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Updated October 1, 2025

Strengthen the voice of neurology

Congress needs to hear from you about the importance of re-opening the government and extending telehealth for patients with neurological conditions. and make sure your voice is heard!

Effects of a government shutdown

Congress failed to pass federal spending legislation by its September 30 deadline, causing the US government to shut down—meaning non-essential federal employees cannot report to work and many services have been paused until Congress reaches an agreement to fund the government. Some past shutdowns have lasted only a couple of days, while a handful of others—like the record 35-day shutdown that started in December 2018—have stretched for weeks. about how a government shutdown could impact you and your patients.

How does the shutdown affect your practice?

The Medicare program will continue to reimburse claims through a shutdown. A government shutdown for any period of time could result in delays in claims processing, audits, and other administrative functions. The Centers for Medicare & Medicaid Services (CMS) will continue to pay Medicaid reimbursement as long as funds allow without a reauthorization in appropriations. CMS will have sufficient funding for Medicaid to fund the first quarter of FY 2026, based on the advance appropriation provided for in the Full-Year Continuing Appropriations and Extensions Act, 2025. In addition, CMS employees who answer Medicare billing questions and process enrollment applications are paid through annual appropriations and could be affected by the shutdown.

During the shutdown, CMS directs all Medicare Administrative Contractors (MACs) to implement a temporary claims hold. This standard practice is typically up to 10 business days, and prevents the need for rapidly reprocessing large volumes of claims. This should have a minimal impact on providers due to the statutory 14-day payment floor. Providers may continue to submit claims during this period, but payment will not be released until the hold is lifted.

The Department of Veterans Affairs (VA) is still requiring physicians to report to work and deliver clinical care, though there will be a delay in reimbursement and administrative functions. The VA will release guidance to people who are affected, and we will share more information once the VA releases its shutdown contingency instructions.

Telehealth extension

Congress previously extended the Medicare telehealth flexibilities that stemmed from the COVID-19 Public Health Emergency until September 30, 2025. These flexibilities permitted CMS to pay for telehealth claims in all geographic originating sites, including the patient’s home, and via audio-only modalities for non-mental health services. Congress was unable to pass legislation to continue these flexibilities, causing them to expire as of October 1.

This means that reimbursement for fee-for-service Medicare patients will be limited to certain rural areas and originating sites, such as a physician’s office. Medicare also will not reimburse additional practitioners, such as therapists, for telehealth services.
In past shutdowns, whenever Congress passed legislation to reopen the government, it made the funding and policies retroactive to the effective date of the shutdown; however, there is no guarantee that Congress will do this for telehealth.

This explainer from the Alliance for Connected Care, of which the AAN is a member, gives more details on how a lapse in flexibilities could impact care, including information about patients enrolled in a Medicare Advantage plan.

On Wednesday, October 1, 2025, CMS released the following information:

In the absence of Congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an  Practitioners should monitor Congressional action and may choose to hold claims associated with telehealth services that are not payable by Medicare in the absence of Congressional action.

Medicare physician reimbursement fix

The reconciliation bill signed into law on July 4, 2025, included a 2.5% positive adjustment to physician reimbursement under Medicare in 2026. This congressional fix to cuts included in the Medicare Physician Fee Schedule (MPFS) usually happens concurrently with appropriations for the next fiscal year, but is not part of the current government funding conversation. The AAN will continue to work with policymakers to find long-term, structural changes to the MPFS that will help appropriately value the delivery of neurological care.

How does the shutdown affect NIH and research funding?

Current National Institutes of Health (NIH) grantees will continue to be able to draw from their award as long as no problems arise. If a drawdown of funds triggers an edit check or limit control, grantees cannot continue accessing funds, with assistance likely unavailable from the NIH. Any direct clinical care being provided through the NIH Clinical Center will continue, as well as medically necessary admittance of new patients.

As new information becomes available from Congress or the administration, we will update this page. If you have any questions about how this shutdown may impact you or your patients, please contact us at advocacy@aan.com.