Congress Ends Government Shutdown & Extends Ambulance Relief
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Tag: Medicare
Senate Cloture on Shutdown Package
The Senate has made progress towards ending the government shutdown. The Senate, by a vote of 60 to 40, invoked cloture on consideration of the House-passed Continuing Resolution after an agreement was reached yesterday with eight Senate Democrats on replacement language, which the Senate will vote on next.
On our specific issues, the language would do the following:
1. Extend the temporary Medicare ambulance add-ons payments through January 30, 2026
2. Prevent PAYGO cuts to Medicare providers and suppliers from H.R. 1
3. Extend Medicare sequestration provider cuts for another month
We will keep you posted on new developments.
Contact your member of Congress today!
With the Medicare ambulance add-ons having expired at least temporarily, it is critical that you contact your Members of Congress now to ask for their support in reinstating and making permanent this vital financial relief. They can demonstrate their support by cosponsoring the Protecting Access to Ground Ambulance Medical Services Act (H.R. 2232, S. 1643). Please customize the sample template letter to let them know of the financial impact of the loss of the additional 2% urban, 3% rural and 22.6% super rural in additional Medicare payments on your operation.
Click the link below and write your members of Congress today about reinstating and extending the add-on payments.
Medicare Claims Hold Clarification
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Congressional Letter on Updating Medicare Zip Codes
On September 18, Congresswoman Carol Miller (R-WV) was joined by 13 members of Congress in a letter to CMS requesting that the agency update the zip code designations under the Medicare ambulance fee schedule based on the 2020 census.
According to an analysis by AAA data firm of Health Management Associates, the update would result in a net of 1,490 zip codes being redesigned as super rural instead of rural and 782 zip codes being rural instead of urban. Ground ambulance service organizations that serve these rural and super rural areas would thus benefit from the additional reimbursement for rural and super rural areas.
CMS is overdue in automatically updating the zip codes based on the 2020 census data.
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Impact of Potential Federal Government Shutdown on Medicare Payments
Impact of Potential Federal Government Shutdown on Medicare Payments, Including the Temporary Aad-ons for Ground Ambulance Services
The federal government is funded through annual appropriations enacted by Congress. Funding for the federal government’s current fiscal year is currently set to expire today, September 30, 2025. If Congress fails to pass a spending package for the full year – – or a temporary funding package for a shorter period (known as a “continuing resolution”) – – many federal agencies will have to curtail their activities. On September 18, 2025, the House of Representatives passed a continuing resolution that would have funded the federal government through November 21, 2025; however, that bill failed to pass the Senate. As a result, barring a last-minute deal, a federal government shutdown will commence on October 1, 2025.
A government shutdown is not expected to impact Medicare payments to health care providers, i.e., Medicare Administrative Contractors will continue to process and pay Medicare claims. However, past government shutdowns have impacted other Medicare operations, including provider enrollment and pre- and post-payment audit activities. Providers that are currently in the process of enrolling and/or revalidating their Medicare enrollment may experience delays in the processing of these applications.
As a reminder, existing law requires that Medicare Administrative Contractors hold claims for a minimum of fourteen (14) days. This “payment floor” would provide a bit of breathing room in the event of a relatively short federal shutdown. If, however, a shutdown continues for longer than 2 weeks, it is likely that Medicare contractors would be forced to pay ambulance claims with dates of service on or after October 1, 2025 at the statutorily required amount (i.e., an amount that does not take into account the current add-ons). If the spending deal to reopen the government includes the retroactive extension of those add-ons, the MACs would need to subsequently adjust any payments made at that lower amount. There is precedent for such retroactive adjustments. Of course, the current hope is that a deal can be reached early enough to avoid the need for any retroactive adjustments.
Thus, while Medicare payments for ambulance services will continue without interruption, the payment amounts will be impacted. This is because the temporary add-ons for ground ambulance services (i.e., the 2% urban, 3% rural, and super-rural bonuses) are currently set to expire on September 30, 2025. The hope is that any deal to avert a shutdown and/or to reopen the government after any potential shutdown will include an extension of these critical add-ons.
The American Ambulance Association is monitoring the situation closely, and will continue to keep our members updated as new information become available.
National Ambulance Provider and Supplier Coalition Meeting: May 22, 2025
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House Reintroduces Vital Medicare Extender and EMS Workforce Bills
Medicare Ambulance Extender Bill Introduced in House
Yesterday, March 18, Representatives Claudia Tenney (R-NY), Terry Sewell (D-AL), Cliff Bentz (R-OR), Paul Tonko (D-NY), Mike Carey (R-OH), Danny Davis (D-IL), Carol Miller (R-WV) and Marie Gluesenkamp Perez (D-WA) reintroduced the Protecting Access to Ground Ambulance Medical Services Act (H.R. 2232). This legislation would extend the temporary Medicare ambulance add-on payments at their current levels of 2% urban, 3% rural and 22.6% super rural until January 1, 2028.
The AAA and our partners at the International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of Emergency Medical Technicians (NAEMT) and National Rural Health Association (NRHA) have spearheaded efforts to extend and increase the levels of the Medicare ambulance add-on payments. We expect to see a Senate bill with the higher levels of 3.4% urban, 4.3% rural and 26.7% super rural introduced in the near future.
EMS Workforce Shortage Bill Introduced in House
Additionally, yesterday Representatives Marie Gluesenkamp Perez (D-WA), Brad Finstad (R-MN), Randy Feenstra (R-IA), Suzanne Bonamici (D-OR), Michael Lawler (R-NY), Josh Harder (D-CA) reintroduced the Preserve Access to Rapid Ambulance Emergency Medical Treatment Act (PARA-EMT Act). H.R. 2220 would provide funding for grants to help recruit and train paramedics and EMTs, reduce barriers that prevent veteran medics transitioning to civilian paramedics and EMTs, and request the Secretary of Labor to conduct a study on the EMS workforce shortage and report their findings.
The legislation is supported by the AAA, NAEMT and NRHA. A copy of the press release on the introduction of H.R. 2220 can be found here.
Congress Extends Ambulance Add-On Payments Through September 30
Yesterday evening, March 14, the United States Senate by a vote of 54 to 46 passed the Full-Year Continuining Appropriations and Extensions Act, 2025 (H.R. 1968) to fund the federal government through the end of the 2025 fiscal year ending September 30. An extension of the current levels of the temporary Medicare ambulance add-on payments was included in H.R. 1968 with an expiration date of also September 30. President Trump is expected to sign H.R. 1968 into law shortly.
The AAA, our champions and supporters on Capitol Hill, and EMS partner organizations fought hard to ensure the ambulance extension was included in the lean bill of just 99 pages. We greatly appreciate the outreach by the AAA membership and state EMS associations to their members of Congress in support of the extension of the ambulance add-on payments. The AAA will continue to advocate for a long-term extension of the add-on payments at the higher levels of 3.4% urban, 4.3% rural and 26.7% super rural.
Revised versions of the Protecting Access to Ground Ambulance Medical Services Act with a long-term extension of the add-on payments, and at the higher levels in the Senate bill, will be reintroduced in the near future. Once introduced, we will be launching a new Call To Action asking you to contact your members of Congress to cosponsor the legislation
President Jamie Pafford-Gresham on the Ambulance Medicare Extenders
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AAA Releases 2025 Medicare Rate Calculator
On December 23, 2024, CMS posted a revised version of the CY 2025 Ambulance Fee Schedule Public Use Files on its website. These files contain the Medicare allowed amounts for the various levels of ambulance service and mileage. The file is organized by state, and by payment locality within each state. The 2025 Ambulance Fee Schedule Public Use File can be viewed by clicking here.
Unfortunately, CMS has elected in recent years to release its Public Use Files without state and payment locality headings. As a result, in order to look up the rates in your service area, you would need to know the CMS contract number assigned to your state. This is not something the typical ambulance service would necessarily have on hand. For this reason, the AAA has created a reformatted version of the CMS Medicare Ambulance Fee Schedule, which includes the state and payment locality headings. Members can access this reformatted fee schedule below.
The American Ambulance Association is also pleased to announce the release of its 2025 Medicare Rate Calculator tool. The AAA believes this is a valuable tool that can assist members in budgeting for the current year. This calculator has been updated to account for recent changes in Medicare policies, including the 2025 Ambulance Inflation Factor and the extension of the temporary adjustments for ground ambulance services (i.e., 2% urban, 3% rural, and super rural bonus) through March 31, 2025. This extension was the result of Section 3203 of the American Relief Act, 2025. Barring further legislation, these temporary adjustments will expire on March 31, 2025.
Note on Medicare Sequestration: Both the Ambulance Fee Schedule Public Use Files and the AAA Medicare Rate Calculator display the current Medicare allowables. Neither takes into account the impact of so-called “budget sequestration” on Medicare payments. By law, the sequester requires Medicare contractors (and Medicare Advantage insurers) to reduce the amounts they pay under the Medicare Ambulance Fee Schedule by 2% (i.e., 2% off the 80% of the Medicare allowable typically paid by the Medicare contractor).
CMS Posts Revised 2025 Public Use File
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A Message from AAA President Jamie Pafford-Gresham
Happy New Year from Our New Association President
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Congress Extends Medicare Ambulance Add-On Payments
On Saturday, December 21, the American Relief Act of 2025 (H.R. 10545) became law and thereby averted a partial federal government shutdown. Of critical importance to ground ambulance service organizations, H.R. 10545 also extends the temporary Medicare ambulance add-on payments of 2% urban, 3% rural and 22.6% super rural through March 31, 2025. In addition, the new law wipes clean the PAYGO scorecard preventing a potential 4% cut in Medicare reimbursement for ground ambulance and other Medicare services.
The House of Representatives passed by a vote of 366 to 34 the Continuing Resolution (H.R. 10545) to extend funding for the federal government just hours before reaching the previous funding deadline of midnight on December 20th. The Senate then passed H.R. 10545 by a vote of 85 to 11 late that evening. The CR funds the federal government primarily at current funding levels through March 14, 2025.
The negotiations on the American Relief Act were extremely tense with a more robust initial legislative package, which would have extended the Medicare ambulance add-ons for two years, being replaced with a slimmer bill with fewer and shorter health care provisions. The extension of ground ambulance service payments ended up being just one of twenty-five provisions in the final 118-page Continuing Resolution, which was originally over 1,600 pages.
The AAA greatly appreciates the advocacy of our champions and supporters on Capitol Hill to ensure that the temporary ambulance payments extension was included in the final CR. We also want to thank our AAA members for reaching out to their members of Congress to request their help with the add-on payments. We will continue to push for a longer extension of the ambulance payments at percentages higher than the current levels upon the expiration of the CR.
CMS Notifies Individuals Potentially Impacted by WPS Data Breach
On September 6, 2024, the Centers for Medicare and Medicaid Services (CMS) announced that CMS and its contractor, Wisconsin Physician Service Insurance Corporation (WPS), have begun the process of notifying nearly a million Medicare beneficiaries that were potentially impacted by a data breach involving WPS.
The data breach involved WPS’ use of the third-party application MOVEit. MOVEit is a file transfer application developed by Progress Software. In May 2023, a hacker group called CL0P discovered a security vulnerability that allowed the company to steal sensitive information from secure databases used by numerous governmental agencies and corporations. This included the protected health information (PHI) of Medicare beneficiaries and non-Medicare beneficiaries stored within WPS’ databases.
The notices inform affected Medicare beneficiaries of the steps they can take to protect themselves. As part of its remedial efforts, WPS is offering affected Medicare beneficiaries one year of free credit monitoring from Experian.
CMS indicated that it was not aware of any reported incidents of fraud or improper use of a Medicare Beneficiary Identifier (MBI). However, CMS noted that, if the beneficiary’s MBI was potentially impacted, they would mail a new Medicare card with a new MBI to the patient. Thus, the data breach has the potential to impact the patient demographic information you currently maintain within your billing systems. This is especially true for AAA Members that operate in Medicare jurisdictions currently administered by WPS (Iowa, Indiana, Kansas, Michigan, Missouri, and Nebraska). Specifically, the MBIs on file for existing patients may no longer be accurate. This also has the potential to impact Medicare eligibility information that you receive from other parties like hospitals, skilled nursing facilities, etc.
AAA Members will have to make a business judgment on how to address these potential concerns. One possible option would be to implement a process to confirm the MBI of existing patients prior to the submission of new claims. Another possible option might be to implement internal procedures to flag claims that are denied for an incorrect MBI as potentially related to this issue, and to then verify the patient’s correct MBI prior to resubmitting any denied claims.
2023 Year-End Government Affairs Update
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AAA Releases 2024 Medicare Rate Calculator
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Impact of Partial Government Shutdown on Healthcare
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Preserving Access to Ground Ambulance Medical Services Act of 2023
Earlier today, Senators Catherine Cortez Masto (D-NV), Susan Collins (R-ME), Debbie Stabenow (D-MI) and Bill Cassidy, MD (R-LA) introduced the Preserving Access to Ground Ambulance Medical Services Act of 2023. The legislation would extend the temporary Medicare ambulance add-on payments for an additional three years.
“We thank Senators Cortez Masto, Collins, Stabenow, and Cassidy for introducing the Preserving Access to Ground Ambulance Medical Services Act and for their strong support for ground ambulance services and the communities and patients we serve,” said AAA President Randy Strozyk. “The disparity between Medicare reimbursement and the costs of providing services has grown significantly through reductions in reimbursement and skyrocketing expenses for labor, ambulances, and equipment. This bill would help reduce that gap and maintain access to vital ground ambulance services for communities around the country.”
The Senate version of the bill would go even further by increasing the add-on payment levels for urban from 2% to 3.4% urban, for rural from 3% to 4.3% rural and for super rural from 22.6% 26.2%. The last extension of the add-on payments was scheduled to end on December 31, 2022, but our champions on Capitol Hill were able to secure a two-year extension through December 31, 2024. The additional three-year extension is critical to keep the add-on payments in place through ambulance data collection and provide time to Congress to then use the data to reform the Medicare ambulance fee schedule.
Representatives Brad Wenstrup (R-OH), Terri Sewell (D-AL), Buddy Carter (R-GA) and Paul Tonko (D-NY) introduced the House version (H.R. 1666) of the bill on March 17. The House bill would be a three-year extension of the add-on payments at their present levels.
This progress is the result of tireless advocacy on the part of AAA volunteer leaders, staff, and consultants made possible by the sustained support of our members. It is critical that AAA members reach out to both their Senators and Representatives to cosponsor the respective versions of the Preserving Access to Ground Ambulance Services Act of 2023. It is vital that we generate a groundswell of support in the Congress for extending the add-on payments and will need that support to then also advocate for the higher add-on percentages when Congress negotiates on Medicare payment extensions.
Letter to VA Reimbursement of Ambulance Services
The AAA has sent a letter to VA Secretary Denis McDonough asking him to delay the implementation of a final rule that would allow the Department of Veterans Affairs (VA) to reimburse at the lower of billable charges or Medicare rates for certain non-contracted ambulance services. The proposed rule was issued back in 2020 but we understand that the VA could now issue the final rule in January 2023. GMR has been advocating on Capitol Hill for a delay in air and ground ambulance services. The AAA will be issuing later today a request for AAA members to reach out to the VA to also request the delay.
December 12, 2022
The Honorable Denis McDonough
Secretary of Veterans Affairs
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Secretary McDonough,
The American Ambulance Association (AAA) respectfully requests that the Department delay release and implementation of the final rule on the “Change in Rates VA Pays for Special Modes of Transportation (RIN 2900-AP89).” Reimbursing for services to veterans at Medicare rates would have dire consequences for the ability of ground ambulance service organizations to provide lifesaving 9-1-1 emergency and also interfacility ambulance services not only to veterans but entire communities. We ask that the Department delay the rule until after Congress has had an opportunity to act on the results from the Medicare ambulance data collection system which is currently underway.
As documented by the Government Accountability Office (GAO) in 2007 and 2012, the Medicare program reimburses ground ambulance service organizations below the cost of providing their services when temporary add-ons are not considered. Since 2012, the disparity between the cost of providing ambulance services and reimbursement by Medicare has only increased through sequestration cuts, a reduction in inflation updates, and other Medicare payment policy changes. Ground ambulance service organizations are already facing difficult financial straits and cannot
sustain a reduction in reimbursement from another federal payor.
Ground ambulance service organizations serve as the foundation for emergency medical response for veterans and communities throughout the country. Our members are a vital component of our local and national health care and 9-1-1 emergency response systems and serve as lifelines of medical care for many rural and underserved communities. However, our ability to continue to serve communities is already at risk due to inadequate reimbursement and access to care for veterans would be further jeopardized if the Department were to reimburse at lower levels for ground ambulance services.
The AAA is the primary association for ground ambulance service organizations, including governmental entities, volunteer services, private for-profit, private not-for-profit, and hospital-based ambulance services. Our members provide emergency and non-emergency medical transportation services to more than 75 percent of the U.S. population. AAA members serve
patients in all 50 states and provide services in urban, rural, and super-rural areas.
Again, we request that you delay the release and implementation of the final rule on the “Change in Rates VA Pays for Special Modes of Transportation”.
If you have any questions regarding our request, please do not hesitate to have a member of your staff contact AAA Senior Vice President of Government Affairs Tristan North. Tristan can be reached by phone at (202) 802-9025 or email at tnorth@ambulance.org.
Thank you in advance for your consideration.
Sincerely,
Shawn Baird
President