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Congress Repeals the Sustainable Growth Rate and Ends the Instability of Reimbursement Rates...

Tuesday, May 12, 2015   (0 Comments)
Posted by: Jennifer Kelly, PhD

Full Title: Congress Repeals the Sustainable Growth Rate and Ends the Instability of Reimbursement Rates for Medicare Providers  With the help of professional psychology’s advocacy efforts, Congress has repealed the sustainable growth rate (SGR) once and for all!  In the past month leading up to this historic vote, psychologists from around the country sent more than 13,000 letters to their members of Congress and visited over 350 Congressional offices during the 2015 State Leadership Conference. “This is a huge victory for psychologists, their patients and the entire health care system,” said APA Executive Director for Professional Practice Katherine C. Nordal, PhD. “When professional psychology stands up for their patients, Congress listens. We couldn’t have done it without the tireless grassroots support of our members.”

Yesterday, the U.S. Senate passed H.R. 2, The Medicare Access and CHIP Reauthorization Act (MACRA) by a vote of 92-8. The U.S House of Representatives overwhelmingly passed MACRA in March, and President Obama is expected to sign the bill into law.

The replacement of SGR with Medicare payments based on rewarding value should foster the development of new payment and delivery systems which look to improve patient care and restrain cost growth. MACRA increases reimbursement rates to providers and helps with the transition to a new Medicare payment system, specifically:

  • Beginning in July 2015, implements a 0.5 percent annual updates to Medicare providers through 2019;
  • From 2020-2025, rates stay at the 2019 levels; and
  • In 2026, Medicare providers will receive an annual update of 0.25 percent and professionals participating in tests of alternative payment models would receive an annual update of .75 percent.

MACRA also establishes an incentive payment program called the Merit-Based Incentive Payment System (MIPS) which transitions the three existing incentive programs (i.e. PQRS, Value-Based Modifier, and Meaningful Use of EHR) into one consolidated program. Medicare physicians and certain primary care providers are eligible in 2019 for MIPS and other health professionals will be added in 2021.

The law also encourages the participation in alternative payment models (APMs). Eligible Providers, including psychologists, who test new APMs that include risk-sharing and quality measurement components will be eligible for a 5 percent bonus between 2019-2024 if they meet certain criteria.  Providers participating in APMs are not eligible to participate in MIPS.

Additionally, Congress retroactively repealed the SGR formula, so services that occurred on or after April 1st will be paid at the same rate as services furnished before April 1st. This was necessary because the SGR and its 21% cut to the Medicare reimbursement rate went into effect on April 1st, however, the Centers for Medicare & Medicaid Services have been holding claims in anticipation of Congressional action.  According to the latest CMS statement sent to providers on April 13th, CMS will begin processing held claims on April 15. If any claims are paid at the reduced rate, they will automatically be reprocessed at the corrected, higher rate. Providers are encouraged to contact their Medicare Administrative Contractor if they have any questions about their claims.

Besides repealing and replacing SGR, MACRA extends funding for The Children’s Health Insurance Program (CHIP) through September 30, 2017.  CHIP is authorized through 2019, but funding for the program only ran through September of this year.

APAPO is encouraged by this victory and all the grassroots engagement by our members. But, our work on behalf of professional psychology is not done!   Now that SGR formula is repealed, we forge ahead with the rest of our legislative goals and ask Congress to:

APAPO will continue to educate our members about this new law and how it affects their practice, and visit for more information.

Thank you for your tireless grassroots efforts that made this a reality!

Jennifer F. Kelly, PhD, ABPP
Federal Advocacy Coordinator

Georgia Psychological Association