Congressional Inaction to Further Delay a Resolution to SGR

By Government Relations Staff

June 22, 2010 — On Friday June 18, the Senate passed by unanimous consent a stand-alone bill to postpone the 21.3 percent Sustainable Growth Rate (SGR) cut retroactive to June 1 and through November 30, 2010.

House leadership has now declined to take up the bill until the Senate considers jobs provisions that previously passed the House as part of the controversial tax extenders package that included postponing the SGR payment cut.

With the two chambers disagreeing on the path forward, though both promising to halt the cut, Congressional inaction further delays a resolution to this critical issue for patients and providers.

As we reported last week, the Centers for Medicare and Medicaid Services (CMS) instructed Medicare Administrative Contractors (MACs) to begin processing claims at lower rates on June 18. Affected payments are being processed on a rolling, first-in/first-out basis. Once retroactive legislation is signed into law, reduced payments will be automatically adjusted so that psychologists and other providers will not have to resubmit claims in order to recoup fees lost due to the SGR cut.

The Medicare "sustainable growth rate" or SGR payment formula, ties Medicare provider payments to factors related to the national economy. In recent years, the formula would have operated automatically to cut most provider payments if Congress had not acted to postpone the scheduled payment cuts. The American Psychological Association Practice Organization (APAPO) continues to keep up the pressure for Congress to enact a permanent solution to the SGR payment formula.

The APAPO will keep members updated about emerging developments with postings on the Practice Central website and in the PracticeUpdate e-newsletter.