This week, the Senate passed the Medicare Access and CHIP Reauthorization Act of 2015 to repeal the Sustainable Growth Rate (SGR) formula that determines Medicare physician payments and extend the Children’s Health Insurance Program (CHIP) for two years. Congress has acted 17 times to temporarily prevent drastic payment cuts resulting from use of the SGR formula. The “doc fix” bill replaces the SGR with alternative, value-driven payment strategies. This is good news for people with Medicare, who need to know their doctors will be there when they need them. The bill also permanently funds the Qualified Individual (QI) program that helps low-income Medicare beneficiaries afford Part B premiums. While the Senate considered an amendment to the bill to permanently repeal the Medicare therapy caps, this measure was not successful. Instead, the therapy caps exceptions process will be extended for two years. When this exceptions process expires, Congress must again act to ensure that people with Medicare are able to retain access to needed therapy services.
Also extended for two years is federal funding for community-based organizations, including State Health Insurance Assistance Programs (SHIPs), Area Agencies on Aging (AAAs) and others, to find and enroll vulnerable Medicare beneficiaries in low-income assistance programs. Like the therapy cap exceptions process, it will be paramount for Congress to ensure this funding continues beyond the two-year extension included in the final bill.
The legislation will now go to the President, and he is expected to sign it into law.