Deficit reduction and long-term care: Enjoy things while you can

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Medicare Advantage organizations are unresponsive to provider questions, long-term professionals say
Medicare Advantage organizations are unresponsive to provider questions, long-term professionals say
If you thought the last few weeks of politicians' stomach-turning brinksmanship over the national debt ceiling wasn't fun — and who did? — you have no reason to look forward to the end of November and December.

A super-powered bipartisan “deficit reduction panel” has until Nov. 23, the day before Thanksgiving, to make recommendations on where to cut $1.5 trillion more in spending. Then, the full Congress has until Dec. 23 to pass cuts. Bah humbug, indeed. This isn't going to be pretty to watch.

The first real drama in this next chapter of “Can I shut down the government and/or economy to make my point?” will come relatively soon. It will be immensely interesting to see whom the major parties will appoint to the 12-member super panel. Will they be bare-knuckle brawler types or more sedate and professorial negotiators?

What about LTC now?

By and large, long-term care providers dodged some big bullets in the agreement reached Tuesday. But that was just the first round of shooting. There will be a lot more funding blood spilled by the end of the year. Operators could be swimming in it.

While Medicaid, Medicare and Social Security were among the exempted areas initially, they'll be fair game in the second phase.

It's not known how much more lawmakers might try to take away with long-term care already in line to lose 11.1% in Medicare funding starting Oct. 1. It's possible that that double-digit cut (which was called for by the Centers for Medicare & Medicaid Services) could be softened. But then the super-panel could inflict still more reductions.

The CLASS Act, despite being offered on a platter by other deficit reductions plans, was given a reprieve in Tuesday's agreement. By the end of the year, however, lawmakers could strip away most of the $120 million slated for next year's start-up efforts. If things really turn south, full repeal of the nation's first long-term care benefit could be back on the table.

As for Medicaid, expect lessening of provider reimbursements, and beneficiaries' eligibility options and benefits. Don't be surprised to see states granted more flexibility, which is generally viewed as not-so-good news for providers.

There is little question that non-Medicaid benefits are going to take a big hit. The provider community will surely feel ripple effects.

Just in case you're wondering what happens if politicians can't meet their end-of-year deadlines, well, “trigger” cuts will kick in anyway. If no agreement is reached, 2% across-the-board cuts would go into effect. Medicaid would be exempted, but providers' Medicare funding would be at risk.

All this has to be considered in addition to a scheduled 29.5% Medicare reimbursement cut for physicians. It's been put off several times already so if that remains an option, look for it to happen again.

One way or another, there's going to be an extraordinary blizzard of rhetoric and political posturing as 2011 winds down. It's liable to make all the hot air coming out of Washington the past few months feel like a cool summer breeze.

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Daily Editors' Notes

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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