WASHINGTON — The federal government is back open — and that’s good news for EMS agencies.
After the longest shutdown in U.S. history, lawmakers passed and enacted H.R. 5371 — the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026, officially ending the funding lapse. The bill not only restores normal government operations but also reinstates critical Medicare provisions that directly impact ambulance providers.
Here’s what EMS leaders need to know.
Medicare ambulance add-ons are back — retroactively
The bill reinstates the ground ambulance add-on payments that had expired on Sept. 30. According to the PWW Advisory Group, that includes:
- A 2% increase for urban transports
- A 3% increase for rural transports
- A 22.6% increase for super-rural transports
These add-ons are extended through Jan. 31, 2026, and are retroactive to Oct. 1, 2025, under Section 6206 of H.R. 5371, which amends the Social Security Act to continue the temporary Medicare payment increases for urban, rural and super-rural ground ambulance transports.
EMS agencies that held Medicare claims during the shutdown can resume submissions at the updated rates. The PWW Advisory Group recommends verifying that the add-ons are reflected correctly on all processed claims, including those submitted to Medicare Advantage plans.
Medicare payments and claims processing
CMS and its Medicare Administrative Contractors (MACs) are expected to resume normal operations following the passage of H.R. 5371. While the bill itself doesn’t specify claim-handling procedures, CMS typically issues guidance to ensure that ambulance claims submitted during the lapse are reprocessed at the correct rates once add-on payments are reinstated.
Under standard Medicare operations, MACs hold claims for up to 14 days before issuing payment, which should allow time to apply the updated rates for services provided on or after Oct. 1, 2025. If any claims were paid at pre-extension rates, CMS is expected to automatically adjust and reprocess those claims to reflect the restored add-ons — a process similar to how the agency has handled previous retroactive payment extensions.
EMS leaders respond
In the latest edition of NAEMT Radio Podcasts, NAEMT President Chris Way said the reopening marks an important reset for the profession.
“Obviously, with the government being shut down, all of our legislative packages that we’ve been putting forward and we’ve been talking about have been kind of off in the parking lot waiting to get driven again,” Way said. “And now it’s time to drive.”He added that the shutdown underscored how bipartisan support is essential for EMS operations to function smoothly.
“It’s interesting — people ask my political opinion, which I don’t really have a political opinion. I have an EMS opinion,” Way said. “And my EMS opinion is that I don’t really care what party you’re a part of. But when you call 911, we don’t ask you whether you have a red card or a blue card, who you voted for, what district you’re in. We send the resources. And if we don’t have the resources to send you because we haven’t gotten paid or because the government’s been shut down, it’s been incredibly frustrating.”
PAYGO reductions delayed
The legislation prevents a scheduled 4% reduction to Medicare payments under statutory PAYGO sequestration by excluding the bill’s budgetary effects from PAYGO scorecards and setting scorecard balances to zero for the session. This delay helps maintain current reimbursement levels while Congress continues work on longer-term funding solutions.
Other provisions affecting EMS operations
The bill includes several extensions of healthcare programs that may affect EMS operations and partnerships:
- Telehealth: Medicare telehealth flexibilities continue through Jan. 30, 2026, maintaining support for tele-EMS and community paramedicine initiatives. The in-person visit requirement for tele-mental health services is delayed until Jan. 31, 2026.
- Acute Hospital Care at Home: Waiver authority for hospital-at-home programs is also extended through Jan. 30, 2026.
- Medicare Sequestration: The timeline for 2% sequestration reductions is extended by one month, into FY 2032.
What EMS leaders should do now
With the government back open, EMS administrators and billing staff should:
- Resume normal Medicare billing and monitor for retroactive adjustments on pending claims.
- Confirm add-on payment accuracy with both Medicare Administrative Contractors (MACs) and Medicare Advantage plans.
- Communicate updates to field and administrative staff so they understand that rates have been restored.
- Stay informed — the current extensions only last until January 2026.
