Mandatory Off-Cycle SNF Revalidation Process—What You Need to Know

Mandatory Off-cycle SNF Revalidation Process—What You Need to Know

CMS will be notifying facilities via letter sent from their Medicare Administrative Contractor (MAC) sometime between October to December 2024 that they must complete the off-cycle revalidation process—here’s what you need to know to be compliant.

Basis for Revalidation Requirements

In 2010 the Affordable Care Act (ACA) required the Department for Health and Human Services (HHS) to implement additional long term care facility ownership transparency.  This was not mentioned again until President Biden addressed the topic in his 2022 State of the Union Address.  In 2023 there was an Additional Disclosable Parties Rule which outlined reporting categories but provided no specific details.  Finally on Sept 19, 2024 the CMS-855A Enrollment Form was updated along with the ADP Guidance.  This included the following:

• • • Major revision of SNF reporting on 855 – New SNF Disclosures Attachment
    • One-third of SNF providers will be notified in each month from Oct-Dec

What to Expect

CMS will be notifying facilities via letter sent from their Medicare Administrative Contractor (MAC) sometime between October to December 2024 that they must complete the off-cycle revalidation process.  Providers will have 90 days to submit the required information to PECOS via the new CMS-855A Enrollment form.  For Providers in the States of Florida, Georgia, Tennessee, South Carolina and North Carolina an extension of this required timeframe has been granted to May 1, 2025 due to ongoing recovery efforts from the recent hurricanes.

If the MAC identifies missing information, providers will have 30 days to respond with the needed data.

If providers meet the required deadlines, their payments will not be cut off.  If providers fail to meet the required deadlines, their payments will be stopped until the MAC determines that the facility has met the requirements.

Expanded Reporting Requirements

In the expanded reporting requirements, the Ownership disclosure is broadened to include:

• • • Providers who are LLCs
    • Disclosure requirements vary based on business structure
    • Property owners
      • •  Landlords will need to provide this information to members
    • Additional Disclosable Parties (ADPs)

The reporting requirements also include detailed information about ownership & management such as:

• • • Additional data regarding other associated parties and their ownership structures
    • SNF providers must now report:
      • • All previously required data, and
        • Additional information about “Additional Disclosable Parties” which includes any person or entity (Employees or Vendors) who:
          • • Exercise operational, financial, or managerial control (This includes Consultants/Vendors who provide management, clinical or administrative services, OR accounting or financial services)
            • Provides policies or procedures
            • Provides financial or cash management services
            • Leases or subleases real property to SNF
            • Owns ≥5% percent of the total value of the real property

For Skilled Nursing Facility Providers that are Corporations – There is no change.  They must continue to report:

• • • All Governing Body Members
      • • Currently disclose all board directors
          • • This applies to:
              • • For-profit and non-profit entities; and
                • Regardless of the body’s specific title  e.g., “governing board,” “leadership council”.

For SNF Providers that are LLCs

• • • All individual and organizational owners of the LLC must be reported regardless of percentage of ownership.  Previously this was just for those with ≥5% ownership.

For SNF Providers that are Trusts

• • • All Trustees must be reported
      • • Can be a person or entity
    • Note: not required to disclose trust’s beneficiaries unless they qualify for disclosure under another category

All ADPs must be disclosed which includes all parties described in the ADP definition.

Changes from current disclosure requirements include if the ADP:

• • • Leases or subleases real property to the SNF
    • Owns ≥5% in SNF’s real property

It is critical that each facility prepare for the completion of the Off-cycle Revalidation Process by:

• • • Being alert for the letter from the MAC in the mail
    • Reviewing the many available resources from CMS and Industry Associations
    • Involving legal counsel if necessary
    • Developing a process for tracking when information is requested and received from all disclosable entities
    • Gathering the required information and document all efforts made during this process

Access  instructions on completing the Off-cycle Revalidation Process at GUIDANCE FOR SNF ATTACHMENT ON FORM CMS-855A

Providers may email the designated email box with questions: SNFDisclosures@cms.hhs.gov