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The U.S. Senate failed to pass a resolution to fund the federal government before the Sept. 30 deadline on Tuesday.
Among many other far-reaching consequences of this most recent government shutdown, it means the sun has set on the latest extension of CMS telehealth and Acute Hospital Care at Home program flexibilities, which had been extended numerous times since they were first authorized as part of the COVID-19 public health emergency in 2020.
With the government now shut down, patients who have become used to Medicare coverage for telehealth and hospital-at-home could see disruptions in care. And some providers could halt investments in these programs, despite their rapid growth and popularity over the past five years.
After weeks of urging lawmakers to act and ensure virtual care access with an immediate temporary extension, healthcare advocacy organizations say some health systems are considering suspending these virtual care services altogether.
Until these providers are confident about the future of reimbursements, they say, they may steer patients to in-person care alternatives or else simply try to weather potential financial losses.
Uncertain reimbursements
Russell Vought, director of the White House Office of Management and Budget, directed government agencies to execute their shutdown plans on Sept. 30.
While Medicare payments would continue under the U.S. Centers for Medicare and Medicaid Services under the government shutdown contingency plan, the legal authority for reimbursement to telehealth and hospital-at-home programs expired Tuesday due to lawmakers' inaction.
That means certain chronic care management and behavioral services that vulnerable populations rely on would be affected, and any new applications for Medicaid services would likely be delayed or halted. Workers have also come to rely heavily on telehealth and the Acute Hospital Care at Home program services since Medicaid flexibilities launched in 2020.
The American Telemedicine Association and others had supported and endorsed a temporary extension through Nov. 21 that was proposed in the U.S. House of Representatives a few weeks ago.
But while there's generally been bipartisan support for telehealth flexibilities and efforts to permanently extend improved care access for millions, the threat of the constant expirations has resulted in great uncertainty across the healthcare sector.
"Amid this repeated headache, some providers are seriously considering eliminating telehealth and remote patient monitoring," said Tom Leary, senior vice president and head of government relations at HIMSS, told Healthcare IT News on Tuesday.
"This is even as telehealth has shown extreme successes in breaking down geographic and logistical barriers for millions of Americans," he added.
This past month, HIMSS, parent company of Healthcare IT News, and numerous other healthcare organizations urged Congress to act to maintain support for virtual care.
"Extending current Medicare telehealth flexibilities will preserve access, ensure continuity of care and allow the U.S. health system to keep innovating to meet the needs of every patient, everywhere," said Leary.
Gambling on future policy
Some providers could continue to offer telehealth services, taking a gamble that they will get paid retroactively after the shutdown is resolved and their claims are assessed by CMS. (No information was available on the CMS website about virtual care reimbursements during the shutdown at press time.)
Responding to our request for comment, a spokesperson for the ATA noted that its members are navigating the challenges of the government shutdown in real time and are approaching their go-forward strategy in different ways.
The shutdown is forcing healthcare providers and systems to make difficult decisions regarding telehealth services, with some providers continuing care or planning to absorb costs, "in hopes that a retroactive reimbursement provision will be enacted, recognizing that critical care outweighs the risk," the ATA spokesperson said by email Wednesday.
"Others are prioritizing patient care immediately while preparing for additional operational or financial actions if the shutdown continues," they added. "In inpatient settings, some hospitals are absorbing costs."
But some other providers and hospitals are already blocking beneficiaries from scheduling virtual visits to mitigate risk, the ATA spokesperson said.
While some small clinics "are continuing to see patients while monitoring the evolving situation," they added, "they cannot sustain this model without certainty; prolonged uncertainty may lead to significant financial strain and, in some cases, force closures."
Meanwhile, "providers are communicating to patients that they may be responsible for fronting costs if CMS reimbursement is delayed," according to the ATA.
"Medicare patients woke up this morning without telehealth coverage for the first time since the pandemic, five years ago," Kyle Zebley, executive director of ATA Action and senior vice president for public policy at the ATA, said in a statement. "Our healthcare services are regressing, falling woefully short for millions of patients in need.
"Most providers and hospital systems are taking calculated risks to continue care during this time, but long-term continuity depends on action by our telehealth champions in Washington to restore these flexibilities and ensure retroactive reimbursement."
Healthcare IT News has reached out to the Department of Health and Human Services – which is expected to furlough 41% of its employees during the shutdown – to ask whether any claims for reimbursement would be paid once the government is in operation again and an extension for virtual care programs is granted. We will update this article if a statement is provided.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
