A series of significant regulatory changes are expected to hit skilled nursing over the course of 2023, but experts are also warning providers not to lose sight of some smaller but still important changes coming into play as early as Jan. 1.

Continuing its efforts to increase transparency and track ownership changes in the sector, the Centers for Medicare & Medicaid Services kicks off the New Year with enhanced background requirements for owners. The shift puts SNF owners in the same category as other “high-risk” provider types, such as substance abuse disorder clinics.

If a skilled nursing facility is being initially enrolled in Medicare, or changes ownership, then each individual who owns 5% or more of the SNF must submit fingerprints along with the enrollment application, according to legal experts. Fingerprinting would also be required if an existing SNF reports a new owner.

Fingerprints are taken by a vendor, LiveScan, and to submit fingerprints, an owner has to visit a LiveScan location and should expect challenges.

“In some cases, the original fingerprint cards have been rejected because the print for one or more fingers did not meet the required standards,” attorneys at Husch Blackwell noted in a recent blog.

“These new requirements are likely to slow down the enrollment process for SNFs and other providers undergoing (change of ownership) or enrolling as new providers,” they added. “This is important to consider when structuring any transaction. If any SNF providers are needing to add any new owners or will be having a change of ownership at the end of the year, these new requirements can be avoided if the enrollment applications are submitted before Jan. 6, 2023.”

Provider Relief changes

A new Provider Relief Fund reporting period also begins on the first day of the New Year and ends March 31, 2023. The inclusion of American Rescue Plan Rural Payments in this phase may create challenges for some operators who received both types of relief, provider advocates warn. The Phase 4 reporting window will be for payments received from July 1 to Dec. 31, 2021 with a period of availability of Jan. 1, 2020 to Dec. 31, 2022.

The Jan. 1 launch is part of a seven-period plan from the Health Resources and Services Administration. Legal experts and others have noted an uptick in audit and recoupment efforts, signs that the federal government will remain serious about PRF accounting in 2023. 

Later changes

There will of course be other changes coming in 2023, such as a much-anticipated federal staffing mandate. Some, including promised MDS adjustments, won’t kick into gear until the next federal fiscal year in October, but it’s best to not wait until then to take action, Melissa Brown, chief operating officer of Gravity Healthcare Consulting, told McKnight’s Long-Term Care News.

“Section GG is replacing Section G and currently almost everyone has their CNAs document daily using Section G language, which means that this information cannot be used for Section GG,” she said. “The training and auditing for nurse’s aides to learn and accurately use Section GG terminology in their documentation is daunting, and if providers haven’t started yet, they need to get going by Jan. 1. 

“Additionally, with this change, our SNF communication should change too. Our Medicare Utilization Review meetings, morning meetings, care plan meetings – we should all be using Section GG terms instead of therapy terms or the Section G nursing terms. Section GG was designed to unify our language across disciplines and levels of care, and today is the day to get started on that transition.”