On December 13, 2024, the Centers for Medicare & Medicaid Services (“CMS”) continued revisions to its “Guidance for SNF Attachment on Form CMS-855A” (“Guidance”). The Guidance is CMS’s subregulatory advice and FAQs to skilled nursing facilities on the completion and submission of the new Form CMS-855A SNF Disclosures Attachment (“SNF Attachment”) for every skilled nursing facility (“SNF”). The Guidance continues to confirm the due date for all SNFs to submit the off-cycle revalidation information is May 1, 2025, unless an exception described below applies.
Changes include the following:
- Pending Revalidation and Changes of Information
The Guidance sets out that a SNF must report the following changes described in the SNF Attachment within 30 days of the change: (1) five percent or greater direct or indirect owners of the SNF; (2) general or limited partners of the SNF (regardless of the percentage); (3) managing organizations or employees of the SNF; (4) corporate officers of the SNF; (5) corporate directors of the SNF; and (6) persons with a five percent or greater mortgage or security interest in the SNF. All other changes to data on the SNF Attachment must be reported within 90 days of the change. If the SNF needs to report a change to any of the above information before it submits its revalidation application, it should submit a Form CMS-855A change of information application.
- Pending Revalidation and Changes of Ownership
The Guidance provides that the information to be reported if a change of ownership (“CHOW”) is submitted after October 1, 2024, the SNF provider is not required to submit an off-cycle revalidation, since all of the required information will already have been provided in the CHOW revalidation. Specifically, if a CHOW is expected to occur (and CHOW application will be—but has not yet been—submitted) before the expiration of the deadline to submit the revalidation application, then, except as detailed below, the seller should submit the revalidation application as requested with information about the SNF’s current owners/managers/ADPs, etc., since it is possible the sale will not happen.
If the sale does occur later, the buyer must complete the full Form CMS-855A CHOW enrollment application, including the SNF Attachment.
Note that if a buyer submits a CHOW application (including the SNF Attachment) before it submits its revalidation application, it does not need to complete the revalidation application. The SNF will be removed from the revalidation cycle, and the Medicare Administrative Contractor will contact the SNF.
- Updates to Additional Disclosable Parties
One aspect of the SNF Attachment is the obligation to identify and report all “Additional Disclosable Parties” (“ADP”). An ADP is defined as any person or entity that: (1) exercises operational, financial or managerial control over the SNF; (2) provides policies or procedures for the SNF’s operations; (3) leases or subleases real property to the SNF; (4) owns five percent or more of the real property’s total value; or (5) provides services such as financial, clinical consulting or accounting. The Guidance has clarified that administrative services can involve services such as, but not limited to, compliance/oversight, human resources, public relations/outreach/advertising, technical assistance to the SNF’s main information system, etc. The Guidance sets out that this category does not include custodial, building security and similar services. It also does not include electronic health record (“EHR”) vendors or payroll vendors. Neither EHR vendors nor payroll vendors need to be reported as ADPs in any of the ADP categories.
Also, SNFs occasionally contract with pharmacies, labs, x-ray suppliers and nursing staffing companies to help serve the SNF’s residents (e.g., the pharmacy provides drugs for the facility’s patients). The Guidance provides that for purposes of disclosure: (1) pharmacies, labs and x-ray suppliers are not considered ADPs; and (2) nursing staffing companies are considered ADPs under the “administrative services” category. However, these companies need only be reported if the SNF has not yet submitted its revalidation application or SNF Attachment. If the SNF has submitted the revalidation/SNF Attachment, it does not need to revise its application to furnish this data.
Practical Takeaways
- The new CMS-855A form requires detailed ownership and management information from SNFs, specifically through a multiple-page SNF Attachment.
- The definition of Additional Disclosable Parties has been revised.
- Changes were made for parties involved in a change of ownership.
For more information on the reporting and the CMS-855A form, 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 give legal advice outside of an attorney-client relationship.
