losses, but the bill does not show net federal budget estimates.

Proponents' View#

  • The bill appears intended to make Medicare ambulance payments more accurate by using recent cost data and periodic reviews.
  • Supporters may argue that updating rates to include labor costs and uncompensated care will help ambulance providers remain financially sustainable.
  • Requiring air ambulance reporting and applying data-based adjustments could improve transparency and allow rates to reflect actual costs for both ground and air services.
  • Regular reviews and a stakeholder convening aim to produce informed recommendations and ongoing improvements to the payment method.

Opponents' View#

  • One concern is that the bill could increase Medicare spending if payments are raised to match providers’ reported costs.
  • The bill leaves many technical details to future rulemaking. It is unclear how the Secretary will choose or verify alternative data if No Surprises Act data are not available for air ambulances.
  • Requiring new reporting and more frequent reviews may increase administrative work and costs for both CMS and providers.
  • Using the consumer price index in non-data years may not track ambulance-specific cost drivers (like wages or medical equipment) as closely as dedicated cost data.
  • The bill does not clearly define what counts as a “sufficient” data submission for air providers, creating uncertainty about when penalties might apply.