Ten months into a new administration, skilled nursing providers still find themselves subject to increasingly burdensome ownership reporting requirements — with few signs that the federal government will stop its campaign to increase transparency and data collection.
An often-extended deadline for all providers to report new, expanded information through a formal revalidation process is, at least for now, set for Jan. 1. The aim is to give the Centers for Medicare & Medicaid Services new information with which to shape future policy and information requests.
And the Department of Health and Human Services Office of Inspector General this month added a review of CMS efforts to ensure nursing home quality after changes in ownership to its workplan.
Providers should take these and other recent actions as signs that pressure that has been building since COVID to better scrutinize nursing home owners, related parties and investment relationships will continue to elicit change, said Eugene Gonsiorek, vice president of clinical regulatory standards for PointClickCare.
That may be the case even as providers experience regulatory relief elsewhere.
“Where CMS has been going is looking at, what can we do in terms of looking at larger entities and seeing if these are leading to poorer quality and low-performing nursing homes,” Gonsiorek told McKnight’s Long-Term Care News Monday. “It seems that, eventually, there will be a higher degree of enforcement or audits around owners of poorly operated facilities.”
He traces the roots of the recent emphasis on nursing home ownership information to the Biden administration, which in early 2023 proposed new accountability and reporting measures that had been authorized by the Affordable Care Act in 2010 but never acted on.
That led to the current revalidation effort, which has been criticized by some providers for being too onerous and, in some ways, too ambiguous about how to identify leaders and influential business associates. That, in turn, has raised concerns about compliance, given that CMS has not fully explained how it will use the new wealth of data.
All skilled nursing facility providers enrolled in Medicare and/or Medicaid must submit a mandatory off-cycle reenrollment (CMS form 855-A) through the Medicare Provider Enrollment, Chain, and Ownership System by Jan. 1.
The American Health Care Association and LeadingAge have both continued to advocate for relief on the deadline, but CMS has not issued any guidance since the federal government reopened. CMS delayed the last deadline of Aug. 1 with three weeks to spare.
The data mining era
Regardless of where the scrutiny is coming from, providers should be working to better understand regulators’ motivation and possible future action.
Those signals aren’t just in recently enacted nursing home regulation, but in audits and other work that can begin influencing future rules years in the making, Gonsiorek said. Take, for instance, last month’s OIG report on the Special Focus Facility program. While it captured headlines for noting repeat lapses among recent program graduates, there’s also a broader warning for providers not on the list.
It “found that some owners, including private equity-backed entities and REITs, operate clusters of low-performing nursing homes, suggesting that ownership structure can influence ongoing quality issues,” Gonsiorek noted.
That reflects the OIG’s stance that CMS ought to be looking more closely for patterns of poor performance among entities with shared ownership or investors.
While surveys and audits can unearth some of those concerns, it’s been hard in the past for CMS to see activities and outcomes across a chain. But more data — and the artificial intelligence tools the agency is embracing — will make it much easier for federal officials to drill down.
“It is so much easier using AI to be able to take a cost report and to break it down into its smallest components, and being able to compare it to something else — maybe a CMS 855A, or another piece of information,” Gonsiorek said.
“It used to take us weeks or months to do that, and they’re going to be able to do it in seconds,” he added. “And I don’t think that nursing homes are looking at all these different pieces of information that we have now and how CMS can start to use it from an audit perspective or an enforcement perspective.”
Another item that could eventually provide more insights on ownership, and spending in particular, is a Medicaid cost reporting provision included in the 2024 federal staffing mandate. While other parts of the law have been made null, Democrats have argued that the Medicaid Institutional Payment Transparency provision should still go into effect in 2028.
Brace for audit impact?
As for what any eventual audits could look like, Gonsiorek guesses CMS might start small — seeing what the market will tolerate and then scaling an approach, much as the agency has done with its work around antipsychotic medication reduction and schizophrenia audits.
The CMS approach will likely be to comb through the revalidation data, spot patterns and then create an enforcement strategy around that. That’s in addition to continuing to make the information collected more user-friendly and incorporating the expanded information into Care Compare, as started this summer.
“There is not (yet) public evidence of sweeping chain-wide audits purely triggered by ownership type,” Gionsorek said. “What we are seeing, however, is a clear shift: OIG has urged CMS to use this ownership information more strategically, especially for identifying low-performing chains.”
The OIG workplan item outlined this month will be due in 2027, when OIG said it will report on how well CMS and state agencies “take actions to identify and respond to declines in nursing home quality related to changes in ownership.”It will review compliance with required submission of updated information within 30 days of a change in ownership and the effects of onsite survey, state monitoring visits and additional documentation requests.
Kimberly Marselas (2025, November 25). Enforcement initiatives, audits likely to follow expanding emphasis on nursing home ownership data – https://www.mcknights.com/news/enforcement-initiatives-audits-likely-to-follow-expanding-emphasis-on-nursing-home-ownership-data/
