Congressional lawmakers are closer than ever to repealing the broken Medicare Sustainable Growth Rate (SGR). Landmark bipartisan, bicameral legislation was considered and passed out of committee on Thursday, Dec. 12, by the U.S. House Ways and Means Committee and the U.S. Senate Finance Committee.

Both committees' versions of the proposal would consolidate and restructure existing quality improvement incentive programs -- including meaningful use, the Physician Quality Reporting System and the value-based modifier -- to reduce the administrative and financial burden on physicians, the AMA reports. They also allow for bonus payments for high-performing practices and lessen potential penalties.

The House version also provides a 0.5 percent update to payments under the Medicare physician fee schedule for three years.

The AMA has announced its support for the current proposal, calling it "a significant improvement over current law" that will "result in a stronger Medicare program." And while Congress will not pass the legislation before they adjourn for the holiday recess, an amendment in the budget agreement includes a temporary three-month "payment bridge" for the SGR and related extenders, averting the nearly 24 percent cut in Medicare payments and giving lawmakers more time to work out the details of a permanent fix.

The House passed the three-month payment bridge that includes a 0.5 percent update and the Senate is expected to vote on the measure before recessing at the end of the week.

The biggest obstacle to the full SGR repeal is finding and agreeing upon budgetary offsets. The Congressional Budget Office has re-scored the cost of repealing the SGR over the next 10 years from $150 billion to $116.5 billion, which AMA President Ardis Hoven, MD, has said presents an opportunity for repeal that will not likely occur again.

Make your voice heard; contact your congressional representative and senators to urge them to keep up the momentum. Go to the AMA's Fix Medicare Now campaign website for e-mail templates, talking points and more.

Note: The deadline to modify your participation status with Medicare has been extended to Jan. 31, 2014. Click here to access the AMA's Medicare Participation Kit to understand your options.

The Centers for Medicare and Medicaid Services has released its payment rates and policies for 2014, outlining policy on a range of payment-related topics. Most provisions take effect Jan. 1, though a few remain open for public comment until Jan. 27. The American Medical Association highlighted several of the provisions in an executive summary.

• A proposed cap on non-facility practice expenses will not take effect. The federal CMS did not finalize its plan to cap payments for more than 200 physician services at rates previously set for ambulatory surgery centers or hospital outpatient departments.
• Physician Quality Reporting System incentives will end in 2014. Beginning in 2015, physicians will receive monetary penalties for failing to satisfactorily report. Under the final rule, physicians will need to report on 50 percent of applicable patients, instead of 80 percent.
• $435 million will be redistributed within the Medicare Physician Fee Schedule in 2014. CMS accepted 76 percent of the recommendations by the AMA/Specialty Society Relative Value Scale Update Committee, including improved payment for mental health services.
• CMS will pay monthly chronic care management services beginning in 2015. Estimates place these payments at about $82 per Medicare patient per month.
• The value-based payment modifier will apply to groups of 10 or more in 2016. Group practices of 10 or more physicians and other health care professionals will receive a yet-to-be-determined payment increase for performing well on cost and quality measures in 2014. Groups that do not perform well, meanwhile, could face a cut of up to 2 percent in their 2016 payments. The AMA and others objected to this expansion; CMS is not required to apply the VBM to all physicians until 2017.

Click here to read the AMA's executive summary to learn more about these and other policy updates in the 2014 Medicare Physician Fee Schedule final rule.

Beginning Jan. 1, 2014, more Coloradans will be newly eligible for free or low-cost coverage through Colorado Medicaid. Currently, Medicaid offers primary care, behavioral health, hospitalization, rehabilitative services, laboratory services, outpatient care, prescription drugs, emergency care, dental care, maternity care and newborn care.

The benefit package for newly eligible Medicaid clients will be largely the same as the current Medicaid benefits, including the new dental benefit and enhanced mental health and substance use disorder benefit.

In accordance with federal law, the newly eligible Medicaid clients will receive preventive and wellness services as defined by the U.S. Preventive Services Task Force. In an effort to align Medicaid benefits, the current Medicaid benefit package will be expanded to include these preventive and wellness services.

Additionally, the newly eligible Medicaid clients will receive habilitative services, which are considered to help individuals maintain skills necessary for daily living.

The benefit package for the newly eligible providing general Medicaid coverage, additional preventive and wellness services and habilitative services must be approved by the Centers for Medicare and Medicaid Services. The Department of Health Care Policy and Financing will continue to update you on the approval process.

For information view a fact sheet here. If you have questions regarding the department's implementation of the Affordable Care Act check out FAQs at Colorado.gov/Health, Colorado.gov/HCPF/ACAResources or submit questions to [email protected].

Also, HCPF encourages all health care providers to check out the department's new ACA resources page specifically developed for providers. Click here for key information about health care reform, the Medicaid expansion and Connect for Health Colorado.

HealthTeamWorks is now accepting applications for the 2014 installment of the Patient-Centered Medical Home Foundations program with grant support from the Colorado Health Foundation. The grant, which will provide practice transformation coaching to more than 100 Colorado practices free of cost, supports a program starting in January 2014.

To provide support to those practices early on in their transformation while also providing advanced curriculum to practices across Colorado already on their transformation journey, the program will encompass two parts.

A continuation of the current PCMH Foundations program will continue to lay the groundwork for practice transformation of new practices and those still early on in their journey to practice transformation. A more advanced Innovations program will expand on pre-established concepts and continue support for many practices that are looking to achieve the Triple Aim.

New practices will address the basics of the Joint Principles of PCMH, a document established in 2007 through the collaboration of four national health care organizations, including the AAFP and AAP, while previous and already advanced practices will expand to more complex topics like integration of behavioral health and patient activation.

"HealthTeamWorks is excited to be able to continue serving the practices here in Colorado with which we have built a strong relationship, but we are eager to begin teaching on a larger scale this advanced curriculum we have been developing," said Amber Carlson, PCMH program manager.

Applications will be accepted through the end of the year and organizations interested in these free services to enhance value and quality of care should contact Amber Carlson for more information at (303) 446-7200 or [email protected]. For more information on the program, watch a webinar or view this flier.