Health Policy and Advocacy

CMS has posted an update to its website clarifying that all Medicare Administrative Contractors (MACs) have been instructed to continue holding claims with dates of service on or after October 1, 2025, for services affected by the expired Medicare legislative payment provisions as a result of the budget impasse in Washington, DC. Specifically, the applies to the telehealth flexibilities in the Medicare program, ie: geographic originating site limitations and the use of telehealth for the F2F visit for hospice recertification. The notice corrects an earlier Medicare Learning Network (MLN) article that incorrectly suggested all Medicare Physician Fee Schedule claims were subject to the hold.

CMS previously explained that the temporary hold “prevents the need for reprocessing large volumes of claims should Congress act after the statutory expiration date” to extend these provisions. Despite the ongoing government shutdown, CMS clarifies that the hold is consistent with the statutory 14-day payment floor and that no payment delays have occurred. Importantly, CMS states that MACs will continue to process and pay held claims in a timely manner with the exception of select claims for services impacted by the expired provisions.

AAHPM members should work directly with their institutions on how they intend to handle the use of telehealth for Medicare patients during the shutdown. In previous years, Congress has restored any lapsed policies retroactively to the date of the shutdown. However, we do not know how this shutdown will be resolved at this time. AAHPM continues to monitor the situation and work with our partners as things develop.

As of October 1, 2025, as the Trump Administration and Republican and Democratic leaders failed to reach an agreement on the fiscal year (FY) 2026 budget or a stopgap measure, the federal government shut down.

The Centers for Medicare and Medicaid Services (CMS) has a contingency plan which states that outlines which functions will continue during this time. The Medicare Program will continue. CMS has sufficient funding to fund Medicaid for the first quarter of FY 2026, so that program will also continue. And staff will be maintained to make necessary payments to states for the Children’s Health Insurance Program (CHIP). CMS will also continue its Federal Marketplace (ACA plans) activities such as eligibility verification. Health Care Fraud and Abuse Control (HCFAC) and Center for Medicare and Medicaid Innovation (CMMI) activities will also continue.

Slowdowns or suspensions of activities are expected for certain CMS activities such as health care facility survey and certification; policy development and rulemaking; contract oversight; and beneficiary casework. This is due to around 47% of CMS staff to be put on temporary unpaid leave. During this time, CMS has also directed Medicare Administrative Contractors (MACs) to implement a temporary claims hold, which is typically up to 10 business days. This is expected to have a minimal impact on physicians, as MACs are already required to hold claims for a minimum of 14 days, known as the “payment floor”.

The Medicare telehealth flexibilities that have been in place since the pandemic have now lapsed, except for patients being treated for mental health or substance use disorders. Medicare is reverting back to telehealth being limited to rural areas and patients cannot receive telehealth services in their homes. The face-to-face visit for the purpose of hospice recertification can no longer be done via telehealth. Additionally, the ability to provide audio-only services to Medicare patients has also lapsed. AAAHPM members should discuss how their institutions are intending to handle these situations.

CMS has noted that clinicians in some Medicare Shared Savings Program accountable care organizations (ACOs) can continue to provide and be paid for telehealth services.

Funding for community health centers, teaching health centers that operate graduate medical education programs, and the National Health Services Corps have also expired. As have special diabetes programs; public health emergency authorities; quality measure endorsement, input and selection; and outreach and assistance for low-income programs.

A separate contingency plan from the Department of Health and Human Services (HHS) states that NIH will continue research necessary for the protection of human life or government property, but it appears they will not be moving forward on any new grant awards. Additionally, NIH will not have the ability to admit new patients to the Clinical Center, except for whom it is medically necessary.