CMS is tightening SNF ownership disclosure and signaling that private equity and real estate investment trust (REIT) reporting will spread across Medicare enrollment. Skilled nursing facilities already report whether owning or managing entities are private equity companies or REITs on Form CMS-855A. In the Calendar Year 2027 Home Health Prospective Payment System proposed rule (CMS-1844-P), published in the Federal Register on July 6, 2026, CMS proposed to broaden enrollment-based ownership and control disclosures and stated its intent to extend PE and REIT reporting to additional enrollment forms. Comments are due August 31, 2026. Owners and operators should prepare to identify PE and REIT interests, map their full organizational structure, and reconcile that data with what they already file.
This article covers the enrollment and ownership-disclosure side of the rules, which lives on the CMS-855 family of applications. That is separate from the SNF cost report related-party disclosures on the Medicare cost report, a topic we address in our coverage of the SNF related-party cost report. Both reach ownership and affiliated entities, but they are filed on different documents, on different timelines, and to different reviewers.
Where the SNF Ownership Disclosure Rules Stand Today
The foundation is the final rule titled “Disclosures of Ownership and Additional Disclosable Parties Information for Skilled Nursing Facilities and Nursing Facilities”, published in the Federal Register on November 17, 2023. That rule implemented portions of Section 6101 of the Affordable Care Act and added definitions of “private equity company” and “real estate investment trust” to the Medicare enrollment regulations.
Under that rule, SNFs must disclose ownership, managerial, and additional-disclosable-party information, and must indicate whether a reported owning or managing entity is a private equity company or a REIT. CMS collects this on the revised Form CMS-855A, the Medicare enrollment application for institutional providers.
The regulatory definitions matter because they are broad. In 42 CFR 424.502, a private equity company is defined as “a publicly traded or non-publicly traded company that collects capital investments from individuals or entities and purchases a direct or indirect ownership share of a provider.” A real estate investment trust is defined by reference to the tax code, meaning “a real estate investment trust as defined in 26 U.S.C. 856.”
The same regulation defines an “additional disclosable party” as, in substance, any person or entity that exercises operational, financial, or managerial control over the facility; provides policies or procedures for it; leases or subleases real property to it; or provides management, consulting, accounting, or financial services to it. That definition already sweeps in landlords, management companies, and professional service providers well beyond the traditional owner list.
What CMS Proposed in 2026 (CMS-1844-P)
The 2026 development is the CY 2027 Home Health PPS proposed rule (CMS-1844-P), published in the Federal Register on July 6, 2026. Although the payment provisions target home health agencies, the enrollment and ownership-transparency proposals apply broadly across Medicare provider and supplier types, which is why SNF owners and operators should read it closely. CMS also summarized the 2023 baseline in its SNF ownership disclosures fact sheet.
The headline for ownership disclosure is expansion. CMS stated its intent to require identification of private equity companies and REITs on additional enrollment applications, specifically Form CMS-855B (clinics, group practices, and certain other suppliers), Form CMS-855S (DMEPOS suppliers), and Form CMS-20134 (Medicare Diabetes Prevention Program suppliers). CMS framed private equity involvement in health care as a Medicare-wide concern rather than a SNF-only one.
For operators with mixed enrollment footprints, this is the practical signal. A nursing home organization that also enrolls therapy groups, physician practices, or DME lines through CMS-855B or CMS-855S should expect the same PE and REIT questions it already answers on CMS-855A to appear on those applications.
CMS also proposed changes to core enrollment definitions that affect who must be disclosed:
- Managing employee. CMS proposed to broaden this definition to expressly include medical directors, clinical directors, departmental heads, supervising physicians, nursing directors, alternate administrators, and other clinical personnel who exercise managerial control.
- Affiliation. CMS proposed to remove the five-year lookback period, so affiliations would be reportable regardless of when they occurred or ended, and to expand the concept to include marketing, business, fulfillment, financial, managerial, or beneficiary relationships.
Read together, these definitional changes enlarge the population of people and entities that a provider must name and track, independent of the PE and REIT question.
One implementation note deserves attention. CMS stated that it intends to accomplish the enrollment-form revisions through the Paperwork Reduction Act information-collection process with the Office of Management and Budget, rather than through separate notice-and-comment rulemaking on the forms themselves. That means the PE and REIT questions and other new fields could take effect on a compliance timeline set by OMB approval of the revised forms rather than by a payment-rule effective date. Operators should watch for OMB clearance of the revised CMS-855B, CMS-855S, and CMS-20134 applications, since that is the point at which the new disclosures become live obligations.
What Owners and Operators Must Prepare to File
The compliance work is largely a data exercise, and it is the same discipline that supports a clean cost report. Start by mapping the full organizational structure so that every owning entity, managing entity, and additional disclosable party can be named and classified.
Practical preparation steps:
- Identify PE and REIT interests. For each owning or managing entity, determine whether it meets the regulatory definition of a private equity company or a REIT, and document the basis for that determination.
- Refresh the additional-disclosable-party list. Capture landlords and property lessors, management and consulting companies, and providers of accounting or financial services, consistent with the 42 CFR 424.502 definition.
- Expand the managing-employee roster. Add clinical leadership roles that the proposed definition would capture, such as medical directors, nursing directors, and alternate administrators.
- Rebuild affiliation records without a lookback cutoff. If the five-year limit is removed, prior affiliations become reportable, so start reconstructing that history now.
- Reconcile disclosures across filings. Make sure the ownership picture on CMS-855A, any CMS-855B or CMS-855S applications, and the cost report tell a consistent story.
That last point is where enrollment disclosure and cost reporting intersect. The related-party and ownership data you assemble for CMS-855 filings should align with what appears on the Medicare cost report, including the newer form discussed in our overview of the CMS 2540-24 Medicare cost report. Inconsistencies between enrollment records and cost reports are exactly the kind of discrepancy that draws scrutiny.
Because the definitions are broad and the data lives in legal, real estate, and finance functions at once, this is best handled as a coordinated project rather than a form-filling task. Pease Bell advises operators across the sector through our skilled nursing and long-term care practice and supports the underlying filings through cost report preparation.
How This Differs From the Cost Report Related-Party Disclosures
It is easy to conflate the two ownership-disclosure regimes, so keep the distinction clear. Enrollment disclosure of ownership, PE, and REIT status is filed on the CMS-855 family of applications and governs the right to enroll and stay enrolled in Medicare. Cost report related-party disclosures are filed on the Medicare cost report and govern how related-party costs are reported and reimbursed.
They overlap in subject matter because both look at owners and affiliated entities, but the audiences, timing, and consequences differ. A gap on an enrollment form can jeopardize enrollment; a gap on a cost report can affect reimbursement and audit exposure. Treating them as one project with shared source data is efficient, but the filings remain separate obligations.
Frequently Asked Questions
What is SNF ownership disclosure under the CMS enrollment rules?
It is the requirement for skilled nursing facilities to report ownership, managerial, and additional-disclosable-party information on Form CMS-855A, including whether any owning or managing entity is a private equity company or a real estate investment trust. The framework comes from the CMS final rule published November 17, 2023, implementing Section 6101 of the Affordable Care Act.
What did CMS propose in 2026?
In the CY 2027 Home Health PPS proposed rule (CMS-1844-P), published July 6, 2026, CMS proposed broader Medicare enrollment disclosures and stated its intent to extend private equity and REIT reporting to Forms CMS-855B, CMS-855S, and CMS-20134. It also proposed to broaden the definitions of “managing employee” and “affiliation.”
When is the comment deadline?
Comments on the proposed rule are due August 31, 2026. Owners and operators who want to weigh in on the ownership-disclosure and enrollment provisions should submit comments before that date.
How does CMS define a private equity company and a REIT?
Under 42 CFR 424.502, a private equity company is “a publicly traded or non-publicly traded company that collects capital investments from individuals or entities and purchases a direct or indirect ownership share of a provider.” A real estate investment trust is defined as “a real estate investment trust as defined in 26 U.S.C. 856.”
Is this the same as the SNF cost report related-party disclosures?
No. Enrollment and ownership disclosures are filed on the CMS-855 forms and control Medicare enrollment. Related-party disclosures are filed on the Medicare cost report and affect reimbursement. They share source data but are separate filings, as explained in our coverage of the SNF related-party cost report.
What should operators do now?
Map the full organizational structure, classify each entity for PE and REIT status, refresh the additional-disclosable-party and managing-employee lists, reconstruct affiliation history in case the lookback is removed, and reconcile all of it against the cost report. Doing this before any form revision takes effect reduces the risk of inconsistent or late disclosures.
