CMS Nursing Home Ownership Disclosure Rules: A Financial Compliance Guide for Skilled Nursing Facilities

Since January 2024, skilled nursing facilities (SNFs) that bill Medicare and nursing facilities that bill Medicaid have been operating under a significantly expanded ownership disclosure regime. For financial and compliance managers, this isn't a paperwork footnote — it changes what your facility must report, when, and who ends up named in a federal database that the public, journalists, plaintiffs' attorneys, and state surveyors can all search. Here's what the rule requires, who it captures, and how to build a process that keeps your facility off the list of facilities CMS flags for incomplete or late disclosures.

Why CMS Changed the Rules

The Centers for Medicare & Medicaid Services (CMS) finalized this rule in November 2023, with an effective date of January 16, 2024, under the authority of Section 6101 of the Affordable Care Act. The stated goal was transparency: CMS and researchers had long argued that existing ownership disclosure requirements didn't capture the full financial structure behind many nursing homes, particularly facilities owned or managed through private equity funds, real estate investment trusts (REITs), and layered management companies. The rule doesn't change who is licensed to operate a facility — it changes who has to be named, and how.

What the Rule Actually Requires

The core change is a new category called an Additional Disclosable Party (ADP), which sits alongside the existing requirement to disclose direct and indirect owners and officers/directors/managing employees. An individual or entity is an ADP if it does any of the following in relation to the facility:

• Exercises financial control over the facility, or provides financial or cash-management services to it
• Leases or subleases real property to the facility
• Owns a whole or partial interest of 5% or more of the value of the facility's real property
• Provides administrative, clinical consulting, or accounting services to the facility
• Sits on the governing board of any entity described above

Crucially, the rule also requires facilities to state whether each direct or indirect owning or managing entity is organized as a Private Equity Company or a Real Estate Investment Trust, using the definitions CMS finalized in the same rule. That means your facility's financial and legal teams need to map out not just who owns the operating company, but who owns the real estate, who manages cash, and who consults on clinical or administrative operations — and confirm the corporate form of each.

How and When to File

Medicare-enrolled SNFs report this information through the revised Form CMS-855A, the standard Medicare enrollment application, at five trigger points: initial enrollment, change of ownership, revalidation, reactivation, and any change-of-information filing. Once information is on file, existing timelines under 42 CFR §424.516(e) still apply for keeping it current: changes to ownership or control must be reported within 30 days, and most other reportable changes within 90 days. Medicaid nursing facilities report through whatever method their state Medicaid agency prescribes — so if your organization operates across state lines, expect the mechanics (though not the underlying disclosure obligation) to vary by state.

One practical wrinkle worth flagging to your team: CMS has said facilities won't be required to submit the new ADP data points until the revised Form CMS-855A is finalized and available for use, and CMS has signaled it will use off-cycle revalidations to build a baseline of ownership data across the sector. In practice, that means many facilities are collecting and organizing this information now, in advance of a formal filing prompt — which is the right approach, since scrambling to reconstruct a facility's full ownership and management chain under a revalidation deadline is not a good use of anyone's time.

The Public Disclosure Piece

This is the part that tends to get compliance managers' attention: the Affordable Care Act requires CMS to make the reported ownership and ADP data available to the public within one year of the rule's publication, which points to public release around November 2024 and ongoing thereafter as data is collected and refreshed. Once live, that data sits alongside CMS's existing public nursing home datasets — meaning your facility's ownership chain, management relationships, and whether any of those entities are private equity firms or REITs becomes discoverable by regulators, advocacy groups, journalists, and litigation counsel. Getting the disclosure right the first time matters more than it might have under the old, narrower rules.

Building a Compliance Process That Holds Up

For financial and compliance leads, the practical work here breaks into four pieces:

• Map the full ownership and services chain — not just the licensed operator, but the real-property owner, any management company, and anyone providing financial, cash-management, accounting, or clinical-consulting services above a nominal level.
• Confirm entity classification — work with legal/finance to determine whether each owning or managing entity meets CMS's definition of a Private Equity Company or REIT, since this determination has to be made affirmatively, not left blank.
• Build a change-tracking process — because the 30-day (ownership/control) and 90-day (other changes) clocks under §424.516(e) start running the moment a change happens, not when someone notices it during the next audit.
• Coordinate Medicare and Medicaid filings separately — remember that Form CMS-855A covers the Medicare side, but Medicaid nursing facility disclosure runs through separate, state-specific channels that your team needs to track independently.

None of this is a one-off filing exercise. It's an ongoing data-governance responsibility that now sits squarely with finance and compliance, not just the credentialing team that used to own Form CMS-855A.

Frequently Asked Questions

Does this rule apply to facilities that only bill Medicaid, not Medicare?

Yes. Medicaid nursing facilities are subject to the same Additional Disclosable Party disclosure obligations, but they report through the method their state Medicaid agency prescribes rather than Form CMS-855A.

What happens if my facility misses a reporting deadline?

Ownership and enrollment disclosure failures can affect Medicare enrollment status, since accurate ownership disclosure is a condition of enrollment. Given that CMS is actively building a baseline of ownership data through off-cycle revalidations, facilities with incomplete records risk added scrutiny during that process.

Is a management company automatically an Additional Disclosable Party?

Not automatically — it depends on what the management company actually does. A company that exercises financial control, provides administrative or accounting services, or handles cash management for the facility meets the ADP definition; a company with no such role would not.

Where can I read the rule itself?

The final rule is published in the Federal Register (November 17, 2023) and summarized on CMS's own fact sheet at cms.gov, which is the authoritative source for the definitions and filing mechanics referenced here.

Keeping Your Team Current

Ownership transparency rules like this one are part of a broader tightening of financial oversight across the skilled nursing sector, and they tend to move fast once a rule is finalized. Building this into your facility's ongoing healthcare compliance training programme — alongside related obligations like the CMS Conditions of Participation — helps make sure finance, compliance, and administration staff aren't relearning the rules from scratch every time CMS issues new guidance.