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Medicare Payment Changes Alert (12-18-09): Congress Temporarily Postpones SGR Cut

us_capitolBusy month for Medicare/Medicaid related news. The American Psychological Association (APA) released a new action alert in regard to a delayed Sustainable Growth Rate cut with a request for clinicians to contact their Congress person. Check the end of the report for a link to contact your representative as well as a suggested letter. Previous important updates this month include 2010 Medicare Payment Changes: Questions and Answers, Update on Impact of Medicare Payment Changes in 2010, and Update on 2010 Medicare Fee Schedules (12-16-09).

Jeff Cook writes:
This week the House voted to postpone for two months the scheduled 21.2% Sustainable Growth Rate (SGR) cut to Medicare provider payments as the debate on health care reform continued to occupy the focus of Congress. The postponement was included in the “must-pass” defense appropriations bill (H.R. 3326), which the Senate is expected to pass in the next few days and the President is expected to sign. The SGR cut will be blocked until February 28, and Congress will have to address this Medicare issue by that deadline.

As you may recall, the House previously passed legislation (H.R. 3961) in November to permanently replace the SGR formula and provide a 1% update for 2010, but the bill has stalled in the Senate due to budgetary concerns. The Senate health care reform bill currently includes a provision to prevent the SGR cut for one year and provide a 0.5% update for 2010.

Other Medicare issues, including our 5% psychotherapy payment restoration, remain a key part of the health care reform bills currently under consideration. Following the implementation of across-the-board cuts resulting from the Centers for Medicare and Medicaid Services (CMS) five-year review, the APA Practice Organization (APAPO) successfully persuaded Congress in 2008 to restore payments for psychotherapy, the only codes that received relief. In 2009, APAPO secured language extending the restoration provision in the Senate and House health care reform bills, as well as all health care reform bills considered by committees of jurisdiction.

Because it is part of health care reform, this critical provision is unlikely to be enacted by January 1. However, Finance Committee staff has indicated that they will seek to apply the restoration to all Medicare payments in 2010.

We need to keep the pressure on Congress to ensure our provision is extended, and retroactively if necessary. Your Senators and Representative need to hear from you TODAY that they should pass the restoration extension as soon as possible.

Take Action:
Click here to urge your Senators and Representative to quickly pass the psychology payment restoration extension.

If you are not able to reach the Legislative Action Center from the above link, please visit here.

Grassroots feedback is also extremely important to our advocacy efforts, so we would very much appreciate it if you would e-mail (jcook [at] or fax (202-336-5797) us any responses you receive from your Representative.

Sample Letter:

I am writing as a psychologist and constituent to share my deep concern that Congress has not yet taken action on several key Medicare priorities. While I am grateful that the Sustainable Growth Rate cut has been prevented for two months, Congress must move quickly to stop the cut from endangering Medicare patients’ access to quality mental health care and should pass a permanent solution that fairly reimburses psychologists and other providers.

Moreover, Congress must extend the 5% psychotherapy payment restoration, which was enacted as part of the Medicare Improvements for Patients and Providers Act to protect Medicare mental health services that were previously cut by CMS’s five-year review. An extension of this critical provision was passed by the House (Sec. 1309 of H.R. 3962 and is included in Senator Reid’s bill (Sec. 3107). My practice is already facing significantly lower reimbursement in 2010 due to CMS’s recent practice expense adjustments, and I simply cannot afford to provide services for less.

Please enact the MIPPA restoration extension as soon as possible and make sure it applies retroactively. This is critically important to my practice and the patients I serve. Thank you for your time and consideration.

Jeff Cook, J.D.
Director of Field & State Operations
American Psychological Association Practice Organization
750 First Street, NE Washington, DC 20002
(202) 336-5875 (Office)
(202) 336-5797 (Fax)

Reprinted with permission: APA

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