Congressional leaders have been struggling to enact legislation that would temporarily block a more than 21% cut in Medicare physician fee schedule payments that went into effect June 1, 2010 under the sustainable growth rate (SGR) formula.  On June 17, 2010, the Senate failed on a procedural vote to move ahead on a pared-down version of H.R. 4213, "The American Jobs and Closing Tax Loopholes Act of 2010."  This version would have provided a 6-month SGR fix, under which physicians would receive a 2.2% payment increase through November 30, 2010 (rather than the 19-month plan the House approved in May).  It also would have extended enhanced Medicaid matching rates and made a series of changes to Medicare and Medicaid payments included in the earlier House bill. The SGR change and other modifications designed to reduce– but not full offset — the cost of the package failed to attract the super-majority of votes of 60 Senators necessary to cut off debate and allow a final vote. Most recently, today the Senate approved by voice vote a measure (H.R. 3962) that separates the SGR component from the broader jobs bill, offset in part by clarifying Medicare inpatient hospital "3-day payment window" policy designed to prevent unbundling of certain services. Under the Senate bill, Medicare physician fee schedule amounts would be increased by 2.2% for the period of June through November 2010, with the SGR cut applying December 1, 2010 unless Congress acts again.  Note, however, that the legislation still must be approved by the House (which is out of session until Monday) before it could be sent to the President’s desk. In the meantime, the Centers for Medicare & Medicaid Services (CMS) issued a list-serve announcement today that it is lifting the hold it had placed on contractor processing of June Medicare physician fee schedule claims; the hold expired June 17, 2010. Held claims will be released and processed on a first-in/first-out basis, and subject to the approximately 21% negative update. CMS adds if Congress acts to modify the negative update now in effect, "CMS is prepared to act expeditiously to make the appropriate changes to Medicare claims processing systems."