CONTINUING RESOLUTION DOMINATES CURRENT CONGRESSIONAL AGENDA: The recent 230- 189 vote in the House of Representatives to pass a Continuing Resolution (CR), to fund the government through mid-December with provisions to defund the Affordable Care Act (ACA), has sent law makers on capitol webboth sides of the aisle into a frenzy this week. The Senate will now have to potentially avoid a filibuster and pass a bill of its own. The House gambit to defund the ACA has set up a ping pong match between the House and Senate, and with mounting pressure from rank-and-file Republicans to avoid a filibuster and pass a clean CR the Senate is expected to pass a bill without the provision to defund the ACA (which may not happen until Sunday).  House Republican leadership will have to decide at that point whether it will continue its strategy to attack the ACA via the CR, or pass a clean bill and take up a larger fight on the ACA during the debt-limit debate, which is set to expire mid-October.

DEBT LIMIT IS NEXT GOP BATTLE, SGR NOT PART OF AGREEMENT: In anticipation of a showdown with the Administration and the Democratic controlled Senate over the debt-limit, the House has temporarily shifted its focus from the CR and have released an outline of areas that it will use as bargaining chips to raise the debt-limit, including delaying the ACA for one year. However, noticeably missing from this package are any provisions to repeal the sustainable growth rate (SGR).

NEXT STEP FOR THE SGR: In a recent meeting with a staff member of House Majority Leader Eric Cantor (R-VA), it appears that the SGR is an item still being looked at for an end-of-the year budget compromise with the White House. However, major points still need to be addressed, including SGR payfors. House Leadership is tasked with identifying these payfors and is looking toward popular Medicare reform proposals, such as premium support models, which received a boost from a recent Congressional Budget Office (CBO) score that said these models would generate significant savings in Medicare. In the run up to the upcoming budget battles, provider groups, like NASS will have to continue to beat the SGR drum, as the Majority leader’s staff indicated that members of the Republican caucus have all but been silent on raising SGR to leadership as a top priority. The Majority Leader’s staff representative, however, reassured NASS that the SGR is still in the topic of serious discussions and a one-year SGR patch is not even being discussed at the moment.

IN THE MEANTIME: Ways and Means Sub Health Committee Chairman Kevin Brady (R-TX) has said that his committee is looking for ways to reduce the price tag of the recent CBO score of the Energy and Commerce SGR bill, as he believes members of his caucus will not support the $175 billion price tag of the bill. Rep. Brady may have a point, considering more than 100 members of Congress have been in office for three years or less, and are not privy to the problems with the SGR. Moreover, outreach to new members is necessary to keep the SGR process as bi-partisan as possible. One possible scenario of the process going awry is if new members of the Republican caucus look toward the ACA for SGR offsets as opposed to less controversial areas of the budget.

AND IF THE GOVERNMENT DOES SHUTDOWN…: Most beltway insiders and Members of Congress have stated that they do not anticipate a government shutdown, however, should one occur, it would last no longer than 5–7 days. During this time period, NASS does not expect any disruptions to physician reimbursements, as this funding comes from the Medicare trust fund and not regular appropriations. If a shutdown persists longer than expected, there could be issues with the Centers of Medicare and Medicaid Services (CMS) paying its vendors who do claims processing. If vendors aren’t getting paid for a significant period of time, they may stop processing claims, but it seems unlikely that a shutdown would go on long enough for that to happen.