The American Society for Gastrointestinal Endoscopy (ASGE) is monitoring the federal shutdown that began today after a lapse in appropriations. Essential functions continue, but many federal activities are curtailed with reduced staffing. The Centers for Medicare and Medicaid Services (CMS) will: continue state payments for CHIP; maintain Federal Marketplace eligibility operations using user-fee carryover; and continue non-discretionary programs (e.g., HCFAC, CMMI). CMS expects slowdowns/suspensions in facility survey & certification, policy/rulemaking, contract oversight, outreach/education, and beneficiary casework. Approximately 53% of CMS staff remain on duty; 47% are furloughed.

What Gastroenterologists Need to Know:

• Clinical operations (HOPD/ASC/office): Expect possible delays in federal services and communications. Plan contingencies if agency responses or approvals slow.
• Medicare operations:
  • Claims & payments: Due to the expiration of these legislative payment provisions, Medicare Administrative Contractors (MACs) have been instructed to implement a temporary claims hold of 10 business days. It should have minimal impact on physicians due to the 14-day payment floor. Physicians may continue to submit claims during this period, but payment will not be released until the hold is lifted. For the latest information, physicians should monitor their MAC’s website and this CMS webpage. 
  • Telehealth: Pre-PHE limits resume for non-behavioral/mental health services (e.g., most home and non-rural originating sites not payable; hospice recertifications require face-to-face). Some practitioner types may not be payable. Consider ABNs and—where appropriate—holding non-payable telehealth claims pending Congressional action. See CMS telehealth resources.
  • MAC operations: MACs remain fully operational, continuing all Medicare Fee-for-Service claims processing and payment functions.
• Research & trials: Federally supported GI research may face postponements or limited support—coordinate with your institution’s research office.
• Patient communication: Reassure patients that endoscopic care continues; any scheduling or administrative delays are unrelated to individual coverage or clinical need.

ASGE will provide timely updates as new information becomes available and will continue engaging policymakers to safeguard patient access to high-quality GI endoscopy.  For additional information CMS operations, see: HHS CMS Contingency.