In December 2024, the Centers for Medicare & Medicaid Services (“CMS”) made many revisions to its “Guidance for SNF Attachment on Form CMS-855A” (“Guidance”). The Guidance is CMS’s subregulatory advice and FAQs to skilled nursing facilities (“SNFs”) on the completion and submission of the new Form CMS-855A SNF Disclosures Attachment (“SNF Attachment”) for every SNF. The Guidance continues to confirm the due date for all SNFs to submit the off-cycle revalidation information is May 1, 2025, unless an exception described below applies.

While no changes have been made to the Guidance since December 20, 2024, many skilled nursing providers are moving ahead in the process of gathering the information and completing the off-cycle revalidations.

Many of the December 2024 CMS changes include the following:

  • Payroll vendors:

The Guidance addresses whether payroll vendors need to be disclosed, stating that payroll vendors are not considered an additional disclosable party (“ADP”).

  • Pharmacies, labs and x-ray providers:

The Guidance addresses whether pharmacies, labs and x-ray providers need to be disclosed, stating that pharmacies, labs and x-ray providers are not considered an ADP. However, if these entities provide “consulting services,” then they are ADPs.

  • Nurse staffing company providers:

The Guidance addresses whether nurse staffing companies need to be disclosed, stating that nurse staffing companies are considered an ADP.

  • Pharmacist consultants:

The Guidance addresses whether pharmacist consultants need to be disclosed, stating that pharmacist consultants are in the reportable clinical consultation group and are considered an ADP.

  • ADP effective date:

The Guidance addresses when to identify the ADP effective date, stating that the ADP effective date is the date on which the relationship between the SNF and the ADP began.

  • Efforts to collect information from an ADP:

The Guidance addresses an SNF’s efforts to collect information from an ADP. The Guidance states that SNFs are expected to use the maximum feasible efforts to secure the required data. CMS emphasizes that all attempts—even multiple ones if necessary—must be made by the SNF to acquire the data. Note that there is no formal definition of the term “maximum feasible efforts” beyond its plain meaning because every factual situation will be different. For this same reason, no official minimum threshold of attempts must be made in all situations. All this said, SNFs are not required to make multiple attempts to obtain information regarding an ADP or its ownership structure if: (1) the ADP refuses to provide the data; and (2) the information is not available and accessible elsewhere. CMS recommends (though does not require) that the SNFs thoroughly document all efforts to secure any data it was ultimately unable to obtain.

Practical Takeaways

  • The new CMS-855A form, which was revised on September 1, 2024, requires detailed ownership and management information from SNFs, specifically through a multiple-page SNF Attachment.
  • A careful review of the Guidance is needed to complete the new CMS-855A form.

For more information on the reporting and the CMS-855A form, please contact:

Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot give legal advice outside of an attorney-client relationship.

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