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The Rural Health Transformation Program Rolls Out Funding Allocations

The Rural Health Transformation Program is rolling out funding allocations right now. AAA advocated for EMS to be specifically included and was successful in assuring that the notice of funding opportunity and state application included multiple references to EMS. How is that playing out in your state and across America? We are finding that ambulance service opportunity varies widely around the country.

Here from a range of perspectives about transformative EMS initiatives and how you can be included. AAA VP of State Affairs and Strategic Advocacy will join a panel of experts moderated by Mickey Schulte of SAVVIK for a lively discussion about RHTP on July 23, please join us!

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CMS Proposes to Update ZIP Codes for Ground Ambulance Fee Schedule; Proposed Rule Implements Continuation of the Add-ons and Promises Future Rulemaking on Data Collection

The Centers for Medicare & Medicaid Servies (CMS) issued the CY 2026 Ambulance Fee Schedule (AFS) proposed rule as part of the annual Physician Fee Schedule rule. It includes three of the American Ambulance Association’s policy priorities germane to the AFS.

First, the Proposed Rule extends the ground ambulance add-ons for urban (2%), rural (3%), and super-rural (22.6%) transports consistent with the statutory mandate. CMS’ Office of the Actuary estimates the extension will provided $260 million over the 10-year budget window to ground ambulance service organizations. CBO had calculated the increase to be $197 million over the same period. 

Second, CMS states that it will address future data collection under the Ground Ambulance Data Collection System (GADCS) in next year’s rulemaking. This recognition of future rounds aligns with the AAA’s ongoing efforts for CMS to continue the data collection, which included securing language in the FY26 appropriations report calling on CMS to continue the program. It is also consistent with our work with MedPAC, which included a  recommendation to continue GADCS in its June 2026 report.

Third, the AAA has been steadfast in its call for CMS to update the geographic designations used to apply the rural and super rural add-on payments. We worked closely with Congressional champions in the House and Senate to echo our request through letters, phone calls, and questions raised during Congressional hearings to administration officials to support the update.

In the Proposed Rule, CMS has finally proposed updating the ZIP codes based on the most recent 2020 U.S. Census and other relevant data. Under the proposal, the vast majority of ZIP codes will remain the same. However,

  • 1,172 ZIP codes would shift from urban to rural; and
  • 602 ZIP codes would shift from rural to urban.

The preamble does not mention ZIP codes shifting to super-rural. CMS indicates that the detailed results will be available on its website at: https://www.cms.gov/medicare/coverage/ambulances-services-center

The AAA is reviewing these materials and will provide a detailed analysis with the membership shortly. Based on an analysis by Health Management Associates at the request of the AAA, the latest Census data would result in a net change of 1,490 zip codes changing from rural to super rural – which CMS did not address in the Proposed Rule. Also, HMA had estimated that 119 zip codes would change from rural to urban as opposed to 602 zip codes cited in the document.

In addition to working to ensure the appropriate application of the data to the AFS geographic designations, the AAA will encourage CMS to deem an area designated as a rural or super-rural that would otherwise no longer receive such designation to retain its previous designated status if there are 1,000 or fewer individuals per square mile in the area.  We will also urge CMS to establish an administrative appeals process to allow ambulance services providers and suppliers to seek reconsideration of a change in a ZIP code’s status as a rural or qualified rural area during the first 12 months after the Secretary finalizes a change in the designation.

CMS Seeking Comments on Medicaid State Directed Payments Including Provider Assessment, IGT, and GEMT, Proposed Rules

The AAA will be submitting comment about the underfunding of ambulance service to CMS in it’s rulemaking on Medicaid State Directed Payments. Many states have implemented Medicaid supplemental payment programs. Under HR.1, passed last July, no additional states may implement these programs. Additionally states that have them must not exceed Medicare payment for the same services. Because of the state by state variablility of these programs, the AAA is focusing it’s comment on the fact that basing payment on Medicare is insufficient to assure patient access to vital ambulance services. Medicare has been demonstrated through multiple studies to pay well below cost for ambulance services.

Attached are the AAA comments, as well as a guide that individual companies and state associations may wish to use in formulating their own comment letter, specific to their state situation.

State and Agency Comment to CMS on SDP Rule

Final-SDP-CMS-Rule-Comment-Letter-7.10.2026

2026 Ambulance Ride-Along Toolkit

Educating your members of Congress about ambulance industry issues makes them much more likely to support your efforts. An easy and effective way to educate them is to invite them to participate in a local Ambulance Ride-Along!

The House and Senate will be adjourning for summer recess in August and members of Congress will return home to their districts and states. This is the perfect opportunity for you to educate your members of Congress about issues facing our industry.

One of the most effective ways to deliver key messages on how Congress can support the ambulance industry is to host your member of Congress or their staff on a tour of your operation and an ambulance ride-along. The AAA has made the process of arranging a ride-long or scheduling a meeting easy for you with our 2026 Ambulance Ride-Along Toolkit.

Are you willing to host a Member of Congress at your service but unsure of how to set it up? Email  Ben Mergendahl at bmergendahl@ambulance.org.

Everything you need to arrange the ride-along or schedule a meeting is included in the Toolkit. Act now and invite your elected officials to join you on an Ambulance Ride-Along!

2026 Ride-Along Toolkit

What You Need to Know About DEA Form 41 for Drug Destruction

Post Authored and Shared by LogRX

Destruction of drugs sounds a little strange, but it’s part of the process the DEA requires for EMS and other first responders when handling controlled substances. It’s important to understand a little about controlled substance destruction, but this phase is often where auditors run into questions.

Destruction is a high-risk moment in the chain of custody process. It’s when partials and expired meds are destroyed as part of the restock cycle. An important piece of the workflow is filling out a DEA Form 41.

Here’s what you need to know to ensure you’re recording drug destruction in a clear, safe, DEA-compliant way.

Key Takeaways:

  • DEA Form 41 documents the final step in the controlled substance lifecycle.
  • Manual DEA Form 41 workflows create unnecessary risk. Handwritten logs, duplicate data entry, and disconnected systems make it harder to maintain consistent, audit-ready documentation.
  • Automating DEA Form 41 documentation improves accuracy and audit readiness.

What DEA Form 41 Actually Documents (in Plain-English)

As most first responders know, the DEA oversees and regulates “scheduled” drugs (also known as controlled substances. They require regular reporting of drug logs from first responders and practitioners.

 

Download DEA Form 41 Here

For many agencies, compliance used to mean jotting everything down in a paper logbook and then going through it every few months to compile reports. Now, as many in EMS are turning toward digital tracking and reporting solutions, options like LogRx make this job easier and more accurate.

Part of the process is the disposal of inventory (controlled substances) that may be expired, opened, or otherwise unusable. Because this is such a sensitive area, it’s very important that the process is clearly documented.

DEA registrants, agencies, and supervisors need to be familiar with the DEA Form 41, which is the appropriate form to file for drug destruction. The form is often known as “Registrant’s Inventory of Drugs Surrendered,” and it’s required documentation whenever controlled substances are formally destroyed.

The DEA Form 41 asks for several pieces of information

  • Which controlled substances were destroyed (drug name, dosage form, strength)
  • How much was destroyed (quantity and units)
  • When and where destruction occurred
  • Who handled and witnessed the destruction

Think of it as closing the chapter on the life of a controlled substance. Your numbers should reconcile, and everything should add up to show that your team keeps a careful eye on controlled substances.

When is the DEA Form 41 Required?

 

Controlled substances have to be discarded safely, according to proper regulations and instructions. That means documentation is crucial.

The DEA Form 41 is required to document:

  • Expired medications
  • Damaged/contaminated medications
  • Partial waste in accordance with agency policy
  • Meds removed from service

While the DEA Form is required, agency policy is still very important. You should follow the rules and guidelines of your particular agency, which may include additional requirements for drug destruction.

In the process, consistency is crucial. Drugs should be disposed of and documented in a clear, regular manner. It should be a natural part of your workflow. While the guidelines may vary on the frequency, it’s important to have a clear policy and procedure in place

What Auditors Look for on a DEA Form 41

When you face a DEA audit or need to send in reports, you might be wondering what auditors are looking for. When do questions start to pop up about the logs?

Controlled substances are destroyed when they can no longer be used. For many EMS agencies, the destruction events happen as part of the normal workflow and drug lifecycle management. During inventory and restocking, it’s quite common to discover that some drugs need to be discarded. Each time you get rid of a drug, the paperwork needs to be completed.

The problems and questions arise when manual paperwork doesn’t line up with reality.

Now, this doesn’t mean that your team had bad intent. In fact, most compliance issues aren’t because of diversion or theft. Most of the issues arise because manual steps are tricky.

Think of copying medication details by hand, entering quantities from one log or spreadsheet to another, chasing signatures and witnesses, deciphering handwriting, and rechecking totals because the numbers don’t add up. The biggest issue with manual tracking is how easy it is for records to be lost, misinterpreted, or damaged over time.

Factor all this into the many other responsibilities that first responders have, and compound that with the chaos of shift change, emergency response, and general exhaustion. It becomes pretty clear why manual documentation isn’t the best approach.

Should an audit come up (and it often does), one of the most important factors is reconciliation between those drug inventory logs and your destruction records. The records should include dates, quantities, and lot numbers. The records should also be easy to find when and if an audit occurs.

Make the job easier on yourself by storing completed forms in a way that’s clear and easy to retrieve later. That means digital files (but keep in mind that PDFs and shared drives can also get lost and messed up).

That’s why a tool like LogRx can help ensure that you’ve completed the proper documentation and you’re audit-ready any time.

How LogRx Supports DEA Form 41 Documentation

LogRx supports the DEA Form 41 documentation. It was built around the idea that documentation needs to be clear, simple, and first-responder-friendly. Moreover, it should come from a source of truth, which in EMS is your controlled substance tracking records.

LogRx makes it easy to automatically fill out your DEA Form 41, using the data you’ve already recorded as part of your team’s normal workflow.

When a medication is designated for destruction, LogRx pre-fills key fields from your inventory history like drug details, quantities, and associated events. Your team can focus on review and finalization, not retyping and piecing puzzles together.

With LogRx, you get faster paperwork, fewer errors, and a clean audit trail. The form is built directly from the same data you’re using to manage your controlled substance program. Compliance is less stressful when documentation is automatic.

LogRx and Other Form Support

LogRx helps make all your paperwork easier. Forms like the DEA 222 acquisition form are easier to manage when accurate inventory data is already available in a simple, user-friendly report.

LogRx stores images and helps you track inventory in a compliance-friendly way. You get end-to-end documentation continuity for the life of all controlled substances that you and your team may need to handle on the job.

When your inventory is tracked, and reports are easy to generate, you can quickly see what you have on hand. You can be proactive about ordering and inventory management. The data provided in the LogRx administrative dashboard gives you all the details you need to identify trends, monitor usage, and tell the story of each controlled substance in your organization’s purview.

One of the best features of LogRx is that it works directly from your team’s handheld devices, while they’re on the go. With a simple snap from their phone or tablet, they can scan in medication and log use fast, even while they’re on the go.

LogRx works out of range, too. Should your team lose cell service while in the field, they can still track, and the information will be updated automatically when they come in range. Real-time tracking is crucial for accuracy and simplicity. It saves the “what happened” scramble at the end of the day.

Compliance with controlled substance reporting rules may not be the most exciting thing on your administrative to-do list, but it protects your team and helps ensure you have exactly what you need on hand when your patients need it.

To see how seamlessly LogRx works with the DEA Form 41, reach out. We can demonstrate the process and show you what a difference that LogRx can make for your team. Make drug destruction reporting simple and fast with LogRx.

Note: This article is for informational purposes and does not constitute legal advice. Always follow DEA requirements and your agency’s policies when handling and destroying controlled substances.

HMA Releases New White Paper on Ground Ambulance Payment Challenges and Policy Options

Health Management Associates (HMA) has released a new white paper, Ground Ambulance Payment Landscape: Challenges and Policy Options,” providing an in-depth examination of the complex payment environment facing ground ambulance services and exploring potential policy solutions to improve sustainability and access.

The publication adds to a growing body of ambulance-focused research developed by HMA in recent years. Notably, this is the fourth ambulance-related white paper HMA has published. These studies have helped elevate critical issues affecting ambulance providers and have informed discussions among policymakers, regulators, and stakeholders nationwide.

For members who may have missed previous reports, HMA’s recent ambulance-focused publications include:

Together, these reports underscore the ongoing financial, operational, and reimbursement challenges confronting ground ambulance services while providing data-driven insights to support meaningful policy reform.

Members interested in reviewing the new or previous white papers can access them through HMA’s website.

Read the Paper

EMS ROCS Act Reintroduced in House and Senate

Senator Peter Welch (D-VT) and Senator Bernie Sanders (I-VT), alongside Representative Becca Balint (D-VT), have reintroduced the Emergency Medical Services Reimbursement for On-scene Care and Support (EMS ROCS) Act (S. 3730 / H.R. 7277). The bipartisan, bicameral legislation would require Medicare to reimburse EMS providers for medically necessary care delivered on scene, even when a patient is not transported to a hospital.

Under current Medicare policy, EMS agencies generally receive payment only when a patient is transported, despite the fact that EMS clinicians increasingly provide definitive assessment, stabilization, and treatment on scene. This issue is particularly acute in rural communities, where transport times are long, hospital access is limited, and Medicare beneficiaries account for a significant portion of EMS patients. As a result, EMS agencies are often delivering critical care without reimbursement.

Supporters argue that the EMS ROCS Act would modernize Medicare payment policy to better reflect contemporary EMS practice, support appropriate treatment-in-place, and reduce unnecessary hospital transports. The legislation is intended to help stabilize EMS agencies facing rising costs, workforce shortages, and growing volumes of non-transport care, challenges that have forced some rural providers to reduce services or shut down entirely.

The bill has multiple Senate cosponsors and is endorsed by the American Ambulance Association, the National Association of Emergency Medical Technicians (NAEMT), the National Rural Health Association, and the Vermont Ambulance Association, all of which emphasize that fair reimbursement for on-scene care is essential to preserving access to emergency medical services, particularly in rural and underserved communities.

House Passes 2-Year Ambulance Medicare Relief Extension

The U.S. House of Representatives by a vote of 341 to 88 has passed the Consolidated Appropriations Act for 2026, which would fund the rest of the Federal government for the remainder of FY 2026. Included in the legislative package is an extension for 23 months of the 2% urban, 3% rural, and 22.6% super rural temporary increases in Medicare payments for ground ambulance service organizations. The Senate is scheduled to consider the package next week in time to avoid a partial government shutdown at the end of the month.

The temporary ambulance increases currently run through January 30. Under the package, the increases would be extended through December 31, 2027. Most of the temporary Medicare provider and supplier provisions set to expire would be extended for 11 months through the end of this year. As a result of the efforts of our champions and supporters on Capitol Hill, we were able to secure a longer extension at the same duration of the temporary telehealth provision.

According to an estimate by the Congressional Budget Office, the additional year will provide more than $100 million in relief for a total of $197 million in continued funding to ground ambulance service organizations over the next 23 months.

We will keep you informed as to the Senate consideration of the package.

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