Shutdown could add ‘layer of complexity’ to Medicare competitive bidding timeline

WASHINGTON – As lawmakers on both sides of the aisle continue to dig in their heels, one of the big questions for HME stakeholders about the federal government shutdown: Will it delay the final rule on the next round of competitive bidding? 

Based on historical timelines, stakeholders expect CMS to release the final rule, in theory, around Oct. 31. 

“Does it help us?” said Cara Bachenheimer, head of the Government Affairs Practice at Brown & Fortunato, of the shutdown, which began at midnight on Sept. 30. “That depends on who you ask. I don’t know if that’s good or bad, but it adds a layer of complexity.” 

Expect delays, CMS says 

In a contingency plan posted to its website the week prior to the shutdown, CMS said its ability to develop payment rules and make other policy decisions would depend on the funding source and duration of a lapse in appropriation.  

“With limited staff to review and provide operational support, the agency would expect delays in rule-making and other policy development,” it stated. 

Business mostly as usual – for now 

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) on Oct. 1 issued reminders that Medicare fee-for-service claims are now on a temporary hold of up to 10 days before processing. Providers can continue to submit claims, “but payment will not be released until the hold is lifted,” they stated. Additionally, telehealth flexibilities, which began during the COVID-19 pandemic and were extended several times via federal continuing resolutions, ended Oct. 1. 

“The essential services will keep going – providers can continue to bill – but we can’t get distracted in the face of the larger challenge of competitive bidding,” says Ike Isaacson, senior vice president of government and regulatory relations for VGM. “I still want folks contacting legislators, telling their stories. The (shutdown) will get figured out, but it can’t distract us from the biggest challenge.” 

How long will the shutdown last? 

While shutdowns are uncommon, they are not unheard of. The last one, from Dec. 22, 2018, to Jan. 25, 2019, during President Donald Trump’s first term, lasted 35 days – the longest such closure in U.S. history. 

“With this White House, they're going to take full advantage and possibly do layoffs of federal workers, so I think there's going to be pressure to end the government shut down (quickly),” said Jay Witter, senior vice president of public policy for AAHomecare, which in September launched a $3 million campaign to delay the final rule. “Efforts will still be going on, but the shutdown will limit our access to CMS and Health and Human Services meetings.”