Access to Ambulances in Rural Areas

In April, Representatives Terri Sewell from AL, Devin Nunes from CA, Peter Welch from VT, and Markwayne Mullin from OK, introduced the Protecting Access to Ground Ambulance Medical Services Act of 2021 (H.R.2454.)

The bill would ensure that ambulance service providers, including rural providers and providers in underserved communities are able to continue delivering quality critical first responders and healthcare services.

Currently, ambulance services providers across the U.S., are reimbursed by Medicare at rates below the cost of providing services. Consequently, providers rely on add-on payments to continue providing services. Add-on payments vary depending on whether a provider is located in an urban, rural, or “super rural” ZIP Code.

According to Representative Sewell,Inadequate Medicare reimbursement rates are putting a strain on ambulance service providers. The problem is particularly severe for rural communities and has been worsened by the demands of the COVID-19 pandemic. This bill would permanently adjust Medicare reimbursement practices so that vital ambulance services are available to all Americans.

Specifically, H.R 2454 would end the band aid approach and make permanent adjustments to the reimbursement methodology for services in urban, rural, and “supper rural” areas by building the temporary add-ons into the base rate fee. Specifically, the bill would extend the current temporary Medicare ground ambulance increases of 2% urban, 3% rural, and the “super rural” bonus payments for five years.

According to the sponsors of the bill, the five year extension would allow a new data cost collection system time to be put into place and would collect meaningful data following the delays caused by the COVID-19 pandemic.

Representative Nunes, suggests, “Extending temporary Medicare ground ambulance add-on payments for another five years and expanding coverage for those living in zip codes with fewer than 1,000 people per square mile will keep ambulance costs affordable for Americans when they need ground ambulance transportation.”

The bill is supported by the Alabama Rural Health Association, American Ambulance Association, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of Emergency Medical Technicians, and the National Volunteer Fire Council.

Go to for more information on H.R.2454.

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