John O’Connor

Let me begin by saying I like Seema Verma. She seems like a very nice person and a more than capable administrator for the Centers for Medicare & Medicaid Services. And I know she has a very, very difficult job.

Yet I’m still chewing on something she posted last week.

But first some background: As many long-term care operators know, CMS proposed a “Medicaid Fiscal Accountability” regulation in November. According to the long-term care analysts who have dissected it, the agency didn’t fully consider its potential for destruction. By provider estimates, it could lead to more than $50 billion in reduced payments. Moreover, CMS exceeded its regulatory authority by forwarding this measure in the first place, providers insist. These criticisms may or may not be true.

When the feds unveiled this plan, they promoted it as a way to reduce dodgy accounting tricks that drive Medicaid supplemental payments. This intention also may or may not be true.

Regardless, the ensuing industry blowback hit a nerve, apparently. How do I know? Because of the way Verma responded to her critics in a blog released under her name on Wednesday.

Boiled down, the reply amounted to: “Liar, liar, pants on fire!” Okay, that’s a slight overstatement. Here’s a direct quote from the blog:

 “This proposed rule is not intended to reduce Medicaid payments, and alarmist estimates that this rule, if finalized, will suddenly remove billions of dollars from the program and threaten beneficiary access are overblown and without credibility.”

On second thought, Verma pretty much IS claiming that the measure’s critics are a pack of hysteria-inducing liars.

Perhaps this kerfuffle is best seen as just another chapter in the troubled life of the Medicaid program.

The federal lawmakers who were its architects didn’t have the guts to make sure long-term care was covered under Medicare. Instead, they took the coward’s route and made limited coverage a Medicaid benefit. In other words, you could get help so long as you could show you were destitute. At least on paper.

Ever since, the government, providers and consumers have been playing reindeer games that would shame a contortionist. And as we can see, the goofiness is far from over.

The industry is howling — perhaps rightfully so — that this latest measure will trim billions and billions of dollars in payments. Funny how proposed reimbursement cuts can be figured to the exact dollar, yet nobody in the sector seems to know how much revenue any particular nursing facility actually takes in. One of life’s great mysteries, I suppose.

As for CMS? Where’s its guarantee that deserved funding won’t be cut? And what happens if/when mistakes occur? Will CMS dash off checks to make things right? Don’t hold your breath.

Then there are the consumers. As in, well, us. We want government-backed long-term care coverage. We just don’t want our taxes raised to pay for it.

Medicaid and long-term care have been in a troubled relationship from the beginning. What’s truly amazing is that the marriage has lasted this long.

So why don’t we all put the faux outrage on hold for a while? Maybe instead we should try to develop a comprehensive long-term care program that requires fairness, funding and accountability — and is more likely to encourage good care than finger pointing.

John O’Connor is Editorial Director for McKnight’s