Nursing Home Leaders Relieved to Focus On Pending Legislative Issues as Government Shutdown Is Averted

A government shutdown has been temporarily averted – for 45 days at least – after Congress passed a stopgap bill Saturday evening. And while skilled nursing and other long-term care operators and their reimbursements would not have been immediately impacted, the industry could have seen indirect ramifications.

So for now, the sector – whose members were in attendance Sunday at an annual conference for the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) – greeted the news with relief.

“We’re so happy that Congress was able to pass the continuing resolution,” Cynthia Morton, executive vice president at Advion, the advocacy group for ancillary service providers and suppliers in the long term and post-acute care community, told Skilled Nursing News.

Mandatory programs such as Medicare and Veterans Affairs-related reimbursements must continue even if the government suspends discretionary spending. Also, because state governments are responsible for managing the Medicaid program and receive funding on a quarterly basis, Medicaid reimbursements are unlikely to be affected in the short term.

But while claims would not have been impacted, Morton noted that Advion is keeping an eye on the situation. “This kind of puts off the discussion a little bit, so it’ll come back in a number of days, and we might be back here again. It’s important for (members of Congress) to work together.”

If the shutdown were to proceed, the sector could see delays related to discussions on certain legislative issues under consideration, including the finalization of the physician fee schedule. That said, it’s looking likely now that the rule will be approved in early November ahead of its implementation in January 2024, policy experts shared. 

“So there’s a lot of conversation right now on Capitol Hill [on physician payment],” said Alex Bardakh, Society for Post-Acute and Long-Term Care Medicine’s (AMDA) senior director for Advocacy and Strategic Partnerships. ”They didn’t shut down, so we can actually have those conversations.”

Earlier, Clif Porter, senior VP of Government Relations at AHCA/NCAL, said both sides of the government should settle their differences quickly for the sake of “stability.” 

“We are pleased that Medicare and Medicaid are insulated from this government shutdown, so that long term care providers can continue serving our residents. However, we encourage Congress to come to a swift resolution to bring forth stability and a fully operational federal government.”

The Department of Health and Human Services (HHS) shared a contingency plan on its website last week, and stated that the Centers for Medicare & Medicaid Services (CMS), meanwhile, would operate largely as normal.

Moreover, if the shutdown were to continue, CMS will have “sufficient funding for Medicaid to fund the first quarter of FY 2024, based on the advance appropriation provided for in the FY 2023 appropriation,” the statement on HHS’ website read.

CMS would maintain the staff necessary to make payments to eligible states for certain programs it oversees. It’s important to also note that in the event of a shutdown about half, or 3,236, of CMS staff will be retained including 2,928, or 45%, who are exempt due to their activities or positions being funded or otherwise exempt, according to the HHS contingency plan. Meanwhile, 308 employees, or nearly 5%, whose activities are deemed necessary by implication, will be legally able to continue their employment. This latter category includes CMS employees who will be working to ensure that funded activities, such as the Medicare program, continues operations.

Under the Antideficiency Act (ADA), HHS said it would have maintained existing HHS activities, including research and vaccine and therapeutic development. “HHS also will retain a limited number of staff to perform necessarily implied activities in support of funded activities, such as Medicare, Medicaid, and other mandatory health program payments.”

Congress passed a stopgap bill to avert a government shutdown until Nov. 17, just hours ahead of a midnight deadline when funding for federal agencies was set to run out.