Update: The Centers for Medicare & Medicaid Services has again extended the deadline for skilled nursing facilities to submit information for the required off-cycle revalidation to August 1, 2025, regardless of when the facility received its notification letter. CMS also updated its guidance, which can be viewed here.

In October, CMS announced it would require off-cycle revalidation of all skilled nursing facilities (SNFs) across the country through the end of 2024. During this process, CMS will collect ownership, management, and related party information that was not previously required to be disclosed.

Who Does This Affect?

CMS is requiring revalidation for all SNFs regardless of size, ownership, or nonprofit status.

When Is This Occurring?

Facilities will receive a request from their Medicare Administrative Contractor (MAC) between October and December 2024. One third of SNFs will receive their notice this October, with the remainder following in November and December. Once a provider receives a notice, it will now have until August 1, 2025 to complete the required documentation.

Why Is This Occurring?

CMS enacted a final rule in November 2023 implementing portions of the Patient Protection and Affordable Care Act, which added a section to the Social Security Act related to ownership, management, and related parties. Federal regulations permit CMS to conduct off-cycle revalidations when the need arises, such as the implementation of this new rule.

What Do I Need to Do?

Watch for the notice from your MAC. Once you receive your notice, your facility must complete the revised Medicare Provider Enrollment Application Form (CMS-855A) by August 1, 2025.

Unlike in previous revalidations, SNFs should skip Sections 5 and 6 of the form and instead complete Attachment 1. This attachment will collect information on topics including ownership, management, organization, and administration. While some of this information was already required under previous reporting standards, other data must be disclosed for the first time. CMS guidance for filling out the revised form can be found here.

Data collected should be submitted through CMS’s PECOS system, although paper versions are permitted.

The definitions of the information required to be disclosed are broad, and 90 days may not be sufficient to collect all data. In particular, SNFs must report detailed information — including ownership information — for all “Additional Disclosable Parties” (ADPs). This can include outside accounting, administrative, cash management, clinical consulting, financial management, management, operational, and policy development services. ADPs can also include landlords or partial owners of facility property.

All providers should review the new form and associated CMS guidance and begin collecting information as soon as possible. Additionally, CMS recommends SNFs contact legal counsel for assistance completing certain required disclosures.

What Happens if I Do Not Submit the Form on Time?

Failure to turn the form in on time can result in a deactivation of billing privileges. Once this occurs, an entirely new enrollment application is required. Services provided to Medicare patients during a gap in coverage prior to reactivation will not be reimbursed.

Other Notes

The new form CMS-855A will become the standard for all provider enrollment transactions that occur after or were pending on October 1, 2024. This includes new enrollments, revalidations, reactivations, and changes of ownership. The new form will also apply to changes of information, though this does not require completion of the entirety of Attachment 1.

How Can I Find Assistance?

For more information or assistance completing the revalidation process, please contact Terrill Johnson Harris at tjharris@foxrothschild.com, Margaret F. Sport at msport@foxrothschild.com, or another member of Fox Rothschild’s Health Law Team.

This information is intended to inform firm clients and friends about legal developments, including the decisions of courts and administrative bodies. Nothing in this alert should be construed as legal advice or a legal opinion. Readers should not act upon the information contained in this alert without seeking the advice of legal counsel. Views expressed are those of the author(s) and not necessarily this law firm or its clients. Prior results do not guarantee a similar outcome.