CMS Updates Guidance for SNFs Completing Medicare Form 855A

(Oct. 29, 2024) As reported in last week’s Intelligence, all skilled nursing facilities (SNFs) will receive a notice by the end of the year from National Government Services (NGS), the Medicare Administrative Contractor (MAC) for NYS, 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 not only regarding the ownership and control of the facility, but also on various entities and individuals who provide the facility with real estate, clinical consulting, financial services, and other operational and administrative services. Specifically, providers will need to report detailed 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.

Instead of completing sections 5 and 6 of the CMS-855A, SNFs will be required to complete a separate SNF attachment. The attachment is divided into two parts, Organizations and Individuals, with a separate attachment completed for each organization and/or individual that must be reported.

Last week, CMS updated the sub-regulatory guidance outlining the information that SNFs must provide. In response to specific questions, CMS clarified that providers of the following services or items counted as reportable employees or ADPs that trigger disclosure (not an exhaustive list):

• tax preparation services (in addition to cost reports and any accounting activity)
• financial audits (in addition to investment banking, investment management, asset management, financial advice, accounting)
• mortgage/security interests stemming from a U.S. Department of Housing and Urban Development (HUD) or other government loan
• individuals or entities who oversee and have responsibility for any aspect of the SNF’s daily activities or transactions regarding:
  • maintenance (but NOT housekeeping)
  • marketing
  • social services
  • therapy 
  • (note that these are in addition to other “daily activities” originally named that included medical records, patient activities, and dietary/food operations)

The update does clarify that to be reportable, the person need not serve in a supervisory role to have operational control, though this in no way means every employee involved in any operational activity must be reported. Only persons in a position of oversight and responsibility need be disclosed. It also specifies that Electronic Health Record (EHR) vendors are NOT included and that mortgage/security interests can include those stemming from an HUD or other government loan.

While SNFs must update changes to the information reported on the 855A within specified timeframes, the update clarifies that only changes to the control or management of the SNF itself must be reported within 30 days, with other changes reportable within 90 days. Finally, the update indicates that SNFs are expected to use the maximum feasible efforts to secure the required data, but declines to define required efforts any further.

We urge SNF members to review the original article that outlines the requirement; monitor the guidance document, keeping in mind that it is likely to be updated; become familiar with the new 855A SNF attachment (starting on p. 52); and begin compiling the information that will be required for the form.

LeadingAge National will be meeting with CMS to discuss concerns regarding the extent of the required disclosures, and we will keep members updated on the evolving guidance.

Contact: Darius Kirstein, dkirstein@leadingageny.org, or Karen Lipson, klipson@leadingageny.org