Effective October 1, 2024, the Centers for Medicare & Medicaid Services (“CMS”) introduced significant updates to the CMS-855A form, specifically requiring a new Skilled Nursing Facility (“SNF”) Attachment for every SNF. These changes, following the implementation of regulations finalized in November 2023, impact how SNFs disclose detailed ownership and management information. The adjustments stem from Section 1124(c) of the Social Security Act and are aimed at enhancing transparency in Medicare and Medicaid programs. The revised CMS-855A form adds substantial complexity to the process for SNF providers, who must now navigate new disclosure and revalidation requirements. Accompanying guidance to the revised form may be found here.
What’s New in the CMS-855A Form?
The updated CMS-855A form, effective October 2024, introduces a multiple-page attachment designed specifically for SNFs, titled “Attachment 1: Skilled Nursing Facility Disclosures.” SNFs must now report ownership, governance and management information in greater detail than ever before. For example, all members of the SNF’s governing body must be disclosed, as well as owners in a limited liability company, regardless of ownership percentage. Additionally, SNFs structured as trusts must disclose all trustees.
One of the more demanding aspects of the new requirements is the obligation to identify and report all Additional Disclosable Parties (“ADP”). An ADP is defined as any person or entity that:
- Exercises operational, financial or managerial control over the SNF;
- Provides policies or procedures for the SNF’s operations;
- Leases or subleases real property to the SNF;
- Owns 5% or more of the real property’s total value; or
- Provides services such as financial, clinical consulting or accounting.
Reporting Changes: What and When?
The new SNF Attachment requires continuous reporting of changes, which must be submitted as they occur. For instance, changes to 5% or greater owners, corporate officers or general partners must be reported within 30 days, while other updates can be reported within 90 days.
Failure to provide timely and accurate information may result in serious consequences, such as decertification from Medicare, termination of Medicare billing privileges or revocation of Medicare enrollment. In addition, CMS has initiated off-cycle revalidations for all SNFs from October to December 2024. Due to recent circumstances, the revalidation application due date for SNFs in Florida, Georgia, South Carolina, North Carolina and Tennessee is now May 1, 2025. SNFs have begun receiving revalidation notices and must respond within 90 days, submitting the required ownership and management information.
The Role of “Additional Disclosable Parties”
One of the more intricate aspects of the new rules involves ADPs. These are individuals or entities with a level of influence or control over the SNF’s operations or property, even if that control is indirect or minimal. CMS has clarified that there is no minimum threshold of influence required for disclosure, making it particularly challenging for SNFs to identify and report all relevant ADPs.
To report ADPs, SNFs must provide organizational structures and describe the relationships between ADPs and the facility. For instance, if an ADP is an LLC, all managers and owners—regardless of ownership percentage—must be disclosed.
Expanded Definitions and Documents
The final rule from November 2023 expanded key definitions to assist SNFs in providing the requested data. For example, the definition of a “managing employee” now includes an individual (including a general manager, business manager, administrator, director or consultant) who directly or indirectly manages, advises or supervises any element of the practices, finances or operations of the SNF.
SNFs are required to submit the following charts with their initial, revalidation, reactivation and 42 CFR § 489.18 change of ownership applications:
- A chart identifying all the entities listed in Section A of the Organizations section of the Attachment that shows their relationships with the SNF and each other. This chart will include the SNF’s organizational ADPs.
- A chart identifying the organizational structures of all its owners, including owners not listed in the SNF Attachment (e.g., less than 5% direct or indirect owners of corporations).
- A chart outlining the organizational structures of each ADP of the facility. This must include a written description of the relationship of each ADP to the facility and to all the SNF’s other ADPs.
At least one of these charts must also identify the SNF’s ultimate parent company and the entities situated between the SNF and the parent in the organizational arrangement.
Implications for Mergers and Acquisitions
The new disclosure requirements are particularly important for SNFs undergoing mergers, acquisitions or joint ventures. Any change of ownership must be reported within 30 days, and failure to disclose new owners or managers can result in delays or denials of Medicare enrollment.
Medicaid Enrollment Changes
While the focus has been on Medicare, the CMS final rule also revised Medicaid provider enrollment requirements. State Medicaid agencies must now establish mechanisms to collect data similar to the Medicare disclosure requirements. SNFs enrolled in Medicaid should monitor their state agencies for updates and prepare for similar data reporting obligations in the future.
Legal and Compliance Challenges
Given the extensive and complex nature of these new disclosure requirements, SNFs are encouraged to consult legal counsel to navigate the new rules. The process of collecting and maintaining accurate ownership and control information will require significant effort, especially for facilities with numerous ownership interests, such as those managed through limited liability companies, partnerships or trusts.
Practical Takeaways
- The new CMS-855A form, effective October 2024, requires more detailed ownership and management information from SNFs, specifically through a new multiple-page SNF Attachment.
- Providers will complete the SNF Attachment in lieu of Sections 5 and 6 of the paper CMS-855A form. However, if providers have PECOS access, they will answer these SNF Attachment questions within Sections 5 and 6 accordingly.
- SNFs must report changes to ownership, management or control within 30 days, or risk facing penalties for non-compliance.
- Facilities must disclose information on Additional Disclosable Parties, including those who lease property or provide management services, even if their influence is indirect.
For more information on the reporting and the CMS-855A, please contact:
- Brian Jent at (317) 977-1402 or bjent@hallrender.com;
- Lauren Hulls at (317) 977-1467 or lhulls@hallrender.com;
- Julie Mitchell at (317) 429-3643 or jmitchell@hallrender.com;
- Sean Fahey at (317) 977-1472 or sfahey@hallrender.com;
- Todd Selby at (317) 977-1440 or tselby@hallrender.com; or
- Your primary Hall Render contact.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
