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Senate Passes on 'Doc Fix' Before Leaving for Recess

By Melissa Attias, CQ Roll Call

March 27, 2015 -- The Senate punted last week on a House-passed package to replace Medicare's physician payment formula, departing for a two-week recess without taking any action to avert a 21 percent cut to doctors scheduled to take effect April 1.

Senate Majority Leader Mitch McConnell, R-Ky., told senators that the Centers for Medicare and Medicaid Services (CMS) will be able to handle the delay for up to two weeks and that the Senate will address the legislation (HR 2) quickly when it returns. "I think there's every reason to believe it's going to pass the Senate by a very large majority," he said.

Minority Leader Harry Reid of Nevada said Democrats were willing to proceed to the measure and that he was disappointed it would not get done. "As I've indicated to the leader earlier on—early on today, we would hope we could get this done but I understand it's late, whatever day it is," he said.

Reid added that it's his understanding that senators could vote on a "very limited number" of amendments to the package when they return and McConnell said he expects to find a path forward quickly.

The leaders' comments came around 3 a.m. last Friday after a marathon series of votes on amendments to the Senate's fiscal 2016 budget resolution (S Con Res 11). The House had already backed the physician payment measure in an overwhelming 392-37 vote, with 212 Republicans and 180 Democrats endorsing the deal negotiated by Speaker John A. Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-Calif.

The package to replace the oft-criticized sustainable growth rate (SGR) formula also has the backing of President Barack Obama and has drawn an outpouring of support from influential physician groups. Robert M. Wah, president of the American Medical Association, said in a statement his group is "extremely disappointed" the Senate didn't vote on the package before leaving town.

"We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation's patients and physicians need and deserve," he said.

The current one-year payment patch (PL 113-93) expires in four days and CMS has said it doesn't have any plans to hold off on processing claims as it has done in the past to buy Congress time. But in an email to health professionals, the agency noted that electronic claims aren't paid until at least 14 calendar days after they're received, providing something of a cushion before doctors feel the scheduled cut. CMS also said it would provide an update by April 11 about whether Congress has acted.

In addition to replacing SGR, the bill includes a two-year extension of funding for the Children's Health Insurance Program and community health centers, and would require wealthier seniors to pay more for their Medicare outpatient and prescription drug coverage starting in 2018 to help offset the cost.

It would generate additional savings by preventing Medigap plans sold to those who enroll in Medicare beginning in 2020 from covering the deductible for outpatient services, which is currently $147 a year, as well as by adjusting payment rates for certain health providers.

The bill also includes permanent extensions of programs to help low-income Medicare beneficiaries pay their premiums for outpatient coverage and to allow low-income Medicaid enrollees who become ineligible to keep their coverage for a transition period.

Some Senate Democrats have expressed concerns with the package because it includes two rather than four more years of funding for CHIP, which expires Sept. 30, as well as language that applies abortion restrictions to the community health center money. Meanwhile, Republicans Jeff Sessions of Alabama and Ben Sasse of Nebraska have both outlined opposition to the deal, citing the fact that it's not fully paid for.

The Congressional Budget Office estimated last week that the bill would increase the federal deficit by $141 billion through fiscal 2025, though House GOP leaders have emphasized that it would cost $900 million less than freezing doctors' payments for that period. They maintain that comparison is a more appropriate baseline because Congress has repeatedly passed short-term patches to prevent cuts from taking effect.

Lawmakers came close to replacing SGR last year when the three committees with jurisdiction over Medicare agreed on a permanent fix, but the effort faltered when lawmakers were unable to agree on offsets.

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