Despite Lack of Senate Action, Medicare Physicians Won’t Face Pay Cut

Late last week, the Senate recessed for its Easter break without taking action on legislation to permanently repeal and replace the Sustainable Growth Rate (“SGR”).  The House had passed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2), known as the SGR replacement, on the afternoon of March 26 but didn’t leave enough time for full Senate consideration, a move to limit changes to the bill that was part of the strategy of the House leadership.

Although the current SGR patch expired on March 31, doctors will not face an immediate 21 percent cut in Medicare payments.  According to CMS, the agency will not process claims at the lower rate until April 15, temporarily shielding physicians from cutbacks and giving senators enough time to act on the Medicare deal when they return on April 13. CMS said that it will be forced to put the payment cuts into effect if the Senate fails to pass the legislation by April 15. However, even if that should occur, CMS could still reprocess claims to reflect the new payment rate.

This means that the Senate will have just two days to resolve the issue and join the House in passing H.R. 2 after it reconvenes.  With H.R. 2 passing the House with overwhelming bipartisan support (392-73) and the White House indicating last week that President Obama will sign the measure, it appears extremely likely SGR repeal legislation will pass the Senate.

The bigger question is whether the Senate will pass a “clean” version of the House bill or attach amendments and send the measure back to the House.  Speculation surrounds the idea of each party in the Senate being allowed to offer one or two amendments followed by a vote on final passage.  If amendments are included, the House would then have to pass the Senate version of the SGR replacement or move for a conference committee to be appointed that would iron out any differences between the two versions.

SGR Replacement Bill Alters Medicaid DSH Cuts

The SGR replacement bill that will likely be passed and signed into law the week of April 13 includes a one-year delay of cuts to Medicaid disproportionate share hospitals.  The cuts were originally scheduled to take effect in 2014 and end after 2020.  However, prior legislation revised that timetable so that the cuts are now set to start in 2017 and end after 2024.  Should H.R. 2 be signed into law, which is widely expected, the cuts will start in 2018 and end after 2025.

CMS Extends Delay on RAC Enforcement of Two-Midnight Policy

On Wednesday, April 1, CMS announced that the delay on Recovery Audit Contractor (“RAC”) reviews of inpatient hospital patient status under the two-midnight policy will be extended through April 30. The current prohibition required by the Protecting Access to Medicare Act of 2014 expired on Tuesday, March 31. The Medicare Access and CHIP Reauthorization Act of 2015, which will extend the delay on RAC enforcement of the two-midnight policy through October 1, has been passed by the House and is awaiting action by the Senate.

Bills Introduced This Week

No bills were introduced this week as the House and Senate were out of session.

Next Week in Congress

The House and Senate will remain on Easter recess. They are scheduled to return on April 13.