CMS Ownership Disclosure Filing Checklist for Skilled Nursing Facilities

CMS finalized its nursing facility ownership disclosure rule in November 2023, and it's been in effect since January 16, 2024 — but most skilled nursing facilities still haven't had to act on it, because the new disclosures only come due at your next Form CMS-855A submission: initial enrollment, revalidation, or a change of ownership or information. That "not yet, but soon" status is exactly why facilities get caught out. This checklist walks through what actually has to be disclosed, who counts as an Additional Disclosable Party, how private equity and REIT status gets determined, and how to prepare the 855A attachment before you're staring down a revalidation deadline.

What the rule actually requires

The rule expands what Medicare-enrolled skilled nursing facilities (SNFs) and Medicaid nursing facilities must disclose about who owns and controls them. It does two things: it widens the definition of who counts as a disclosable owner beyond the traditional 5%-ownership test, and it requires facilities to state explicitly whether any of those owning or managing entities is a private equity company or a real estate investment trust, using CMS's own definitions of those terms. The stated goal is transparency — CMS intends to make the disclosed data publicly available within a year of it being reported, so this isn't an internal compliance record, it's heading toward a public database.

Checklist: identifying your Additional Disclosable Parties

An Additional Disclosable Party (ADP) is a broader category than "owner" in the traditional sense. Under the rule, an entity or individual is an ADP if it does any of the following in relation to your facility:

• Exercises operational, financial, or managerial control over the SNF, or over any part of it — this catches management companies and consulting arrangements that don't show up on a simple ownership chart.
• Sets operational policy for the facility, even without a formal ownership stake.
• Provides financial or cash management services to the facility.
• Leases or subleases real property to the SNF, or owns 5% or more of the total value of that real property — this is the piece that pulls in a lot of REIT and sale-leaseback structures that facilities may not have previously treated as "ownership."
• Provides management, administrative, clinical consulting, accounting or financial services to the facility.

Go through this list against every contract and arrangement your facility has — not just your cap table — because management agreements, real estate leases and outsourced financial services are exactly the relationships this rule was written to surface.

Checklist: private equity and REIT status determination

• Test every identified ADP against CMS's PE and REIT definitions, not your own informal sense of what counts. The rule sets specific definitions for both entity types — don't assume a "family office" or "investment fund" label puts an entity outside scope.
• Document the determination, not just the conclusion. If you decide an ADP is not a PE company or REIT, keep a record of how you reached that conclusion — this data is heading for public disclosure and potential audit.
• Check upstream ownership, not just your direct investors. PE and REIT involvement is often several layers up the ownership chain from the operating entity that holds your Medicare enrollment — trace it fully.

Checklist: preparing the Form CMS-855A ownership attachment

For every ADP you've identified, the 855A attachment expects:

• Organisational basics — legal business name, identifying data, business structure type (corporation, LLC, partnership, trust, and so on), and whether the entity is an ultimate parent company.
• Ownership and management detail specific to entity type: for corporations, officers, directors and 5%-or-greater shareholders; for LLCs, every member and manager with their ownership percentage; for partnerships, every partner regardless of percentage; for trusts, every trustee.
• The relationship itself — how the ADP relates to the SNF and to other ADPs, what services it actually provides, the effective date of the relationship, and what kind of control (operational, managerial or financial) it exercises.

Build a standing internal register of this information rather than reconstructing it from scratch at each filing — ownership and management relationships change, and the accuracy of what you file is now a public-facing commitment, not a private compliance file.

Checklist: process and timing

• Identify your next trigger event. Existing enrolled SNFs don't have to proactively refile — but the expanded disclosures apply at your next initial enrollment, revalidation, or change-of-ownership/change-of-information submission requiring a Form CMS-855A. Know your revalidation cycle so this isn't a surprise.
• Check your state's Medicaid process separately. If you're Medicaid-certified, the federal Medicare 855A process doesn't automatically cover Medicaid disclosure — that depends on your state Medicaid agency having its own collection mechanism in place, which varies by state and timeline.
• Assign a single accountable owner — typically compliance or finance leadership — for keeping the ADP register current between filings, so revalidation doesn't become a scramble to rebuild the ownership picture from memory.
• Brief your leadership on the public-disclosure timeline. Because CMS expects to publish this data within a year of reporting, ownership structures that were previously confidential business arrangements should be reviewed with that visibility in mind before filing, not after it's public.

FAQ

Do all SNFs need to refile Form CMS-855A immediately?

No. CMS has not required a proactive, immediate refiling from every currently enrolled facility. The expanded ownership and ADP disclosures apply at your next required Form CMS-855A submission — initial enrollment, revalidation, or a change of ownership or information.

What's the difference between a traditional 5% owner and an Additional Disclosable Party?

Traditional ownership disclosure focused on direct equity stakes of 5% or more. An ADP is a broader category that also captures entities exercising operational, financial or managerial control, real estate lessors with a 5%-or-greater property interest, and providers of management, administrative, clinical, accounting or financial services — relationships that don't show up on a simple equity ownership chart.

Does this apply to nursing facilities that only take Medicaid, not Medicare?

Medicaid nursing facilities are also covered by the disclosure framework, but the mechanics run through your state Medicaid agency rather than the federal Form CMS-855A, and only once that state agency has established its own means of collecting the data.

Why does CMS specifically want private equity and REIT status disclosed?

CMS has stated the aim is transparency into ownership structures — including private equity and real estate investment trust involvement — that regulators, researchers and the public have historically struggled to see clearly, given how many nursing facility ownership and property structures sit several layers away from the operating entity.

Getting the compliance function ready for this

This rule turns ownership and financial-structure knowledge into a standing compliance requirement, not a one-off legal exercise handled at acquisition. Learnsignal's healthcare compliance and CPD training for US providers is built for exactly this kind of regulatory-literacy gap, and pairs well with our guide to CMS Conditions of Participation for nursing homes and our explainer on beneficial ownership and control more broadly. Whoever owns your enrollment filings needs to understand both the finance and the regulatory side of this — that combination is exactly what keeps a facility off CMS's list of incomplete or inaccurate disclosures.

Related readiness checklists: the Ontario LTC accountability agreement reporting checklist and the CQC financial viability & market oversight checklist for the UK.