How the Government Shutdown  Might Impact EP & Patient Care

Clinical Care & Administrative Disruption

• Centers for Medicare & Medicaid / Medicare & Medicaid Administration - Though entitlement programs like Medicare and Medicaid continue, many administrative and support functions rely on appropriated funding. During the shutdown, claims processing, appeals, audits, and other administrative workflows may slow or bottleneck. Medicare telehealth flexibilities lapsed on September 30, and Congress has made no efforts to renew them during the shutdown.

• No Surprises Act / Independent Dispute Resolution (IDR) - CMS has confirmed that the IDR process (used for out-of-network payment disputes under the No Surprises Act) remains open during the shutdown (because its operation is supported by user fees, not direct appropriations). However, response times, reviews, or other administrative services may be delayed if staffing is impacted. 

• Programs requiring active federal oversight / waivers - Initiatives like hospital-at-home (e.g. Acute Hospital Care at Home under Medicare) have already been scaled back or paused in many systems, citing lapses in waiver renewals or uncertainty over funding. Other programs that depend on federal authorization or oversight may face temporary suspension or uncertainty until Congress restores funding.

 

Telehealth, Remote Monitoring, & Virtual Care 
Because many of the COVID-era telehealth flexibilities had expiration dates tied to the public health emergency or specific legislative carve-outs, several changes went into effect on September 30, 2025, even before the shutdown: 

• Home as an eligible originating site (for Medicare): Patients generally can no longer use their home as a telehealth “originating site,” except in designated rural areas.

• Audio-only coverage: Reimbursement for telephone-only (audio) visits has lapsed under Medicare. 

• Expanded provider eligibility & non-physician billing: Broader telehealth billing authority for allied health professionals and non-physician providers has expired.

• FQHC and RHC distant site participation: Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can no longer serve as distant-site telehealth providers under current Medicare rules. 

 

These rollbacks already strain telehealth in EP, where remote follow-up, device monitoring, and virtual consults have been lifelines—especially for homebound patients, those in rural areas, or mobility-limited patients. Without these flexibilities, some patients may lose access to consistent, safe virtual care.

 

The shutdown exacerbates this: fewer CMS staff means delays in processing telehealth claims, providing clarifications, or issuing new guidance. Practices may face confusion or coverage gaps during this transitional period.

 

Research, Grants, & Device Innovation 

• NIH and Other Federal Research & Grants - The National Institutes of Health and various federal research agencies are reducing operations. Many grant application reviews, renewals, and administrative processing are paused or significantly delayed. Ongoing clinical trials may face enrollment or payment delays, especially if federal contract or regulatory oversight is involved.

• FDA Device Review / Inspections - The Food and Drug Administration may reduce staff or scale back non-urgent inspections or reviews of new devices. That slowdown in regulatory activity could delay approvals or modifications critical to EP technology development.

 

Workforce, Training, & Visa / Immigrations

• Visa Processing / Immigration - Trainees or staff on H-1B, J, or other federal-visa categories may see delays in processing, renewals, or associated federal interactions. This adds uncertainty to recruitment, retention, and pipeline development.

• Federally Funded Training Programs - Any fellowship, residency, or training program that relies on federal funding (direct or indirect) may see administrative delays, funding uncertainties, or stoppages.

 

What Heart Rhythm Advocates is Doing 

• HRA continues to engage with Congress, HHS, CMS, and other stakeholders to emphasize how EP care, arrhythmia monitoring, device infrastructure, and remote care depend on federal continuity.

 

• We are urging lawmakers to protect essential health-related programs (telehealth, hospital-at-home, device oversight) from collateral damage in broader fights.

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Key Risk Areas & Mitigation

• Gaps in coverage / service continuity
  Patients needing device check-ins, arrhythmia follow-up, or virtual consults may face interruptions if alternative pathways aren’t ready.

 

• Billing / cash flow stress
  Delays in reimbursements or back-office operations may strain practice liquidity, especially for smaller or resource-limited EP practices.

 

• Regulatory uncertainty
  Some rules may “pop back” if funding is restored, but practices should monitor for retroactive guidance, clarifications, or reversals.

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Suggested Mitigations

• Contingency planning
  For practices reliant on remote monitoring or telehealth, identify fallback workflows: in-person visits, hybrid protocols, or partnerships to ensure continuity.

 

• Coordinate with institutional leadership / legal teams
  Review whether your institution has guidance or a playbook for operations during federal funding lapses, especially for federally funded research.

 

• Stay updated / advocacy
  Monitor HRA communications. Engage with professional societies and policymakers to advocate for stability in EP-relevant programs.

 

• Communicate with patients
  Be transparent about possible delays, alternate care routes, and what changes might affect them.