SGR Replacement Likely To Pass House, but Fate in Senate Unclear

House Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.) are touting a bipartisan deal to permanently replace Medicare's sustainable growth rate formula, the AP/Washington Times reports (Fram, AP/Washington Times, 3/24).

Background

House and Senate lawmakers last week introduced bipartisan, bicameral legislation to permanently replace the SGR.

Both the House and Senate will need to approve an SGR replacement measure before Congress adjourns for recess and when the current doc fix expires at the end of March to avoid the automatic payment cuts. Physicians face about a 21% reduction in Medicare reimbursement rates unless Congress acts by April 1, 2015 (California Healthline, 3/23).

Boehner, Pelosi Praise Deal

Boehner called the deal "a good product" that the House is "going to pass" on Thursday, adding that he "hope[s]the Senate will move as quickly as possible" to approve the measure. He said, "We have no intentions of passing any kind of a short-term doc fix."

Pelosi said, "In this environment I think we made great progress," alluding to Republicans' control of both the House and Senate (AP/Washington Times, 3/24).

According to Modern Healthcare, providers on Tuesday also expressed support for the deal.

The American Hospital Association in a letter to House members wrote, "While we are disappointed that hospitals would be looked to as an offset given that Medicare already pays less than the cost of delivering services to beneficiaries, the package strikes a careful balance in the way it funds the SGR repeal and embraces a number of structural reforms to the Medicare Program."

In addition, American Health Care Association CEO Mark Parkinson said his organization "enthusiastically" supports the deal, noting, "Each year we are in a battle up on Capitol Hill to determine whose turn it is to pay for the doc fix. There's no reason to believe this will get any better without a permanent" SGR replacement (Demko, Modern Healthcare, 3/24).

Measure Expected To Pass House, Approval Unclear in the Senate

Both Republican and Democratic leaders have said they expect the measure to pass by a wide margin in the House. However, it is uncertain whether the measure will see action in the Senate before the Legislature enters a two-week recess at the end of this week.

Sen. Richard Durbin (D-Ill.) said it seemed unlikely that the Senate would take action on the measure this week (AP/Washington Times, 3/24). Meanwhile, Senate Minority Leader Harry Reid (D-Nev.) remained noncommittal about whether Senate Democrats would support the deal. He said, "I believe we should wait until we get what they've done in the House" (Modern Healthcare, 3/24).

Nonetheless, House Democratic Whip Steny Hoyer (Md.) said he believes there is enough support in both chambers for the measure to pass. He added, "This is a compromise, but it is a good compromise. It is a compromise that we can embrace." Hoyer noted that he has been talking with Senate leaders about the issue (Lillis, The Hill, 3/24).

According to Modern Healthcare, Senate Democrats could block the measure from passing if they all vote against the deal (Modern Healthcare, 3/24).

CMS Could Give Congress More Time

CMS likely would be able to give Congress some additional time to consider the replacement SGR bill if lawmakers are unable to pass the measure before adjourning for recess, National Journal reports (Scott, National Journal, 3/24).

According to the AP/Times, Congress in the past has delayed paying physicians for two weeks while lawmakers worked to reach agreements on the SGR (AP/Washington Times, 3/24). Cristina Boccuti, a policy analyst at the Kaiser Family Foundation, said, "In those instances, Congress wasn't able to pass the override before the expiration of the previous override," so CMS directed its contractors to delay processing physicians' Medicare claims.

However, former CMS Administrator Tom Scully said that such a delay likely can only occur for two weeks. Boccuti said that after that period, CMS might have to begin paying physicians at the reduced rates but could make up the difference once the SGR replacement is enacted (National Journal, 3/24).