Good news – The government shutdown has ended, the Medicare extenders are being put back in place, and the 4% PAYGO reductions have been avoided, for now at least. The longest federal government shutdown officially ended with the passage and enactment of H.R.5371 - Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026.
It is a lengthy text, but the PWW|AG team pored over the document and here’s a summary of the specific provisions that EMS agencies should be aware of. We’ve included the actual text from the Bill at the end of this summary.
Key Takeaways for EMS Agencies
- The Medicare extenders (2% urban, 3% rural and 22.6% super-rural) have been extended through January 30, 2026, and are retroactive to October 1, 2025.
- Any Medicare claims that agencies may have been holding should now be processed and paid at the correct amounts. We recommend carefully verifying that this is true with your claims submitted.
- Keep an especially close eye on Medicare Advantage claims to ensure that each Plan processes these at the correct amounts – including the add-ons.
- The potential S-PAYGO reduction has been avoided, for now at least.
- Thereby preventing a potential additional reduction of 4% through sequestration.
Summary of the relevant provisions of the Bill
DIVISION F – HEALTH EXTENDERS
TITLE II—MEDICARE
Sec. 6206. Extension of add-on payments for ambulance services. This section extends Medicare ground ambulance add-on payments through January 30, 2026.
Sec. 6213. Medicare Sequestration. This section extends by one month (in FFY 2032) the mandatory Medicare payment reductions under sequestration.
Sec. 6204. Extending acute hospital care at home waiver authorities. This section extends the Acute Hospital Care at Home initiative, as currently authorized under CMS waivers and flexibilities, through January 30, 2026.
Sec. 6208. Extension of certain telehealth flexibilities. This section extends Medicare telehealth flexibilities that were extended in the Consolidated Appropriations Act, 2023, through January 30, 2026.
Specific Bill Language: https://www.congress.gov/bill/119th-congress/house-bill/5371/text
The team at PWW|AG will be monitoring the implementation of these changes and will keep you posted on any changes or issues. Let us know if the extenders are not included in your Medicare payments or any other unusual issues you notice, particularly in any communication from the Medicare Administrative Contractor (MAC) or the Medicare Advantage plans serving your area.
Reach out to us at contact@pwwag.com.
