AANEM News Express

AANEM News Express

SGR Repeal Bill Sails Through Both Houses of Congress

Both the U.S. House of Representatives (393-37) and the U.S. Senate (92-8) voted overwhelmingly to pass H.R. 2, the “Medicare Access and Chip Reauthorization Act” or MACRA, repealing and replacing the sustainable growth-rate (SGR). President Obama signed the bill into law on Thursday, April 16.  
The President called the bill, “A milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs.” 
Each party in the Senate proposed three amendments, but none of them passed. Conservatives wanted the entire $214 billion package to be paid-in-full (only $70 billion is covered by the bill through policy changes covering Medicare beneficiaries and providers). Democrats proposed to extend the Children’s Health Insurance Program (CHIP) for four years (the bill extends it for two years).
The most current SGR patch officially expired on April 1, but the Centers for Medicare and Medicaid Services (CMS) held off on processing claims submitted on or after April 1, which will now be processed under the new payment formula.
The bill spans 262 pages. Here are some of its highlights:
  • Repeals the SGR, providing a 0.5% payment increase each year through 2018 and leaving the current payment system otherwise untouched for four years.
  • Creates a new Merit-Based Incentive Payment System (MIPS) as of 2018, consolidating the Physician Quality Reporting System (PQRS), Value-Based Modifier, and “meaningful use” program for electronic health records (EHRs).
  • Funding is provided for quality measure development ($15 million per year from 2016-2020).
  • Requires all EHRs be interoperable by 2017.
  • Encourages participation in alternative payment models (APMs) by providing a 5% bonus to participating providers starting in 2018 (provided certain requirements are met) and exempting them from the new Merit-Based Incentive Payment System. The Department of Health and Human Services (HHS) is expected to publish more information by May 1, 2015.
  • Requires Medicare to reimburse, under at least one payment code, monthly care management services for individuals with chronic care needs.
The passage of H.R. 2 finally ends the annual uncertainty for Medicare beneficiaries and providers, but the bill is by no means “ideal.” For example, according to an April 9th report outlining the effect of H.R. 2, the CMS Office of Actuary said it anticipates, “That physician payment rates under H.R. 2 would be lower than scheduled under the current SGR formula by 2048 and would continue to worsen thereafter.”  
However, now that the budgetary concerns with the repeal are largely covered (at least for the next decade) and additional funding for several other health programs is provided for, H.R. 2 will simplify future advocacy efforts to pass additional legislation.

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