Medicare Sustainable Growth Rate Formula & Doc Fix Explained
Since 2003, Congress has passed more than a dozen temporary fixes to Medicare’s Sustainable Growth Rate (SGR) formula – often referred to as the “doc fix.” This winter, Congress has made unprecedented progress toward repealing the complex and unpopular formula used to determine Medicare reimbursement rates for physicians. Two committees in the House – the Ways […]
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National Council, NASMHPD to Host Webinar on CMHC Conditions of Participation
Late last year, the Centers for Medicare and Medicaid Services (CMS) finalized regulations outlining the conditions that community mental health centers must meet to participate in Medicare. The final rule applies primarily to organizations that offer partial hospitalization services under Medicare and establishes, for the first time, a broad array of service requirements and quality standards.
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New Cosponsors Join Bill to Expand Medicare Coverage for Mental Health Services
Several new cosponsors have signed onto a bill this month that would allow Medicare coverage for mental health services of marriage and family therapists and mental health counselors services. Currently, Medicare does not pay for services from these providers, an exclusion that limits patients’ access to services and unduly excludes an important class of professionals serving […]
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Senate Committee Urges CMS to Preserve Mental Health Drug Access
In a rare display of unanimity, the 24 members of the Senate Finance Committee have sent a joint letter to the Centers for Medicare and Medicaid Services urging the agency to roll back a proposal that would drastically limit consumers’ access to mental health drugs.
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Bill Introduced to Reform Chronic Care in Medicare
A bipartisan bill introduced in Congress last week aims to overhaul the way older Americans receive care under Medicare and rein in the program’s rising costs. The Better Care, Lower Cost Act of 2014 (S. 1932/H.R. 3890) would give Medicare providers and insurance plans incentives to use team-based care to treat patients with chronic health conditions.
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Rep. Murphy Calls CMS to Task for Proposal Limiting Mental Health Drug Access
Congressman Tim Murphy (R-PA) has written to the Centers for Medicare and Medicaid Services (CMS) asking the agency to justify its decision to strip key mental health drugs of their protected status in Medicare. Stating that “the CMS proposal appears not to be grounded in a concern over beneficiary health,” Murphy asked the agency to account for the rationale behind its controversial proposal issued earlier this month.
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CMS Proposes to Strip Mental Health Drugs of Protected Status in Part D
The Centers for Medicare and Medicaid Services (CMS) this week announced a proposed rule that would eliminate protected status for antidepressants and antipsychotics in Medicare Part D prescription drug plans.
The proposed rule, announced Monday, revises prior agency policy that required Part D plans to include on their formularies “all or substantially all” drugs within six classes: antidepressants, antipsychotics, anticonvulsants, antineoplastics, and immunosuppressants. This policy, known as the “six protected classes” policy, has been in effect since the inception of Part D and has enjoyed strong bipartisan support in Congress.
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Budget Compromise Passes Congress; Includes Short-term Medicare Pay Fix
Congress this week approved a bill setting top-line budget numbers for 2014 and 2015. The agreement alleviated fears of another government shutdown by paving the way for an omnibus spending package that will set programmatic spending levels for the remainder of the fiscal year. It also includes a three-month postponement of an imminent 20 percent cut to Medicare physician pay rates, giving House and Senate negotiators breathing room to finish their work on a comprehensive, permanent fix that could include the Excellence in Mental Health Act.
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Clarifying the Medicare Conditions of Participation for CMHCs
Recently published guidance from the Obama Administration established, for the first time, conditions of participation (CoP) for community mental health centers in Medicare. In the weeks since this guidance was issued, the National Council has received many questions from our members asking whether and to what extent these guidelines apply to them. Keep reading for answers.
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Happy Birthday, Medicare Part D! 10-Year Anniversary of Landmark Law is Dec. 8
On December 8, 2003, President George W. Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act (MMA), which established the Medicare Prescription Drug Coverage Program known as Medicare Part D. In creating the first-ever outpatient prescription drug benefit under Medicare, the law closed a significant gap in health insurance coverage for Medicare beneficiaries.
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Conditions of Participation Issued for Community Mental Health Centers
For the first time, community mental health centers offering partial hospitalization services under Medicare must meet specified Conditions of Participation, under guidance released by the Centers for Medicare and Medicaid Services (CMS) last week. The six Conditions of Participation (CoPs) establish requirements for client care, staff and provider operations, and quality measurement. The CoPs apply to community mental health centers (CMHCs) that participate in Medicare as partial hospitalization providers.
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Medicare Physician Pay Fix Advances
Leaders of two key Congressional committees have agreed on a framework to scrap the current Medicare physician payment formula and replace it with one that would link reimbursement to the quality of care provided – a step that could put an end to the annual “Doc Fix” debate.
Without congressional action, Medicare physicians will suffer a major cut in pay rates this January. The cut is required under the Sustainable Growth Rate (SGR) formula, which compels Medicare to adjust payment rates each year to align with a predetermined rate of growth in the program. In practice, this has meant that Medicare payments would take an ever-increasing yearly cut – but each year, Congress has passed legislation postponing those cuts.
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House Committee Unanimously Approves Medicare Physician Pay Reform
The House Energy & Commerce Committee this week unanimously passed legislation to reform and repeal the Medicare physician Sustainable Growth Rate (SGR) formula. This formula requires yearly adjustments to physician pay to bring it into line with an approved formula for sustainability; however, in practice it has resulted in large potential cuts that Congress overrides each year. Physicians and Medicare advocates have long urged a permanent fix for the SGR, but Congress to date has not been able to agree on how to offset the expense.
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