At EMS|MC, part of our responsibility is keeping your agency informed of federal developments that directly impact reimbursement, operations and the future of EMS care. This month, three significant actions out of Washington deserve close attention.
Ambulance Inflation Factor Announced
On Monday, CMS released Transmittal 13464 (CR 14269), announcing a 2.0% Ambulance Inflation Factor (AIF) for dates of service on or after January 1, 2026. The AIF reflects the annual CPI-U inflation adjustment reduced by the Multifactor Productivity (MFP) offsetโan important indicator of how Medicare reimbursement will shift in the coming year.
Government Shutdown Ends: Key EMS Impacts
This update follows the conclusion of the longest government shutdown on record, which ended November 12, 2025.
What this means for your agency:
(1) Medicare Extenders Restored
The Medicare add-ons (2% urban, 3% rural, 22.6% super-rural) are extended through January 30, 2026, and retroactive to October 1, 2025.
โข Claims held during the shutdown should now process at the correct amountsโplease verify this carefully.
โข Monitor Medicare Advantage Plans closely to ensure each plan processes the add-ons appropriately.
(2) S-PAYGO Cuts Avoided (For Now)
The potential 4% PAYGO sequestration reduction has been prevented at this time.
Important:
Retroactive application means MACs and Medicare Advantage Plans may take additional time to reprocess claims and issue corrected payments.
This bill only funds the government through January 30, at which point Congress will need to revisit all funding issuesโincluding the future of Medicare extenders.
Bipartisan CARE Act Advances in Congress
Congress is also considering the Comprehensive Alternative Response to Emergencies (CARE) Act, which would pilot Medicare reimbursement for treat-in-place care.
Whatโs happening
Sens. Susan Collins (R-ME) and Peter Welch (D-VT) introduced the CARE Act to establish a five-year Medicare pilot reimbursing EMS for treatment provided on scene without transport.
Early program models saved Medicare over $500 per encounter, reduced unnecessary transports, and relieved system strain.
Support comes from:
โข National Association of Emergency Medical Technicians
โข North East Mobile Health Services
โข International Association of Fire Chiefs
Why this matters
โข Recognizes EMS care beyond transport
โข Supports better patient outcomes and system efficiency
โข Helps financially strained and rural agencies
โข Reduces the uncompensated burden of non-transport calls
EMS|MC will continue to monitor all of these developments and will release any updated information, new insights or additional steps that need to be taken as the situation continues to develop.