By Linda Rouse O’Neill
Congress kicks off 2015 with bipartisan, bicameral collaboration
SGR repeal gets pushed to September. Is this the year?
Every year, and sometimes multiple times each year, Congress makes a habit of delaying a statutorily required reduction to the physician sustainable growth rate (SGR) payment formula that affects overall physician Medicare reimbursement payments. In early 2014, the President signed into law the 17th short-term congressional SGR “patch” bill, further delaying efforts to repeal and replace this formula that determines physician payment rates.
There had been very high hopes that a more permanent SGR alternative would be enacted before the end of 2014. For the first time ever, lawmakers in both chambers of Congress had agreed on policy to replace the formula. The policy, which appears to still be widely supported, would:
- Consolidate all various quality programs such as value-based purchasing and meaningful use incentive payments
- Reward quality and value
- Ensure five years of 0.5 percent reimbursement increases to provide stability
- Incentivize innovative models such as patient centered medical homes
According to a recent Congressional Budget Office (CBO) report, this proposed bipartisan legislation would cost approximately $174.5 billion between fiscal years 2015 and 2025. However, the hard part in getting any permanent repeal legislation passed is agreeing on the offsets necessary to pay for the bill.
Congress has a renewed focus and strong desire to repeal and replace the current SGR formula, evaluating several replacement and short-term alternatives to the current rules. Since enacting any of these alternative policies to count toward the 2015 fiscal year would need to have taken place on or before April 1, 2015, it should come as no surprise when the President signs the 18th short-term patch into law.
The good news, however, is that this could be the last SGR patch we will see. In late February, Rep. Tom Price (R-GA), the chairman of the House Budget Committee, told the American Medical Association that a full SGR repeal is likely by the end of the current fiscal year (Sept. 30).
Funding for two other policies – the U.S. government debt ceiling and the Children’s Health Insurance Program (CHIP) – expires at the end of the fiscal year, meaning Congress will need to have a firm SGR repeal solution and offset in place by mid-summer to avoid any obstacles preventing its approval.
Supreme Court ACA subsidy case garners industry attention
Speaking of summer, all eyes will be on the Supreme Court at the end of June when the justices are expected to give their decision regarding the validity of tax subsidies that help Americans purchase health insurance through Affordable Care Act (ACA) federal exchanges. The justices met in early March to hear oral arguments in the King v. Burwell case, and many are unsure how they will rule. The White House even admitted that there is no “Plan B” currently in place if the Court decides to do away with insurance tax credits.
HIDA will be keeping a close eye on these ACA developments in the coming months, as well as monitoring the progress of SGR repeal. For more information about these and other HIDA Government Affairs topics, visit us at www.HIDA.org or contact us at HIDAGovAffairs@hida.org.