The U.S. government shut down on October 1 after lawmakers were unable to reach a funding agreement. The date also marked the deadline to extend the Medicare telehealth flexibilities that have been in place since the COVID-19 public health emergency (PHE). As such, telehealth flexibilities have lapsed for Medicare beneficiaries, except those being treated for mental health or substance use disorders.
The flexibilities included waivers for geographic and originating site restrictions, an expanded list of eligible practitioners, audio-only telehealth visits, telehealth for hospice care recertification, and the delayed in-person visit requirement for tele–mental health services. These flexibilities increased access to cancer care for Medicare beneficiaries and helped providers reach rural populations and people who might not be able to take time off work, find child care, and arrange transportation for an in-person visit.
As outlined in the Centers for Medicare & Medicaid Services (CMS) contingency plan, the Medicare Program will continue during the shutdown. CMS has funding for Medicaid for the first quarter of fiscal year 2026, based on the advance appropriation provided for in the Full-Year Continuing Appropriations and Extensions Act 2025.
Although the future of the telehealth flexibilities is uncertain for the duration of the shutdown, and the situation is evolving, here is an overview of what cancer care providers need to know now.
During the Shutdown
Practitioners who choose to continue to provide expanded telehealth services during the shutdown should provide patients with an advance beneficiary notice informing them of a potential denial of Medicare payment. Practitioners may also choose to hold telehealth claims or request reprocessing after the shutdown based on instructions from their Medicare Administrative Contractors (MACs).
Until further legislation is passed, beginning October 1, Medicare telehealth services are once again limited to patients in rural areas as they were before the PHE, and beneficiaries can no longer receive telehealth services in their homes. Additionally, audio-only telehealth coverage for patients with Medicare and the Acute Hospital Care at Home program has lapsed. However, physicians in certain Medicare Shared Savings Program accountable care organizations can continue to provide and be reimbursed for telehealth services, including services that have lapsed with the shutdown.
The Association for Clinical Oncology will monitor Medicare claims processing for any potential delays or other reimbursement issues problems that could result from staffing reductions at CMS and the shutdown.
Shutdown Duration Matters
CMS directed MACs, which process claims for Medicare fee-for-service payments, to hold claims for 10 business days. This is standard practice when legislative payment provisions such as the telehealth flexibilities expire to ensure Medicare payments are accurate and consistent with statutory requirements. The hold prevents the need for reprocessing large volumes of claims should Congress act after the statutory expiration date.
Additionally, MACs do not process electronic claims until 14 calendar days after receipt, so if the shutdown lasts fewer than 14 days and Congress passes legislation to extend the flexibilities (either in a funding bill or separate legislation), claims will be processed and reimbursed as normal, provided the legislation is clear that telehealth flexibilities are in effect retroactively.
Take Action
Although Congress typically restores lapsed policies back to the effective date of a shutdown, it is still essential that lawmakers hear from constituents. Join ASCO in urging Congress to permanently extend Medicare telehealth flexibilities. Lawmakers need to hear from you that continued access to telehealth is essential for people with cancer who need uninterrupted access to high-quality care.
