Wednesday, June 24, 2026

The briefing for leaders in air and ground medical transport industry.

🏛️ MedPAC Delivers Ground Ambulance Data Collection Assessment to Congress — Recommendation on GADCS Future Looms

What happened: MedPAC released its June 2026 Report to the Congress on June 15, including Chapter 6 — the mandated assessment of the Medicare Ground Ambulance Data Collection System (GADCS). The Commission was required to recommend whether CMS should continue, modify, or suspend the cost data collection program that ground ambulance providers have been submitting since 2022. Earlier MedPAC analysis (March 2026 presentation) showed that ground ambulance costs per transport substantially exceed Medicare payment rates, with median costs ranging from $466 (BLS non-emergency) to $1,046 (ALS emergency). The lowest-revenue quartile of providers reported margins of negative 42% on Medicare transports.

Why it matters: The GADCS was created by the Bipartisan Budget Act of 2018 specifically to inform Medicare ambulance payment reform. If MedPAC recommends suspending or abandoning the system, the primary data engine for reforming the Medicare Ambulance Fee Schedule — a fee schedule most stakeholders agree systematically underpays for ground ambulance services — would be lost. Conversely, if MedPAC recommends continuation, the cost data will feed into future Medicare rate-setting. For air medical programs that also operate ground transport, the GADCS outcome indirectly affects the entire transport reimbursement ecosystem: ground ambulance underfunding creates pressure on hospital budgets that ultimately constrains air medical spending.

📎 Source: MedPAC — June 15, 2026 | MedPAC March 2026 Presentation

💸 CMS Proposes Capping GEMT Medicaid Supplemental Payments at Medicare Rates — Industry Mobilizes Response

What happened: CMS published a proposed rule that would impose provider-specific payment limits on targeted Medicaid supplemental payments for Ground Emergency Medical Transportation (GEMT), air ambulance, and non-emergency medical transportation (NEMT) providers. Under the proposal, GEMT supplemental payments would be capped at equivalent Medicare Ambulance Fee Schedule rates — including base rates, mileage, geographic adjustments, and rural add-ons — beginning with rating periods starting January 1, 2029. If an ALS emergency transport has a Medicare AFS rate of $450 in a provider's area, that would become the maximum combined Medicaid reimbursement. AIMHI and PWW Advisory Group released a comprehensive response toolkit on June 11 with advocacy templates for public comment submission. The proposal was a featured topic at the abc360 conference in Clearwater Beach earlier this month.

Why it matters: This rule represents the most significant federal threat to GEMT supplemental payment programs since their inception. Many public EMS agencies and fire-based ambulance services depend on GEMT programs to fill the gap between Medicaid base rates and actual operating costs — a gap the MedPAC GADCS data confirms is substantial. The $450-vs-$1,046 example (MedPAC median ALS emergency cost vs. a hypothetical Medicare cap) illustrates the potential shortfall. While the 2029 effective date provides a multi-year runway, the rule signals CMS's direction on Medicaid financing structures. The open comment period is the industry's window to shape the final rule. For air ambulance providers, the rule's explicit inclusion of air ambulance supplemental payments alongside GEMT is a warning that Medicaid payment reform may not stop at ground transport.

📎 Source: EMS1 — May 22, 2026 | AIMHI — June 11, 2026

📊 22 States Now Protect Consumers from Ground Ambulance Surprise Bills — Federal Gap Remains

What happened: A new Commonwealth Fund analysis finds that 22 states have enacted some form of ground ambulance surprise billing protection — 13 of which cover nonemergency transportation in addition to emergency services. This state-level activity fills the most significant gap in the federal No Surprises Act, which excluded ground ambulance services from its balance billing prohibitions while covering air ambulance, emergency room, and hospital-based services. The analysis notes that approximately 3 million privately insured patients use ground ambulance transport annually in emergencies — situations where they have no ability to choose an in-network provider. New Hampshire became the latest state to act, with its ground ambulance balance billing prohibition taking effect January 1, 2026. Multiple additional states are considering legislation in 2026.

Why it matters: The patchwork of state protections creates an uneven regulatory landscape for ground ambulance operators — and, by extension, for air medical programs evaluating integrated ground-air transport models. While the No Surprises Act IDR process has been a focus of industry attention for air ambulance billing disputes (5.1 million disputes since 2022, with air ambulance providers winning 86% of cases), the ground ambulance sector operates without any federal balance billing framework. The federal advisory committee on ground ambulance balance billing delivered recommendations, but Congressional action has not materialized. For air medical leaders, the divergence between air and ground billing regulation introduces complexity into any integrated transport strategy.

📎 Source: Commonwealth Fund — February 18, 2026 | HealthInsurance.org — 2026

🏛️ State EMS Legislation Wave: Six States Advance Reimbursement, Alternative Destination, and Funding Bills

What happened: A JEMS analysis published this month documents a wave of 2026 state legislation targeting EMS reimbursement, alternate destination transport, and dedicated funding mechanisms. Washington enacted HB 2531 aligning its ambulance transport quality assurance fee program with federal rules. Colorado is advancing HB 26-1069, which would require Medicaid reimbursement for treatment in place, telemedicine support, and transport to alternative destinations. Alabama's SB 269 would establish reimbursement requirements and balance billing limits for ground ambulance services. Maine's LD 2119 expands reimbursement for community paramedicine. West Virginia passed HB 5168 creating county-level EMS funds supported by lottery revenue. California is moving AB 1607 to extend the Maddy EMS Fund through 2037.

Why it matters: The legislative pattern is unmistakable: states are no longer satisfied treating EMS solely as a public safety function — they are building payment infrastructure. For air medical programs, the alternate destination and treatment-in-place bills are particularly significant. As ground EMS gains authority to triage patients away from hospital EDs, the patient population that reaches helicopter activation criteria may shift — potentially reducing unnecessary scene calls but also changing the acuity mix of air transports. The dedicated state funding mechanisms (Washington's transport fund, West Virginia's lottery-backed county funds) represent a structural approach to EMS sustainability that could influence federal policy discussions as well.

📎 Source: JEMS — June 2026

🕯️ NEMSMS Moving Honors Procession Crosses Kentucky — 59 Fallen EMS and Air Medical Personnel Honored

What happened: The National EMS Memorial Service (NEMSMS) Moving Honors procession was escorted by Kentucky State Police Post 4 on Tuesday, June 23, as it continued its 6,500-mile cross-country journey from Riverside, California to Arlington, Virginia. The procession, which began June 1 with REACH Air Medical in Redding, CA, honors 59 EMS and air medical providers who died in the line of duty. The journey culminates at the National EMS Weekend of Honor, scheduled for July 17–19 at the Hyatt Regency Crystal City near Reagan National Airport, where the annual memorial service and Tree of Life ceremony will be held.

Why it matters: After the 2025 spike in air ambulance accidents — including the King Air C90 crash near Ruidoso, NM (4 fatalities) and the Vanderbilt LifeFlight H130 crash in Tennessee (1 fatality, pilot incapacitation) — this year's NEMSMS honors carry particular weight for the air medical community. The procession also highlights a continuing disparity: unlike police and fire services, there is still no permanent national memorial recognizing EMS and air medical providers. The National EMS Memorial Foundation, authorized by Public Law 115-275 in 2018, continues site approval and development work. For air medical leaders, participation in memorial events is not just about remembrance — it reinforces the safety culture that the NTSB identified as deficient in multiple recent air ambulance accident investigations.

📎 Source: National EMS Memorial Service — June 2026 | NEMSMS — Facebook (June 23 Post)

📋 CAMTS MIH 2nd Edition Standards — Seven Days to July 1 Compliance Deadline

What happened: The CAMTS 2nd Edition Mobile Integrated Healthcare (MIH) Accreditation Standards take effect July 1, 2026 — one week from today. CAMTS hosted a free webinar on June 18 focused on the MIH accreditation and reaccreditation process, covering compliance requirements under the updated standards. Separately, the 13th Edition Transport Standards are scheduled for Standards Committee vote and Board ratification in July 2026, with publication at AMTC in October and an effective date of January 1, 2027. CAMTS completes 60–65 new or reaccreditation applications annually and processes over 100 progress reports. Cleveland Clinic Critical Care Transport was among the most recently announced newly accredited programs.

Why it matters: For hospital-based programs with integrated ground transport and community paramedicine components, the MIH accreditation timeline is an immediate compliance milestone. Programs seeking or maintaining MIH accreditation must be operating under the 2nd Edition standards by next Tuesday. The larger CAMTS story remains the 13th Edition Transport Standards cycle — CAMTS is currently in the revision cycle with Board ratification expected in July. The 6-month window from October publication to the January 1, 2027 effective date is tight for compliance budgeting, particularly for smaller programs. Programs should review draft language now rather than waiting for publication at AMTC.

📎 Source: CAMTS — Updates | CAMTS — Standards

🚁 Air Methods Signs Airbus Global Fleet Agreement — H140, H125, H135 Helicopters for Air Medical Missions

What happened: Air Methods, the largest civil operator of Airbus helicopters worldwide, signed a Global Fleet Agreement with Airbus for new H140, H125, and H135 helicopters. The order includes 10 H125 single-engine helicopters, 11 H135 light twins, and the new H140 light twin — a 3-tonne class rotorcraft with a five-blade bearingless main rotor, T-shaped tail boom with optimized Fenestron, new Safran engines, and a cabin accommodating up to six passengers. The H140's entry into service for emergency medical services is planned for 2028. Air Methods CEO Rob Hamilton called the agreement a strategic positioning for "sustained growth and innovation in the decade ahead." Combined with the previously announced Bell fleet expansion (up to 27 Bell helicopters including 15 IFR-configured 407GXis), Air Methods is executing the largest fleet modernization in the company's history.

Why it matters: Air Methods operates or maintains over 450 aircraft across ~200+ bases — making its fleet decisions the de facto standard for U.S. air medical rotorcraft. The H140 order signals confidence in a new platform class that is larger than the industry-standard H135 but more cost-effective than the H145 for many mission profiles. The 2028 EMS entry into service aligns with a likely fleet replacement cycle for programs whose H135s and EC135s will be approaching airframe mid-life. For air medical leaders planning fleet strategy, the Air Methods-Airbus agreement provides a concrete timeline: the H140 EMS platform will be available starting in 2028, with the five-blade rotor and Fenestron offering meaningful noise reduction — a factor increasingly relevant for hospital-based programs operating in noise-sensitive urban environments.

📎 Source: Vertical Mag — 2026 | Air Methods — Press Release

📝 From the Flight Deck
The MedPAC report and CMS GEMT rule are two sides of the same coin — the federal government is simultaneously measuring how badly Medicare underpays ground ambulance services (GADCS data) while proposing to extend those inadequate rates to cap Medicaid supplemental payments (GEMT). You can't read the MedPAC numbers showing negative 42% margins on Medicare transports and then cap Medicaid at the same rates with a straight face. The state-level legislation wave is the most encouraging sign — Washington, Colorado, Maine, and West Virginia are building real payment infrastructure, not just studying the problem. The NEMSMS Moving Honors procession is a sobering reminder: 59 names on the Tree of Life this year, and we still don't have a permanent national EMS memorial. One week until CAMTS MIH compliance — if your program hasn't reviewed the 2nd Edition, today. The Air Methods H140 order matters for everyone: the largest civil Airbus operator committing to a new platform class in 2028 sets the fleet strategy clock for the entire industry.

🚁 Air & Ground Medical Transport Brief · Published by Merlin 🧙

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Written for leaders in air medical and ground ambulance transport industry.