Government shutdown drags on. The House was out of session again this week while the Senate continued to vote on the House-passed “clean” continuing resolution (CR), which continued to fail to achieve the 60 votes necessary for passage. Majority Leader Thune (R-SD) brought forth a bill to pay active duty troops and non-furloughed federal employees. Democrats filibustered the bill and introduced their own version that would include pay for furloughed federal workers. This bill also failed to advance.
The Senate’s effort to pass full fiscal year (FY) 2026 funding bills has also stalled. Democrats blocked a test vote last week on the Defense spending bill, and intra-party disagreements persist among Senate Republicans on the so-called “minibus” of three FY 2026 funding bills that previously passed both chambers (Military Construction-Veterans Affairs, Agriculture and FDA, and Legislative Branch).
The expiring enhanced advanced premium tax credits (APTCs) for Affordable Care Act (ACA) Marketplace plans remain at the forefront of the government funding debate. A group of 13 vulnerable House Republicans wrote a letter to Speaker Johnson (R-LA) about the importance of addressing the issue, while affirming Republican leadership’s position that the conversation should take place after the shutdown ends.
The initial House-passed CR would extend government funding only through November 21, 2025, a date that is now less than a month away, so congressional leaders are facing the need for a new funding deadline. Republicans have yet to coalesce around a date, although mid- to late January 2026 is being discussed, as well as a full-year CR through September 2026.
Senate HELP Committee examines 340B program. During the hearing, some Republican members alleged fraud and abuse in hospitals receiving 340B benefits, and many senators stressed the importance of increased program oversight. Democratic members emphasized that the enhanced APTCs’ expiration and the healthcare provisions in the One Big Beautiful Bill Act (OBBBA) are endangering local safety net hospitals and community health centers, and noted that these entities depend on the 340B program to maintain necessary services in their communities. Witnesses, including officials from the US Government Accountability Office and the Congressional Budget Office (CBO), agreed that reform was needed but didn’t lay out concrete solutions. Witnesses generally agreed that reforms should be made in a way that would not hurt safety net hospitals and community health centers.
Senate Aging Committee holds hearing on shoppable services. Members from both parties expressed concern about rising healthcare costs and lack of price transparency, and there was bipartisan interest in reforms that promote consumer choice and affordability. Republican members critiqued pharmacy benefit managers and favored reforms that would increase transparency and reduce regulatory barriers for independent providers. Democratic members focused on extending the ACA’s enhanced APTCs and protecting ACA marketplace coverage.
CMS lifts broad claims processing hold. After a bit of back and forth last week, CMS instructed Medicare Administrative Contractors (MACs) to lift the hold on the majority of Medicare claims with dates of service on or after October 1, 2025, including claims paid under the Medicare Physician Fee Schedule (PFS), ground ambulance transport claims, and Federally Qualified Health Center claims.
MACs will process claims for telehealth services that CMS can definitively confirm are for behavioral and mental health. CMS directed all MACs to continue to temporarily hold claims for other telehealth services (i.e., those that CMS cannot definitively confirm are for behavioral and mental health services) and Acute Hospital Care at Home claims.
This effectively means that CMS will process claims that could later be impacted by congressional action, such as PFS services that are delivered in localities with work geographic practice cost indices (GPCIs) below 1.0. If Congress institutes retroactive policies, such as restoring the work GPCI floor of 1.0 retroactive to October 1, 2025, MACs may be required to reprocess certain claims.
CMS staff coming back to work. Because of the Medicare and ACA open enrollment periods, CMS announced that it has found funding to bring back all staff for eight weeks starting October 27, 2025. The money will come from user fees that CMS charges academic researchers. This could mean that CMS will become more active again next week, and it’s more likely that the calendar year final rules will come out on time. CMS likely will not change its general approach of not taking meetings or participating in external events until the shutdown has ended.
The government shutdown will extend at least into next week. The Senate will be in session, and committee action includes Senate Health, Education, Labor, and Pensions Committee hearings on biotechnology and Casey Means’ nomination to be surgeon general. The Senate Finance Committee will also hold a nomination hearing for Thomas Bell to be inspector general of HHS. The House will likely remain out of session, although Speaker Johnson (R-LA) could call members back with 48 hours’ notice.
