|
Congress Ends Government Shutdown: What It Means for Long Term Care
As you may have seen, Congress struck a deal to reopen the federal government. Wednesday, the House passed the government spending package that was passed by the Senate earlier in the week. It now heads to the President’s desk, where he is sure to sign.
This was the longest government shutdown in American history. While we are aware of the challenges that some providers have experienced from a survey and regulatory standpoint, fortunately, our sector was less impacted than others thanks to our essential services and mandatory funding for Medicare and Medicaid. Here is a rundown of key provisions in the deal as well as what comes next with federal government operations resuming.
What’s in the Bill
Congress negotiated a deal that includes a continuing resolution (CR) extending current government funding through January 30, 2026. The agreement also includes:
- a Senate vote in December on a health care bill of Democrats’ choosing—presumably a vote on the enhanced Affordable Care Act’s subsidies that are slated to expire at the end of the year and were the primary issue causing the shutdown;
- three separate spending bills to cover programs related to agriculture, military construction and legislative agencies for most of 2026; and
- reversing the federal workforce reductions in force (RIF) actions taken since October 1, as well as protections against future RIFs for the duration of the CR (through January 30th).
Of specific importance to the long term and post-acute care profession are:
-
Telehealth waivers: The waivers expired on September 30th when Congress was unable to reach a deal and the shutdown began. The compromise that passed this week reinstates the telehealth flexibilities retroactively from October 1 through January 30, 2026. Key waivers that were restored temporarily include:
- Removal of the geographic limitations for medical telehealth services so they can again be furnished nationwide, including in a person's home such as an assisted living residence.
- Restores physical therapy, occupational therapy and speech-language pathology providers as eligible to furnish telehealth services.
- Restores a delay in Medicare in-person requirement for mental health services furnished through telehealth or audio-only telecommunications technology.
- Restores the use of telehealth to conduct face-to-face encounters for Hospice recertification purposes.
-
Work Geographic Index Floor: Temporarily and retroactively restores nationwide the 1.0 payment floor multiplier for the work component of Medicare Part B services paid under the physician fee schedule. This is effective October 1, 2025 through January 30, 2026.
- Extension of funding for quality measure endorsement, input, and selection.
-
Sequestration: This legislation prevents the triggering of statutory 4% PAYGO sequestration cuts to Medicare.
A Return to Normal
Federal agencies, including HHS, will resume full operations. While essential functions, such as Medicare and Medicaid payments and some HUD programs, have continued, delays in processes are expected as agencies return to working order.
With most government staff returning to their positions, agencies will begin processing the backlog of work created during the shutdown. This includes, but is not limited to, impacts on the following activities:
- Survey activities including recognition of surveys conducted during the shutdown
- Deferred survey components
- Deficiency findings and enforcement actions
- The resumption of normal corrective actions
- Medicare certification for new facilities, including initial surveys
- Immediate Jeopardy (IJ) special situations
- Updates to the Five-Star Quality Rating System
Please keep in mind that responses to inquiries to CMS staff may be delayed as staff return to their positions.
Rule-making and other guidance development, which were delayed, will also now fully resume. We anticipate a lot of activity in the coming months, and we continue to engage with CMS on key policies.
What Comes Next
AHCA/NCAL will continue to monitor post-shutdown developments and once more information is available, we’ll provide updates.
We also look forward to advancing our Better Way agenda now with the federal government reopened. Specifically, we remain optimistic that we can make progress on bringing forth more rational regulations and improving Medicare Advantage for the sector.
Clifton J. Porter, II
President & CEO, AHCA/NCAL
| 
