OPEN FOR BUSINESS:
WHAT DOES THIS MEAN FOR EMS?
By Ed Marasco, MPM, CMTE, EMT-P (Ret.)
As you are undoubtedly aware, the U.S. Government is re-opening this week after both the Senate and House agreed to a compromise for a Continuing Resolution (CR). The Government shutdown was the longest in U.S. history and created havoc for citizens on many fronts, from loss of SNAP benefits to snarled travel. The last few weeks have been especially difficult for millions of Americans.
IMPACT ON EMS
One of the areas that did not receive as much press, but in nonetheless a critical safety net matter, was the loss of the Medicare Ambulance Add-On Payments. Decades ago, Congress recognized the Medicare Ambulance Fee Schedule does not adequately reimburse EMS and ambulance suppliers for the cost of readiness. As a high-fixed cost enterprise, EMS is dependent on a critical mass of volume to cover the fixed costs of operations . . . otherwise known as readiness costs. This challenge is especially problematic for rural and super rural ambulance agencies. These agencies provide very vital access to the regional healthcare delivery system, but they often serve limited populations, resulting in lower call volumes than their urban counterparts.
The Medicare Ambulance Add-On Payments provides an increase in the Medicare Ambulance Fee Schedule to help to defray readiness costs:
- Urban 2%
- Rural 3%
- Super Rural 22.6%
This solution has been a “temporary fix” that has lasted for decades. Each Federal budget cycle, when health care spending is addressed, these payments tend to get caught in the wash. This year was no different and on October 1, 2025, when funding for the government expired, so did the Medicare Ambulance Add-On Payments. For the 43 days of the shutdown, ambulance suppliers have gone without that supplemental reimbursement.
KEY ELEMENTS OF THE CONTINUING RESOLUTION
On November 12th, Congress sent a new Continuing Resolution to the President’s desk. The legislation ended the 43-day shutdown and included some key provisions for EMS suppliers.
- January 31, 2026
The CR restores funding for most government programs through January 31, 2026, to allow Congress and the Administration to find agreement on new funding levels.
- Medicare Ambulance Add-On Payments
The supplemental payments have been restored throughout the CR period (1/31/26). While this is a temporary reprieve for our community, it provides some confidence that key constituents in Washington understand the importance of these payments. Your billing team should be aware of this relief and watch EOBs closely to confirm the restoration of the Add-Ons.
- Retroactive Payments
In addition to restoring these payments moving forward, the package also makes the supplemental payments retroactive back to October 1, 2025. If your agency has claims with dates of service between October 1 and November 12, 2025, your billing team needs to be sure these claims are paid with the Add-On payments.
MOVING FORWARD
While the news this week has been positive, it remains imperative the community continues to lobby for a permanent fix to the Medicare Ambulance Fee Schedule. The industry remains fully engaged with congressional champions to push for long-term sustainability, including permanent authorization of the Medicare Add-Ons (H.R. 2322 / S.1643), protection against Medicaid cuts, and advancement of EMS workforce legislation such as H.R. 2220.
It is important that you get engaged with your professional associations, your local champions and your congressional representatives to support these efforts. Our community faces many challenges, and we must advocate for our agencies and the people they serve. Until these fixes are made permanent, our community remains at risk each time there is a stalemate in the Federal government.
*Ed Marasco is QMC’s Executive Vice-President of External Affairs and a veteran healthcare provider and administrator with over 40 years of experience in emergency medical services, reimbursement, and consulting.
