The Protecting Air Ambulance Services for Americans Act of 2025 authorizes the HHS Secretary to revise the Medicare fee schedule for air ambulance services using previously authorized data and new data the Secretary will collect. The statute explicitly adds a new paragraph to section 1834(l) of the Social Security Act to create this authority and sets procedures for stakeholder-informed policymaking.
The bill also forces administrative momentum: it requires HHS to finalize the air ambulance data collection rule within six months of enactment and directs the Government Accountability Office to produce a detailed cost and adequacy report after data collection begins. For providers, payors, and Medicare program managers, the measure replaces opaque reimbursement debates with a structured, data-first process that could alter rates, geographic adjustments, and payment adequacy assessments.
At a Glance
What It Does
The bill adds a new paragraph to 42 U.S.C. 1395m(l) giving the Secretary authority to revise the Medicare fee schedule for air ambulance services based on existing CAA 2021 data and triennial data submissions from providers and suppliers. It requires stakeholder consultation and transparency if the Secretary elects to change rates.
Who It Affects
Medicare beneficiaries using air ambulance services, air ambulance providers and suppliers (including independent operator-owners and hospital-based programs), HHS and CMS administrators implementing the fee schedule, and policymakers relying on better cost data for oversight.
Why It Matters
Air ambulance reimbursement has been litigated and fragmented; the bill aims to produce standardized, empirical inputs for rate-setting and to reduce surprise underpayment or underprovision in rural and underserved areas. Its data mandate and GAO analysis could change how Medicare calculates adequacy and how providers justify base-level funding.
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What This Bill Actually Does
The bill amends the Medicare statute by inserting a new, numbered paragraph into the section that governs payment for certain ground and air ambulance services. That paragraph does three things: it gives the Secretary explicit authority to revise Medicare’s air ambulance fee schedule when informed by data, it references the dataset established under section 106 of division BB of the Consolidated Appropriations Act, 2021 as a starting point, and it creates a recurring data collection obligation for providers and suppliers.
Under the new text, HHS must collect, once every three years, operationally focused information from organizations that furnish air ambulance services to Medicare beneficiaries. The statute lists broad categories—fixed and operating costs per base, utilization by Medicare enrollees, revenue attributable to Medicare for air transports—and allows the Secretary to require other items deemed appropriate.
The Secretary must consider both the historical CAA 2021 data and these new submissions when contemplating fee schedule changes and must run a transparent stakeholder input process if revisions are proposed.The bill couples the data regime with near-term deadlines: it requires HHS to finalize the implementing rule for the CAA 2021 data collection within six months of enactment, compressing administrative timing that previously slowed implementation. Finally, the Comptroller General must produce a report within one year after data collection begins that quantifies average operating costs per base and per transport, payor mix, geographic cost variation, Medicare payment adequacy, and offer recommendations to improve the fee schedule.
That report is designed to give Congress and CMS a factual basis for long-term payment policy.
The Five Things You Need to Know
Section 2 inserts a new paragraph (18) into 42 U.S.C. 1395m(l) specifically authorizing the Secretary to revise the Medicare air ambulance fee schedule using designated datasets.
The Secretary must require providers and suppliers to submit data once every three years on fixed and operating costs per air ambulance base, utilization by Medicare enrollees, and revenue attributable to Medicare for air ambulance services.
The bill directs HHS to rely on data already collected under section 106 of division BB of the Consolidated Appropriations Act, 2021 (the CAA 2021 dataset) as one of the primary inputs for any fee-schedule change.
If the Secretary chooses to alter the fee schedule, the statute requires a transparent stakeholder consultation process that ‘appropriately considers’ both CAA 2021 data and the newly collected data.
The Comptroller General must submit, within one year after CMS begins collecting the new data, a report covering six topics: average annual operating cost per base, average cost per transport, payor mix, Medicare payment adequacy, geographic cost variation, and recommendations to improve the fee schedule.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
New statutory authority to revise the air ambulance fee schedule
This provision adds a new paragraph (numbered (18) in the bill text) to the Medicare payment statute, explicitly authorizing the Secretary to revise the fee schedule for air ambulance services. The mechanics are permissive—the Secretary may revise the schedule—but the authority is conditional on analysis of specified datasets, which elevates data as the legal and policy foundation for any future rate changes.
Use of CAA 2021 dataset as baseline
Subparagraph (B) ties the Secretary’s rate-setting authority to data collected under section 106 of division BB of the Consolidated Appropriations Act, 2021, effectively treating that previously authorized dataset as a statutory baseline. Practically, that means CMS cannot claim a lack of statutory direction to use the CAA 2021 information when crafting payment policy for air ambulance services.
Triennial provider and supplier data submissions
Subparagraph (C) requires a recurring data call every three years directed at providers and suppliers furnishing air ambulance services to Medicare enrollees. The bill specifies three core categories—fixed and operated costs per base, utilization by Medicare enrollees, and Medicare-attributable revenue—and gives the Secretary flexibility to request additional information. This creates periodic cost-accounting obligations for operators and a predictable cadence for CMS to reassess rates.
Mandated stakeholder consultation
If the Secretary decides to revise the fee schedule, subparagraph (D) requires consideration of stakeholder input in a process described as transparent and appropriately data-driven. The language stops short of prescribing a formal notice-and-comment rulemaking for every revision but signals that CMS should document and publicly consider feedback tied to the datasets.
Six‑month deadline to finalize the CAA 2021 data collection rule
This section compels the Secretary to publish a final rule implementing the air ambulance data collection required by the earlier CAA 2021 provision within six months of enactment. The effect is to accelerate administrative action that has faced delays, placing a firm statutory clock on rule issuance rather than leaving the timetable to discretionary agency scheduling.
GAO cost and adequacy study
Section 4 directs the Comptroller General to produce a report no later than one year after CMS begins collecting the statutorily required data. The report must quantify costs per base and per transport, describe payor mix and geographic variation, assess whether Medicare payments are adequate, and recommend fee schedule improvements—providing Congress and CMS an independent, analytical snapshot to inform policy choices.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries in rural and remote areas — clearer, data-based payment rules increase the chance that air ambulance operators receive sustainable reimbursement, which supports continued service availability where alternatives are limited.
- Air ambulance operators with robust cost records — companies that have documented base-level costs and utilization can make a stronger case for rate adjustments that reflect their actual expenses.
- Policymakers and CMS analysts — the bill creates standardized, recurring datasets and a GAO report that improve oversight, enable evidence-based payment design, and reduce reliance on anecdote or litigation.
Who Bears the Cost
- Air ambulance providers and suppliers — they must compile and submit detailed cost, utilization, and revenue data every three years, creating compliance time and expense, especially for small or volunteer programs that lack sophisticated accounting systems.
- CMS/HHS administrative resources — the agency must finalize a rule within six months and manage a recurring national data collection effort, which requires IT, personnel, and adjudication capacity that may not be budgeted.
- Medicare program budget — if the data justify higher payments to reflect operational realities or geographic cost differences, Medicare outlays for air ambulance services could increase, creating fiscal pressure or trade-offs with other priorities.
Key Issues
The Core Tension
The central dilemma is fidelity to accurate, cost-based reimbursement versus administrative cost and fiscal discipline: the bill seeks to stabilize air ambulance service availability by basing Medicare payment on detailed cost and utilization data, but doing so requires burdensome reporting, complex allocation rules, and potentially higher Medicare spending—trade-offs that have no administratively tidy solution.
The bill ties a permissive rate‑setting authority to a specific data architecture, but the statute leaves critical choices to the Secretary. It does not spell out methodology for converting reported costs into per-transport fees, nor does it mandate how to treat proprietary or aggregated submissions.
That creates implementation pressure: CMS must decide cost allocation rules (how to apportion base-level fixed costs across transports), geographic adjustment formulas, and confidentiality protections for competitively sensitive provider data.
The statutory timelines impose practical constraints. A six‑month deadline for finalizing the implementing rule compresses agency rulemaking and stakeholder engagement, risking either a rushed regulatory framework or a narrow rule that requires rapid revision later.
Triennial reporting balances reporting burden against currency of data, but three-year gaps could lag in fast-changing markets—leaving payment policy out of sync with operational realities. Finally, the Secretary’s authority to ‘‘consider’’ stakeholder input without prescriptive procedural steps leaves open disputes about what counts as adequate transparency or participation.
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