Some hospices across the United States are concerned about the various impacts of a recent government shutdown, including their ability to thrive and sustain operations.

Eight Democratic senators on Sunday agreed to advance a bill that would end the shutdown. The bill included agreements to proceed without a guaranteed extension of Affordable Care Act (ACA) tax credits that are due to expire Jan. 1. ACA plans include coverage of the Medicare Hospice Benefit, often requiring that 89% of an insurance deductible is met first.

Expiration of ACA coverage could have hospices in some states facing higher care delivery costs and sustainability issues, according to Paul Ledford, president and CEO of the Florida Hospice & Palliative Care Association.

“Under Florida law, hospices are required to provide hospice services irrespective of a patient’s ability to pay,” Ledford told Hospice News in an email. “So, in those situations, patients would still receive care and it will impact the hospice program significantly more (due to the loss of a payer) than the patient.”

The current government shutdown has lasted for 35 days, marking the longest compared to others. The most recent longest shutdown spanned December 2018 to January 2019 during President Trump’s first administration.

Final passage of the recently introduced Senate bill is to be determined. However, in a recent test vote the Senate voted 60-40 to move toward passing compromise legislation to fund the government and hold a later vote on extending ACA tax credits.

Health care spending issues are among the “central drivers” of the government shutdown, Ledford said. Among the potential impacts is that hospice patients receiving ACA benefits will no longer be able to afford their health insurance policy premiums, he stated. However, this could impact a relatively small portion of hospice patients who are typically seniors and not enrolled in ACA plans.

The cessation of federal supplemental funding for ACA health insurance policies was included in the One Big Beautiful Bill Act, which passed in July. Expiration of ACA benefits leaves an estimated 4.2 to 7.3 million Americans without health care coverage, reported the Medicare Rights Center.

The government shutdown comes during a time of tremendous regulatory change in the hospice space, according to Leading Age.

Telehealth flexibilities implemented during the COVID-19 pandemic have expired during the shutdown period. These waivers included the ability to hold face-to-face recertification visits via telehealth.

Also during the shutdown came the implementation of a new hospice quality reporting system. The Hospice Outcomes and Patient Evaluation (HOPE) tool launched on Oct. 1 and replaced the Hospice Item Set (HIS). The new HOPE tool includes new standardized measures that examine hospice care throughout various points in a patient’s experience.

Hospices may experience delayed response times from CMS’ iQIES Help Desk as a result of the shutdown. This issue could challenge compliance for some hospice providers lacking clarification or needing greater assistance, LeadingAge National indicated. 

Providers should be tracking impacts related to access, costs and quality reporting during the shutdown, the organization stated.

“It is not clear how long a shutdown will last,” LeadingAge National stated in an announcement. “For hospices … we will revert back to pre-pandemic in-person face-to-face expectations. For hospices, [we do] not anticipate iQIES Help Desk staff to be qualified as essential employees, so you may see increased wait times for support, which is complicated timing given the Hospice Outcomes and Patient Evaluation (HOPE) tool launch date.”