Newcomers to the long-term care game may not believe it, but there once was a time when the announcement of the next year’s proposed Medicare payment bump was the hottest ticket around.

For two years now, however, it’s been overtaken by a bigger shadow, cast by a monster that may come out of the closet at any time.

That was clear based on the responses of some top provider leaders to Thursday’s announcement of the fiscal 2025 Medicare Part A proposal.

It called for a 4.1% raise by the Centers for Medicare & Medicaid Services. In pre-pandemic times, and before inflation grabbed hold, that might have been the cause for New Year’s Eve-caliber celebrations. 

It admittedly is better than a poke in the eye. But the largesse is still accepted with an eye over the shoulder.

Long-term care faithful, of course, are more worried about CMS’ pending release of the nation’s first ever nursing home staffing mandate.

American Health Care Association President and CEO Mark Parkinson called the 4.1% proposal “modest” and then worried aloud more about what the staffing mandate could do to operators. The majority of them will have to find, hire and then keep more registered nurses and nurse aides — at costs projected to add billions of dollars to the cumulative payroll.

That’s what makes Thursday’s breaking news item the mere warm-up act to the real main feature. (A year ago, the SNF pay raise proposal came out while still waiting for the first peek at a then-overdue proposed rule for the staffing mandate.)

Just what level of nursing hours will CMS settle on in the end for this first-ever federal staffing mandate? Will that total include LPNs, who were conspicuously left out of the original proposal? In this newly enlightened age of telemedicine, will remote clinicians be able to count toward any of the mandated staffing levels?

Will regulators stick to their guns and phase in requirements over a handful of years, or more, or will consumer advocates and academics have their way and get shorter compliance windows? 

Most of all, just where is the money — and the bodies that will hold all these newly required nurses — going to come from?

The issuance of those answers will surely lead to the new hottest ticket in town.

James M. Berklan is McKnight’s Long-Term Care News’ Executive Editor. 

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.