On March 26, the U.S. House of Representatives by a 392-37 vote passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015.  The Senate must approve the legislation before it can be sent to President Obama for signature.

If the Senate fails to pass the bill by March 31, as a result of the Sustainable Growth Rate (“SGR”) formula physicians will be subject to a 21.2 percent reduction in Medicare payments for services provided to beneficiaries after this date.  The Centers for Medicare & Medicaid Services has indicated that claims will be held for two weeks post-March 31 considering the pending legislation.

As enacted by the House, the bill would permanently repeal the SGR formula for physician payments.  The legislation includes an increase in physician payments of 0.5 percent for 2015 through 2019, with no increases (or decreases) for 2020 through 2025.  Effective  2019, current performance programs, including the EHR meaningful use incentive and value-based purchasing programs, would be replaced by a merit-based incentive payment system (“MIPS”), which includes potential payment increases and decreases in physician payments for meeting or failing to meet certain performance standards.

The bill would extend through 2017:

  • (i) the Children’s Health Insurance Program;
  • (ii) volume decrease adjustment payments for low-volume hospitals;
  • (iii) the Medicare-Dependent Hospital Program; and
  • (iv) the therapy caps exception process.

The legislation would reduce Medicare payments to post-acute care providers and delay for one year until 2018 the reduction in Medicaid disproportionate share payments. The bill would extend through September 30, 2015 the moratorium on certain Medicare contractor review of hospital inpatient stays of at least 2 days. The legislation would cost about $210 billion, of which $70 billion would be offset by reductions in payments to providers and increases in beneficiary financial liabilities.

Leave a Reply

Your email address will not be published. Required fields are marked *