July. It always means one sure thing around this country: heightened anticipation of fireworks.

This year, more than ever, you could also call it a time for heightened fireworks anxiety. Especially since long-term care is getting an enhanced batch this year.

The first parcel actually came earlier this week in Wednesday’s release of the final Phase 3 guidance for the Requirements of Participation. At 876 pages, this whopper would require its own keg of gunpowder to send it flying. An idea more than a few providers might entertain soon enough. (Read all about it in my colleague’s outstanding breaking news coverage.)

But July is also going to bring other regulatory actions that will light up the skies over at least a few nursing homes. 

Before the month is out, the Centers for Medicare & Medicaid Services will be tweaking the Five-Star rating system to reflect more staffing level and turnover information. Yes, as all suspected, introducing the Payroll-Based Journal system a few years ago was merely lighting the fuse for bigger bangs down the line.

In January, CMS started posting RN and weekend staffing levels on the federal “Compare” consumer-facing website. The agency also started posting RN and administrator turnover rates for the first time.

CMS nursing home division chief Evan Shulman told attendees at the NADONA annual meeting Tuesday that a clear correlation has been found between higher staffing levels and lower staff turnover, and higher quality. That’s why July will see PBJ information come more heavily into play. 

The goal is to have less of a siloed approach with the data, he said. That will bring Five-Star ratings further into play. That’s another entity whose utilization has mushroomed since a much simpler debut in recent years. 

The methodology for determining ratings will change, Shulman confirmed. More info on that to arrive in the coming weeks, he confided.

One can smell the flammability quotient rising for many operators already.

Of course, if history is any teacher, we can expect the biggest bang to arrive later in July. That would be the issuance of the final fiscal 2023 SNF PPS rule. You know, the one that has already proposed taking $320 million out of the nursing home payment pipeline instead of adding the usual, typically modest amount.

Shulman duly noted that even though the comment period ended June 10, he and colleagues remained duty-bound not to discuss the rule making process. He added, however, he was sure “thousands” of comments had been received, something we’ve confirmed ourselves in recent weeks.

These stakes are the highest, as virtually everyone close to long-term care has known since well before the fateful April announcement. The big problem is Uncle Sam wants his money back — and in one fell swoop. Talk about fireworks.

The provider community is beseeching Washington to reclaim the Provider Driven Payment Model overages more gradually. Say, over a three-year period.

But it’s July. That’s not a time for low-wattage glow sticks or mere sparklers. Or little bangs. Just remember that.

James M. Berklan is McKnight’s Executive Editor.

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