Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


President Signs SGR Repeal into Law

Last Thursday, President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA), permanently repealing and replacing the Medicare program’s sustainable growth rate (SGR) formula. Hart Health Strategies Inc. has prepared a timeline of implementation detailing the Medicare Access and CHIP Reauthorization Act, which can be found here. The $214 billion package was passed by both chambers of Congress with overwhelming bipartisan support. H.R. 2 will permanently end the automatic cuts to Medicare physician reimbursements, which policy makers have addressed with temporary fixes 17 times since the SGR’s inception in the Balanced Budget Act of 1997. The legislation was a result of quiet negotiations that took place between Speaker of the House John Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.) earlier this year. The package pays for approximately a third --$73 billion – of the bill’s total cost. The House passed the bill by a vote of 392-37 last month. The Senate managed to pass the legislation within 2 hours of the April 15 deadline, in which a 21 percent cut to Medicare physician reimbursements would have gone into place. The final vote in the Senate was 92-8, with Republicans Ted Cruz (Texas), Mike Lee (Utah), David Perdue (Ga.), Marco Rubio (Fla.), Ben Sasse (Neb.), Tim Scott (S.C.), Jeff Sessions (Ala.), and Richard Shelby (Ala.) voting against the legislation in opposition to the bill not being fully offset. In their attempt to schedule the Senate vote on H.R. 2, Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Harry Reid (D-Nev.) reached a deal which allowed each part to offer a limited number of amendments. None of the amendments were approved. Lawmakers rejected a proposal from Sen. Ben Cardin (D-Md.) to repeal Medicare’s annual cap on outpatient therapy costs. They also voted down an amendment from Sen. Patty Murray (D-Wash.) aimed at removing language from the bill prohibiting the use of federal funds to pay for abortions in community health programs – the so called Hyde Amendment language. Murray’s amendment would have also extended funding for community health centers, the National Health Service Corps, and teaching health centers for an additional two years. Furthermore, the provision would have renewed and expanded expired funding for the Medicaid bump to family medicine, general internal medicine, pediatrics, and OB/GYNs for two years to match higher Medicare payment rates. During the rulemaking process, CMS determined that “general internal medicine” included anyone boarded by the American Board of Internal Medicine (ABIM). The Murray amendment specifically included OB/GYNs, which did not meet the CMS definition, in the proposed list to receive bonus payments, but her amendment did not include psychiatry and neurology – cognitive specialties that do not qualify for the bonus payment since they are not ABIM boarded. Sen. Michael Bennet (D-Colo.) offered an amendment to extend funding for the Children’s Health Insurance Program (CHIP) for four years. The program was only extended for two years under the bill. Sen. John Cornyn’s (R-Texas) amendment would have repealed the Affordable Care Act’s (ACA) individual mandate. This amendment was rejected on a party line vote. Sen. Tom Cotton’s (R-Ark.) proposal to simply replace the SGR with a 0.5 percent annual update was also rejected. Republican amendments from Sen. Mike Lee (R-Utah) and Sen. Jeff Sessions (R-Ala.) related to the cost of H.R. 2. Lee’s amendment would have paid for the SGR deal under the “Pay as You Go (PAYGO) budget rules,” which would have prevented the full cost of the legislation from being added to the deficit but would have resulted in sequester cuts next year. Rejection of all six amendments was in part a result of concerns regarding the deadline for reimbursement cuts. Had the Senate passed an amended bill, it would have been sent back to the House for passage, or the differences between the House and Senate versions would have needed to be conferenced. Congress had until Wednesday to pass a bill before the 21 percent pay cut went into place. Though the Senate stayed late into the night on Tuesday to meet the deadline, the Centers for Medicare and Medicaid Services (CMS) has acknowledged in a notice to providers that a small volume of claims will temporarily be paid using the reduced rate. These providers will be reimbursed at a later date once CMS re-processes their claims. The agency noted that they do not yet have an estimate about how many providers will be impacted.

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