Providers now have just three weeks to complete revalidation forms that have caused confusion and concern as federal regulators seek to bring clarity to nursing home ownership.

The Centers for Medicare & Medicaid Services is requiring every federally funded facility in the US to complete an updated revalidation process by Aug. 1. The process requires listing ownership and management details and naming anyone who could have a controlling interest in a nursing home’s operations — down to the vendor and volunteer levels.

Providers who do not submit complete information — or fail to do so at all — risk losing their Medicare certification.

The introduction of several new categories of reporting on form CMS-855A sparked frequent and varied questions, leading CMS to issue FAQs and delay the reporting deadline at least twice. Most recently, the agency pushed back a planned May 1 deadline because an estimated 80% of facilities had not yet been able to comply.

CMS has not provided any recent submission estimates to the American Health Care Association or LeadingAge, both of which had continued lobbying CMS in recent weeks to give providers an extension beyond Aug. 1..

“We know from our conversations with members that people are working on it,” said Jodi Eyigor, senior director of nursing home quality and health regulation for LeadingAge. “People are working toward that August first deadline, and I really don’t expect an extension at this point.”

In an interview with McKnight’s Long-Term Care News Thursday, Eyigor noted that CMS had recently included information about the reporting obligations and its updated subregulatory guidance in an MLN Connects article. She interpreted that as a strong indication that the agency plans to finally move forward with the transparency effort.

But many providers continue to have questions. They’re increasingly concerned about whether information they’ve already sent has been accepted as compliant, and how to respond and what additional details to provide when the Medicare Administrative Contractors make additional requests.

“While we appreciate the previous extensions, the fact remains that many providers continue to have difficulty with this complex and burdensome reporting requirement,” said John Kane, senior vice president of reimbursement policy at AHCA/NCAL in an email. “We are urging skilled nursing providers to do everything they can to meet the Aug. 1 deadline. Meanwhile, we continue to implore CMS to ensure that we put patients over paperwork and prevent an access to care crisis.” 

The increased information collection was triggered by the Biden administration’s intense focus on nursing home ownership and the Medicare agency’s attempts to better understand the connections between skilled nursing organizations and their related entities. The groundwork for the massive revalidation effort was included in a 2023 final rule on ownership disclosures that also established definitions for common skilled nursing investor types and additional parties.

Typically, providers only had to submit validation, also called reenrollment, paperwork when entering the Medicare program, changing owners or top managers, or at routine five-year intervals. The previous process also involved far fewer disclosable parties.

“I think the pain points are the same as they have always been,” Eyigor said.”The additional disposable parties ]requirement] is just really onerous, for one thing. But it’s also incredibly confusing because it varies. CMS, I think, has done their best to try to provide guidance, but for each provider, it’s a unique situation, so that makes it challenging.”

There’s also a huge learning curve as all providers are going through the new, expanded process together and there’s no one to learn from, she added. 

She expects a smoother process when routine triggers for validation return, even as questions remain about when that cadence will resume. Some providers who have spent incredible time and resources on this special one-time revalidation may be due for their routine submission again next year, without further changes from CMS.

Another major question remains: How will CMS use the reams of data and listing it is collecting from providers? The agency has announced plans to move more ownership data to Care Compare, but it’s uncertain how the Aug. 1 collection will play into that.

“We think we understand the intent. It’s CMS wanting to make sure that money’s not being funneled and that sort of thing. But how are you going to make this useful and meaningful to consumers and current residents and families and prospective residents and families or nursing homes and advocates who are trying to improve nursing home care?” Eyigor asked. “How is this information going to be helpful? It might be. It’s just, do they have a plan for making it helpful?”

Both LeadingAge and AHCA have offered webinars and other resources to their members, and some to non-members. Many of them are still available.

CMS also set up a help desk to address revalidation questions at [email protected].