Long-term care reform may have to wait

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There was no battle cry. No calls to storm the halls of Congress. Instead the message at the American Health Care Association's two-day Congressional Briefing was subtle: You can ask lawmakers for long-term care reform, but save your energy for other issues.

This toned-down rhetoric regarding long-term care reform was evident at the lobbying event in Washington, D.C., this week. Bruce Yarwood, president and CEO of AHCA, explained why. He didn't want members to bank on something they likely weren't going to get.

"I was trying to create a little more expectation as to timing," he said.

Instead, he told members, Congress had to pass Medicare Part D. Now the move is on for universal healthcare coverage. Long-term care reform may be next, but it likely won't be now.

"He [Obama] has an agenda I've never quite seen before and it's all on the table now," Yarwood told members at a speech on Wednesday.

The pace for some kind of healthcare reform is moving too fast for Congress to consider the immensely complicated and complex systems of Medicaid and post-acute care that would have to be a part of long-term care reform, he explained to me. President Obama wants a bill by October and lawmakers are adamant about marking one up by the August congressional recess.

"There's only so much you can bite off" between now and July, he said.

So instead, AHCA shifted the fight to Medicare RUGs (Resource Utilization Groups) and fending off a rule that would cut Medicare reimbursements by $1.05 billion for skilled nursing facilities in fiscal year 2010. Another concern is the proposed new classification system called RUG-IV, which would be implemented by fiscal year 2011. The proposal only allows a limited 60-day comment period. Yarwood also talked about the problems with Medicaid stimulus funding and how it has not gone to nursing homes, as promised.

There are certainly no shortage of issues to talk to legislators about and take action on, and AHCA focused on a whole host of them these last two days.

Yarwood mentioned that he is not "walking away" from long-term care reform. And he said he likes a bill spearheaded by Sen. Ted Kennedy (D-MA) that would include provisions for people with disabilities.

But the passion over long-term care reform was clearly missing from the meeting. And that was a bit of a let-down, considering the topic has been front and center on the radar of the long-term care community over the last several months.

Instead, the message at the AHCA meeting this week was sit down. Take a number. Wait your turn.

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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.