In a May 17, 2023 letter to CMS Administrator Chiquita Brooks-LaSure, Senators Charles E. Grassley (R, IA), Elizabeth Warren (D, MA), and Robert P. Casey, Jr. (D, PA), and Representatives Katie Porter (D, CA) and Lloyd Doggett (D, TX) express support for proposed rules on ownership transparency, citing the Affordable Care Act and reports and recommendations of the National Academies of Sciences, Engineering, and Medicine (2022) and the Medicaid and CHIP Payment and Access Commission (March 2023) that call for meaningful disclosure of ownership information.
The bipartisan and bicameral (both Senate and House) Members of Congress also call for the proposed rules to be strengthened in seven specific ways:
- “Require more robust ownership reporting requirements for Medicare-certified nursing homes.” The Members call for “a standardized requirement for nursing homes to report each parent company, holding company, management company, and property company associated with the facility.” In addition, they suggest that CMS “consider categorizing direct and indirect ownerships using the common fund types found in the U.S. Securities and Exchange Commission’s Uniform Application for Investment Advisor Registration (“Form ADV”) instructions.”
- “Require standardized reporting requirements for Medicaid-certified nursing homes” that are the same as Medicare requirements.
- “Require reporting of all related-parties in which nursing home owners have a direct or indirect stake.” The Members call for comprehensive data about related parties “as these interconnected relationships allow nursing home owners to engage in lucrative and potentially unlawful self-dealing.” Having more accurate information about related parties “would allow CMS to set more accurate rates for Medicare- and Medicaid-covered services and ensure that funds are being appropriately used for patient care.”
- “Require a complete listing of each facility in a nursing home chain owned by the same parent company.” The Members propose definition of “chain” as “two or more facilities owned by the same parent company.”
- “Provide clear reporting timelines and establish penalties for failure to report accurate information.” The Members propose that facilities be required “to report any ownership changes within a defined period, such as thirty or sixty days, to capture all restructurings, reorganizations, and changes in additional disclosable parties.” They note, “Without defined timelines for reporting ownership changes or clear consequences for inaccurate reports, facilities may hide ownership to conceal profits and escape liability.” In addition, the Members recommend that CMS consider “a range of penalties, such as fines or the inability to receive Medicare funds – or both – for noncompliance” and incorporation of reporting requirements into the Skilled Nursing Facility (SNF) Value-Based Purchasing Program.
- “Establish a requirement for annual auditing to verify data accuracy.” The HHS Office of Inspector General has reported reliability concerns in the existing Provider, Enrollment, Chain and Ownership System (PECOS) database, “including listing defunct providers, inaccurate enrollment dates, and incorrect provider addresses.” The Members call for “annual audits, including an analysis of ownership information together with cost reports, staffing data, and survey inspection results.”
- “Make these data available in a publicly searchable database” similar to the Care Compare website. The Members note, “Access to ownership data is essential to holding nursing homes accountable and protecting residents.”
The Members ask CMS to answer seven questions, reflecting the seven points above, by June 1, 2023.
June 1, 2023 – T. Edelman