OME Advocate Newsletter

Today marks the 34th day of the federal government shutdown. The Senate is in session this week while the House remains in recess. Majority Leader John Thune (R-SD) is considering limited “rifle-shot” funding bills, narrow, single-purpose measures designed to fund specific programs such as air traffic controllers or active-duty military personnel as senators continue working through nominations. If this government shutdown extends beyond November 5, 2025, it will become the longest running shutdown in U.S. history.

Last week, the Senate failed for the 14th time to advance the House-passed clean continuing resolution, H.R. 5371. Senators John Fetterman (D-PA), Catherine Cortez Masto (D-NV) and Angus King (I-ME) again joined Republicans in support, while Senator Rand Paul (R-KY) opposed. The chamber also voted 54-45 to advance the Shutdown Fairness Act, S. 3012, which would have funded select federal employees, but it fell short of the 60 votes required.

The impacts of the shutdown are escalating as SNAP benefits lapsed on Nov. 1, Head Start programs prepare to close and emergency funds for WIC are nearly depleted. President Trump directed the Pentagon to use $8 billion in previously appropriated defense funds to cover military payrolls, supplemented by a $130 million private donation reported to have come from businessman Timothy Mellon. Despite these temporary measures, hundreds of thousands of federal employees remain furloughed or working without pay.

Senators are also discussing putting another set of long-term spending bills on the floor, though no votes have been locked in. They could advance a package bundling the Defense appropriations bill with three other spending measures: Labor-HHS-Education, Transportation-HUD and Commerce-Justice-Science.

On Friday, Oct. 31, 2025, the Trump administration issued a final rule regarding Public Service Loan Forgiveness (PSLF) that gives the U.S. Department of Education (ED) expanded power to ban organizations from the program if their work is deemed to have a “substantial illegal purpose.” The new rule, which takes effect on July 1, 2026, only allows employers to be sanctioned for activities that occur after that date. Individuals can reapply for eligibility after 10 years or rejoin sooner if they follow a “corrective action plan” approved by the Education Secretary. The final rule has raised concerns among nonprofits, universities and student borrowers for giving ED too much power to bar organizations from the program and potentially leading to work shortages in high demand fields, such as medicine. Under the new rule, the Secretary will determine whether the “preponderance of the evidence” leans against the employer. Though documents indicate that a single violation of the law may not be grounds for expulsion, the determination ultimately comes down to the Secretary’s analysis.

AACOM submitted comments in response to ED’s proposed rule and comprehensive analysis of the final rule is forthcoming.

A recent SmartBrief article underscores the powerful growth of osteopathic medical schools, now training future physicians at 71 locations across the country. COMs are leading efforts to close healthcare gaps, especially in rural and underserved communities. Despite their critical role in the healthcare workforce, many DO graduates are excluded from federally funded residencies. Nearly 30 percent of residency program directors never or seldom interview DOs, and among those who do, 73 percent require them to take the MD licensing exam.

The Fair Access In Residency (FAIR) Act, H.R. 2314 / S. 2715, works to remove these barriers by ensuring equal access to residency opportunities, strengthening the physician workforce and expanding healthcare access nationwide. MedPage Today and Becker’s Hospital Review have also underscored the importance of the FAIR Act. The ongoing government shutdown adds pressure on medical schools in shortage areas that rely on federal education, training and research funds.

Support the FAIR Act to give DO students fair access to residencies and strengthen our healthcare workforce. Urge your elected officials to cosponsor the FAIR Act today!

Take Action!

• Despite the government shutdown, ED reconvened its Reimagining and Improving Student Education (RISE) negotiated rulemaking committee this week.
• Negotiators will continue to discuss a variety of issues related to implementation of the One Big Beautiful Bill Act (OBBBA), P.L 110-21, including establishment of new loan limits for graduate and professional student borrowers and simplification of student loan repayment plans. The DO degree is designated as a professional degree.
• During the first session, some negotiators released a plan to add more health-related programs to the professional student definition, while ED released a proposal that keeps the professional degree list narrow.
• AACOM outlined rulemaking priorities during the first RISE session and followed up prior to the start of the new session.
• View AACOM’s summary of the first RISE session and a National Association of Student Financial Aid Administrators update on the upcoming session.

• On October 20, 2025, the U.S. Citizenship and Immigration Services (USCIS) updated guidance on the new $100,000 H-1B visa application fees, clarifying that it applies to new H-1B petitions filed at or after 12:01 a.m. ET on Sept. 21, 2025 for applicants who don’t already have an H-1B visa and are outside the country.
• Current visa holders can freely travel in and out of the country, and the fee doesn’t apply to visas issued or applications submitted before the September date.
• The Department may waive the fee only in “extraordinarily rare” cases when employing the H-1B worker serves the national interest and no qualified U.S. workers are available. The fee must be paid before filing, with proof of payment or exemption included in the petition.
• AACOM is urging a fee exemption for healthcare workers and higher education institutions.

• On Oct. 21, 2025, the Centers for Medicare & Medicaid Service (CMS) instructed all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service of Oct. 1, 2025, and later for certain services impacted by select expired Medicare legislative payment provisions.
• The update includes claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims and Federally Qualified Health Center claims, as well as telehealth claims that CMS can confirm are definitively for behavioral and mental health services. As the shutdown continues, MACs have been directed to continue the temporary hold on claims for other telehealth services (i.e., those that CMS cannot confirm are definitively for behavioral and mental health services) and acute Hospital Care at Home claims.

• A Venable LLP analysis found that government shutdowns significantly slow federal rulemaking. While Regulations.gov remains operational, reduced staff at the Office of Management and Budget (OMB) delays comment processing, and during the 2018 shutdown, the Office of the Federal Register (OFR) published 65 percent fewer pages than normal.
• Most rules scheduled to be released around this time of year can be expected to be delayed. An agency must accompany a submission to OFR with a “transmittal letter” stating that the proposal is “necessary to safeguard human life, protect property or provide other emergency services.” All regulatory actions, by agency, that are currently pending at OMB can be found on this dashboard.
• Read the Venable analysis for more information.