CMS’s Updated 855A Medicare Enrollment Application

The Centers for Medicare & Medicaid Services (“CMS”) has released an updated Medicare 855A enrollment form (the “New Form”), replacing the 2011 version. This update followed the publication of a final rule implementing Section 6101 of the Affordable Care Act, which requires the disclosure of certain ownership, managerial, and other information for Medicare skilled nursing facilities (“SNFs”) and Medicaid nursing facilities.

These additional ownership disclosure requirements aim to address concerns over quality of care furnished by SNFs that are owned by a private equity company or real estate investment trust (“REIT”). When updating the New Form, CMS expanded the scope of facilities required to make such disclosures, extending the requirements to all providers and suppliers that complete the 855A form. CMS stated that this expansion was required in order to understand the scope of private equity and REIT involvement in the healthcare field and their impact on patient care as a whole. The 2011 version of the 855A enrollment form will no longer be accepted by the Medicare Administrative Contractors, so going forward, providers should ensure that they are using the New Form.

The New Form now includes, among other things, private equity company and REIT ownership disclosures, new provider types, and a new section specifically for opioid treatment personnel.

Some key changes and takeaways on the New Form are below.

• Private Equity and REIT Ownership. Providers must now submit information on whether a private equity company and/or REIT has an ownership interest in the provider. A private equity company is defined as, “a publicly traded or non-publicly traded company that collects capital investments from individuals or entities and purchases a direct or indirect ownership share of a provider.” A REIT is defined as, “a publicly-traded or non-publicly traded company that owns part or all of the buildings or real estate in or on which the provider operates.”
  
  Under Section 5 for organizational ownership interest in the enrolling provider, any private equity companies and REITs that have a 5% or more direct or indirect ownership interest in, or partnership interest in, the enrolling provider must be identified. And if any such organization with an ownership interest in, or partnership interest in, the enrolling provider in turn is owned by any other organization or by any individual (e.g., if it has a parent company), that fact must also be disclosed.
  
  

• New Provider Types. Two new provider types are reflected on the New Form: (1) rural emergency hospitals, and (2) opioid treatment programs. Opioid treatment programs must complete a new Section 10, “Opioid Treatment Personnel,” which is currently only available via the paper form since this section will not be included online until the PECOS 2.0 platform (discussed below) rolls out later this year. In addition, the New Form includes a new hospital subgroup or unit for hospital transplant programs.
  
  
• PECOS 2.0. CMS plans to release a revamped system for completing online Medicare enrollment applications. Some new key features include (1) pre-population of data as submitted in prior enrollment forms, including 855A forms, and as submitted during the enrollment or revalidation process itself, (2) the ability to consolidate enrollments for multiple providers and for multiple states, and (3) a prompt prohibiting submission of an enrollment form if required documentation is not properly uploaded. These upgrades are anticipated to simplify the process for completing the 855 forms online via PECOS.
  
  
• Miscellaneous. The New Form includes a variety of other changes. For example, Chain Home Office information is now embedded in Section 5 instead of having its own standalone section. Business structure options have expanded to include additional structures such as a hospital district as a specific type of federal or state government type. Wet ink signatures are no longer required for persons signing the paper 855A forms, a welcome change for providers.

It is important to note that the additional data required to be reported in the New Form will be publicly reported within one year of submission to CMS, pursuant to Section 6101(b) of the Affordable Care Act. Such public reporting will be limited to the private equity company and REIT ownership interest data, not previously required information such as social security number and birthdate information of individuals on the form. CMS anticipates that this transparency will “allow families to make more informed choices about the care of their loved ones, and it will enable CMS and others to scrutinize more closely how ownership types correlate with care outcomes.”

For questions about the New Form and how it may affect your enrollment or revalidation, please contact any member of the Honigman Health Care Practice Group.