As the landscape of long-term care continues to evolve, skilled nursing facilities (SNFs), commonly known as nursing homes, face imminent changes in their administrative processes due to new expansive reporting requirements from the Centers for Medicare and Medicaid Services (CMS). Rooted in the Affordable Care Act’s mandate for greater transparency, these changes respond to concerns about the quality of care provided by nursing homes owned by private equity and other investment entities. The revised CMS-855A form, updated in September 2024, places new burdens on SNF providers to fully disclose ownership details.
Following a final rule issued by CMS in November 2023, the clock is ticking—with a deadline set for May 1, 2025. While the revised form aims to enhance transparency, it requires SNFs to begin data collection efforts immediately. The new form features the Skilled Nursing Facility Attachment, segmented into two distinct parts: organizations and individuals that must be disclosed, along with the more onerous requirement to identify “Additional Disclosable Parties” (ADP). These ADPs include any entities or individuals with an ownership or management stake in the SNF, a broad category encompassing various parties from management to administrative service providers.
The expanded scope requires that all members of a board of directors, owners of limited liability companies, and interests held by investment firms be disclosed, regardless of ownership percentage. As detailed in CMS’s accompanying sub-regulatory guidance, even volunteers and independent contractors might need to be listed if they meet the disclosure conditions. There remains no minimum threshold for length of service, and CMS encourages erring on the side of full disclosure.
With transparency as a guiding principle, CMS also exempts certain categories from these disclosures. Legal services under attorney-client privilege, as well as electronic health records, payroll vendors, pharmacies, labs, and X-ray suppliers, are not classified as ADPs. To mitigate the daunting nature of these requirements, CMS advises SNFs to maintain comprehensive records of efforts made to collect necessary data, advising providers to inform the Medicare Administrative Contractor about any unavailable information.
The procedural overhaul includes the necessity for three comprehensive organizational charts. These must expose layers of ownership all the way up to the SNF’s ultimate parent company, alongside a structure of each ADP’s involvement. To accommodate the industry’s considerable complexity, CMS acknowledges that particular personally identifiable information, like birthdates and social security numbers, is only required from those with substantial ownership stakes (5% or more).
Given the multifaceted nature of these disclosure mandates, nursing homes are strongly urged to prioritize this task immediately. These new requirements not only reflect a push for transparency but challenge providers to navigate an intricate matrix of relationships to fulfill a federal mandate. The clock is ticking for SNFs to engage in robust data collection efforts, ensuring compliance with what the CMS envisions to be a more transparent and accountable sector in healthcare.
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