House of Representative Leadership Working on Permanent SGR FIX: Home Health and Hospice Impact
March 16, 2015 01:59 PM
Late last week, the leadership of the House of Representatives took significant steps towards a bipartisan bill that would replace the Medicare payment model for physician services, the Sustainable Growth Rate (SGR), with a payment system focused on value and outcomes. The SGR problem has plagued Congress for years, resulting in multiple “patches” the cost of which has been borne by providers and beneficiaries. The permanent reform package is still very fluid, but it likely will include complete SGR reforms, a series of Medicare payment extenders such as outpatient therapy limits, the so-called PIMA bill on program integrity, and the Medicaid CHIP program extension. The price tag is estimated to be from $200 to $210 billion over a ten year budget.
The most important development in the multi-year attempts to replace SGR is the apparent agreement to offset the cost of the SGR reform with only $70-80 billion in other Medicare program changes. NAHC has learned that the offsets are coming from both beneficiaries and providers of services. On the beneficiary side, the changes would include increased costs for Medicare enrollment through means testing of premiums along with restrictions on first-dollar payment of deductibles and copayments through Medigap policies.
Providers of services would be impacted through reductions in annual rate increases and other measures. Specifically, NAHC is informed that the 2018 inflation update, the Market Basket Index (MBI), would be set at 1%, the equivalent of a 1 point reduction when considering an estimated 2.5% MBI and a 0.5% Productivity Adjustment. Home health and hospice, along with the other Post-Acute Care providers would share the same rate reduction.
NAHC has strongly communicated that home health care has been disproportionately cut in recent years with rebasing cuts and other rate reductions. MedPAC has recommended that Congress freeze home health and hospice rates in 2016. NAHC has learned that early versions of the proposal had included consideration of a home health copay and deeper rate cuts to PAC providers.
Along with advocacy on the threat of cuts, NAHC has advanced the need for an extension of the rural add-on and relief from the onerous physician face-to-face encounter documentation requirements, both of which are under serious consideration by the House leadership.
Whether a real bill emerges from this action remains to be seen. If it does, the expected schedule would be the release of the bill late this week with a House vote the week of March 23. Senate action would follow. That schedule is intended to meet the looming physician rate cuts that would occur beginning April 1.
The schedule coincides with NAHC’s upcoming March on Washington from March 22-25. The voice of home care and hospice must be heard. Attending the conference and meeting with your congressional delegation is as important as it has ever been. Please let Congress know what is right for home care and hospice.