Helena — Representative Ed Buttry, sponsor of House Bill 56, told the House Health and Human Services Committee that the bill would create a statewide ambulance provider assessment to generate federal Medicaid matching funds and raise reimbursement rates for emergency medical services.

“This is a big bill,” Representative Ed Buttry said, describing it as “an effort to provide for the financial security and longevity of our ambulance service providers across the state.”

The bill would require ambulance providers to pay an assessment equal to 5.75% of their net operating revenue into a new Ambulance Medicaid Reimbursement Special Revenue Account. The state would submit the program to the Centers for Medicare & Medicaid Services for approval; federal matching funds would be deposited into the special account and then used to increase Medicaid reimbursements to ambulance providers and to cover administration costs. Representative Buttry told the committee the fiscal note shows no net impact to the general fund.

Why it matters: Proponents said the proposal aims to address chronic underfunding and workforce shortages that threaten ground ambulance coverage in rural and frontier parts of Montana. “This is lifeline funding that we desperately need,” Don Whalen, manager of Missoula ambulance service and president of the Montana Ambulance Association, told the committee. Multiple rural providers said low Medicaid reimbursement rates and staffing turnover have left gaps in response coverage.

Proponents described local impacts. Justin Brester, one of the managers for Polson, Ronan and St. Ignatius Ambulance, said the combined services respond to about 4,000 calls a year and face recruitment and retention problems because “they simply can't afford to do it.” Justin Groves of Great Falls Emergency Services said an increase in Medicaid reimbursement “will really be a game changer for us, and allow us to pay our folks really what they should be getting.”

Key provisions and fiscal details presented to lawmakers

- Assessment rate and base: the bill sets the assessment at 5.75% of “net operating revenue,” defined in the bill as gross revenue less bad debt, charity care discounts and non–patient-service revenue.
- Account and use: assessments and any collected penalties would be deposited into an Ambulance Medicaid Reimbursement Special Revenue Account; federal match dollars received would be returned to that account and then used for enhanced Medicaid payments to ambulance providers and to reimburse state administrative costs.
- Implementation conditions: the bill includes a contingent effective date and voidness provision — assessments would not be collected until the state receives necessary federal approvals from CMS; the bill would terminate if federal approval or matching funds are not available.
- Administration costs and assumptions: committee staff and DPHHS explained the fiscal note anticipates roughly $60,000 in program administration costs (about $15,000 state share and $45,000 federal share). DPHHS staff said the fiscal estimate assumes about 18% of ambulance providers would be ineligible to participate because they are not taxable entities. The fiscal note projects that overall the program is budget-neutral to the general fund.
- Data limitations: Representative Buttry and DPHHS staff told the committee that the department requested financial data from 122 ground ambulance providers but only 15 returned the information, limiting the state’s ability to refine revenue estimates.

Committee questions focused on eligibility, mechanics and compliance. DPHHS staff confirmed that providers must be enrolled in Medicaid and be a taxable entity to receive supplemental payments; non‑enrolled providers would still be assessed if they fall within the assessed class, because the federal program requires assessments cover the entire class of providers. Jason Lay of the Department of Revenue said reporting and collections would be administered by DOR, that the agency would likely use an electronic return and payment system, and that a new tax type and form would be required.

An amendment presented by Representative Buttry (described as a department-drafted, "friendly" amendment) would move the provider reporting and payment deadline from March 31 to June 30 and shift the date for the state to issue supplemental payments from June 30 to September 30. The amendment was handed out to committee members during the hearing; the committee took no vote on the amendment during the session.

What the hearing did not decide

The committee held a public hearing with informational witnesses and proponents from ambulance services, fire organizations, the Montana Primary Care Association and the Montana League of Cities and Towns, and officials from DPHHS and the Department of Revenue. No committee vote or final action on House Bill 56 was recorded at the hearing. Representative Buttry closed the hearing and asked for the committee’s support at a later action, noting the bill’s contingent dependence on federal approval.

Next steps

Committee members were told the program cannot begin until federal CMS approval is received. The sponsor and state agencies will remain available for follow-up technical questions; the committee signaled plans for future executive action days but did not take a final vote on House Bill 56 during the session.