LUGPA Policy Update: Overview of Congressional Funding Developments and Healthcare 

September 2025 

As the September 30, 2025, government funding deadline approaches, recent budgetary actions have drawn attention to the possibility of a lapse in funding. A shutdown could affect several health extender policies scheduled to expire on the same date. This update provides an overview of current developments and their potential implications for healthcare stakeholders.

Pocket Rescission and Congressional Response

On August 28, 2025, President Donald Trump informed House Speaker Mike Johnson of his intent to withhold $4.9 billion in foreign aid through a budgetary process known as a pocket rescission.

• How it works: Funds can be proposed for cancellation within 45 days of the September 30 fiscal deadline, which limits Congress’s ability to act within the timeframe outlined by the 1974 Impoundment Control Act.
• Targeted funds: Allocations to the State Department and U.S. Agency for International Development (USAID).

The administration maintains that pocket rescissions are legally permissible, referencing past use in 1977. The Government Accountability Office (GAO) and several lawmakers have raised concerns about the approach, while others note that Congress recently approved a separate $9 billion rescission package in July 2025 through regular legislative procedures. The current action has added complexity to negotiations ahead of the funding deadline.

Implications for Health Extender Policies for Independent Urologists

A lapse in government funding on September 30, 2025, could significantly impact independent urologists, particularly in areas such as reimbursement, telehealth, and operational stability. The effects hinge on:

1. Policy Type – Whether policies involve direct funding, payment adjustments, or program authority.
2. Shutdown Duration – Brief disruptions may be manageable, but prolonged lapses could disrupt practice operations and cash flow.
3. Administrative Response – Agency efforts to mitigate interruptions, such as CMS guidance on claims processing

Below are key areas of concern for independent urologists and their practices:

Medicare Payment Policies

• Impact on Independent Urologists: Independent urology practices rely heavily on Medicare reimbursements for services such as prostate screenings, cystoscopies, and other urologic procedures. Payment policies, including ambulance add-ons or adjustments for rural providers, are critical for practice sustainability.
• Considerations: The Centers for Medicare & Medicaid Services (CMS) can typically hold claims for about two weeks. If a shutdown extends beyond this period, claims may be processed at reduced rates, creating cash flow challenges for practices with high Medicare patient volumes. Independent urologists should prepare for potential delays by reviewing cash reserves and prioritizing essential expenses.

Medicare Telehealth Services

• Impact on Independent Urologists: Telehealth has become integral for follow-up consultations, patient triage, and managing chronic conditions like benign prostatic hyperplasia or overactive bladder. Many independent urologists have adopted telehealth to expand access, particularly for patients in rural or underserved areas.
• Considerations: Medicare telehealth authorities are set to lapse on October 1, 2025, without Congressional action. This could disrupt scheduling, billing, and patient access to virtual care. Independent urologists may need to pivot to in-person visits or explore private pay options, though this could limit access for Medicare patients. CMS guidance will be critical to clarify billing procedures during a lapse.

Medicaid Disproportionate Share Hospital (DSH) Payments

• Impact on Independent Urologists: While DSH payments primarily affect hospitals, independent urologists who collaborate with safety-net hospitals may face indirect challenges, such as delays in referrals or reduced hospital-based support services.
• Considerations: Short-term disruptions are unlikely to affect Medicaid DSH payments significantly, but extended uncertainty could complicate state Medicaid planning, potentially impacting referral networks and patient volumes for independent practices.

Direct Funding Programs

• Examples: Community Health Center Fund, Medicare State Health Insurance Assistance Programs (SHIPs).
• Impact on Independent Urologists: These programs indirectly support independent urologists by facilitating patient education and access to care. A funding lapse could strain community health centers, reducing their ability to refer patients or provide coordinated care.
• Considerations: Programs may operate temporarily using reserves, but prolonged lapses could disrupt services, particularly as Medicare open enrollment begins on October 15, 2025. Independent urologists may need to assist patients directly with enrollment questions or coordinate with other community resources.

National Security Health Authorities

• Impact on Independent Urologists: While less directly relevant, lapses in national security-related health authorities could affect broader healthcare infrastructure, potentially disrupting supply chains for critical urologic medications or equipment.
• Considerations: These authorities would lapse entirely on October 1, 2025, until funding is restored, which could create logistical challenges for practices reliant on specific supplies or federal programs.

Recommendations for Independent Urologists

• Financial Preparedness: Maintain adequate cash reserves to weather potential payment delays, especially for practices with significant Medicare patient populations.
• Telehealth Contingency Plans: Develop strategies to transition telehealth patients to in-person visits or alternative platforms if Medicare telehealth authorities lapse.
• Patient Communication: Proactively inform patients about potential disruptions to telehealth or appointment scheduling, particularly during Medicare open enrollment.
• Monitor CMS Guidance: Stay updated on CMS announcements regarding claims processing and telehealth policies to adapt billing practices quickly.
• Collaborate with Local Networks: Strengthen ties with community health centers and hospitals to mitigate disruptions in referrals and coordinated care.

The pocket rescission has become part of broader fiscal discussions as Congress works toward a funding agreement. With the fiscal year ending September 30, 2025, stakeholders should be aware of the potential for short-term program disruptions and prepare accordingly.

LUGPA will continue to monitor developments and provide updates on how they may affect independent urology practices and their patients.