Who knew? Repeal of RUG-IV delay in bill one day and out the next

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[McKnight's writer Brett Bakshis]

When crafting legislation, horse trades are a well-established part of the ritual. What's unfortunate is that many people who have a stake in these deals don't know about them.

I'm speaking of a move last week to remove the repeal of the RUG-IV delay from the jobless benefits bill (H.R. 4213). It occurred sometime between the time the Senate approved the bill on Wednesday and when the House passed the bill on Thursday.

What was interesting, and a bit disturbing, about this development was that seemingly no one connected with the nursing home community knew about it. To make matters worse, policy and legislative experts affiliated with long-term care said they were not even aware that the repeal of the RUG-IV delay was in the bill.

How do I know this? Because of our enterprising reporter Brett Bakshis. It's fair to say that had it not been for his sleuthing, there's a chance this information never would have come to light.

As background, Bakshis saw that the repeal was in the bill last Tuesday after visiting thomas.gov, a governmental website that offers text of legislation, its sponsors and actions taken on it. Since the Senate was planning to vote on the bill, he sensed the makings of a big story. But when called, the two nursing home associations, the American Health Care Association, and the American Association of Homes and Services for the Aging, were not able to confirm that this repeal was in the bill.

And they were not the only ones. It was only after numerous calls with the associations, the Centers for Medicare & Medicaid Services, the White House, Rep. Charles Rangel's office, the office of the Speaker of the House, and a clerk with the Library of Congress that he was able to get to the bottom of the situation. Finally, the American Health Care Association confirmed Thursday that the repeal of the delay indeed was in the bill but had just been stripped out of it. (As a side note, the House has passed the Veterans', Seniors' and Children's Health Technical Corrections Act of 2010, H.R. 5712, which definitively contains a repeal of the delay.)

Do you, like I, see something wrong with this picture? If experts at the associations, CMS and others charged with following these bills say they don't know what is in them, then who does? This by the way, has been a common criticism of the healthcare reform bill. People have accused it of being so overloaded that not even lawmakers are fully aware of what's in it. One problem is that these bills, including the jobless benefits legislation, undergo numerous iterations by the time they are passed.

But the repeal of the delay of RUG-IV is a pretty important provision. Maybe, in hindsight, it's good no one knew it was in the legislation. This way, no one was disappointed when it failed to make it into the final version.


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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 Marty Stempniak.