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SGR Issue Remains Unresolved After Contentious Day on the House Floor

Tuesday, December 20, 2011

The fate of H.R. 3630, the “Middle Class Tax Relief and Job Creation Act” and the “doc fix” provisions contained within it remain unresolved as of Tuesday afternoon as the House of Representatives passed a resolution rejecting the Senate’s version of the measure and requesting a bicameral conference to reconcile the differences between the two bodies.

The important end-of-the-session measure, H.R. 3630, includes must-pass provisions impacting payroll tax levels and the Unemployment Insurance (UI) program in addition to provisions addressing the Medicare Sustainable Growth Rate (SGR) or “doc fix.”  Enactment of H.R. 3630, in some form, is necessary to avert a 27.4 percent SGR cut scheduled for January 1, 2012 as well as to avert changes to payroll tax level and UI benefits for some citizens. 

Early last week, the House passed a version of H.R. 3630 that included a two-year “doc-fix” with a 1-percent increase in the SGR level for each of the two years, in addition to payroll tax and UI provisions.  ASA has supported the House position as preferable to other alternatives.  Over the weekend, the Senate effectively rejected the House version and passed its own version that includes, two-month “doc fix” that freezes rates at current SGR levels until February 28, 2012.  The Senate version also revised the House’s payroll tax and UI provisions.

It remains unclear how the differences between the House and Senate will ultimately be reconciled.  The Senate adjourned for the year following its weekend session.  However, the House Republican leadership has indicated that the House will remain in session until agreement with the Senate is reached.  The leaders have urged the Senate to return to Washington, D.C. for negotiations.   

Due to the political instability surrounding the resolution of the “doc-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 has consistently pushed for repeal of the flawed SGR formula and replacement with a new mechanism that accurately reflects the increasing costs of providing care to Medicare beneficiaries.  Short of repeal, the ASA supports the longest possible “doc-fix” tied to positive payment updates.

ASA will continue to update members with new developments.

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