Health Care Implications Should a Federal Government Shutdown Occur

By: Nancy Spector, WEDI Senior Director, Federal Affairs

The federal government’s fiscal year ends at midnight on September 30 and without passage of a budget or continuing resolution (CR) the shutdown will happen. Should a shutdown occur, there are significant implications for the health care sector.

During a shutdown, mandatory spending will continue and many Department of Health and Human Services (HHS) programs fall into this designation, such as Medicare, Medicaid, and the Children’s Health Insurance Program. Discretionary spending and programs related to it, however, could stop. In addition, dozens of other health care priorities unrelated to funding could be caught in the crosshairs.

Medicare Telehealth Flexibilities

Several Medicare telehealth flexibilities introduced during the Covid-19 public health emergency (PHE) have been made permanent, but there are a few critical ones that are set to expire on September 30 if no Congressional action is taken. They include:

· Originating Site (Location where the patient gets medical services through telehealth.)

Prior to the PHE, patients were required to be at an originating site in a certain geographic location to receive medical services via telehealth. The telehealth flexibilities allowed patients to receive telehealth wherever they were located, such as their home, without any geographic restrictions. This allowance has been very popular among patients and credited with increased patient access to health care. Without an extension, the originating site requirements and geographic location restrictions will return for non-behavioral or non-mental telehealth. Continuation of telehealth services without originating site requirements or geographic location restrictions will be allowed for diagnosing, evaluating, or treating mental health disorders and substance abuse disorders and monthly end-stage renal disease-related clinical assessments.

· Distant Site (Location where the physician or qualified health care professional performs the telehealth service.)

Before the PHE, only certain types of distant site providers could provide telehealth services. With the flexibilities, all health care professionals eligible to bill Medicare, including physical therapists, occupational therapists, speech-language pathologists, and audiologists, can provide distant site telehealth services. Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are also able to serve as distant site providers for non-behavioral or non-mental telehealth services. Without an extension, physical therapists, occupational therapists, speech-language pathologists, and audiologists will no longer be eligible to provide telehealth services. Providers will have to provide telehealth services at their currently enrolled practice location. FQHCs and RHCs will no longer be allowed as distant sites for non-behavioral or non-mental telehealth services. Permanently, FQHCs and RHCs can serve as distant sites for behavioral or mental telehealth services.

· Technology

Most non-behavioral or non-mental telehealth services require the use of two-way, interactive, audio-video technology. The flexibilities have allowed the use of audio-only telehealth for some non-behavioral or non-mental telehealth. Without an extension, this flexibility will end.

· Other Requirements

The use of telehealth to conduct hospice care eligibility recertification has been allowed. The requirement to conduct an in-person visit within 6 months of the initial behavioral or mental telehealth visit, and annually thereafter, has been waived. Without an extension, these flexibilities will end.

Programs

· Acute Hospital Care at Home Program

The Acute Hospital Care at Home program is a Centers for Medicare & Medicaid Services (CMS) waiver program that was launched in March 2020 and has been extended by Congress three times. The program allows for certain health care services to be provided outside of a traditional hospital setting and within a patient’s home. In the five years of the program, feedback on the program has been positive and data have shown lower mortality rates, lower readmission rates, and decreased costs for participants. Senate and House bills introduced in July, currently in their respective committees, call for a five-year extension of the program. Congressional action is necessary for this program to continue after September 30.

· In-Home Cardiopulmonary Rehabilitation Flexibilities

Starting during the PHE, the in-home cardiopulmonary rehab flexibilities allowed for the use of audio-visual real-time telehealth services in the patient’s home by designating the patient’s home as a provider-based location of a hospital outpatient department. Services, including exercise and education programs, are supervised through remote audio-visual technology.

The “Sustainable Cardiopulmonary Rehabilitation Services in the Home Act” was introduced in the Senate in January but no further action has been taken on it. The flexibilities have been previously extended and are now set to expire on September 30.

Cybersecurity Information Sharing Act

The Cybersecurity Information Sharing Act of 2015 (CISA 2015) requires reauthorization to prevent it from sunsetting on September 30. The intent of CISA 2015 is to support collaboration between the private sector and federal government and sharing of cyber threat indicators and defensive measures. The law provides liability protections for private organizations when sharing information with the Department of Homeland Security. Without the law, there are concerns that critical information sharing will stop. While the reauthorization of the law is not tied to the issue of government funding, it has the misfortune of needing Congressional action at the same time as the budget showdown.

Other Expiring Items

Other items set to expire on September 30 include the Medicaid Disproportionate Share Hospitals payments and the Medicare-Dependent Hospitals and Low-Volume Adjustment programs that support small, rural hospitals.

Expired Health Laws and Programs

In addition to the items set to expire on September 30, Congress has other expired laws and programs to address in the future, including the Advanced Alternative Payment Model bonus payments (expired 12/31/24), Pandemic and All-Hazards Preparedness Act (expired 12/31/24), Older Americans Act (expired 9/30/24), and Rare Pediatric Disease Priority Review Voucher Program (expired 12/31/24).

This is not an inclusive list of health laws, programs, and flexibilities that are set to expire on September 30 or other expired items that face an uncertain future without enactment of a federal budget or CR extension. Those in health care, like the rest of the nation, will be watching closely to see if an agreement on the budget is reached before midnight tomorrow.