Washington, D.C.—Good morning, ProviderNation. John Boehner has gone, but he did not leave without a parting gift to long term and post-acute care. It is true that the two-year budget compromise, which passed both houses of Congress and which the president will sign into law as soon as it reaches his desk, did include an extension of the Medicare cuts under sequestration.
It is also true, though, that it doesn’t include any direct cuts to the profession. Take it from Your Humble Correspondent that in the final, furious days of negotiations there were significant threats in the opposite direction. Considering that one side of Congress is always in the mood to cut entitlements, and that the other side was exercised over a certain recent report from an IG whom we will not mention, then you see why some provider advocates aren’t just willing to file the budget under “Could Be Worse,” they’re counting it as a minor-key miracle.
“We are pleased with the final form of this legislation, even though it contains a pay-for that impacts our profession,” AHCA/NCAL overlord Mark Parkinson told his members last week. “While it is unfortunate that Congress continues to use this pay-for when funding options are needed, immediate cuts that further erode already slim SNF margins would have been a far worse option. Real threats—such as a cut to bad debt reimbursement or an elimination of the provider assessment—are not in the legislation.”
Two years also offers at least the prospect of that elusive D.C. prey: regulatory certainty.
Which brings us to the House’s new speaker. It is true that Paul Ryan, R-Wis., has been (shall we say?) skeptical about Medicare’s long-term future. And it is true that, at least in his hot youth, Ryan was a bit of an Ayn Rand fanboy.
But provider advocates I’m hearing from are convinced that Ryan is someone with whom business can be done.
“Our members have enjoyed a good working relationship with Speaker Ryan,” Parkinson says in a statement Monday. “Every step of the way, he has welcomed our input and perspective, even if we didn’t see eye to eye on every issue.”
Here again, we see how essential that two-year budget is. Whatever else it means, it means that Ryan won’t have to do any heavy lifting on a new budget until (at least) after next fall’s elections. That gives him time to work with the fire-eaters in his own party who pushed Boehner out the door, and it also gives time to advocates to make their case that their work isn’t just essential: it’s worth it.
“In the coming weeks and months,” Parkinson adds, “we will be especially interested to work with Speaker Ryan on advancing initiatives that are of vital importance to our sector, such as new ways of thinking about how providers are reimbursed and legislation that further opens access to long term and post-acute care services for older Americans.”