Temporary SGR Patch Expected to Clear Senate Vote

Tony Berberabe, MPH @OncBiz_Wiz
Published: Monday, Mar 31, 2014

The Senate is expected to consider and vote on a bill passed by the House on March 27 that includes language to patch the sustainable growth rate (SGR) formula for 12 months and delay ICD-10 implementation until at least October 1, 2015. Industry stakeholders would much prefer a permanent fix to the SGR formula, but most are in favor of a stopgap measure to prevent a 24% drop in Medicare reimbursement rates from going into effect on April 1.

The bill, HR 4302, calls for a 0.5% update through December 31, 2014 and a 0% update from January 1, 2015 through March 31, 2015. For passage, the bill must receive 60 affirmative votes from the Senate. Reportedly, the Senate will not be able to remove any sections of the bill before a vote, including the ICD-10 delay provision, which would prohibit the Department of Health and Human Services from implementing the transition at any point before October 1, 2015. This likely means that the bill will pass.

Roberta Buell of onPoint Oncology says that “there are many moving parts to this bill that symbolize deals that were made to appease certain factions in an election year.” In addition, Buell says the bill includes provisions for value-added purchasing for imaging and re-valuation of clinical laboratory tests to align them with private payers.

In her newsletter that covers reimbursement issues, she highlights the following sections of HR 4302 that are of interest:

  • Page 3, Section 101 Physician Payment Update
  • Page 4, Section 102 Update of the Work GPCI Floor
  • Page 11, Section 111: Extension of the Two-Midnight Rule
  • Page 19, Section 212: Delay in Transition from ICD-9 to ICD-10 Code Sets

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