House Passes SGR Replacement Bill, ICD-10 Not Affected

****Update, 3/27/2015: The Senate will not vote on the SGR bill until after they return from a two week recess that begins this evening, according to the Wall Street Journal. The Centers for Medicare and Medicaid Services said their typical 14-day delay in paying claims would provide Congress some time to pass legislation before SGR-related  physician payment cuts go into effect.****

In a landslide 392 to 37 vote, the US House of Representatives this morning passed legislation that provides a permanent replacement to the Sustainable Growth Rate (SGR) that has vexed healthcare providers for more than a decade. The bill, H.R. 2, the Medicare Access and CHIP Reauthorization Act, did not include any references to ICD-10 implementation or an ICD-10 delay. The bill now moves to the Senate for consideration, who is expected to vote on the bill either tonight or Friday morning.

While there is the possibility amendments could be added to the bill in the Senate, AHIMA’s Washington, D.C.-based advocacy staff has said it does not expect ICD-10 delay language to be added into the bill moving forward. If passed by the Senate and signed by President Obama the SGR repeal would be a major hurdle overcome by ICD-10 proponents, who in 2014 saw a last minute ICD-10 delay slipped into SGR legislation that put off implementation of the new code set until October 1, 2015.

A similar scene almost played out yesterday with H.R. 2, when an amendment was proposed by Rep. Gary Palmer (R-AL) calling for a delay of ICD-10 implementation until October 1, 2017. However, this amendment and other proposed amendments were not added to H.R. 2 after the House Rules Committee voted to close the bill.

Legislators have until March 31 to pass legislation to prevent the SGR formula from being implemented, which would mean a 21.2 percent cut in Medicare payments to providers. If passed by the Senate and signed by the President, the SGR repeal would come after 17 temporary “patches” were passed by Congress over 12 years.

The legislation repeals the “flawed” SGR formula and replaces it with the “bicameral, bipartisan agreement to return stability to Medicare physician payments,” according to a Congressional summary document written by supporters of H.R. 2.

“The [SGR] formula was passed into law in the Balanced Budget Act of 1997 to control physician spending, but it has failed to work,” the summary states. “Since 2003, Congress has spent nearly $170 billion in short-term patches to avoid unsustainable cuts imposed by the flawed SGR.

“This policy removes the imminent threat of draconian cuts to Medicare providers and ensures a 5-year period of stable annual updates of 0.5 percent to transition to a new system. The new system moves Medicare away from a volume-based system towards one that rewards value, improving the quality of care for seniors.”

Read a summary of the H.R. 2 here.

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