Government shutdown continues
After taking multiple votes, the Senate failed for a second week to pass a continuing resolution (CR) to reopen the federal government. Republicans were unable to break a Democratic filibuster to end debate and pass the House-passed CR extending current fiscal 2025 funding levels for federal agencies and programs through Nov. 21.
The Democrats’ alternative bill, which funds the government through Oct. 31, permanently extends the ACA enhanced advance premium tax credits, and repeals some health care provisions from the One Big Beautiful Bill Act including the Medicaid provisions, failed on multiple straight party line votes.
Both measures would, among other things, also extend several expiring Medicare provisions, including but not limited to:
Medicare coverage of telehealth health flexibilities (the pandemic-era flexibilities expired Sept. 30)
Medicare waivers for Hospital at Home programs
The floor for work geographic practice cost indices
The AMA continues to monitor the situation for opportunities to advocate for physicians and their patients during this politically sensitive process.
Impact of government funding shutdown on Medicare telehealth
As a reminder, physicians who provide telehealth services to Medicare patients should be aware that the Medicare telehealth flexibilities lapsed for care to all patients except those being treated for mental health or substance use disorders. This means that telehealth services are limited to rural areas as they were before the COVID public health emergency and that patients cannot receive telehealth services in their homes. Note, however, physicians in certain Medicare Shared Savings Program accountable care organizations (ACOs) (PDF) can continue to provide and be paid for telehealth services. In addition, the ability to provide audio-only services to Medicare patients lapsed, as did the Acute Hospital Care at Home program.
No Surprises Act dispute resolution remains up during government shutdown
The Centers for Medicare & Medicaid Services (CMS) confirmed last week that the Independent Dispute Resolution (IDR) process, used for resolving out-of-network claims under the No Suprises Act (NSA), will remain open during the government shutdown, and disputing parties should continue to submit claims. The IDR process is largely run on administrative fees paid to use the process and therefore is not dependent on government funding. However, CMS warned that there may be other delays associated with a prolonged lapse in government funding, including in the review and processing of IDR complaints and response times to inquiries.
This comes as the administration has been working to address the backlog of IDR claims in the system. In September, the administration released a fact sheet (PDF) that states that as of July 2025, 96.5% of all IDR disputes submitted since the beginning of the program have either been resolved or are less than 30 business days old. Physicians have been highlighting (PDF) the delays associated with the IDR process for years as detrimental to the financial stability of practices waiting for payment.
