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Special "News You Can Use" <> March 27, 2015

First the Good News:

The House of Representatives overwhelmingly voted to move HR 2. I have included the major terms of HR 2 at bottom. CMA's long-term work at the grassroots and in Washington resulted in landslide-level support for HR 2: Only 2 of California's 53 representatives did not support HR 2. I cannot over-emphasize the fact that member dues paid for this long-term work, and that's why we were able to get landslide-level support for HR 2.

Now the Bad News:

The Senate “kicked the can down the road” for two weeks because of both procedural issues (an “inside baseball” procedural issue that precluded a vote on HR 2 unless unanimous consent was obtained) and political issues among a very few senators (several senators refused to grant unanimous consent because of their concerns about how to pay for HR 2).

Now More Good News:

Our two senators were prepared to support the legislation.

What Happens Next?

The Centers for Medicare and Medicaid Services (CMS) said they can hold physician claims on the payment floor for 14 days to avoid the devastating 21% payment cut that occurs on April 1, 2015. However, the Senate will need to act the first day they return to avoid the actual 21% payment cut. More instructions to come from CMS. At some point in the next two weeks, we may ask physicians to call our two senators’ offices to demonstrate support. For now, sit tight.

Summary of the Major Provisions of HR 2 — “The Medicare And CHIP Reauthorization Act” (MACRA):

  • Repeals the SGR. Provides automatic 0.5% updates each year for four years. In 2019 physicians can choose from two payment tracks: 1) Fee-for-Service Track that simplifies and consolidates the quality reporting programs and reinstate large bonuses up to 12% and reduces current penalties; 2) Alternative Payment Model Track that provides 5% bonus payments. The new payment models and the quality measures are to be developed by physicians. There is also $125 million in funding assistance for small practice physicians.
  • Extends the expiring CHIP Program for two years at the higher ACA funding levels. It covers nearly 1 million kids in California who would lose their insurance without it.
  • Extends the expiring Community Health Center funding.
  • Extends the important National Health Service Corps and the Teaching Health Center Rural primary care residency programs through 2017.
  • Reverses the CMS decision to eliminate the bundled payments for 10-day and 90-day global surgical service. Also requires CMS to collect data on these services.
  • Makes permanent the Qualifying Individual Medicare program that helps low-income seniors pay for premiums and continues the Transitional Medical Assistance Program for Medicaid.
  • Extends the moratorium on RAC audits of the hospital two-midnight rule which helps hospitals and physicians.
  • Delays the ACA cuts to DSH hospitals for one more year.

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