HELLPP Act Language Enters Senate SGR Legislation

In a very encouraging development, on December 12 APMA’s signature HELLPP Act legislative language—recognizing DPMs as physicians under Medicaid—was adopted as an amendment to the US Senate Finance Committee’s Medicare physician payment reform legislation. Sens. Charles Schumer (D-NY) and Chuck Grassley (R-IA) were our committee champions who made this happen.

This is an exciting and important step to moving our legislation closer to the finish line, but our grassroots activism cannot let up now. We need all APMA members to write and make a phone call to their elected representatives urging that the HELLPP Act language remains in any final Medicare physician payment reform legislation.

In the short-term, Congress is passing a three-month patch at near current physician reimbursement levels so as to give more time for a permanent Sustainable Growth Rate (SGR) formula overhaul to be devised. Lawmakers dedicated to permanent reform of the SGR payment formula for Medicare providers now have to merge a trio of plans approved by congressional committees.

The House Ways and Means and Senate Finance committees this past Thursday approved two similar pieces of legislation stripping out the SGR and replacing it with a system of incentives that rewards or penalizes doctors based on the quality of service they provide. Those bills, containing slightly different policy, must now be combined with yet another bill approved by the House Energy and Commerce Committee this summer. Congress will also have to come up with a way to pay for the fix—expected to cost about $150 billion—if it stands any hope of getting through the full House and Senate.

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