Bill affecting skilled nursing facility payments, ICD-10 deadline passes House in controversial vote

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House Speaker John Boehner (R-OH)
House Speaker John Boehner (R-OH)

A bill linking skilled nursing facilities' Medicare payments to hospital readmissions passed the House of Representatives Thursday, through a voting method that provoked outrage from some legislators. The measure also would extend the ICD-10 transition period and prevent a looming physician pay cut.

The Senate is scheduled to vote on the bill Monday, and it then likely would go swiftly to the White House for the president's signature. Doctors otherwise would experience a steep cut in Medicare reimbursements as of Tuesday, April 1, under the Sustainable Growth Rate formula. Given this pressure, some pundits expect the bill to pass the Senate, even though this would require a 60-vote super majority.

While lawmakers continued to disagree about how to permanently repeal and replace the SGR, Speaker of the House John Boehner (R-OH) and Senate Majority Leader Harry Reid (D-NV) negotiated the “doc fix” bill and introduced the proposal Wednesday. As of Thursday morning, leaders in the Republican-controlled House had not mustered the two-thirds majority to pass the bill in a standard vote, The Hill reported. Therefore, they brought it up for a voice vote.

In a voice vote, the presiding officer asks members to vote by saying “yea” or “nay” as a group. Relatively few representatives were present when the voice vote was called for this bill, and some objected strenuously to the tactic, according to news reports.

“Short on votes for controversial spending bill, so GOP & Dem leaders rammed it through by ‘voice vote' in empty House chamber. Not right,” wrote Rep. Justin Amish (R-MI) on Twitter.

Some objectors argued against another temporary SGR patch, considering that there is broad support for repeal. However, lawmakers have not agreed on how to fund a repeal.

Long-term care providers are concerned that the cost of an SGR repeal would be offset in part by across-the-board Medicare cuts for skilled nursing facilities. The American Health Care Association/National Center for Assisted Living proposed an alternative savings method, based on tying payments to SNFs' hospital readmissions. A version of this plan is in the bill that now is before the Senate. 

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