SGR Discussions Commence in Congress

The Committee on Energy and Commerce’s Health Subcommittee met last week to begin discussion on legislation that would provide a permanent fix for the currently flawed Medicare Sustainable Growth Rate (SGR). Though a bipartisan agreement was reached in 2014 on a replacement policy, the bill has been roadblocked as legislators on both sides of the aisle cannot decide how to offset the costs of the bill.

In the absence of a permanent solution, Congress has had to pass a “patch” bill each year to avoid Medicare payment cuts. Such a bill was passed at the end of March last year, which included language that effectively delayed ICD-10-CM/PCS implementation by one year, until October 1, 2015. This most recent patch is set to expire at the end of March this year, but any legislation containing a permanent SGR fix will need to be passed by Friday, March 27, which is the last day Congress is in session.

Everyone agrees the formula is broken, says Margarita Valdez, director, congressional relations at AHIMA, but the question is whether members of Congress will be able to come to resolution to pay for a permanent fix prior to the deadline.

While the SGR legislation is not directly related to ICD-10, Valdez plans to monitor the bill closely for any relevant amendments in the weeks to come. Neither of last week’s hearings referenced ICD-10 in the oral testimony.

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