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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

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.

Senate Cloture on Shutdown Package

The Senate has made progress towards ending the government shutdown. The Senate, by a vote of 60 to 40, invoked cloture on consideration of the House-passed Continuing Resolution after an agreement was reached yesterday with eight Senate Democrats on replacement language, which the Senate will vote on next.

On our specific issues, the language would do the following:
1. Extend the temporary Medicare ambulance add-ons payments through January 30, 2026
2. Prevent PAYGO cuts to Medicare providers and suppliers from H.R. 1
3. Extend Medicare sequestration provider cuts for another month

We will keep you posted on new developments.

Senators Collins and Welch Have Introduced TIP Senate Companion Legislation

Senators Susan Collins (R-ME) and Peter Welch (D-VT) introduced the Senate version of the CARE Act (S. 3145) to establish a CMMI demonstration program for reimbursement of ambulance responses with medical care provided on-site without transport to a medical facility. Linked below is a copy of the press release from Senator Collins, as well as both the House and Senate versions of the bill.

Sen. Collins Press Release

Senate Bill Text

House Bill Text 

 

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