Bill protects nursing home market basket

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It's not perfect, but the $856 billion, 10-year bill released today cuts nursing homes some slack.

To be specific, the bill, which was released by the Senate Finance Committee, would not reduce the market-basket update for nursing homes. The associations have been concerned about this possibility since it appeared in Senate Finance Chairman Max Baucus' "framework" for reform released last week. Apparently, nursing homes got the senator's ear.

"The bottom line is he heard us about the importance of the market basket, giving us a predictable revenue stream because Medicaid is so unpredictable state by state," said Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging.

(I got Minnix's ear as he spoke by cell phone in Philadelphia, heading to a fall policy conference in Brainerd, MN.)

Make no mistake. Nursing homes are still smarting from the 1.1% cuts to Medicare initiated by the Centers for Medicare & Medicaid Services. But they are grateful for Baucus' nod on the market basket, otherwise known as an annual cost-of-living, increase.

"He helped stabilize the Medicare side of it," Minnix said. "He created provisions to be innovative and we've got a lot of work to do to change our business model to stay viable."

There are other encouraging provisions for nursing homes. The exceptions process for therapy caps would extend for two years, until Dec. 31, 2011, under the bill. It also has plans for demonstration projects for issues such as workforce improvement that please nursing homes.

Of course, the new bill also contains a slew of new requirements regarding ownership and staffing transparency. That is likely to displease many providers, particularly on the for-profit side.

But to keep this all in perspective, the introduction of this bill is just one more piece—albeit a big one—of an increasingly intricate healthcare reform puzzle. A lot can change, particularly considering Republicans have opted not to support Baucus' bill.

AAHSA is still hopeful that a final Senate bill, which would include input from several committees, would include the CLASS Act. The act, which originated in the Senate HELP Committee, would create a disability insurance fund. AAHSA has long championed this concept.

Then, of course there is the House bill, which would eliminate the market basket for most of 2010.

So, perhaps the Senate Finance Committee bill is a case of being grateful for small favors. There is plenty more to fight for, but all in all, the bill is not as troubling as long-term care stakeholders had feared. Nursing homes have a voice, and it was heard today.


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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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