House of Representative Leadership Working on Permanent SGR FIX: Home Health and Hospice Impact
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.
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