Skilled nursing operators unnerved by what they see as excessive information demands for a new, off-cycle Medicare revalidation process were assured Thursday that current guidance will be updated frequently over the next week, and then perhaps as often as weekly in the future.
Numerous providers peppered Centers for Medicare & Medicaid Services Technical Advisor Frank Whelan with questions during a CMS SNF Open Door Forum conference call. Most were about the timing and information crunch brought by last month’s agency announcement that providers must fill out expanded forms calling for more data than ever about ownership, management and other associated parties’ leaders.
Contrary to provider claims that there has been little direction given, Whelan said “very detailed” sub-regulatory guidance has been in play. It was updated two days ago, could be amended again today, possibly also Monday and frequently in the future.
“If you haven’t read this sub-regulatory guidance yet, we very strongly urge you to do so,” he said. “It’s very detailed as to what’s expected. This document is going to be the principal written means of outreach and education and we’re going to constantly update it over the coming weeks and months” as issues arise.
A legal representative of the American Health Care Association/National Center for Assisted Living sent a letter to leaders of CMS and the Department of Health and Human Services on Wednesday, critical of the way the revalidation requirements have been explained and must be delivered.
Compliance worries
Many inquiries Thursday focused on how deep providers must dig to provide information on their investors and business partners. “Frankly impossible” is how one caller described trying to retrieve information that could be “several layers deep” in other entities.
Whelan said the sub-regulatory guidance addresses such challenges, to an extent. He noted that direct or indirect owners holding 5% or greater of any such “additional disclosable party” (ADP) must be accounted for, including those that “go up the chain” and perhaps down another vein of an ownership structure.
He called requirements “very similar” to what’s required today in sections 5 and 6 of the provider enrollment form, which, in effect, are being folded into requirements in the new CMS-855A form.
“We understand in the ADP world, it’s a little bit different,” he said. “In terms of how far you go, SNFs are basically expected to use the maximum feasible efforts to secure the required data. This really isn’t any different from today when providers and suppliers sometimes experience difficulties obtaining certain information. It’s critical that SNFs make all attempts possible, even multiple ones if need be to acquire the SNF data.”
How much effort is enough?
He added that the agency considers “valid” providers’ concerns about how much effort would be considered enough. Officials are discussing the matter internally and will issue sub-regulatory guidance on the topic, he said.
“We’re not really able, on this form, to define what maximum feasible [effort] is because every factual situation is going to be different,” he acknowledged. “For the same reason, we’re not really able to establish on this call a formal threshold of the number of attempts you have to make to get the data.”
He recommended providers document all efforts to retrieve requested information, ostensibly implying that could wind up being mitigation for absent verbiage.
He pointed to strict statutory language when asked why providers have to send CMS information on a business partner that might have already been sent in for other purposes. He also noted that providers have a 30-day window to notify officials of things like a change in clinical consultants; changes in disclosable party ownership must be noted within 90 days.
Whelan asked numerous questioners to email in “excellent” inquiries so that they could be considered and later clarified in the sub-regulatory document. That included one from Martin Allen, the author of AHCA’s letter Wednesday to CMS and HHS, who asked how the requirements for personally identifiable information might differ between ADP owners and vendors.
Whelan deferred similarly on questions on how to handle board members who have no ownership stake, and what providers should do if they experience a change of ownership amid the revalidation process. The nationwide revalidation period is currently scheduled to last 90 days from the time providers receive their notices in October, November and December of this year.
He also emphasized that providers in five states recently affected by hurricanes Helene and Milton — Florida, Georgia, South Carolina, North Carolina and Virginia — will have an extended deadline of May 1, 2025, to comply with Medicare revalidation requirements.
Provider questions on the process can be sent to [email protected].
