Bill Aligns Medicare Payments for EMS Providers with Community Needs, Ensures EMS Can Provide Essential Medical Care to Rural Communities
WASHINGTON, D.C. – U.S. Senators Peter Welch (D-Vt.) and Bernie Sanders (I-Vt.), members of the Senate Finance Committee, alongside U.S. Representative Becca Balint (D-VT-At-Large), today reintroduced the Emergency Medical Services Reimbursement for On-scene Care and Support (EMS ROCS) Act, bicameral legislation that would require the government to pay for vital EMS services provided to individuals on Medicare.
Currently, Medicare does not reimburse EMS providers unless the patient is transported to a hospital. However, EMS providers regularly deliver vital services on-scene when responding to 911 calls. In rural communities, the demand for EMS services for medical emergencies continues to increase—especially for Medicare beneficiaries, who make up about 40% of patients treated by EMS.
“Vermont’s EMS providers deliver essential medical services in rural communities, and they deserve to be reimbursed for that work. That’s why it only makes sense that our government should pay for vital EMS services, regardless of whether someone needs an ambulance ride to the hospital,” said Senator Welch. “We need commonsense solutions modernize Medicare to ensure that EMS are paid for their lifesaving work—our bill does just that.”
“Simply put, EMS are the first responders to some of people’s most difficult moments, and often are the difference between life and death,” said Senator Sanders. “We must do everything we can to ensure they receive the support and resources they need and deserve, and that includes reimbursement for all the care they provide. Rural communities in Vermont and across the country depend on their essential services and this bill is a right step forward in helping EMS agencies get fairly compensated for these services – even when transportation to the hospital is not needed.”
“For rural Americans, our EMS providers are often heroes that deliver lifesaving care on scene when hospitals are far away and minutes matter,” said Rep. Balint. “They should be paid for that work regardless of whether it’s provided at home or in the ambulance. The EMS ROCS Act is a crucial step towards fixing the ‘no payment’ loophole and preserving access to care for rural Vermonters.”
In addition to Senators Welch and Sanders, the legislation is cosponsored in the Senate by Sens. Tina Smith (D-Minn.), John Fetterman (D-Pa.), and Amy Klobuchar (D-Minn.), and Michael Bennet (D-Colo.).
“EMS workers are truly the best of us with unbelievably tough jobs. In moments of life and death, they show up ready to help,” said Senator Fetterman. “Right now, Medicare doesn’t reimburse them unless a patient is transported to a hospital, even if care is provided on the scene. We should be fighting to make sure EMS workers are compensated for the care they provide, and that’s why I’m proud to join my colleagues on the EMS ROCS Act to help do right by these professionals.”
“Emergency services are a critical lifeline for Coloradans in times of crisis,” said Senator Bennet. “It is crucial that EMS professionals receive compensation for their lifesaving services. Coloradans should not be forced to make unnecessary trips to the hospital, and our emergency providers should not go without pay for the care they provided. This legislation is essential to ensuring Medicare patients get appropriate treatment and their providers get appropriate payment.”
Inflationary pressures, coupled with the increasing volume of services that are ineligible for reimbursement, pose a serious threat to EMS providers, particularly those serving rural and older communities. These challenges are forcing EMS providers to curtail service and, in some areas, shut down services entirely. In recent years, several EMS providers in rural Vermont have closed their doors due to mounting expenses, leaving local residents with fewer options for emergency services.
The EMS ROCS Act is endorsed by the American Ambulance Association, National Association of Emergency Medical Technicians (NAEMT), National Rural Health Association, and the Vermont Ambulance Association.
“The National Rural Health Association applauds Congresswoman Balint and Senator Welch for introducing the EMS ROCS Act. Rural EMS providers face unique challenges due to higher fixed costs over a lower volume of services, greater distances for responding to calls, and workforce shortages. Additionally, Medicare under-reimburses for rural transports by 89%. NRHA is proud to have bicameral support for legislation that improves challenges in Medicare reimbursement for rural EMS, which will expand access to emergency services and improve healthcare in rural areas,” said Alan Morgan, CEO, National Rural Health Association.
“With his reintroduction of the EMS ROCs Act, Senator Welch demonstrates yet again his profound support for the quality medical care our paramedics and EMTs deliver every day to Vermonters. By ensuring that ambulance service organizations are reimbursed for on-scene medical treatment, regardless of patient transport, this legislation aligns policy with the advancements in pre-hospital medical care,” said Drew Hazelton, President, Vermont Ambulance Association.
In November, Senator Welch joined Senator Susan Collins (R-Maine) in introducing the bipartisan Comprehensive Alternative Response to Emergencies (CARE) Act to require the Centers for Medicare and Medicaid Services to test a five-year “treatment-in-place” model in which Medicare reimburses EMS providers when they treat a patient outside of the hospital, such as for minor medical incidents, rather than transporting them to a hospital for care.
Learn more about the EMS ROCS Act of 2026.
Read and download the full text of the bill.
###