House Passes SGR Repeal Bill; Action Moves to Senate
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On March 26, the U.S. House of Representatives passed legislation by an overwhelming vote of 392 to 37 that would permanently repeal the Medicare sustainable growth rate (SGR) physician payment formula, averting a 21 percent SGR-induced cut scheduled for April 1, 2015, and would put Medicare on track to being a prudent rather than passive payer of Part B services. As of press time, it is expected the Senate will take up similar legislation that, if passed, the President has said he will sign into law.

 

Deep cuts in Medicare Part B payments were averted last year due to a temporary intervention by Congress, but that legislative “patch” expires on March 31, 2015.

 

Under the bill, the “Medicare Access and CHIP Reauthorization Act” (H.R. 2), Part B provider payments would be updated by 0.5 percent July 1, 2015 through 2019. Professionals who remain in fee-for-service Medicare would do so in exchange for zero updates in 2019-2025, with the opportunity to receive additional payment adjustments through a new quality incentive payment program.  In 2026 and subsequent years, professionals participating in advanced payment models that meet certain criteria would receive annual updates of .75 percent, while all other professionals would receive annual updates of 0.25 percent.

 

The bill would also extend funding for the Children’s Health Insurance Program (CHIP) through fiscal year 2017. Without an extension, funding for the program ends on Sept. 30, 2015.

 

H.R. 2 now heads to the Senate for a vote. However, it is unclear whether the Senate will move the bill to the floor for a vote this week before it adjourns for the Spring recess.  Support for the bill has been growing in the Senate despite some early objections over a two-year versus four-year extension of CHIP funding. 

 

UCAOA members can contact their senators on March 26 using the American Medical Association's toll-free Physicians Grassroots Hotline at 1-800-833-6354 and urge them to vote this week to pass H.R. 2.

 

While CMS is taking initial steps to prepare for the 21 percent payment reduction for all physician services if Congress does not act by March 31, Medicare does not pay electronic claims sooner than 14 calendar days (29 days for paper claims) after the claims are received. Accordingly, if Congress passes legislation shortly after the deadline, it is possible that any lag-time between the deadline and congressional action will have a minimal impact on payment.

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