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House and Senate Committees Approve SGR Proposals; House Passes Budget Bill with 3 Month SGR Fix

Posted on 12/13/2013 by NTOCC ® in Public Policy Updates

Yesterday, the House Ways & Means and Senate Finance Committees approved and reported out their respective bills for the long-term repeal of the sustainable growth rate (SGR) formula. Although this process started with unified bicameral, bipartisan language the bills that were reported out of the two committees today are no longer the same. The biggest difference between the two is that the Ways & Means bill includes a 0.5 percent pay increase for doctors and the Finance Committee bill does not. Additionally, neither Committee addressed the offsets that are needed for this legislation and thus, neither of these bills will be enacted this year. Instead, last night the House passed a two year budget deal which included a three month extension of the current SGR formula to give Members additional time to negotiate a full repeal.

The House Ways & Means Committee unanimously voted to pass H.R. 2810 out of committee, without amendments. As mentioned, the bill includes a 0.5 percent pay increase, each year, for three years, for Medicare physicians; however the bill does not include a number of other Medicare payment extenders and health care programs that are currently set to expire on December 31st.  Chairman Camp (R-MI)  indicated that the extenders were very important and that he plans to address them as the bill moves to the House floor.

The Senate Finance Committee passed by voice vote their long-term SGR repeal measure. There were over 135 amendments filed, however only 32 amendments were accepted, while 29 amendments were offered but withdrawn, with the remaining left unaddressed. The Senate measure maintains the 2013 payment rates through 2023, with no increase.  In contrast to the House proposal, the Senate passed version included Medicare payment extenders such as outpatient therapy caps and Medicare work geographic adjustment.

Both the House and Senate versions would, among other things, consolidate, streamline, and restructure existing quality improvement incentive programs - including meaningful use of electronic health records, the Physician Quality Reporting System and the value-based modifier.

The Finance committee approved three amendments of particular interest for NTOCC members:

  • Senators Menendez (D-NJ) and Brown’s (D-OH) amendment “To Clarify the Two-Midnight Policy for Medicare Inpatient Determinations.”  The amendment would require CMS to seek advice and consultation from hospitals, physicians and other expert stakeholders to determine appropriate criteria to account for medically necessary inpatient admissions that last less than 2 midnights.  The provision would also provide for a delay in the enforcement of the 2-midnight rule for any admission occurring prior to October 1, 2014.  It is important to note that on Wednesday, the House Ways & Means Committee stripped language to delay the two-midnight from the SGR 3-month patch bill the committee considered.
  • Senators Carper (D-DE), Isakson (R-GA), Rockefeller (D-WV), Wyden (D-OR), and Cardin’s (D-MD) amendment, “Quality Measurement to Encourage Health Care Providers’ Transfer of Existing Patient Care Preferences.”  Under current law, hospitals, nursing homes, and home health agencies frequently fail to transfer notice of existing patient health care information and preferences when patients are discharged from the hospital or move into a new care setting.  The amendment would direct the HHS Secretary to contract with measure developers to create, and submit for endorsement by a consensus-based entity, a Medicare quality measure for hospitals, nursing homes, and home health agencies to ensure that the notice of documentation related to patient health information and care preferences are transferred with patients as they move to other care settings or return home.
  • Senators Thune (R-SD), Casey (D-PA ), and Enzi’s (R- WY) amendment “To provide a demonstration project on remote patient monitoring (RPM) in the Medicare program to ensure seniors can remain in their homes longer and to prevent hospital readmissions.”  This amendment is based on the stand-alone Fostering Independence Through Technology Act and would require the Secretary of Health and Human Services to create pilot projects that incentivize home health agencies and other entities to purchase and utilize remote patient monitoring and communications technologies.  NTOCC recently wrote a letter of support of the FITT Act.

In addition, there were several amendments that were filed, but were withdrawn during the mark-up that were of interest to NTOCC:

  • Senators Wyden (D-OR) and Isakson (R-GA) offered and withdrew an amendment, “The Better Care, Lower Cost Delivery System for Medicare Beneficiaries with Multiple Chronic Conditions.” This amendment would create a “Better Care Program”(BCP) as an eligible Advanced Payment Model. A health plan or group of providers that meet criteria related to patient satisfaction and engagement, quality measurement focused on multiple chronic conditions, and effective use of resources may participate as a BCP under a risk-adjusted capitated financial arrangement. Implementation of the BCP must focus on the nuances of a chronically ill Medicare population, as well as calculate long-term cost savings based on a the entity’s ability to deliver the full continuum of covered services including the physical, behavioral, and psychosocial needs of those eligible to enroll.
  • Senators Carper (D-DE) and Grassley (R-IA) offered and withdrew an amendment, “Increasing Patient Medication Education and Adherence.” The amendment would require certification and endorsement of Medicare quality metrics related to medication adherence and require Medicare Part D plans to increase patient medication education and adherence.
The long-term SGR-repeal proposals are not expected to be passed by Congress until next year, when they could be wrapped into a larger debt ceiling package. The Senate is expected to take up the budget agreements that includes the short-term SGR patch next week.