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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Latest Maneuver in “Doc Fix” Debate Includes Excellence in Mental Health Act

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Senator Ron Wyden (D-OR), chairman of the influential Senate Finance Committee, has introduced a bill to permanently repeal the unpopular Medicare physician payment formula, while enacting a Medicaid demonstration program that would bolster the nation’s community behavioral health system.

The Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 (S. 2110) would establish a four year, 8-state demonstration program based on the Excellence in Mental Health Act. In states selected for participation, community behavioral health organizations that meet certain criteria for providing a comprehensive range of high-quality services would in turn be eligible for enhanced Medicaid reimbursement. The National Council has long supported the Excellence in Mental Health Act, which would provide an influx of much-needed resources into the behavioral health safety net.

Wyden’s bill is the latest sally in a congressional skirmish over the Medicare payment formula, also known as the “doc fix.” Key Republican and Democratic committee leaders have reached an agreement on the framework for permanently repealing the troubled Sustainable Growth Rate formula, but they remain stymied over how to pay for it. The House this week passed a slimmed-down version of the bill (H.R. 4105) that would have been paid for by repealing the Affordable Care Act’s individual mandate, a no-go in the Democratic-controlled Senate. Wyden’s bill includes both the SGR repeal as well as a package of “extenders” – an assortment of Medicare, Medicaid, and tax-related policies that are typically approved by Congress as a temporary patch each year. The Congressional Budget Office estimates that Wyden’s bill would cost $180 billion over 11 years. The bill does not include a cost offset at this time.

The legislative patch that is currently holding off scheduled cuts to Medicare physician pay is set to expire on March 31. Congress must either enact a permanent fix or pass another temporary delay before the end of the month to ensure the cuts do not go into effect.

Image via Washington Post