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.