SGR Repeal Sails Through Senate; President Set to Sign

SGR Repeal Sails Through Senate; President Set to Sign


Late last night (Tuesday, April 14) The US Senate overwhelmingly passed The Medicare Access and CHIP Reauthorization Act by a vote of 92 to 8. The passage of the measure, which repeals Medicare’s Sustainable Growth Rate (SGR) reimbursement formula for physician reimbursement under Medicare, came just hours before the Centers for Medicare and Medicaid Services (CMS) was to institute a 21 percent cut to providers’ Medicare payments. Instead, the bill provides positive annual payment updates of 0.5 percent, starting July 1 and lasting through 2019. Claims that were held for the first half of April will be processed and paid at the rates that were in place before the 21 percent cut was scheduled to take effect.

In addition, the bill includes a two-year extension of funding for the Children's Health Insurance Program and funding for community health centers, which serve low-income individuals in every state. Additionally, the bill would delay fully enforcing CMS' so-called "two-midnight" rule for two months.

“Passage of this historic legislation finally brings to an end to an era of uncertainty for millions of Medicare beneficiaries and their doctors. Eliminating the cycle of annual ‘doc fix’ crises that threatened draconian cuts to Medicare reimbursement rates means that we can focus more of our energies on providing quality podiatric medical treatment and care, which save lives and limbs, and enhances the lives of our seniors, military families, and Californians with disabilities,” said California Podiatric Medical Association President Thomas J. Elardo, DPM. “Patients will be able to get the care they need and deserve.”

Dr. Elardo also praised CPMA members for their commitment and efforts over the years in helping to achieve this victory for podiatric physicians and their patients.

APMA’s bipartisan HELLPP (Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians) Act legislation was not able to be offered as an amendment to the bill. The Senate leadership limited amendments to three for each party, and the HELLPP Act did not make the final cut. Ultimately, no amendments to the SGR bill were approved by the Senate.

In addition to addressing Medicare payment, the legislation outlines several provisions that should be beneficial for physicians, including:

  • Medicare’s current quality reporting programs will be streamlined and simplified into one merit-based incentive payment system, referred to as “MIPS.” This consolidation will reduce the cumulative financial penalties doctors otherwise could have faced.
  • Protections are included so that medical liability cases cannot use Medicare quality program standards and measures as a standard or duty of care.
  • Incentive payments will be available for doctors who participate in alternative payment models and meet certain thresholds.
  • Technical support will be provided to help smaller practices participate in alternative payment models or the new fee-for-service incentive program.

While the bill supports physicians who choose to adopt new payment and delivery models, it also retains Medicare’s fee-for-service model. Participation in new models is entirely voluntary.