US House Repeals SGR Formula, Senate Vote Looming

It looks like trouble continues for a bill that would delay payment cuts to physicians who treat Medicare patients for one year. Early attempts to muster support for HR 4302 (Protecting Access to Medicare Act of 2014), a US House of Representatives measure to fix the sustainable growth rate (SGR) formula, hit some snags and the House decided to reconvene later in the session to address unfinished business and put the measure to a voice vote.

Although the House passed the bill, it must now go to the Senate, who will consider and vote on the bill before it lands on the President’s desk. The bill, while delaying the payment cuts, also pushes the deadline for the transition to ICD-10, for at least one year.

Doctors groups oppose the temporary patch and have lobbied heavily for a longer-term fix to the formula that was set up in the 1990s but has never been fully enacted and instead been overridden nearly every year.

ICD-10 is the set of diagnostic and procedural codes that would have gone into effect on Oct. 1, 2014. But a single sentence in the proposed House bill says, “The Secretary of Health and Human Service may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for codes sets” and finishes by citing sections in the Social Security Act and the Code of Federal Regulations where the secretary's authority to mandate ICD-10 are located.