U.S. Senate Approves The Sustainable Growth Rate (SGR) Bill
April 21, 2015
In 1997, Congress passed the Balanced Budget Act, which included a formula for reducing Medicare’s payment rates to healthcare providers over time known as the Sustainable Growth Rate (SGR). But out of fear that the SGR’s payment cuts would prevent physicians from agreeing to treat Medicare patients, Congress delayed its full implementation and passed temporary payment measures instead. Since 1997, Congress has attempted to find a permanent solution to this issue, and this year, both chambers agreed it was time to repeal the SGR once and for all.
Earlier this year, the House of Representatives passed their version of SGR reform in a bill that also retained the Medicare Therapy Cap and Exceptions Process. The cap limits the amount of outpatient rehabilitation therapy a Medicare beneficiary can receive on an annual basis, but with an ‘exception’ for people with extraordinary needs, such as many people with MS. Despite concerted efforts among many, many activists and groups to amend the Senate version of the SGR reform with a separate repeal of the Medicare Therapy Cap, the amendment failed by 2 votes.
Last week, the Senate approved their version of the SGR bill by a strong majority, and without an amendment on the rehab therapy cap. The final SGR reform package retains the therapy cap and exceptions process until December 31, 2017, and adds provisions for more targeted reviews of high cost claims. Most importantly, the SGR bill prevents a 21% reduction in provider payments beginning tomorrow. Activists will be asked to weigh-in on reforming the rehab therapy caps again when the time is right to approach Congress on it once again.