In November 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule requiring the disclosure of certain ownership, managerial (managing employees), and other information regarding Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities. CMS clarified their definition of “Managing Employee,” to explicitly include nursing home medical directors.
A general manager, business manager, administrator, director, or other individual that exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operation of the provider or supplier, either under contract or through some other arrangement, whether or not the individual is a W–2 employee of the provider or supplier. For purposes of this definition, this includes, but is not limited to, a hospice or skilled nursing facility administrator and a hospice or skilled nursing facility medical director.
A nursing facility enrolled in Medicare or Medicaid must use CMS form 855A to submit a change of information-including adding a new managing employee- and provide this information in Section 6A:
It is important to note that it is the facilities responsibility to submit this form to CMS. When facilities are submitting this information, they will need to complete Sections 1, 2B1, 3, 6, 13, and the relevant portions of 15 on form 855A.
CMS will issue sub-regulatory guidance sometime in 2024 that will outline the timing, content, and means of the data publication. CMS has indicated that the information will be published in an easy-to- read manner via an accessible, navigable, and searchable website, like Care Compare, that users can understand. They also indicated that information will be published in a manner that allows users to search for trends, relationships, and connections in nursing home ownership structures. No sensitive information, such as social security numbers, will be published1.
While most SNF medical directors are technically neither “managing” nor “employees,” this is the regulatory language that is used to describe the medical director’s relationship to the facility. Is it unlikely that this language will increase our liability exposure substantially, as plaintiffs’ attorneys have historically been able to determine the identity of a medical director easily without a public listing. But it is difficult to predict to what extent increased regulatory scrutiny on the medical director will change the landscape, if at all. We will be monitoring these trends closely, and ultimately feel that competent, dedicated medical directors should feel confident that the impact will be minimal—and that SNFs engaging knowledgeable, committed medical directors should feel proud to list their identity. As to any change in professional liability insurance coverage or premiums, the designation as “managing employee” would seem to solidify the responsibility of the facility to indemnify the medical director for any and all duties performed in the role of medical director. CMS already has most of this information on any physician who bills Medicare, as a similar form (CMS-855i) is required. We have been assured that the SSN or other personal information will not be disclosed publicly.
Please note:
The above guidance is general, and we strongly urge you to speak with your facilities about your specific situation as the facilities are filling out this form.
Questions? Contact AMDA’s Public Policy Department at publicpolicy@paltc.org or 410-992-3145.
1 – MLN Matters January 2, 2024 Memo: MM13333 - Medicare Program Integrity Manual: CY 2024 Home Health Prospective Payment System Updates (cms.gov)