Health Information Management

Shutdown's effects could linger for healthcare

APCs Insider, October 18, 2013

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After 16 days of negotiation, brinkmanship, and finally, agreement, the government shutdown ended Wednesday night when President Barack Obama signed legislation to keep the government funded through January 15.

While the shutdown has had a far-reaching and immediate impact on a wide swath of government agencies, from the IRS to the National Park Service, its effect on the healthcare industry is still largely up in the air.

CMS was scheduled to release the OPPS final rule by November 1 after the proposed rule was released in July. After the 16-day shutdown, however, we don’t yet know whether CMS will stick to that schedule. The last government shutdown occurred in 1996, predating the creation of the OPPS.

The shutdown forced CMS to furlough 65% of its nearly 6,000 workers, leaving staff that worked on Medicare, Health Care Fraud and Abuse Control, the Center for Medicare and Medicaid Innovation, and Pre-existing Condition Insurance Plan activities.

The release of the final rule isn’t solely dependent on CMS finishing their review of comments—which was likely underway before the shutdown—and then publishing. The Office of Management and Budget must first review the rule, and it is likely also facing a backlog of work.

This leaves CMS with a few options for OPPS, and few of them are appealing for the healthcare industry. The rule could be released as planned by November 1, but the odds of that happening are probably scant. CMS could also decide to simply release the rule on time by responding to fewer comments than is typical. This would seem unlikely considering the far-reaching changes in the proposed rule.

CMS is required by law to give providers 60 days from publication to implement the changes introduced. If the rule is delayed, CMS could try to shorten that timespan so that January 1 remains the implementation date. CMS could also keep January 1 as the implementation date, but delay enforcement until 60 days after the rule was released. CMS in the past has provided a three- or six-month grace period for providers to implement certain changes. 

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