RESCUE Act of 2026
- Sponsor
- Rep. Pfluger, August [R-TX-11]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jul 27, 2026
Bottom line
This bill aims to modernize Medicare's ambulance service payment system by requiring regular, data-driven adjustments to better reflect the true costs of providing emergency medical transport.
What it actually does
The bill, titled the RESCUE Act of 2026, amends the Social Security Act to revise how Medicare pays for ground and air ambulance services. It mandates the Secretary of Health and Human Services to conduct initial and ongoing triennial reviews of payment components (relative value units, conversion factor, base rates, mileage rates) for ambulance services, starting in 2028, to ensure they reflect actual costs, including labor and uncompensated care. It also updates data collection requirements for air ambulance services and applies a penalty for non-compliance.
Proponents argue
Proponents argue that the current Medicare payment system for ambulance services is outdated and does not adequately cover the costs incurred by providers, leading to financial strain, particularly for rural and independent services. They contend that regular, data-based updates will ensure fair reimbursement, improve access to critical emergency services, and account for rising operational costs and uncompensated care.
Opponents contend
Opponents might express concerns about potential increases in Medicare spending if payment rates are significantly raised, especially without clear mechanisms for cost control or efficiency incentives. They could argue that frequent regulatory adjustments might create administrative burdens for both providers and the Centers for Medicare & Medicaid Services (CMS), or that the proposed methodology might not fully address underlying systemic issues in healthcare costs.
The bill is concise and its core provisions are understandable with a careful read, making it accessible for evaluation.
Section 2(1) amending Section 1834(l)(1)
Mandating Regulatory Updates for Ambulance Service Payments
This provision mandates that, starting in 2027, the payment amounts for ambulance services under Medicare will be determined by regulation, rather than solely by reference to federal employee pay schedules. This shifts the authority and responsibility for setting these rates more directly to the Secretary of Health and Human Services.
Supporters argue
Supporters argue this change allows for more flexible and responsive adjustments to payment rates, enabling CMS to better adapt to evolving costs and service delivery models in the ambulance sector.
Critics contend
Critics might argue that shifting to purely regulatory determination could lead to less predictable payment adjustments or increased political influence over rate setting, potentially destabilizing provider finances.
Tradeoffs
Balances the need for flexibility in payment adjustments against the desire for stability and transparency in rate-setting mechanisms.
Section 2(7) adding new paragraph (18)(A) to 1834(l)
Initial Comprehensive Review and Revision of Payment Amounts
This provision requires the Secretary, by regulation, to conduct an initial comprehensive review of the Medicare fee schedule components for both ground and air ambulance services (relative value units, conversion factor, base rates, mileage rates). The goal is to adjust these components for 2028 to accurately reflect the costs, expenses, and resources involved in furnishing these services, including labor-related costs and costs associated with uncompensated care.
Section 2(7) adding new paragraph (18)(B) to 1834(l)
Ongoing Triennial Review and Adjustments
Following the initial review, the bill mandates triennial (every three years) reviews and adjustments to the ambulance fee schedule components, starting in 2031. These adjustments will account for changes in medical practice, technology, new services, updated cost data (including labor and uncompensated care), and other relevant factors. In years that are not data-based adjustment years, payment amounts will be increased by the consumer price index for all urban consumers (CPI-U).
Section 2(7) adding new paragraph (18)(C) to 1834(l)
Use of Most Recently Available Data for Reviews
This provision specifies that the Secretary must use the most recently available data for all reviews and adjustments, including information collected under paragraph (17) of the Social Security Act (which relates to ground ambulance data collection) and Section 106 of the No Surprises Act (NSA) for air ambulance services. If NSA data is unavailable for air ambulance services, the Secretary must use comparable information identified in consultation with stakeholders.
Section 2(7) adding new paragraph (19) to 1834(l)
Stakeholder Consultation for Future Fee Schedule Modifications
By December 31, 2028, the Secretary is required to convene experts and stakeholders, including organizations representing ambulance services, to assess the adequacy of payments under the fee schedule. By July 1, 2029, this group must submit recommendations to the Secretary and Congress for further modifications to the fee schedule and payment methodology to improve valuation.
Section 2(6) amending Section 1834(l)(17)(E)
Air Ambulance Data Submission Requirements
This provision requires providers and suppliers of air ambulance services to submit cost and other information, similar to what is required under Section 106(a)(2) of the No Surprises Act, for years after the last NSA reporting year. This submission must occur at least once every three years, in a form and manner specified by the Secretary. It also allows the Secretary to use existing data collection systems for this purpose and to align reporting years with ground ambulance services.
The bill extends the existing 10% payment reduction penalty for insufficient data submission (currently applicable to ground ambulance services) to air ambulance services. This penalty would apply starting January 1 of the year subsequent to the first year air ambulance providers are required to submit information.
Section 2(6)(A)(i) amending 1834(l)(17)(D)(i) and (ii)
Why it matters:This is standard legislative practice for extending existing statutory mechanisms to new groups or contexts, often done through technical amendments to avoid redundancy.
Case for: Proponents would argue that applying a penalty for non-compliance with data submission ensures that air ambulance providers submit the necessary cost information, which is critical for accurate and fair payment rate adjustments. Without such a mechanism, data collection efforts might be undermined.
Case against: Some air ambulance providers might argue that the penalty is overly punitive, especially if the data submission requirements are complex or if they face genuine difficulties in compliance. They might prefer a phased approach or technical assistance before imposing financial penalties.
Estimated impact: Potentially significant financial impact on individual air ambulance providers who fail to comply, and a strong incentive for all providers to submit required data.