April 17, 2023

LeadingAge Supports Transparency in Nursing Home Ownership

BY Jonathan Lips

LeadingAge submitted comments to the Centers for Medicare and Medicaid Services (CMS) on April 14 concerning a proposed rule that would require nursing homes enrolled in Medicare or Medicaid to disclose and submit certain ownership, managerial, and other information to CMS and state Medicaid agencies.

The Affordable Care Act, enacted in March 2010, added Section 1124(c) to the Social Security Act which established requirements for Medicare and Medicaid nursing homes to disclose certain information relating to ownership and management of their organizations, and directed CMS to establish rules for implementation. CMS proposed regulations to implement these provisions several years ago but decided against finalizing them at that time.  The agency is revisiting the issue now as part of the Biden Administration’s focus on nursing home reform, including transparency and accountability of ownership.

Our comments expressed support for efforts to ensure that older adults and families receive quality care in nursing homes, including the goals of transparency with respect to ownership and management as set forth in the 2010 statutory language.  We noted that nonprofit, mission-driven nursing homes have long- disclosed ownership and management information through Internal Revenue Service filings that are freely available to the public.   And we also voiced support specifically for an aspect of the proposed rule that would require owning and managing entities of skilled nursing facilities to disclose whether they are either a private equity company or a real estate investment trust.

Our letter also offered comments and recommendations relating to certain aspects of the rule which we believe would support the goals of transparency and accountability, while providing needed clarifications for nursing home operators and lessening the burden of data submission.  We noted that CMS did not include in the proposed the rule a provision from Section 1124(c) that specifically allows nonprofit nursing homes to submit IRS Form 990 as a means of compliance, to the extent that the information submitted meets the statutory requirements. We strongly urged CMS to add language for implementation of that section, and we also asked CMS to define and clarify key terms within the proposed rule, to ensure that information disclosed is not broader than intended.

With the deadline for comments now passed, CMS will proceed to evaluate feedback. If finalized, the rule would become effective 60 days after the date of publication in the Federal Register. 

LeadingAge will continue to monitor these issues closely. For more details about what CMS included in the proposed rule, please see our earlier article on the topic.