A small group of Democrats have joined with US Sen. Chuck Grassley (R-IA) to turn up bipartisan heat on federal regulators as they weigh increasing transparency into nursing homes’ ownership structures.
US Sens. Bob Casey (D-PA) and Elizabeth Warren (D-MA) and US Reps. Lloyd Doggett (D-TX) and Katie Porter (D-CA) have added their names to a letter sent to the Centers for Medicare and Medicaid Services. The agency is finalizing a proposed rule on facility transparency. Casey chairs the US Senate Special Committee on Aging.
The lawmakers’ letter to US Health and Human Services Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure urges them to clarify ownership definitions; set “strong” auditing and enforcement measures; and make available in an “easily searchable format” the “comprehensive reporting information.” The letter was sent last Wednesday.
“Private equity-owned nursing homes are associated with higher Medicare costs and increased emergency department visits and hospitalizations,” the letter stated.
The lawmakers also want CMS to add seven requirements to a proposed rule that has languished since being introduced in May 2011. Those addition include:
- Requiring a complete listing of each facility in a nursing home chain owned by the same parent company;
- Requiring reporting of all related parties in which nursing home owners have a direct or indirect stake;
- And requiring more robust ownership reporting requirements for Medicare-certified nursing homes.
In 2007, the New York Times reported on alleged deficiencies in nursing homes owned by private equity. Grassley was the top Republican on the Senate Committee on Finance and launched a sweeping probe into nursing home ownership structures that led to legislation that required facilities to disclose all individuals and entities that have controlling interests, offer administrative services or hold property leases. The law also required CMS to wrap up rulemaking on regulatory language on transparency within two years, but the agency never completed its work to finalize that rule.
In February, CMS proposed a new rule that would use a tool included in the Affordable Care Act to require more information on nursing home owners, managers and real estate and other partners. It also plans to include private equity and real estate investment trust definitions, which regulators said would set the stage for the disclosure of whether those types of owners or investors play a role in a specific nursing home.
CMS will begin capturing such information in an updated nursing home enrollment application to be used starting this summer, reserving the right to have specified providers complete such paperwork even outside their normal five-year reenrollment cycle.
The latest letter from Grassley and colleagues also includes seven questions that lawmakers want answered by June 1, demanding to know, among other information, how CMS will implement ownership reporting requirements; whether it plans to standardize reporting requirements; if it will address “related party” transactions; and whether the agency will require a complete listing of each facility in a nursing home chain owned by the same parent company.