Government Reopens Following Passage of Funding Bill
What RHCs Need to Know Following the End of the Government Shutdown
Telehealth Flexibilities Return, Congress Waives PAYGO, and more!
As we shared on NARHC’s Community Forum, President Trump signed the government funding bill on Wednesday night following successful votes in the Senate and the House. This means that the 43-day government shutdown is now over.
An extension of the enhanced Affordable Care Act (ACA) subsidies, that will otherwise expire on December 31, were at the heart of Democrats’ fight. In the end, seven Senate Democrats and one Independent struck a handshake deal with Senate Republicans to fund the government through January in exchange for a future vote on the subsidies. However, the agreement does not guarantee Republican support for extending them, nor does it ensure that such a vote will also take place in the House of Representatives.
This means that the ACA subsidies are in the same position now as they were before the shutdown: slated to expire at the end of 2025. There have been talks among Republicans to offer a different plan to the original ACA, such as a directly sending money to households rather than subsidizing premiums. While these talks are important, none of these alternate plans have been solidified.
An expiration of these subsidies is expected to lead to an increase in the uninsured population by 4 million over the next ten years. Now that the government has reopened, we encourage you to continue advocating for the extension of these credits here.
Medicare Telehealth Flexibilities Return
Under this legislation, Medicare telehealth flexibilities that lapsed in September are now extended through Jan. 30, 2026. Also, any claims that were put on hold will be paid retroactively from October 1st onward. While this new plan does not include a fix to the RHC billing and coding issue we’ve been pushing for in legislation such as the CONNECT for Health Act of 2025 (H.R.4206 & S.1261), it does allow RHCs to provide telehealth services to Medicare patients without geographic restrictions (patients can be located in their homes, etc.) under the G2025 methodology.
You can continue to help us push for passage of the CONNECT for Health Act here.
Congress Prevents Additional Medicare Sequestration
This legislation also contains a critical waiving of PAYGO that was triggered by the passage of H.R.1 this summer. PAYGO was initially created to prevent policymakers from passing legislation that increased the deficit, although lawmakers have never let it go into effect.
If not waived, PAYGO was expected to result in an up to additional 4% sequestration on Medicare payments. However, given Congress’s decision, PAYGO cuts to Medicare will not go into effect.
NARHC members have been advocating for a PAYGO waiver through our VoterVoice platform, a tool that allows folks to directly message their legislators. We’d like to give a special shoutout to those who attended NARHC’s 2025 Policy Summit in June and 2025 Fall Institute in October, as the largest number of VoterVoice messages on this topic were sent to Congress during these events.
Other News.. United HealthCare Stopping Coverage of RPM
United HealthCare announced a plan to end their coverage of Remote Physiologic Monitoring (RPM) for nearly all uses, other than treatment for heart failure, by January 1st, 2026. This change will affect their commercial plans, as well as Medicare Advantage and Medicaid Managed Care plans. These changes specifically say the use of RPM for Type 2 diabetes and hypertension will no longer be covered, which are two of the most popular uses.
Medicare Advantage plans are legally required to cover the same benefits available through traditional fee-for-service Medicare. So, there may be some challenges as this develops. In the policy document, UnitedHealthcare argues that MA plans are allowed to make different coverage determinations for services that do not have a national coverage determination (NCD) or local coverage determination (LCD). Thus, they may be able to get around these requirements.
Critics have expressed concern that if United HealthCare is successful, a dangerous precedent could be set in that companies that administer Medicare Advantage plans will be able to refuse other services available through traditional Medicare. We will continue to track this as more information arises.
Looking for the Latest News from Washington, DC?
You’ll find it on NARHC’s Community Forum! Our DC team regularly shares advocacy updates there, so don’t miss out on the latest news and insights.
As always, we ask that you consider supporting our advocacy efforts by making your voice heard-- the most powerful voice in these conversations! You can view all of our active advocacy campaigns here.
Sincerely,
National Association of Rural Health Clinics
