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Volume 23.07

On November 15, 2023, the Centers for Medicare & Medicaid Services (CMS) placed on display at the Federal Register a Final Rule that will implement portions of section 6101 of the Affordable Care Act, requiring the disclosure of certain ownership, managerial, and other information regarding Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities, commonly known as nursing homes.

It also defines the terms private equity company and real estate investment trust, about which information must be disclosed on Form CMS-855A, the Medicare enrollment application.

These efforts are a continuation of the many integrity-related efforts currently underway by CMS impacting numerous provider types.

The Final Rule requires the following:

  • Medicare SNFs and Medicaid nursing facilities will need to disclose the data outlined in section 1124(c) upon initial enrollment and revalidation. Medicare SNFs will also have to: (1) report this information as part of any change of ownership pursuant to 42 CFR § 489.18; and (2) report any change to this data within the timeframes specified in 42 CFR § 424.516(e). These new section 1124(c) data elements include:
    • Each member of the facility’s governing body, including the name, title, and period of service of each member.
    • Each person or entity who is an officer, director, member, partner, trustee, or managing employee of the facility, including the name, title, and period of service of each person or entity.
    • Each person or entity who is an additional disclosable party of the facility.
    • The organizational structure of each additional disclosable party of the facility and a description of the relationship of each such additional disclosable party to the facility and to one another.

Additional disclosable parties are those:

  • Exercising operational, financial, or managerial control over the facility or a part thereof, or provides policies or procedures for any of the operations of the facility, or provides financial or cash management services to the facility,
  • Leases or subleases real property to the facility, or owns a whole or part interest equal to or exceeding five (5) percent of the total value of such real property, or
  • Provides management or administrative services, clinical consulting services, or accounting or financial services to the facility.

The nursing facility will report this additional information when initially enrolling in Medicare or Medicaid, when a change of ownership occurs under 42 CFR §489.18, and when revalidating enrollment.  Although revalidation occurs every five (5) years, CMS can perform off-cycle revalidations to secure the new information.

The final rule also defines a private equity company and real estate investment trust.

A private equity company is a publicly traded or non-publicly traded company that collects capital investments from individuals or entities and purchases a direct or indirect ownership share of a provider.  A real estate investment trust is a real estate investment trust as defined in 26 U.S.C. 856.

CMS previously revised the Form CMS-855A Medicare enrollment application such that all providers and suppliers (including SNFs) that complete the revised Form CMS-855A must disclose whether a particular owning or managing entity reported is a private equity company or real estate investment trust.

A copy of the Final Rule is available here.

All the integrity measures included in various new rules will require providers of all types to have access to skillsets, whether internal or external, to continually monitor Medicare enrollment data on some periodic basis.  Unfortunately, all the new rules mean more resources devoted to administrative-related activities and fewer resources available for patient care.