Senate Agrees to Another Temporary “Doc Fix,” Delays ICD-10

The Senate voted to approve a House bill (H.R. 4302) that will create another temporary “doc fix” to the Medicare sustainable growth rate (SGR) and delay the implementation of the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) until at least October 1, 2015. The healthcare industry had been preparing to switch to the ICD-10 code set on October 1, 2014. The House bill passed 64-35 in the Senate and by voice vote in the House. The president signed the bill on April 1. A separate Senate bill that would have permanently fixed the SGR failed to come to a vote.

Senate Bill Fails

The last “doc fix” bill was set to expire at midnight on March 31, 2014, so a permanent or temporary doc fix was needed. A permanent fix was offered in S. 2110 by Senate Finance Committee Chairman Ron Wyden (D-Ore.), but his measure never came to a vote.  Wyden’s bill, to repeal and replace the SGR, would have been paid for by using savings from winding down military operations in Afghanistan, known as Overseas Contingency Operations (OCO) funding. However, when Wyden asked for unanimous consent to move his bill, Sen. Jeff Sessions (R-Ala.) objected, characterizing this OCO funding mechanism as a gimmick. Sessions then moved for the Senate to pass a Republican alternative that would fund the SGR replacement by repealing the individual mandate required by the Affordable Care Act (ACA). Wyden objected to Session’s motion, which lead to consideration of the House alternative, H.R. 4302, Protecting Access to Medicare Act of 2014.

H.R. 4302

The bill repeals the current 24 percent cut in reimbursements for physicians treating Medicare patients set to take effect on April 1, 2014, and replaces it with a 0.5 percent update through December 31, 2014, and a zero percent update from January 1, 2015, through March 31, 2015. The bill also directs HHS to continue through June 2015 certain medical review activities related to the two-midnight rule; amends the ACA to repeal the limitation on cost-sharing (deductibles) for employer-sponsored health plans; directs HHS to specify a skilled nursing facility all-cause all-condition hospital readmission measure (or any successor) by October 1, 2015; revises requirements for the Medicare end state renal disease (ESRD) prospective payment system; authorizes HHS to collect and use certain information on physicians’ services in the determination of relative values in the formulae for setting physicians’ fees; and increases the amounts of reductions to Medicaid disproportionate share hospital (DSH) allotments for fiscal year (FY) 2017 through FY 2024.