CMS Begins Off-Cycle Enrollment Revalidation for All SNFs

(Oct. 21, 2024) All skilled nursing facilities (SNFs) will receive a notice by the end of the year requiring them to revalidate their Medicare provider enrollment by submitting a new Centers for Medicare and Medicaid Services (CMS) Form 855A. The new form requires the disclosure of extensive information regarding the ownership and control of the facility and of various entities and individuals that provide the facility with real estate, clinical consulting, financial services, and other operational and administrative services. The new form and related revalidation process arise out of regulations aimed at promoting greater visibility into the ownership and control structures of for-profit nursing homes. Although aimed at private equity investors, real estate investment trusts, and chains, the disclosure requirements apply to not-for-profit and government-sponsored facilities as well.

The off-cycle revalidation initiative was announced in a Medicare Learning Network (MLN) Connects newsletter and on the CMS Medicare enrollment webpage. The revalidation notices will be distributed on a phased basis by the Medicare Administrative Contractors (MACs) – National Government Services (NGS) in NYS – and will require completion of the new Form 855A within 90 days. Nursing home members are urged to begin reviewing the new Form 855A and associated guidance now, in advance of receiving the notice from the MAC, as the required disclosures may be voluminous. However, in an Open Door Forum call, CMS indicated that the guidance is evolving and is being released on a rolling basis.

The new form requires information about the ownership and affiliations of "Additional Disclosable Parties" (ADPs), defined as any person or entity who:

exercises operational, financial, or managerial control over the SNF or a part thereof, or provides policies or procedures for any of the SNF’s operations, or provides financial or cash management services to the SNF;
leases or subleases real property to the SNF, or owns a whole or part interest equal to or exceeding 5 percent of the total value of such real property; or
provides management or administrative services, management or clinical consulting services, or accounting or financial services to the facility.

The current CMS guidance provides the following examples of operational, financial, or managerial control that would trigger the disclosure requirements (pp. 6-8):

Financial Control – Can include monitoring or managing the SNF’s finances, authority to approve the expenditure of SNF funds, an owning organization of the SNF that funds part of the SNF’s operations, banks that have given the SNF a line of credit, etc.
Financial Services – Can include investment banking, investment management, asset management, financial advice, accounting, etc.
Managerial Control – Includes “managing employees” or “managing organizations” such as supervisors or non-supervisors who oversee and are responsible for any aspect of the SNF’s operations, including management/oversight of matters such as maintenance. However, this does not mean that every SNF employee who is responsible for any action in the SNF’s organization (e.g., nurse, administrative assistant) needs to be reported. There must be some degree of broader oversight and decision-making authority involved.
Operational Control – Includes persons/entities that oversee and have responsibility for any aspect of the SNF’s daily activities or transactions (e.g., person in charge of the SNF’s (1) medical records, (2) patient activities, or (3) dietary/food operations). The person need not serve in a supervisory role to have operational control.

Examples of ADP management, administrative, clinical consulting, and accounting or financial services set forth in the guidance include the following (this is not an all-inclusive list):

Management Services – Includes parties that furnish to the SNF the services described above as "managerial control," under contract or other arrangement with the SNF (e.g., management company).
Administrative Services – Can involve services such as compliance/oversight, human resources, public relations/outreach/advertising, technical assistance to the SNF’s main information system, etc. (This category does not include custodial, building security, and similar services.)
Clinical Consulting Services – Can involve assessing or advising how to improve or modify any aspect of the SNF’s provision of health care.
Accounting Services – Can include an accountant or accounting company or auditors the SNF hires/contracts with to perform any accounting or auditing activity (e.g., preparation of cost reports) for the SNF.
Cash Management Services – Can include parties that give guidance/advice on cash flow and other financial matters; handling the SNF’s financial transactions, such as ACH payments and mobile banking; etc.

Given the breadth of these definitions and examples, even not-for-profit and government-sponsored nursing facilities may be subject to voluminous disclosure requirements regarding the entities and individuals they engage to provide services to the facility. The form requires disclosure of the ownership structures of the ADPs, the identities of the owners, and the individuals who directly provide services to the SNF.

The CMS guidance recommends that SNFs consult with their attorneys and other professional advisors concerning the entities and individuals that must be disclosed. Questions regarding the guidance and required disclosures may be submitted to CMS here.

LeadingAge National will be meeting with CMS to discuss concerns regarding the extent of the required disclosures. LeadingAge NY and National will keep members updated on these new requirements and the evolving guidance. More information is available here, here, and here.

Contact: Karen Lipson, klipson@leadingageny.org