House Passes SGR Reform Bill

Yesterday, a majority passed Medicare legislation that reforms the physician payment formula also known as the Sustainable Growth Rate (SGR). H.R. 2 will now go to the Senate where it is expected to pass.

The bill includes the previously reported provisions that affect home health and hospice services:

  1. The annual payment rate update (Market Basket Index) is set at 1% in 2018. This represents an estimated 1 point reduction from what would otherwise be the update
  2. A two year extension of the home health rural add-on at 3%. Under the bill, the add-on would expire with episodes beginning January 1, 2018 and later.
  3. Modification of the home health surety bond requirements setting the bond minimum at $50,000 and allowing Medicare to scale the bond value up commensurate with the volume of Medicare revenue in the home health agency.

The Medicare beneficiary changes do not include a home health copay.

The bill “would institute a permanent fix in the physician payment methodology” which is good news for Medicare providers as there have been 17 previous “patches” that were financed by cutting provider payment rates.

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Breaking News: President Obama Approves SGR Patch, Delays ICD-10

President Obama has signed into law the Protecting Access to Medicare Act of 2014 which prevents a scheduled payment reduction for physicians and other providers who treat Medicare patients from taking effect on April 1, 2014. The law maintains the 0.5 percent update for those services that applied from January 1, 2014 through March 31, 2014 for the period of April 1, 2014 through December 31, 2014. In addition, it provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015.

For providers, the impact of  ICD-10 is widespread. Stakeholders will be regrouping to determine how to proceed in regards to education, training, documentation, electronic medical records, billing, auditing, quality reporting and compliance.

Please see the CMS MLN Connects Weekly Provider eNews website for reference

Senate Approves SGR Patch, Delays ICD-10

Yesterday, the Senate approved a temporary patch to the sustainable growth rate (SGR) payment formula that will prevent Medicare payment cuts for an additional year and delay the implementation of ICD-10 to October 2015. The bill now requires President Obama’s signature to go into effect.

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Docs Willing to Accept Payment Cuts to Force Permanent SGR Repeal

Doctors who are opposed to the proposed temporary fix to the sustainable growth rate (SGR) payment formula (which is set for a Senate vote this afternoon) have said that they would take the 24 percent cut in Medicare payments this year to force Congress to permanently repeal the formula.

The SGR, which determines how much the government pays physicians who treat Medicare patients, has been a concern to physicians since its implementation in the 1990s.

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New Bill Delays Reimbursement Cuts & ICD-10 For One More Year

The House of Representatives has reached a deal to delay physician Medicare reimbursement cuts under the SGR formula for one more year. According to the Congressional Budget Office, the cost to repeal the SGR with the ACA delay will total more than $180 billion.

Another bill, which Congress will vote on today, “consolidates Medicare sequester cuts scheduled for 2024, so that they all take place in fiscal year 2024, rather than dividing them between fiscal years 2024 and 2025.” The bill also contains language that would delay ICD-10 implementation until 2015.

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LTC Advocates Say SGR Repeal Deal Leaves More to be Desired

Yesterday, bipartisan leaders from the Senate and House announced that they had reached a deal to repeal SGR. The SGR Repeal and Medicare Provider Modernization Act will provide a 0.5% payment update for five years under a fee-for-service model and will also consolidate the physician quality reporting system, electronic health record and value-based modifier programs into a single program. The summary includes that the bill “implements a process to re-base misvalued codes” and “requires development of quality measures in close collaboration with physicians.”

Although encouraged by the bipartisan policy solutions, LTC advocates believe the agreement does not address how Congress would pay for the provisions outlined, nor does it address the offsets needed to pay for the new physician payments. It also does not include a therapy cap relief-a big issue for LTC providers.

Physician groups have been more supportive of the legislation believing it creates incentives for care coordination and expands the use of Medicare data for transparency and quality improvement.

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Breaking News: SGR Repeal Deal Reached

A bipartisan team of U.S. House and Senate negotiators has reached a deal to repeal the sustainable growth rate (SGR) formula, according to MedPageToday. Under the new arrangement, physicians will see a yearly raise of 0.5 percent for the next five years. Most lawmakers have endorsed the deal, but some are disappointed that it only includes a five-year payment update and not the originally-planned 10 years.

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