All the King’s Horses Working to Avert Government Shutdown

Literature is ripe with classic phrases that seem timelessly apropos. For example, take the partial federal government shutdown. For days, the phrase repeated in the marble corridors of Congress and in America’s newsrooms has been “the stroke of midnight.”

Specifically, that would refer to the deadline for arriving at an agreement to keep the lights on, even as Friday’s deadline looms.

For most Americans, Friday will simply mark another day closer to the celebration of Christmas and Hannukah. But for thousands of federal employees, a government shutdown would impact their financial situation at one of the worst possible times of the year. A shutdown could also impact important healthcare priorities inside the 1,500-page Continuing Resolution (CR) that needs a “yea” vote to keep government services from stopping.

“(The) key items for providers in the proposed CR were an extension of the Medicare telehealth exceptions, and a removal of most of the Medicare pay cut for physicians,” retired Centers for Medicare & Medicaid Services (CMS) career professional Stanley Nachimson wrote.  

Nachimson, a regular panelist on the ICD10monitor-produced Talk Ten Tuesdays weekly Internet broadcast, said he didn’t foresee “much impact on Medicare auditing at this point,” but added that some healthcare provisions would be eliminated.

Matthew Albright, another former CMS career professional and now the chief legislative affairs analyst for Zelis, reported to RACmonitor that among the healthcare-related items tucked inside the massive CR bill were the following:

• Provider reimbursement: The bill adds a “supplementary boost” to the Medicare Physician Fee Schedule (PFS) conversion factor of 2.5 percent for 2025;

• Telehealth: Extends pandemic flexibilities through 2026;

• PBM reform: Requires Pharmacy Benefit Managers (PBMs) to “fully pass through 100%” of drug rebates and discounts to the employer/plan; prohibits PBMs from retaining a portion of the amount paid (a “spread”) for prescription drugs in the Medicaid program; and prohibits PBMs from deriving renumeration for covered Part D drugs based on the price of the drug; and
  
  
• Medicare Advantage (MA) Provider Directories: Requires MA plans to maintain accurate directories.

“The CR version released Tuesday evening had a total of 113 healthcare-related provisions,” wrote Albright.

Ronald Hirsch, vice president of R1-RCM and a longtime panelist and editorial contributor to Monitor Mondays, appeared to be concerned about the shutdown’s impact on healthcare.

“The risk seems to be CMS staff, along with tens of thousands of other government employees, including our military, not getting paid,” Hirsch wrote in an email to RACmonitor. 

Adding to the lexicon of relevant and perhaps somewhat hackneyed colloquialisms would be that “the show must go on” – specifically, the efforts on the part of legislators to see if the CR can be resurrected or a different stopgap legislative agreement reached.

Until then, we wait until the “stroke of midnight.”