After the Senate “hotlined” compromise rural relief legislation — a process that typically results in easy approval for a bill — a hold from one lawmaker stalled out the effort right before Senators left for a summer recess that does not end until the first week of September.

This means that industry advocates and Congressional champions must rethink its fight on Capitol Hill, and rural providers, who have already been dealing with the full brunt of national bidding expansion reimbursement cuts sicne July 1, must continue to deal with the fallout from those cuts for at least the summer.  (And as we have seen, some providers are already not taking on additional rural Medicare beneficiaries.)

The reversal was a gut-wrenching blow for providers and industry advocates that had worked to advance the legislation despite the July 1 implementation date having come and gone. After the House passed a version of rural relief that differed from a version the Senate approved in late June, a revised bill was placed on the Senate’s “hotline” process yesterday. The major change in the legislation was that the compromise delayed implementation of the full bid expansion cuts until Sept. 30, while the version the Senate originally approve din June delayed the cuts until July 1, 2017. 

How Things Played Out

When a bill is hotlined, it means the bill is considered non-controversial and is essentially automatically approved unless there is considerable objection. Senators have 24 hours to object to the legislation, otherwise it is considered passed.

In the case of the Senate compromise, it appeared that a yet unknown Democratic Senator placed a hold for inquiry (which are anonymous) on the legislation at shortly after 4 p.m. ET yesterday, and then the Senate recessed early, stalling out rural reform.

“The bill cleared on the Republican side and did not clear on the Democrat side,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products. “… It did not pass the Senate via the hotline process due to what appears to be one Senator who held up the rural relief prior to the eight-week Congressional recess. Very, very disappointing.”

“We’re very disappointed and quite amazed given that we got a larger bill passed in the Senate several weeks ago, and a smaller one didn’t go through,” said Tom Ryan, president and CEO of the American Association for Homecare. “At 4 in the afternoon, there were no holds, and then all of a sudden we were getting notifications that there was a hold.”

“This was not the end of the week that we were anticipating,” said Cara Bachenheimer, senior vice president of Government Relations for Invacare Corp.. “We thought things were going to move along very smoothly. If you’ll remember the Senate hotlined a 12-month delay three weeks before. … At this point we have very limited information in terms of exactly who put the hold on it, besides it being a Democratic Senator, and exactly why. We have a lot of leadership Democrats calling around today in hopes of uncovering that mystery.”

Going Forward

The industry still has the ability to fight for some form of rural relief reform when lawmakers return from their summer recess. There is a window of opportunity between lawmakers’ return to Washington in early September and the November elections to push through some form of relief, so the industry is already working with its Senate and House champions to determine a plan.

“Providers are aghast and everyone is in a state of disbelief, but we know we still have to fight this thing,” Ryan said. “We had a lobbying call this morning; we regrouped. AAHomecare is 1,000 percent behind moving forward. I reengaged our lobbyist for the fight.”

“We’re already hearing from our Congressional champions that they too are extremely disappointed,” Johnson said. “And, from their perspective, they want to provide a longer term solution, which they were planning to do even with the three-month delay.”

But for the summer recess rural providers will have to soldier and figure out a workable way to run their businesses and care for their patients as best they can under the cuts that were implemented on July 1. While that is a difficult position for providers, the industry is not out of the game. Much work can be done during the summer to keep the industry going.

“The fact is that the law didn’t get passed by the Senate,” Bachenheimer said. “So nothing is getting the President’s signature on this issue. … From the providers’ perspective the July 1 cuts are in place now.

“It ended in a way that we’re obviously not happy with, but … when you look at how far we came,” she continued. “The amount of energy, grassroots, grasstops, industry lobbyist all working in a coordinated way, we got to a point where you can’t discount all that hard work and how effective that was. It’s amazing how far we got, and that’s our strength on a go-forward basis.”

And the industry can wield that considerable political capital once lawmakers return to the Hill in September. Between now and then, Ryan said providers shouldn’t give up hope, must keep in mind that the industry is in a very good position to resume the fight in DC, and in the meantime they and their patients should remain in contact with their Representatives and Senators.

“Keep the noise level up,” he explained. “I know it’s difficult. Providers are worn out; they’re beat up; they’re making tough, tough decisions every single day that affect their personnel; and it’s hard to keep engaging in a legislative battle.

“We have high-level support, and there is an understanding that his has to be fixed,” he continues. “Let us work it inside this crazy town, but we need everybody across the country to take this time this summer and let their outrage out and let [lawmakers] know that this has to be fixed.”