Senate passes rural ambulance bill

March 3, 2026 – MONTGOMERY, Ala. – The Alabama Senate passed a bill designed to protect rural ambulance services and make sure that rural Alabamians can continue to receive medical service.

Senate Bill 269 (SB269) is sponsored by Senate Minority Leader Bobby Singleton (D-Greensboro) who represents a very rural district.

"This bill is about a matter of life and death," said Sen. Singleton. "In the rural areas it becomes a matter of life especially when you have hospitals closing on a daily basis."

The bill establishes minimum reimbursement rates that health insurers must pay ambulance providers, tying those payments to a percentage of the federal Medicare rate. This change is designed to bring Alabama closer to the reimbursement levels seen in neighboring states, where higher rates have helped keep EMS agencies financially viable.

Key provisions include:

- Treat‑in‑place coverage - EMS providers will be reimbursed when they deliver medical care on scene without transporting a patient, a service that currently often goes unpaid.

- Ban on balance billing - Ambulance services cannot charge patients more than the in‑network cost‑sharing amount, reducing unexpected medical bills.

- Standardized reimbursement - Insurers must accept the mandated reimbursement as payment in full, preventing additional charges to patients.

Alabama's EMS system has been under strain for years, with rural hospital closures and long transport times leaving many communities vulnerable. Ambulance providers have warned that without financial reform, more services could shut down, worsening emergency response times

Singleton said that he had amended the bill to sunset on June 1 2029. This means that the legislature would have to address this issue again before the sunset.

Senator Larry Stutts (R-Sheffield) is a medical doctor. He expressed a number of concerns about the legislation.

"I am for rural areas having ambulance service. I live in a rural area. I practiced in a rural area," Sen. Stutts said.

That said, Stutts expressed concerns that this bill was cost shifting the total costs of medical services to the patients with the insurance and means to pay it in order to compensate the ambulance services for the care they provide for the patients who can't or won't be able to pay for it.

"All hospitals do that," said Stutts. "Half the people in the hospital don't pay their bill, which in turn drives up their insurance premiums."

"Cost shifting happens all the time," said Stutts. "We as a society have decided that everybody gets care whether they pay for it or not and they all get the same level of care."

"Probably 20 to 25% of the people who ride in an ambulance pay for the service," stated Stutts. "In this scenario we are cost shifting the cost to a small share of patients." "This bill unduly shifts the cost to a small group of people which is why I am going to vote no on your bill"

Singleton said that the ambulances are needed to transport patients to the emergency room (E.R.) for treatment from a doctor.

Stutts said, "We are making the assumption that there is a doctor in the ER."

"It is 40 miles to DCH (in Tuscaloosa) from the south end of the county (Hale)," said Singleton.

Singleton explained that the treatment in place option allows the ambulance service to provide treatment at site and avoid making a trip to the hospital.

"Who is going to be making the decision on whether or not to treat in place?" asked Stutts. "if they decide to treat in please who has that liability. If a paramedic makes the decision to treat in place and it turns out he is wrong?"

Singleton said, "If the customer insists on being transported they will be."

Stutts said, "That is putting that ambulance service in a difficult situation."

"A very small percentage of the people that ride in an ambulance pay the cost for everybody," said Stutts. "Most of the regular ambulance riders don't pay anything."

Senator Tim Melson (R-Florence) is also a doctor.

"Why are we thinking that an ambulance driver is able to make that decision?" said Sen. Melson. "I would hate for my decision to go to the hospital or not is made by an ambulance driver."

Stutts said, "A significant number of the people that come in with a heart attack come in complaining of indigestion."

"Who is going to be responsible for the liability if they make the decision to treat in place and they make the wrong decision," said Stutts.

Singleton asked, "Is this trying to protect doctors?"

"Not at all," said Stutts. "It is protecting patients and also their healthcare costs."

"We are putting people in a very awkward position on whether or not to transport," said Stutts. "My main objection is the cost shifting."

Singleton said, "We are talking about saving lives of people."

Several insurance companies including Blue Cross, ALFA, PEEHIP, SEHIP, and United Healthcare have asked to be left out of the bill.

"I am not leaving out anyone in the Senate bil," said Singleton. "They all have customers who are using ambulance services. Farmers are getting hurt in accidents and need an ambulance to come out to the farm. I am not excluding anybody in my bill

Senator Rodger Snitheran (D-Birmingham) said, "We are standing here because of the failure of this body to pass Medicaid expansion."

"We didn't do nothing to keep the hospitals open," said Smitherman. "I would hope that we get past these philosophical things and get to saving lives."

"We need to engage in Medicaid expansion so these hospitals reopen again so emergency rooms can open again," said Smitherman.

"We are talking about spending $250 million for the rich folks so they can send their kids to private schools," said Smitherman defending the costs of this bill by comparison.

Smitherman said that the needs for ambulances – particularly in rural areas – has increased as more hospitals have closed and fewer Alabamians have easy access to doctors.

"We don't have enough doctors to go around, and that is partly because we are living longer and thus have more need for doctors," said Smitherman.

"Your substitute is a lot better than the House version," said Stutts. "Some of those provisions are an improvement on the House bill."

SB260 passed the Senate 26 to 2.

It now goes to the House of Representatives for their consideration.

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