URGENT: CMS Starting Off-Cycle Revalidation of All SNFs Beginning October 1, 2024
In an effort to increase transparency about skilled nursing facilities (“SNFs”), the Centers for Medicare and Medicaid Services (“CMS”) has revised the CMS-855A form (09/24) and has instructed the Medicare Administrative Contractors (“MACs”) to send off-cycle revalidation notices to one-third of the nation’s SNFs each month starting October through December of this year. Also, as of October 1, 2024, all SNFs that are enrolling, revalidating, reactivating, or undergoing change of ownership (“CHOW”) must submit the new CMS-855A form. SNFs that have pending CHOWs may be required by their MACs to complete the new 855A form if their new enrollment has not been finalized.
SNFs will have 90 days to complete and submit the 855A for revalidation; failure to do so timely could result in decertification and loss of Medicare billing privileges.
The new 855A requires detailed information about SNF ownership and management, as well as other Additional Disclosable Parties (“ADPs”) and the ADPs’ ownership structures. The list of reportable ADPs is broad, and includes any party that provides polices or procedures, exercises financial control, provides financial or cash management services, leases or subleases real property, owns 5% or more of the SNF’s real property, or provides management or administrative services, clinical consulting, accounting or financial services. CMS has indicated that there is no de minimus threshold for determining what should be disclosed, nor is reporting limited to related-party interactions. Instead, CMS has acknowledged that it is “unable to address all conceivable factual scenarios within and among organizations or to individually identify every potential disclosable party and associated occupational title,” and suggests that SNFs consult with their legal counsel or other professional advisor to determine whether a relationship is reportable.
There are also onerous obligations with regard to identifying individuals within the ADP, such as for example, if the ADP is an LLC, identifying ALL direct or indirect owners regardless of percentage. ADPs can include publicly traded companies, banks, accounting firms, as well as consulting companies and possibly even trade associations or insurance companies to the extent that they provide policies and procedures. Among other requirements, SNFs must provide an organizational chart that shows the relationship of each ADP to the facility and to all the SNF’s other ADPs.
With the effective date for the new 855A revalidations just days away, SNFs should immediately start preparing by ensuring staff are watching for their MAC letters, and that appropriate teams are beginning to identify and gather the data required.
For more information, please contact Paula Sanders at psanders@postschell.com or Mark Mattioli at mmattioli@postschell.com.
Disclaimer: This post does not offer specific legal advice, nor does it create an attorney-client relationship. You should not reach any legal conclusions based on the information contained in this post without first seeking the advice of counsel.
About the Authors
Paula G. Sanders is a Principal and Chair of the Firm's Health Care Practice Group, where she focuses her national practice exclusively on health care law. She represents clients on both substantive and procedural aspects of health facility regulation, such as surveys; licensure, certification and immediate jeopardies; changes of ownership; Medicare/Medicaid; compliance; investigations and audits; accreditation; payment matters; governance; fraud and abuse, False Claims Act investigations and voluntary disclosures.
Mark L. Mattioli is a Principal in the firm's Health Care Practice Group and focuses his national practice on assisting and defending healthcare entities in transactional, regulatory, and litigation matters. His clients include hospitals and health systems, as well as long-term care, home health, and dialysis providers, clinical labs, and medical device and durable medical equipment (DME) manufacturers.