On March 26, the House of Representatives overwhelmingly passed legislation that would permanently repeal the Sustainable Growth Rate (SGR). H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, garnered broad bipartisan support and passed the House in a stunning 392-37 vote. The focus then immediately shifted to the Senate. While there was hope that they would take up and pass the legislation before going on a two-week recess, Senate leaders have indicated they will take up H.R. 2 for a vote upon the Senate's return on April 13.

Therefore, advocacy efforts over the next two weeks will be crucial for the future success of this legislation. We cannot afford to be frustrated or deterred. We must also guard against complacency. On the heels of a historic House vote, the support of virtually the entire house of medicine, and with the backing of the president of the United States, we must not let this opportunity pass.

In response to the latest SGR news, ACC President Kim Allan Williams, Sr., MD, FACC, expressed concerns with how the Senate's delay could impact clinician and practice stability. "Upon its return from recess next month, the Senate must quickly take up and pass the bipartisan legislation that the House so overwhelmingly approved," said Williams in a statement. "The SGR has created a cycle of short-term fixes causing administrative burdens for practices and uncertainty for clinicians and Medicare patients. After more than a decade, it is time to end this flawed payment formula and focus on providing quality patient care."

What Can You Do?

While your Senators are at home over the next two weeks, contact them – via email, by calling their local offices, or even by meeting with them in person – and urge them to take up and pass the provisions of H.R. 2. For help scheduling a meeting with your Senators in your state, please contact Elizabeth Shaw at eshaw@acc.org. Download the ACC Advocacy Action Mobile App to access a congressional directory at the touch of a button. Search "ACC Advocacy" in your app store.

Talking Points

• The Senate must take up and pass the House-passed H.R. 2 as soon as they return from recess on April 13.
• Absent passage of this bill, the Centers for Medicare and Medicaid Services (CMS) may have to implement the 21 percent cut on the 15th calendar day for services rendered on or after April 1. This leaves no time to draft or debate an alternative approach.
• This consensus legislation, crafted on a bipartisan basis, passed the House with 392 votes. 212 Republicans and 180 Democrats voted for this bill.
• The ACC has worked closely with Congress and virtually all of organized medicine, including nursing, hospital and health advocacy organizations, over the last several years to craft the policy at the core of H.R. 2. This bill will repeal the SGR and combine quality reporting programs to reward clinicians for improved patient outcomes. It also extends funding for the Children’s Health Insurance Program (CHIP) for two years at levels supported by children’s advocacy groups.
• SGR cuts have been averted by temporary patches 17 times. These patches are fiscally irresponsible and have already cost more than the cost of full repeal. H.R. 2 offers structural reforms to strengthen Medicare and will end the detrimental cycle of patches.

How Will Medicare Claim Payments Be Impacted?

Because both chambers of Congress are in recess until April 13, Congress is officially unable to pass legislation to avert the 21 percent cut to Medicare payments that will take effect on April 1. Under current law, electronic claims are not paid by the Centers for Medicare and Medicaid Services (CMS) sooner than 14 calendar days (29 days for paper claims). Although the cut will take effect on April 1, this time frame could allow for the Senate to return from its two-week recess, take up H.R. 2 as soon as April 13, and potentially avoid any interruption in payments.

What happens next remains unclear. The most recent announcement from CMS leaves the Agency with flexibility to determine the course it will take. At times in the past when congressional action has been anticipated shortly after a cut was scheduled to go into effect, CMS has held claims until the new law has taken effect and immediately paid them at the new rate. At other times, CMS has instructed its contractors to immediately begin paying claims at the reduced rate and then required reprocessing of those claims at the higher rate after congressional action has occurred. Your ACC expects further information on or around April 11. Until we have more information, members should continue submitting Medicare claims per usual.

Please contact ACC Advocacy at advocacyleg@acc.org with any questions

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