Latest therapy caps ping-pong set straight

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If all the recent legislative action (or inaction, as the case may be) on Capitol Hill has your head spinning, don't worry-—you're not alone.

In the last week or two, Congress has been scrambling trying to come up with a fix for Medicare physician pay, therapy caps exceptions, state Medicaid assistance, unemployment insurance and a whole host of other programs that were either set to expire or already had.

It can be confusing enough trying to sift through the bevy of bills coming out of Washington at the best of times. But when multiple proposals containing remarkably similar provisions are being discussed and debated and amended and blocked and reintroduced all at the same time, even the guys who make their living tracking legislation start calling each other to ask what the heck is going on.

"It takes someone with such a keen eye right now and such an in-depth knowledge of what's going on," Susan Feeney, spokeswoman for the American Health Care Association, told me Thursday while talking through recent events in Washington. "The morass that's going on up on Capitol Hill is just indecipherable at times."

So what's been passed? What's been blocked? What's going on with all of these temporary "fixes?" Let's sort it all out:

Last Thursday (Feb. 25), the House of Representatives voted on and approved The Temporary Extension Act of 2010, which contains a temporary physician pay and therapy caps fix, as well as extended unemployment insurance through COBRA, through March 31. The Senate voted Tuesday evening to adopt this temporary fix, and President Obama signed it into action hours later.

This is what we have now. Medicare physician pay cuts have been delayed, and the therapy caps exceptions process has been extended until March 31. The big therapy caps exceptions process that is vital to so many long-term care residents and providers is also effective again, retroactive to Jan. 1.

On Monday, at about the same time that all this was going on, Senate Majority Leader Harry Reid (D-NV) and Sen. Max Baucus (D-MT) introduced a larger "extenders" bill that would delay physician pay cuts and extend the therapy caps exceptions process through Dec. 31. It also would extend a temporary 6.2% increase in state Medicaid funding by six months, through June of 2011.

This bill, though it deals with the same issues and was introduced at roughly the same time as the other bill, has not been approved. Dubbed The American Workers, State and Business Relief Act, the proposal is a substitute amendment to the Tax Extenders Act of 2009, which passed the House in December.

"The common thought right now is that this larger extenders bill will be voted on next week," Feeney said. "But anything can happen between now and then. And, anything can be stripped out. So what we're seeing right now that's in it might not be in the final package."

Make sense to you? Yeah, me neither. Maybe I'll focus on something easier to understand, like the fine print in the MDS or curing Alzheimer's.

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McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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