SGR Short-Term Extension Filibustered in Senate
On February 24, the House passed H.R. 4691, legislation that extends a number of expiring federal programs for 30 days, including current Medicare physician payment rates, which would once again postpone the 21 percent cut that was scheduled to take effect on January 1, 2010. The Senate attempted unsuccessfully on the night of February 25 and the morning of February 26 to pass the same bill by unanimous consent, but objections were raised by Senator Jim Bunning (R-KY), who demanded that the $10 billion cost of the program extensions be offset, despite the fact that procedural rules specifically allowed the physician payment exclusion to take place. The Senate adjourned for the weekend, so the 21 percent Medicare physician payment cut will be effective on Monday, March 1.
In a bit of good news, the Centers for Medicare and Medicaid Services (CMS) are notifying their contractors to hold Medicare physician claims for 10 business days, effective March 1, to give Congress time to approve a long-term postponement of the 21 percent SGR cut. The agency will also be sending out a similar message on its various list serves this afternoon to physicians, and contractors will be instructed to disseminate this information as well. Majority Leader Harry Reid (D-NV) continues to work with Senator Bunning to lift his hold but if Bunning refuses to stop his filibuster, Reid will have to file cloture to shut down the debate and push action on the bill to midweek. Bunning is the only Senator opposing the extension.
Regulations Issued on Mental Health Parity Law
On January 29, the Department of Health and Human Services, the Department of Labor and the Department of the Treasury issued the long-awaited regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). There were many clear victories in the rule, including a requirement that health plans have a single combined deductible for mental health/substance use disorder treatment and medical/surgical treatment and a statement that discriminatory application of "non-quantitative" treatment limitations, such as prior authorization and step-therapy is also a violation of the law. APA strongly advocated for these areas to be covered in the regulations. There are still several unanswered questions and areas where the Departments have asked for further input. DGR will be working with the Office of Healthcare Systems and Financing (OHSF) and key councils to develop comments in response to the rule and urge further clarification.
Labor-HHS-Education Appropriations Bill Likely to be in"Minibus" this Year
With health reform dominating its schedule this fall, Congress has yet to approve seven of the twelve annual appropriations bills. Four of these bills have been passed by both the House and the Senate and are awaiting a conference committee report, but three have not yet been passed out of the Senate, including the Labor-HHS-Education bill which funds federal agencies such as NIH, SAMHSA and CDC. While congressional aides say there have been no decisions about how the appropriations process will proceed for the rest of the year, Senate Appropriations Chairman Daniel Inouye (D-HI) says he expects Congress will opt to enact a "minibus" bill made up of no more than four of the outstanding bills in mid December. The Labor-HHS-Education bill will likely be included in the minibus package along with the other appropriations bills that have not yet been approved by the Senate. Currently, all programs funded through the Labor-HHS-Education bill are operating at FY '09 levels which actually negates the slight increases that NIH and SAMHSA were slated to receive on FY '10.