CMS Final Rule Elevates Transparency and Accountability in Skilled Nursing Facilities Participation in Medicare and Medicaid Programs

Pieter Gunst03 mins

The Centers for Medicare & Medicaid Services (CMS) announced a Final Rule on November 15, 2023, that imposes more rigorous demands for disclosure of ownership, managerial, and control data from skilled nursing facilities (SNFs). Such information is needed for the facilities to take part in broader Medicare and Medicaid programs, a significant step in improving transparency and accountability in the healthcare sector.

As reported by JD Supra, these changes were introduced to better identify and address instances of fraud and abuse, as well as quality and safety concerns, by providing a more comprehensive overview of the network of individuals and entities that manage or control SNFs participating in Medicare and Medicaid.

The Final Rule includes several specific details that skilled nursing facilities should be cognizant of:

  1. The Rule extends the required range of disclosure to include not only immediate direct and indirect owners but also other entities or individuals with a beneficial ownership or controlling interest of five percent or more. This further encloses a range of associates, whether they be through legal, operational, or financial means.
  2. A fact previously not required, now, SNFs are obliged to reveal if they have been subject to a civil money penalty (CMP) of $10,000 or more in the past five years, offering a detailed report about each CMP. This is a conspicuous movement towards encouraging better compliance and ethical conduct.
  3. For the first time, SNFs must make known the identity of each trustee if the disclosing entity is a trust, amping up the transparency concerning the individuals with substantial control over the operation.

These changes are expected to create a more comprehensive landscape of ownership and control in skilled nursing facilities, ensuring these facilities are more accountable and held to a higher degree of scrutiny for their actions.

As an era of ever-increasing accountability and transparency in healthcare continues, it is crucial for legal professionals to remain abreast of these changes, especially those that deal with SNFs. This will be essential to help organizations prepare for participating in Medicare and Medicaid programs while adhering to new and necessary compliance requirements.