State lawmakers are working on a bill that they say would create much-needed funding for Colorado’s emergency medical services and save the state millions of dollars a year in health care spending.
The measure, House Bill 26-1069, would expand the list of services that EMS agencies can bill to the Colorado Department of Health Care Policy and Financing, which administers the state’s Medicaid program, or to private insurance companies.
Ambulance services in Colorado have been struggling with funding for years. A 2023 state study found that many EMS agencies in Colorado were operating without enough funding in large part because insurance reimbursement rates, from both the state and from commercial insurers, are significantly lower than the agencies’ actual costs.
Democratic state Rep. Katie Stewart of Durango, a former EMT, is sponsoring the bill and says funding issues continue to threaten Colorado’s emergency medical services, especially in the state’s rural areas.
“We are already seeing the effects of this lack of funding and this lack of support,” Stewart said. “The ramifications of not supporting our folks in EMS means that we will not have these workers to show up when you dial 911.”
Other sponsors of the measure are state Rep. Lisa Feret, of Arvada, and state Sen. Kyle Mullica, of Thornton, both Democrats.
Currently, ambulance services in Colorado must be reimbursed only when they transport a patient to an emergency room. Under the bill, they could also be reimbursed for treating someone on-site without transporting them, a practice commonly called treatment in place.
Scott Sholes, EMS Chief of Durango Fire & Rescue, called the current system “a historical funding pitfall” during his testimony to lawmakers in support of the bill.
“We get some of the reimbursement only when we transport patients using the most expensive means – ambulances – to the most expensive destinations – that’s the hospital emergency rooms,” Sholes said. “But we don’t get reimbursed for providing clinically appropriate treatment, rendering ambulance transport unnecessary.”
A number of other states already allow EMS agencies to bill for treatment in place, and Congress is considering legislation to expand federal reimbursements for it.
The measure would also require Colorado, but not private insurers, to reimburse emergency medical responders when patients are taken to behavioral health clinics instead of emergency rooms or if telehealth services are used during an emergency call.
An earlier version of HB-1069 would have required private insurance companies to reimburse EMS agencies for such situations and would have allowed ambulance services to reimburse for transportation to other locations as well, like urgent care clinics.
But Stewart said those provisions were removed to appease health insurance companies, which originally had concerns about the bill.
“As introduced, House Bill 1069 did raise some substantial concerns for our members,” said Kevin McFatridge, Executive Director of the Colorado Association of Health Plans, during a legislative hearing on the bill. “We appreciate these efforts and believe they reflect meaningful progress toward addressing many of the operation and affordability concerns raised by carriers.”
Stewart also assured lawmakers during the committee hearing that nothing in the bill would prevent ambulances from taking patients to emergency rooms.
“This will not stop anyone from being transported to an ER if that is what they want or need,” Stewart said. “Instead, this will empower EMS and patients to make the smartest decisions about their care.”
Apart from providing funding for EMS agencies, the measure would likely save Colorado millions of dollars a year in health care spending because it would result in fewer emergency room and hospital visits. Any savings are particularly significant this year as lawmakers struggle to balance a billion-dollar budget deficit driven largely by the cost of health care.
Nonpartisan legislative fiscal analysts project the bill would save $2.1 million in the first fiscal year, starting in July 2026, $4.6 million in the following fiscal year, and $4.9 million in future years.
A separate proposal working its way through the legislature, House Bill 26-1238, would define emergency medical services as essential in state law. The change would allow ambulance services to receive state funding reserved for public safety, emergencies, or disasters.
Legislative committees unanimously approved both bills and they now await consideration in the House.
