Committee hears bill to assess ambulance providers to fund Medicaid reimbursement supplements

Representative Batri opened the committee hearing on House Bill 56, a bill proposing a statewide ambulance provider assessment to secure federal matching funds and create a Medicaid supplemental payment program for ambulance providers.

Under the proposal, ambulance providers — excluding entities that exclusively provide air ambulance or public ambulance providers — would pay an assessment equal to 5.75% of their net operating revenue (defined in the bill as gross revenue less bad debt, charity care, discounts and non-patient-service revenue). Collections would be deposited into an Ambulance Medicaid Reimbursement Special Revenue Account, which would receive the provider assessments and federal match; the account would be statutorily appropriated for supplemental payments and program administration. The bill requires that assessments not be collected until the state receives CMS approval for the program.

Proponents representing ambulance services, county associations and providers argued the program would shore up underfunded EMS providers, particularly in rural areas facing workforce shortages and service closures. Justin Gross of Great Falls Emergency Services said the assessment is “a financial assessment that we levy on ourselves as an industry to increase federal funding” and passed around letters of support from some 80 providers. Don Whalen, president of the Montana Ambulance Association, said HB 56 would secure federal funding “at no cost to the state or taxpayers” by using provider assessments for the state match.

DPHHS witnesses, including the division administrator for health resources, said the department supports the bill and noted the supplemental reimbursement would stabilize Montana’s EMS industry. The fiscal note shows a general fund appropriation in FY2026 for Department of Revenue start-up costs; the sponsor and witnesses said the initial general fund outlay would be repaid from collected assessments in FY2027 and FY2028 and that the program is revenue neutral over the multi-year window if federal approval is obtained.

Committee members asked about how supplemental payments would be allocated among providers. Industry witnesses said program rules would be developed in coordination with the state Medicaid office and could include distribution formulas that prioritize rural providers; the bill itself does not set distribution tiers. Witnesses also discussed the incentive for providers not currently billing Medicaid to enroll so they can qualify for supplemental payments, and stressed the program cannot redistribute funds in a way that would violate federal rules tying supplemental payments to actual Medicaid service volume.

Ending: The sponsor closed stressing the life-saving importance of ambulance services and asking for committee support; the hearing record included multiple proponents and DPHHS informational witnesses and ended without a formal vote recorded in this transcript.