CMS is mandating all skilled nursing facilities (SNFs) to complete an off-cycle revalidation using a new Attachment 1 to the CMS 855A enrollment form (CMS-855A Medicare Enrollment Application Institutional Providers) to capture new data on ownership, managerial, and related party information. Such data were not required before modifications to the 855A were completed in September 2024. The new disclosure requirement implements the November 17, 2023 Final Rule and seeks to identify private equity ownership and control of SNFs. All previously enrolled SNFs should plan to complete the form to keep their ability to bill the Medicare program active. Notices will be sent to 1/3 of SNF providers each month from their respective Medicare Administrative Contractors (MACs) throughout October through December 2024.
CMS is seeking a significant amount of additional information than it previously required. The form now seeks to collect: all governing body members, all owners of an LLC, all Trustees of the SNF if an established Trust, all additional disclosable parties (ADP), and persons/entities within the ADP. ADPs are any organization that exercises operational, financial, or managerial control; leases or subleases real property; provides management, administrative, clinical consulting, financial, and accounting services to the facility. For each ADP type, the SNF must report information on all the entities and persons. Organizational structure diagrams or flowcharts for the SNF, each SNF owner, and each ADP are also required, as is specific identifying information on 5% or greater owners and the date of their ownership.
Providers seeking revalidation and all applications (pending as of October 1) have until May 1, 2025 to submit the form, making a good faith effort to identify information about entities and individuals with ownership and management control and ADPs by the deadline. A SNF must document an owner or ADP’s refusal to provide the requested information about ownership, ownership percentages, and final adverse legal actions, such as convictions, exclusions, license revocations or suspensions. SNFs must respond to MAC requests for more information within thirty days of a request. Failure to respond can result in loss of the ability to bill Medicare and potentially Medicaid. Please note that the previous extension for only states most impacted by Hurricane Helene (i.e. Florida, Georgia, South Carolina, North Carolina, and Tennessee) is no longer in effect.
This article has been updated on November 26, 2024 to reflect recent guidance from CMS on the SNF attachment, clarifying certain requirements and changing the original 90-day filing period.
More specific reporting instructions and guidance on the new form can be found here.
What do SNFs need to do now?
- Although providers should begin preparing the application with necessary information now, currently enrolled SNFs should wait until contacted by the MAC to submit the application form. Be on the lookout for this notice and establish due dates/timelines to acquire the required information.
- Each SNF will need to complete the revised Medicare Provider Enrollment Application Form with the SNF Attachment (CMS-855A, 09/24 version), excluding Sections 5 and 6.
- Identify all ADPs. These include many contractors not previously reported.
- MACs will also need to notify any SNFs to complete this form for initial, revalidation, reactivation, and Change of Ownership (CHOW) applications, depending on the stage of processing.
The revalidation represents a major change in disclosure requirements designed to identify private equity ownership and control of SNFs. Enrolled or enrolling SNFs should seek legal counsel with any concerns. The attorneys at Goodman Allen Donnelly, specifically Peter Mellette, Harrison Gibbs, Nora Ciancio, Elizabeth Coleman, and Alex Owens are ready to assist with any questions about the SNF Attachment to the 855A or completion of the mandatory form.
We acknowledge with appreciation Angelina Han (W&M Law Class of ‘2026) for her assistance in preparing this article.
