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House to Act on Senate Revisions to H.R. 3630 Tonight – SGR Patch Hangs in the Balance

Monday, December 19, 2011

A rapidly-escalating political fight over the fate of H.R. 3630, the “Middle Class Tax Relief and Job Creation Act,” which includes payroll tax levels, extending the Unemployment Insurance program and the Sustainable Growth Rate (SGR) continues to dominate Washington this week.  While legislators must act quickly to avert a 27.4 percent SGR cut scheduled for January 1, 2012, options remain toward resolving this issue.

The U.S. House of Representatives is expected to vote on U.S. Senate revisions to H.R. 3630, the “Middle Class Tax Relief and Job Creation Act.”  House GOP Leadership has indicated that they intend to reject the Senate’s changes opting to send the bill to a conference committee, where chamber leadership-appointed negotiators would have to work out a compromise. 

Previously during an unusual Saturday session, the U.S. Senate passed a revised version of H.R. 3630 that includes, among other provisions, a 2-month “doc fix” that would effectively freeze rates of the current SGR levels until February 28, 2012.  The original text of H.R. 3630 that passed the U.S. House of Representatives earlier last week included a more favorable “doc fix” of two years in duration with a 1-percent payment increase scheduled for both years. 

Due to the political instability surrounding the resolution of the SGR fix, the Centers for Medicare & Medicaid Services (CMS) began informing health officials, as they have done in the past, that it plans to instruct Medicare claims contractors to hold claims containing 2012 services for the first 10 businesses days of January 2012 (January 1, 2012 – January 17, 2012).  This would only apply to Medicare claims in a prospective manner, for services provided on or after January 1, 2012, and would not apply retrospectively to claims for services provided in 2011.  The potential hold on these January 2012 claims (January 1, 2012 – January 17, 2012) is expected to have little impact on physician payments because existent law does not allow payment for claims submitted electronically any sooner than 14 calendar days after receipt or payment for claims submitted by paper any sooner than 29 days after receipt.

ASA will continue to update members with new developments.  We continue to push for the longest possible SGR patch with positive Medicare payment updates.

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