MECHANICSBURG, Pa. — With Congress missing the midnight deadline to pass a new spending bill, the federal government shut down at 12:01 a.m. today. Lawmakers have not indicated when a deal might be reached and key provisions for ground ambulance providers expired along with the funding resolution.
The PWW Advisory Group reported that the 2% urban, 3% rural and 22.6% super-rural Medicare add-on payments for ground ambulance services lapsed on Sept. 30. Industry groups are urging Congress to include an extension in any stopgap or full-year appropriations package.
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Medicare payments and activities
Medicare operations will largely continue during the shutdown:
- Claims and payments: Medicare Administrative Contractors are expected to process and pay ambulance claims on their normal schedules.
- Administrative tasks: Enrollment actions, including revalidations and some audit work may slow or pause, particularly if the shutdown stretches on.
Ambulance add-ons
If Congress passes a funding bill within two weeks:
- Medicare Administrative Contractors (MACs) hold claims for 14 days before paying, so they should have time to apply the renewed add-ons and payment levels would remain unchanged.
If Congress takes longer than two weeks:
- MACs will begin paying claims dated Oct. 1 and later without the add-ons.
- Should lawmakers later restore the add-ons — potentially retroactive to Oct. 1 — MACs would reprocess those claims and issue the additional payments, as they have in previous lapses.
If the spending bill omits the ambulance add-ons, Medicare will stop paying the 2% urban, 3% rural and 22.6% super-rural boosts for trips on or after Oct. 1; only new legislation could restore them. Medicare’s telehealth flexibilities and hospital-at-home waivers also expired and need congressional renewal to continue.
