Uncertainty surrounding the information required for the new nursing home Medicare revalidation process has led to high levels of concern, particularly among for-profit operators, who view it as yet another punitive measure. Following letters from nursing home advocates about the rushed timing of the off-cycle revalidations, the Centers for Medicare & Medicaid Services (CMS) has decided to extend the deadline to spring, but many wonder if even more time is needed.

Aside from lack of clarity, large-scale data requirements, including an expanded list of ownership parties to be disclosed, are causing worries. These worries are compounded by whether Medicare Administrative Contractors (MACs) hired to do the paperwork will be able to process it in time, even with the extension.

CMS is now requiring facilities to complete the revalidation process by May 1, 2025. The federal agency had originally offered the spring extension only to states affected by Hurricanes Helene and Milton, while the rest of the country was beholden to a tight 90-day deadline, per an open door forum in October.

Cascadia Healthcare’s Chief Legal Officer and Executive Vice President of Corporate Affairs Steve LaForte told Skilled Nursing News that operators are still trying to be proactive with the revalidation requests, but that there has been little consideration for operating realities, in terms of the volume of what CMS is requesting.

There’s the possibility that operators will give too much information or too little, creating confusion. CMS has added some guidance on who to include in disclosures, but it’s still too unclear, LaForte said.

“Do I need to disclose all my pharmacies? Do I need to do it on a rolling basis as I change vendors?” are all questions perplexing operators, LaForte said. “I think you’re either going to get too much information that isn’t relevant, or you’re going to get not enough information because you’re making judgment calls, and your judgment calls are wrong … [This is] not out of a sense of mal-intent, but out of a sense of trying to be efficient in the process.”

The real risk here will be in how CMS enforces the process, he said. If CMS comes in with increasingly punitive enforcement, they’re either going to hold up or deny payments, and that has its own effect on care provision, and in turn access to care.

“History tells us that [CMS doesn’t] tend to enforce things in a charitable way to operators,” said LaForte. “I’m going to, unfortunately, based on past history, make the assumption that it’s going to be somewhat punitive, and if it’s somewhat punitive, that’s going to affect facilities viability and sustainability.”

Meanwhile, the largest advocacy group for for-profit operators, the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL), has said that the hastily pushed revalidation is a process that puts “paperwork over patients.”

Pulling resources away on already thin margins

Ultimately, the off-cycle revalidation will just take people’s attention away from the bedside, and it will pull time and money away from other daily operations to accomplish this on already thin margins, LaForte noted.

“I don’t know conceptually that it’s a bad thing, and I understand in part why they’re doing it. Sometimes it hits the mark and sometimes it misses the mark,” he said.

No one regulation operates in a vacuum, he said, likening the industry to a ‘Frankenstein’ cobbled together with regulation to meet a particular moment. “I think this is another one of those things where there’s a bigger reality here and CMS is looking at one very narrow swath,” he said.

For nonprofit providers, Janine Finck-Boyle with LeadingAge said that while the extension is helpful, associations and members are still concerned about other elements in the process, specifically about extensive data requirements and the expanded list of disclosable parties required in the revalidation process, echoing LaForte’s thoughts. Finck-Boyle serves as vice president of health policy for LeadingAge.

LeadingAge has told CMS that the scope and complexity of the information nursing homes must submit will present challenges, even with the extension. The organization asked CMS to more clearly define key terms within the proposed rule to ensure information disclosed isn’t broader than intended.

“We would expect the information collected to meet privacy recommendations and security risk assessments,” Finck-Boyle said. Personal identifiable information won’t be disclosed and all Privacy Act protections will be maintained with the added ownership reporting requirements, CMS told LeadingAge.

Still, LeadingAge has historically supported transparency of ownership, especially when it comes to whether an operator has private equity involvement, she said.

“Such a requirement would, in part, help to ensure a level playing field for consumers,” said Finck-Boyle. “Nonprofit, mission-driven nursing homes have long disclosed ownership and management information through Internal Revenue Service (IRS) filings that are freely available to the public.”

And, some nonprofit operators have already gotten their Medicare revalidation paperwork completed, she said.

Connect with MACs

Another concern for LeadingAge and its members is ensuring that MACs are processing revalidations in a timely manner. Failure to submit the required information on time may result in the deactivation of a nursing home’s provider enrollment status and termination of billing privileges, Finck-Boyle said.

LaForte said Cascadia has already begun discussion with their MACs despite not receiving and revalidation requests yet. “MACs are just sitting back scratching their heads. They’re not getting the appropriate guidance from CMS,” added LaForte.

LeadingAge will continue to monitor the guidance and update members with any changes, as well as engage with them regarding issues and concerns with the revalidation process in order to advocate for potential future changes in the process, she said.

Martin Allen, senior vice president of reimbursement for the American Health Care Association and National Centers for Assisted Living (AHCA/NCAL), was happy the agency heard the association’s concerns – the extension will help ensure providers are able to stay in compliance and refocus their time and energy to residents, he said.

“We will continue to work with HHS and CMS on clarifying our additional concerns and streamline reporting requirements overall,” Allen told Skilled Nursing News.