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CMS Form 855A Enrollment Revalidation Guidance Updated Again

(Nov. 5, 2024) The Centers for Medicare and Medicaid Services (CMS) has again updated the sub-regulatory guidance for completion of the new skilled nursing facility (SNF) addendum to the Form 855A. As previously reported, this guidance is being updated on a rolling basis in support of an off-cycle SNF enrollment revalidation initiative. By the end of the calendar year, all SNFs will receive a notice from their Medicare Administrative Contractor (MAC) requiring them to submit a new CMS Form 855A and SNF Attachment within 90 days. The new form requires the disclosure not only of information concerning the ownership and control of the SNF, but also of various entities and individuals who provide the facility with real estate, clinical consulting, financial services, and other operational and administrative services (known as "Additional Disclosable Parties," or ADPs).

On Nov. 1st, CMS issued the latest update to the guidance. This update included the following:

  • Additional information on the entities and individuals who must be included in required organizational charts (Section (VI)(C));
  • Clarification of clinical consulting services (CCS) and policies/procedures (P/P) (new Section VI(G)); and
  • Clarification in Sections (III)(E)(i) and (ii) that both specified owners of the ADP and individuals or entities with control over the ADP must be reported.

The disclosures pertaining to individuals and entities who provide CCS and P/P were updated to include the following:

  • CCS do not include those furnished: (i) by or on behalf of a government entity (such as a state survey agency); or (ii) by a Quality Improvement Organization (QIO) or accrediting organization.
  • CCS and P/P do not include the mere use of templates. CCS, for instance, must be actual advice or recommendations to qualify as such.
  • The SNF need not accept or utilize the advice or recommendations for the latter to qualify as CCS. It is the provision of the advice/recommendations – rather than their acceptance – that meets the threshold for disclosure. For P/P, however, the SNF must use the furnished P/P for the latter to mandate reporting.
  • CCS and P/P do not in and of themselves include auditing or other reviews for compliance.
  • Suppose the SNF contracts with a firm that provides CCS. The SNF must disclose the firm and any persons therein who furnish the CCS to the SNF. However, not every consultant in the firm must be reported regardless of whether they are the persons providing the CCS to the SNF. Only those who are furnishing them to the SNF need be disclosed. Thus, if a firm has 50 clinical consultants and only two of them – X and Y – are providing the CCS, only X and Y must be reported.

The guidance emphasizes that SNFs are expected to use the maximum feasible efforts to secure the required information from their ADPs. CMS recommends, but does not require, SNFs to thoroughly document all efforts to secure any data that they are ultimately unable to obtain. When a SNF submits the form, it should enumerate in an email or cover letter any required information that it was unable to secure.

Nursing home members are urged to identify their ADPs in advance of the receipt of a letter from the MAC and obtain the information elicited in the Form 855A SNF Attachment. Members are also encouraged to continuously check the CMS link to the sub-regulatory guidance for updates and to consult with counsel and auditors for advice concerning the completion of the form. More information is available here and here

Contact: Karen Lipson, klipson@leadingageny.org