Volume XXX, Number 4,
 April 2015

AHCA issues guidance on Sustainable Growth Rate (SGR) delay

According to a memorandum released on March 30, 2015 by the American Health Care Association, the failure of the U.S. Senate not voting on a new Sustainable Growth Rate (SGR) bill (also known as the “Doc Fix) has led to provider uncertainty in regard to Medicare Part B services.  Specifically, providers are at potential risk because of two key factors: (1) the potential of a -21.2 percent adjustment to the Part B fee schedule effective April 1 depending on whether or not the SGR bill is enacted when the Senate returns from recess, and (2) the therapy cap exceptions process that expires on March 31, after which there will be no exceptions to the hard cap of $1,940……..which, again, would not apply if the SGR bill is enacted when the Senate returns from recess.

Since no current guidance has been released from the Centers for Medicare and Medicaid Services (CMS) regarding this issue, the AHCA Finance Committee’s Billing and Operations Subcommittee and the Therapy Policy Advisory Group has developed recommendations for providers to consider during this period of uncertainty.   CLICK HERE to view the detailed FAQ pdf document on AHCA’s website that they developed regarding the SGR issue.

Questions regarding this issue should be directed to Dan Ciolek at dciolek@ahca.org.


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If you have suggestions for education sessions or questions about THCA education, please contact Sue Wilson at the THCA office swilson@txhca.org.