CMS Staff Being Called Back
The Centers for Medicare and Medicaid Services (CMS) is calling back its 3,000 furloughed staff starting October 27. CMS says it is doing so because of the Medicare open-enrollment period, which began October 15, and the Affordable Care Act open-enrollment period, which starts on November 1. To pay for the return of staff absent annual funding bills, reports indicate that CMS is tapping funds collected from user fees that researchers pay to access Medicare and Medicaid data. These funds will be reimbursed to the data user fee fund when regular congressional appropriations resume.
Update on CMS’ Claims Hold
On October 21, the Centers for Medicare & Medicaid Services (CMS) provided a claims hold update via the All Fee-For-Service Providers | CMS and the MLN Connects® Newsletter for Tuesday, October 21, 2025.
The updates reiterate previous Information that was provided in the October 17, 2025, posting, including that except for behavioral health services, many of the statutory limitations on payment for Medicare telehealth services prohibitions that were lifted in response to COVID-19 Public Health Emergency, and extended through legislation, took effect again on October 1, 2025, and again reminding providers to monitor for Congressional actions.
Highlights from CMS’ updates include the following:
- CMS has instructed the Medicare Administrative Contractors (MACs) to lift the claims hold and process claims for certain services impacted by select expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025 (Pub. L. 119-4, Mar. 15, 2025) with dates of service on and after October 1, 2025. This includes telehealth claims that CMS can confirm are definitively for behavioral and mental health services.
- CMS has directed MACs to temporarily hold claims for telehealth services that CMS cannot confirm were “definitively” for behavioral and mental health services and for acute Hospital Care at Home claims.
- CMS reminds practitioners who chose to perform telehealth services not payable by Medicare (without Congressional action) that they may wish to consider providing beneficiaries with an Advance Beneficiary Notice of Noncoverage, and further, may opt to hold claims associated with telehealth services (in the event there is new law that allows for the telehealth services, and is retrospective back to 10/1/25). Additional information on telehealth can be found here.
- Finally, CMS reiterates that participation in certain Medicare Shared Savings Program Accountable Care Organizations (ACOs), that is those who participate in two-sided risk and have selected prospective assignment of beneficiaries in their ACO, includes the ability to provide and receive payment for covered telehealth services to certain Medicare beneficiaries. Providers delivering services in these situations should closely review this CMS Telehealth fact sheet for additional terms that must be met to take advantage of these flexibilities. However, CMS has added in their October 21 announcements that for clinicians in applicable ACOs, telehealth claims that CMS can confirm are definitively for behavioral and mental health services will be paid. At this time, claims for some telehealth services will continue to be held.
PACE Program Applications Pending with CMS
The federal government shutdown has resulted in the furlough of many federal employees, including PACE program account managers. LeadingAge has heard from PACE Organizations experiencing delays in approval and processing of new program applications and service area expansion applications at CMS because communication has ended with workers who have since been furloughed. LeadingAge has been in contact with CMS about how programs experiencing delays or lack of communication should proceed. If you have an application pending with CMS, please email Georgia (ggoodman@leadingage.org) with information about the application including the H-contract number, name and location of the site, and the dates of the CMS review window.
