Conservatives Make Late Push for Fully Paid SGR Deal

Conservative senators are pushing to strike a provision in legislation to repeal the Sustainable Growth Rate (“SGR”) and pressure Congress to pay for the remaining $141 billion of the doc fix deal’s cost later this year.  Sens. Ben Sasse (R-NE), Jeff Sessions (R-AL), Mike Lee (R-UT), Ted Cruz (R-TX) and David Vitter (R-LA) are expected to offer an amendment that restores the “pay-as-you-go” requirement to the bill so that its full cost must be offset with spending cuts or revenue increases.  The version that passed the House only offset $70 billion of the total cost and included a provision that exempts the measure from the pay-as-you-go budget rule. 

If the amendment is adopted, Congress would have until the end of 2015 to come up with more ways to offset the total cost. Should lawmakers fail to find new spending cuts or revenue increases, sequester savings would kick in and reduce all mandatory spending programs subject to such cuts, which include cuts in Medicare spending of up to 4 percent. These sequester savings are required under a 2010 law to eliminate any increase in the deficit caused by legislation that raises the cost of mandatory spending programs or tax cuts that are not paid for.

The Senate returns on Monday, April 13, and is expected to take action on the bill early next week.  Despite conservative opposition, and barring a more serious threat from other senators, it appears likely the SGR replacement bill will pass the Senate and be signed into law.

CMS Finalizes Payment and Policy Updates for Medicare Health and Drug Plans 

On Monday, April 6, CMS released the final changes to Medicare Advantage and the Medicare Part D Prescription Drug program for 2016. The changes in payments outlined by the rate announcement will impact plans differently depending on their characteristics. However, CMS announced that, on average, the expected revenue change is 1.25 percent without accounting for up to an additional 2 percent for expected growth in coding acuity.

CMS also published a proposed rule to align mental health and substance abuse disorder benefits for Medicaid and Children’s Health Insurance Program enrollees with benefits required of private health plans under the Mental Health Parity and Addiction Equity Act.  The Act requires plans to provide behavioral health coverage with the same terms as coverage for medical and surgical care.

The proposal applies to all Medicaid beneficiaries who receive services through managed care organizations or under alternative benefit plans and to all CHIP enrollees regardless of whether they receive fee-for-service or managed care.

Subcommittee to Review Post-Acute Care Legislation 

The House Energy and Commerce Subcommittee on Health announced it will hold a hearing on April 16 to discuss the current state of post-acute care for Medicare beneficiaries and ways to improve it.  The hearing will review H.R. 1458, the Bundling and Coordinating Post-Acute Care (“BACPAC”) Act.  The BACPAC Act seeks to reform the delivery of Post-Acute Care Services under the Medicare program by providing for a system of bundled payments that seek to improve efficiencies in the delivery of post-acute services.

The subcommittee will also review post-acute legislative changes in H.R. 2, the Medicare Access and CHIP Reauthorization Act.

Bills Introduced This Week

There were no health care related bills introduced this week as Congress was not in session.

Next Week in Washington

The House and Senate return on Monday, April 13, to begin an extended work period that will last until Memorial Day.  The major order of business will be passing the SGR replacement bill.  Earlier this week, the House Ways and Means Committee announced that its Health Subcommittee will hold a hearing next Tuesday, April 14, on individual and employer mandates and related penalties under the Affordable Care Act.