As I write this at 4:30 pm EST, the Senate had yet to take up the Medicare Access and CHIP Reauthorization Act of 2015, H.R. 2, which will repeal the SGR formula, reverse the 21% SGR cut that applies to claims for services provided on or after April 1, provide stable and positive updates for four and a half years starting in July, consolidate and streamline existing Medicare reporting programs into a new Merit-based Incentive Payment System, and create incentives for Patient-Centered Medical Home and other alternative payment models. It needs to pass the bill, without making changes to what the House already passed, by midnight, or Medicare will begin applying the 21% cut tomorrow, April 15, for claims for services provided on April 1. This will continue on a rolling basis until both the House and Senate approve identical legislation.
Senator Majority Leader Mitch McConnell and Minority Leader Harry Reid have expressed optimism that H.R. 2 will pass the Senate before midnight. Reportedly, they are seeking unanimous agreement for up to six amendments to first be voted on, three from Republicans and three from Democrats. All but one of the amendments would require 60 votes, making it very unlikely that the Senate will approve them. One amendment, requiring that Congress find savings by the end of the fiscal year to offset the entire cost of the full cost of the legislation (instead of it only being partially offset as is currently the case), would require a simple majority vote. If this amendment (or any of the other amendments) were to pass the Senate, then the 21% SGR cut will begin to be processed starting tomorrow morning, because there is no prospect that the House would be able, or inclined, to consider amendments that would upend the overwhelming bipartisan majority for the bill it passed last month. Requiring that the entire bill be paid for would also certainly invite opposition from Democrats (who would be concerned that it would lead to entitlement cuts) and provider groups, like hospitals, who would be concerned that their Medicare payments would be at risk.
Keep checking ACP’s website, www.acponline.org, and my twitter feed, @bobdohertyACP, for developments this evening.