The RESCUE Act Is Real. Here's How to Actually Read It.
Written By: Asbel Montes, Co-Founder & Managing Partner, Solutions Group
This is the second article in a series I'm writing about how Medicare pays for health care services provided by emergency medical service providers. The first piece, Are We Paying for the Wrong Thing? (July 24), used much of the same government data I examine here. It made one central point: Medicare only pays an ambulance provider when a patient is transported to a facility. It does not pay for clinical care delivered on scene when no transport occurs.
That article was about what Medicare pays for. This one is about a new bill that would change how Medicare calculates what it pays. Those are related questions, but they are not the same question. And the RESCUE Act addresses only one of them.
On July 29, Representative August Pfluger, a Republican from Texas, and Representative Jill Tokuda, a Democrat from Hawaii, introduced the RESCUE Act of 2026. Six additional members of Congress joined as original cosponsors, split evenly between the two parties. The bill is one of the most significant efforts in decades to change how Medicare calculates ambulance payments. It's worth understanding, not just if you work in EMS, but if you care about how Medicare sets prices for essential health care services.
What the Bill Actually Does
Here's the short version. Medicare's current ambulance payment formula was built in 2002 and uses cost data from 1998 (yes, that's almost 30 year old data). One of the formula's core building blocks is called the relative value unit, or RVU. RVUs determine how Medicare values one type of ambulance service relative to another, and those underlying values have not been comprehensively updated since 2002.
The RESCUE Act would require Medicare to update those values beginning in 2028, using real, current cost data. It would then require additional updates every three years. The bill would also require air ambulance providers to report cost and revenue data for use in updating their side of the fee schedule. Ground ambulance providers already report cost and revenue data through the Ground Ambulance Data Collection System, or GADCS. Air ambulance cost reporting would be a new federal effort, which means the quality, consistency, and long-term usefulness of that data remain to be seen.
The bill would also permanently eliminate the annual "productivity adjustment," a small reduction that has been applied to ambulance payment updates over time. Removing it would not create one dramatic increase in a single year, but it would prevent those reductions from continuing to compound.
In other words, the RESCUE Act is designed to modernize the price Medicare assigns to ambulance services.
What the Bill Does Not Do
The bill does not change the basic circumstances under which Medicare pays for ground ambulance services.
It does not create a new Medicare payment for treatment provided on scene when no transport occurs.
It does not establish a broad payment pathway for alternative destinations.
It does not create new patient billing protections.
This bill is about the price of an ambulance service under Medicare's existing payment framework. It is not a bill about who can be billed, what patients may owe, or how Medicare should pay for care that does not result in a transport.
Reading It Through MedPAC
MedPAC, the Medicare Payment Advisory Commission, is the independent congressional agency that advises Congress on Medicare payment policy. In June 2026, MedPAC analyzed cost and revenue data submitted through GADCS, the same general body of data the RESCUE Act would use to support future payment updates.
Its analysis supports the bill's basic premise: the current ambulance payment system is built on outdated information.
But MedPAC's numbers also tell a more complicated story.
I want to walk through those numbers carefully rather than rounding them into a simpler narrative.
I chaired the Ground Ambulance and Patient Billing Advisory Committee, known as GAPBAC. It was a federal committee Congress created under the No Surprises Act. GAPBAC completed its assignment, delivered its final report, and has since been dissolved. I'm describing it in the past tense, intentionally.
In March 2024, GAPBAC recommended that Congress establish a permanent advisory body to continue monitoring ground ambulance payment and patient billing issues over time. We understood that a one-time fix would not be enough. Ambulance payment policy is too complex, and the industry changes too quickly, for Congress to examine these issues once and consider the work complete.
The RESCUE Act includes a more limited version of that concept: a stakeholder review due in 2029. That's narrower and more limited than what we proposed, and no ongoing federal body has replaced GAPBAC in the meantime.
One more thing worth saying clearly: the RESCUE Act does not address patient billing protections, which was GAPBAC's actual job. How much Medicare pays, and what a patient may be billed, are separate policy issues. They may overlap, but they are not interchangeable.
Which Brings Me Back to the Wrong Thing
This brings us back to the question in my first article.
Even a well-designed version of the RESCUE Act only updates the price Medicare pays for a transport. It doesn't touch the roughly one-in-four ground ambulance calls that never end in a transport. Those calls never generate a bill, regardless of the care provided on scene.
I want to state the counterargument clearly, because it deserves serious consideration. If Medicare started paying broadly for ambulance responses that do not end in a transport, Medicare spending on ambulance services would increase significantly. The program could be paying for a much larger number of encounters than it does today.
That is a legitimate concern. Any serious proposal to pay for treatment in place, alternative destinations, or other non-transport care would need to address cost with real data, not simply argue that payment would be fair.
But the current rule, pay for the transport and generally not the care provided without one, is rarely defended on its own policy merits. It is largely the structure we inherited, and one that has remained in place while the role of EMS has changed.
How to Actually Watch This Bill
Do not treat the introduction of the RESCUE Act as a sign it is about to become law.
Standalone Medicare payment bills rarely move through Congress on their own. If this legislation advances, it will likely be incorporated into a larger healthcare or year-end legislative package, similar to the packages that have carried temporary ambulance payment provisions in the past. It will also need a formal cost estimate from the Congressional Budget Office before Congress can fully evaluate its budgetary impact. No official estimate is available yet. On top of that, 2026 is a midterm election year, which tends to reduce the time Congress spends on bills like this one.
Over the next several months, here is what I'll be watching:
Whether the Congressional Budget Office (CBO) releases a cost estimate;
Whether policymakers distinguish between high-volume and low-volume providers, rural and urban service areas, and different operational models;
Whether the bill gains support in the House Ways and Means and Energy and Commerce Committees;
Whether the conversation expands beyond the price of a transport to include what EMS is actually being asked to do for patients today.
Final Thoughts
The RESCUE Act is real.
Its central premise is reasonable: Medicare should not rely indefinitely on decades old assumptions to determine ambulance payment.
But modernizing the price of an ambulance transport is not the same as modernizing the ambulance payment system.
That is the distinction I hope this series continues to explore.
The first question was: Are we paying for the wrong thing?
The next question may be: If EMS is evolving beyond transport, when will Medicare's payment model evolve with it?
