The Emergency Medical Services (EMS) industry faces a critical crisis of recruitment, retention and reimbursement that threatens the reliability of emergency response across the nation.  While Medicare beneficiaries represent only a portion of those requiring ambulance services, Medicare’s payment rates for ambulance create massive ripple effects throughout the entire EMS ecosystem, influencing commercial insurance rates, state Medicaid programs and local government funding decisions.  The traditional reliance on volunteer labor, while still important to local EMS communities, is no longer sustainable as few individuals can commit the same level of volunteer hours, leaving EMS as a poorly funded mandate that communities struggle to maintain.  This fundamental mismatch between the critical nature of EMS services and their inadequate funding structure demands immediate attention and comprehensive reform, beginning with the Medicare Ambulance Fee Schedule.

In 1997, the Balance Budget Act mandated the development of the Medicare Ambulance Fee Schedule (MAFS) via a Negotiated Rule Making Committee. Using a stakeholder engagement process, the MAFS was published in March of 2002 and subsequently adopted. However, a Government Accountability Office (GA) report (GAO-03-986), released shortly after that in 2003, expressed concern about the adequacy of these rates and recommended CMS consider adjustments, particularly for rural areas. In 2003, Congress acted via the Medicare Prescription Drug, Improvement, and Modernization Act to create “add on” payments of 2% urban, 3% rural and 22.6% super rural increases that continue to this day. These payments have been extended several times since the MMA but, absent Congressional action, are currently expired as of September 30, 2025. 

Congress has recognized that dependence on temporary add-on payment extensions is an inadequate long-term solution, and in 2018, the Balance Budget Act mandated that CMS develop and implement a cost data collection system for ground ambulance services (GADCS).  The law also directed the Medicare Payment Advisory Committee (MedPAC) to analyze the GADCS data, evaluate the adequacy of Medicare payments and geographic cost variations, assess the reporting burden on ambulance organizations and recommend whether organizations should continue to submit GADCS data in the current form or if the data collection system should be revised. The report is due June 15, 2026.

Given the involvement of multiple federal state and local agencies in EMS governance and the broad ripple effects of Medicare ambulance payment policy, it is essential for the EMS community to come together to advance payment reform that reflects diverse operational realities, supports innovation and aligns with the broader shift toward value-based care.  In preparation for the release of MedPAC’s report, the EMS community is convening this Committee to develop consensus based, data driven policy recommendations to reform the Medicare Ambulance Fee Schedule and/or to create a payment system that adequately reflects the cost of providing emergency medical services, especially in life-threatening situations.  These recommendations are intended to inform policymakers and ensure that any reforms, regardless of how MedPAC interprets the GDACS data, are grounded in operational realities and support long-term sustainability and innovation in EMS.