In a letter to the Centers for Medicare & Medicaid Services (CMS), MACPAC commented on a proposed rule requiring disclosure of nursing facility ownership information. MACPAC recently completed a comprehensive review of Medicaid nursing facility payment policies, which is included in the Commission’s March 2023 Report to Congress on Medicaid and CHIP. The report outlines principles for states to consider when setting Medicaid payment rates and methods and makes recommendations on steps that the U.S. Department of Health and Human Services (HHS) can take to improve the availability of data to assess whether state policies are consistent with these principles. One of the Commission’s recommendations is that HHS direct CMS to collect and report comprehensive ownership data in a standard format that enables analysis.
The proposed rule implements the disclosure requirements in the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) and expands reporting requirements for nursing facilities owned by private equity (PE) companies and real estate investment trusts (REITs). The Commission strongly supports these changes, which are consistent with MACPAC’s recent recommendation.
In addition, MACPAC offered technical comments on how CMS could further expand collection of comprehensive data on nursing facility ownership to enable future analyses. This includes establishing a standard process for collecting PE and REIT ownership data for both Medicare- and Medicaid-certified facilities, as well as gathering information on for profit, non-profit or public entities that purchase nursing facility real estate and receive special tax consideration for doing so. Finally, the Commission supports efforts to use the new ownership data to examine the effects of ownership on quality outcomes and recommends that CMS make the data available to researchers using common identifiers that can be easily linked with existing CMS data.