Who Checked the Private Equity Box?

If you have filled out a Form CMS-855A since January 2024, you answered a question about private equity, and you have probably never wondered what everyone else put down.

We pulled all four of them. CMS rebuilt its hospital and nursing home ownership files on October 19, and the answer is sitting in public.

"How many owners actually tick the private equity box, and what happens to the question when a building changes hands?"

The Box Nobody Checks

The SNF All Owners file carries 300,738 owner records across 14,404 nursing home enrollments.

Of those enrollments, 98 have at least one owner flagged PRIVATE EQUITY COMPANY. That is 0.68 percent, and it is the lowest-scoring field of the fourteen owner-type boxes on the form (chart above).

The hospital file reads the same way. 49 of 9,138 hospital enrollments, 0.54 percent, name a private equity owner.

Two name a REIT.

Now, the boxes directly above tell you where the answers went instead:

LLC on 9,726 nursing home enrollments, 67.52 percent
MANAGEMENT SERVICES COMPANY on 3,931, 27.29 percent
HOLDING COMPANY on 3,272, 22.72 percent
CONSULTING FIRM on 2,381, 16.53 percent
FINANCIAL INSTITUTION on 1,806, 12.54 percent

None of that is evasion on its face. An LLC is a legal form and a private equity company is a business model, and a disclosing party can honestly be the first without reading itself as the second.

The practical effect is still that the field written to answer a policy question returns 98 rows and the field describing paperwork returns 9,726.

The INVESTMENT FIRM box, which predates the 2023 rule, does better at 2.57 percent. So the older, vaguer question gets a yes almost four times as often as the newer, sharper one.

Same Build Date, Different Question

Here is the part that matters if you are tracking who bought what.

CMS publishes two owner files per provider type off the same enrollment records. All Owners is the standing picture.

Change of Ownership is the transaction record, buyer and seller, with both CCNs and an effective date.

Both were posted October 19, and both carry the September 29 build stamp.

The SNF All Owners file has 40 columns. The SNF Change of Ownership owner file has 34, and the six it is missing are PRIVATE EQUITY COMPANY, REIT, CHAIN HOME OFFICE, TRUST OR TRUSTEE, PARENT COMPANY and OWNED BY ANOTHER ORG OR IND.

On the hospital side the gap is four fields, led by the same two (chart below).

The reverse difference is empty. The sale file carries nothing the standing file lacks.

So the one CMS file built specifically to record a nursing home or hospital changing hands has no column for whether the buyer is private equity or a REIT. The question gets asked of the facility and not of the transaction.

Where it gets more awkward: the shared INVESTMENT FIRM box reads 2.57 percent in SNF All Owners and 0.69 percent in the sale file, on 10,678 enrollments that by definition just went through a deal.

Your 855B Is Next

This stops being a nursing home curiosity in the CY2027 home health proposed rule, 91 FR 41216, filed in July and still without a final rule under its RIN. At 91 FR 41307, CMS writes that the 855A "requires providers and suppliers to report whether any party listed on the application is a PEC or a REIT," and announces "our intention to expand this requirement" to three more forms.

One of them is Form CMS-855B, the clinics and group practices application. Another is Form CMS-855S for DMEPOS.

The third is the MDPP form, which CMS notes is exempt from PRA burden accounting anyway.

CMS concedes the revisions "would" impose a collection burden and defers it to a future information collection request, which means the forms do not change the day the rule lands.

Final Thoughts

The 2023 rule that created these two fields, 88 FR 80141, took effect on January 16, 2024, and implemented a statutory disclosure duty. Nearly three years of answers later, the field returns 98 nursing homes and 49 hospitals nationwide.

Treat the number as a floor on what gets disclosed rather than a measurement of what exists. The useful read for an administrator about to inherit a question like this on an 855B is narrower and more certain: the box is new, the guidance about who counts is thin, and almost nobody above you has checked it yet.

Thanks for reading.