On Nov. 12, the longest shutdown in U.S. history ended after both the Senate and House of Representatives passed a temporary spending bill that the president immediately signed into law. The legislation funds military construction, veterans' affairs, the Department of Agriculture, and the legislative branch through Sept. 30, 2026. The rest of the government, including the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, are funded until Jan. 30, 2026.
Telehealth Flexibilities Extended Once Again
The spending bill will extend Medicare coverage of telehealth services through Jan. 30, 2026, and will pay retroactively for services rendered during the shutdown. Since the shutdown began, CMS released numerous updates on how Medicare Administrative Contractors should deal with telehealth claims. On Nov 14, CMS updated its Telehealth FAQ for Calendar Year 2026. In them, CMS states that it will continue to pay claims for how telehealth services that were provided during shutdown will be paid, the same way they had been paid before October 1, 2025, and telehealth flexibilities will apply retroactively as if there hadn't been a lapse. CMS also clarifies that starting January 31, 2026, physical therapists, occupational therapists, speech-language pathologists, and audiologists will no longer be able to furnish Medicare Telehealth services. Note that an extension beyond this date requires congressional action.
GPCI Floor Extended for Rural Providers
The second flexibility that was retroactively extended under the new funding package was the Geographic Price Cost Index floor. The floor was first created under the Affordable Care Act and has been extended ever since, until the policy expired when the government shutdown on Sept. 30. This floor has ensured that the "physician work" component of the Medicare payment formula is at least at a national average to mitigate geographical disparities. By setting this floor, Congress boosts payments for providers in rural areas in over 50 Medicare payment localities. When the policy expired, all localities that had been protected by the floor saw their work GPCIs decrease slightly, which could have led to a small decrease in payment. Unlike the telehealth claims, these claims will need to be reprocessed.
MACs Look to CMS for Guidance
CMS will likely issue guidance on how to formally process claims that were affected by the extension of the lapsed policies. APTA's focus will be on ensuring that providers are paid for services they delivered during the shutdown. APTA will provide updates to members with further guidance from CMS when available.
Keep Advocating for Medicare Telehealth Coverage
While APTA is pleased with the extension of Medicare telehealth flexibility and the GPCI floor extension, our advocacy is not over yet. These policies expire on Jan. 30, 2026, when once again, Medicare beneficiaries will lose access to telehealth services. That's why we need you to take action and tell your members of Congress about the unique benefits of telehealth physical therapy. Visit the APTA Patient Action Center to learn how to contact your legislators about these issues and be an advocate for the profession.
