James M. Berklan

As of this writing, drama rages over whether Congress will allow the government to grind to a halt at midnight Friday due to a funding tug-of-war. As we’ve seen before, countless aspects of U.S. life would be affected.

Amid all the brinkmanship also lies the fate of the Medicare Part B therapy caps, which are currently in full effect due to congressional inaction last month. A proposal to repeal the 20-year-old thorns-in-the-side could be folded into any solution lawmakers come up with.

But none of it would come easy.

First, we’d have to get warring Republican and Democrat factions to agree on at least a handful of higher-profile national issues. These include immigration reform, military spending and numerous other campaign favorites.

Once the overall vehicle would be agreed to — if that’s possible  — then would come the race to have a therapy caps repeal added to it, probably as part of a big Medicare spending provision.

Earlier this week, the best-case scenario had the House passing a bill by Thursday without therapy caps or Medicare extender policies in it. Then, the Senate would add an extender bill — with a therapy cap repeal within — and send it back to the House for final approval.

The path for getting it done by today, along with a continuing resolution, existed at mid-week. But with each passing hour, the odds have grown slimmer.

The anticipation from long-term care and other therapy providers has been palpable. That’s because much of the spade work has already been completed. Congressional staffers from both sides of the aisle agreed to a plan that a huge consortium of caregivers also found favorable. That was a huge step.

Now it all comes down to how to pay for it. And, this time, the rest of the country’s business as well.

The possibilities include hustling a deal through by Friday night, punting ultimate decision-making through the weekend while negotiators finalize a deal, extending current conditions about a month, or going nuclear with a full shutdown. Stubborn faces could then scowl at each other from their respective sides of the aisle as talk shows exploded with made-for-TV indignation.

However it unfolds, providers expect good news on the other end. Eventually. There might be a “payfor” funding jolt that accompanies a caps repeal, but all of the providers I’ve spoken with said it would be worth it — barring a total hosing on the funding end.

Lawmakers, of course, also could revert to the sweeping exceptions process that expired Jan. 1. It largely exempted many long-term care residents from the limits for numerous years. But that seems unlikely, given the progress made by the multiple legislative committees working on the issue.

The ultimate payoff of a therapy-cap repeal would be free-flowing care for beneficiaries, without the figurative funding sword always hanging overhead. Taking that uncertainty out of the picture would allow providers to concentrate on other pressing challenges, of which there is never a shortage.

Keep your eye on Washington — and here too, of course. We’ll bring you the news on developments when — and if — they happen.

Follow Editor James M. Berklan @JimBerklan.