[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9970 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 9970
To amend title XVIII of the Social Security Act to ensure appropriate
payments for ambulance services under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 27, 2026
Mr. Pfluger (for himself, Ms. Tokuda, Ms. Van Duyne, Ms. Schrier, Mr.
Joyce of Pennsylvania, Mr. Schneider, Ms. Tenney, and Ms. Sewell)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committee on Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to ensure appropriate
payments for ambulance services under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Reimbursing Emergency Services for
Critical Urgent Encounters Act of 2026'' or ``RESCUE Act of 2026''.
SEC. 2. AMBULANCE SERVICES PAYMENTS.
Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) is
amended--
(1) in paragraph (1)--
(A) by inserting ``, for years before 2027,'' after
``under this part through''; and
(B) by inserting ``(and for each year, beginning
with 2027, by regulation)'' after ``title 5, United
States Code,'';
(2) in paragraph (2)(D), by inserting ``and, beginning for
2028, in accordance with paragraph (18), determine and apply
updated payment amounts (as defined in subparagraph (A)(ii) of
such paragraph) and the adjustments described in such
paragraph'' after ``and other relevant factors'';
(3) in paragraph (3)--
(A) in subparagraph (B)--
(i) by inserting ``(before 2028)'' after
``each subsequent year''; and
(ii) by striking ``and'' after the
semicolon;
(B) in subparagraph (C)--
(i) by inserting ``(before 2028)'' after
``each subsequent year''; and
(ii) by striking the period at the end and
inserting a semicolon; and
(C) by inserting at the end the following:
``(D) for services furnished in 2028, substitute
the updated payment amounts (as defined in paragraph
(18)(A)(ii)) for such services as the payment amounts
provided under the fee schedule for such services; and
``(E) set the payment amounts provided under the
fee schedule for services furnished in 2029 and each
subsequent year at amounts equal to the payment amounts
under the fee schedule for services furnished during
the previous year, updated by the adjustments or
increase applicable to such year in accordance with
clause (ii) or (iii), respectively, of paragraph
(18)(B).'';
(4) in paragraph (4), by inserting ``including for purposes
of carrying out the provisions of paragraph (18),'' after
``under this subsection,'';
(5) in paragraph (15), by striking ``the preceding
provisions of'' after ``amount otherwise applicable under'';
(6) in paragraph (17)--
(A) in subparagraph (D)--
(i) in clause (i)--
(I) by inserting ``(or, in the case
of a provider or supplier of air
ambulance services, beginning January 1
of the year subsequent to the first
year for which such providers and
suppliers are required to submit
information pursuant to subparagraph
(E)(ii)(II)),'' after ``Beginning
January 1, 2022,'';
(II) by redesignating subclauses
(I) and (II) as items (aa) and (bb),
respectively, and moving the margin of
each such item, as redesignated, 2 ems
to the right;
(III) by striking ``(as defined in
clause (ii)) to a provider or supplier
of ground ambulance services'' and
inserting ``(as defined in clause
(ii))--
``(I) to a provider or supplier of ground ambulance
services'';
(IV) by striking at the end the
period and inserting ``; and''; and
(V) by adding at the end the
following new subclause:
``(II) to a provider or supplier of
air ambulance services that--
``(aa) is required to
submit information for a year
determined by the Secretary
under subparagraph (E)(ii)(II);
and
``(bb) does not
sufficiently submit such
information, as determined by
the Secretary.'';
(ii) in clause (ii)--
(I) by inserting ``or a provider or
supplier of air ambulance services''
after ``with respect to a provider or
supplier of ground ambulance
services'';
(II) by striking ``made a
determination under clause (i)(II)''
and inserting ``made--
``(I) in the case of a provider or supplier of
ground ambulance services, a determination under clause
(i)(I)(bb)'';
(III) by striking at the end the
period and inserting ``; or''; and
(IV) by adding at the end the
following new subclause:
``(II) in the case of a provider or
supplier of air ambulance services, a
determination under clause (i)(II)(bb)
that the provider or supplier of air
ambulance services failed to
sufficiently submit information as
described in clause (i)(II)(aa).'';
(iii) in clause (iii)--
(I) by inserting ``of ground
ambulance services or a provider or
supplier of air ambulance services''
after ``may exempt a provider or
supplier''; and
(II) by inserting ``or provider or
supplier of air ambulance services,
respectively,'' after ``ability of the
provider or supplier of ground
ambulance services''; and
(iv) in clause (iv), by inserting ``or air
ambulance services'' after ``ground ambulance
services'';
(B) in subparagraph (E)--
(i) in clause (ii)--
(I) by striking ``shall require''
and inserting ``shall--
``(I) require'';
(II) by striking at the end the
period and inserting ``; and''; and
(III) by adding at the end the
following new subclause:
``(II) require providers and
suppliers of air ambulance services to
submit, in such form and manner and at
such time as specified by the Secretary
in accordance with clause (iii),
information described in section
106(a)(2) of the No Surprises Act for
years after the last NSA reporting year
(as defined in clause (iv)) as the
Secretary determines appropriate, but
in no case less often than once every 3
years.''; and
(ii) by adding at the end the following new
clauses:
``(iii) Application to air ambulance
services.--In carrying out clause (ii)(II), the
Secretary--
``(I) may, as the Secretary
determines appropriate, use the data
collection system under subparagraph
(A) to provide for a single process for
the submission of information under
this paragraph, including information
described in such clause with respect
to providers and suppliers of air
ambulance services; and
``(II) shall, to the greatest
extent practicable, align the years for
which information is required to be
submitted under such clause with the
years for which information is required
to be submitted under clause (ii)(I).
``(iv) Last nsa reporting year.--For
purposes of clause (ii)(II), the term `last NSA
reporting year' means the year with respect to
which information is required to be submitted
under section 106(a)(1)(B) of the No Surprises
Act.''; and
(C) in subparagraph (F)(i), by striking
``thereafter,, such'' and inserting ``thereafter,
such''; and
(7) by adding at the end the following:
``(18) Updating fee schedule to reflect most recently
available data.--
``(A) Initial review and revisions.--
``(i) In general.--To improve the valuation
of ground ambulance services and air ambulance
services under this subsection the Secretary
shall review the relative value units,
conversion factor, air ambulance base rates,
and the mileage rates applied under the fee
schedule under this subsection and shall, by
regulation and taking into account the
information required under subparagraph (C),
make such adjustments as are necessary to
ensure that such relative value units,
conversion factor, base rates, and mileage
rates that are applied under the fee schedule
for 2028 with respect to ground ambulance
services and with respect to air ambulance
services, as applicable, reflect the costs
(including labor-related costs and costs
related to uncompensated care), expenses, and
resources used in furnishing the respective
ambulance service.
``(ii) Updated payment amounts defined.--
For purposes of this subsection, the term
`updated payment amounts' means the payment
amounts determined, with application of the
adjustments pursuant to clause (i), under the
fee schedule under this subsection for 2028.
``(B) Ongoing review and adjustments.--
``(i) Triennial review.--For each data-
based adjustment year (as defined in clause
(iv)), with respect to ground ambulance
services and with respect to air ambulance
services, the Secretary shall review the
relative value units, conversion factor, air
ambulance base rates, and the mileage rates (or
any successor to or replacement for such units,
factor, or rates, including under any payment
methodology developed pursuant to this
subsection that is different from the
methodology in effect as of the date of
enactment of this paragraph), as applicable to
the respective services, established under the
fee schedule under this subsection.
``(ii) Triennial adjustments based on
updated factors and data.--For determining
payment amounts under the fee schedule under
this subsection for ground ambulance services
and air ambulance services furnished during a
data-based adjustment year, the Secretary
shall, based on the review under clause (i)
with respect to such year and taking into
account the information required under
subparagraph (C), by regulation adjust the
number of relative value units, conversion
factor, air ambulance base rates, mileage rates
(or any successor to or replacement for such
units, factor, or rates, including under any
payment methodology developed pursuant to this
subsection that is different from the
methodology in effect as of the date of
enactment of this paragraph), or any
combination thereof, as applicable to the
respective services, to take into account
changes in medical practice, changes in
technology, the addition of new services, new
data on relative value components, new cost
data (including on labor-related costs and
costs related to uncompensated care), and other
relevant information and factors. The Secretary
shall publish in the Federal Register an
explanation of the basis for such adjustments
made for a data-based adjustment year.
``(iii) Adjustments for years that are not
data-based adjustment years.--Beginning with
2029, with respect to a year that is not a
data-based adjustment year, for determining the
payment amounts under the fee schedule under
this subsection for ground ambulance services
and air ambulance services furnished during
such year, such payment amounts for such
services furnished during such year shall be
computed by increasing the payment amounts
determined under this subsection for such
services furnished during the previous year by
the percentage increase in the consumer price
index for all urban consumers (U.S. city
average) for the 12-month period ending with
June of the previous year.
``(iv) Data-based adjustment year
defined.--For purposes of this subparagraph,
the term `data-based adjustment year' means
2031 and each third year thereafter.
``(C) Use of information.--For purposes of
subparagraph (A) and clauses (i) and (ii) of
subparagraph (B), the Secretary shall use the most
recently available data related to ground ambulance
services and air ambulance services for which payment
is made under the fee schedule under this subsection,
including (as applicable to the respective services)
information collected or obtained pursuant to paragraph
(17), information collected or obtained pursuant to
section 106 of the No Surprises Act, and such other
information specified by the Secretary on costs
(including labor-related costs and costs related to
uncompensated care), expenses, and resources directly
or indirectly related to furnishing such respective
services. In applying the previous sentence with
respect to air ambulance services, in the case that
information collected or obtained pursuant to section
106 of the No Surprises Act is not available, the
Secretary shall instead use such other comparable
information (as identified by the Secretary in
consultation with the organizations described in
paragraph (4)) on such costs, expenses, and resources
related to furnishing air ambulance services.
``(19) Stakeholder consultation for continued assessment
for modifications to improve fee schedule.--Not later than
December 31, 2028, the Secretary shall convene experts and
stakeholders, including organizations described in paragraph
(4), to assess the fee schedule applied under this subsection
for ground ambulance services and for air ambulance services
and the adequacy of payments for such respective services under
such fee schedule and to submit, not later than July 1, 2029,
to the Secretary and Congress recommendations for modifications
to such fee schedule, including the payment methodology under
the fee schedule, to improve the valuation of such respective
services under this subsection.''.
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