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1 1 (December 12, 2024)

handle is hein.crs/goverpz0001 and id is 1 raw text is: Congressionol Research Service nforming the IegisI9tive debate since 1914 December 12, 2024 Hospital Ownership: Medicare Sources of Information Congress's understanding of hospital ownership is crucial in exercising its legislative and oversight role with respect to health care costs, quality, and access. The Centers for Medicare & Medicaid Services (CMS)-the agency that administers the Medicare program-collects ownership information from Medicare health care providers and suppliers, including hospitals. This data collection focuses primarily on program integrity, such as ensuring accurate and proper Medicare, and fraud, waste, and abuse prevention and detection. This specific focus can make it difficult to use CMS data to determine ownership's effect on health care cost, quality, and access. Although CMS's data collection may satisfy reporting requirements for the purposes noted above, the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) have determined the Medicare ownership data are not sufficiently detailed, complete, or accurate to capture the complex business, organizational, and corporate structures in the health care sector. The data do not permit systematic analyses of the effects of ownership type on health care cost, quality, and access; this type of analysis is essential for Congress to develop informed policies and conduct effective oversight. This In Focus addresses two Medicare sources of hospital ownership information-the Provider Enrollment, Chain, and Ownership System (PECOS) and the Cost Report e- Filing (MCReF) system. Content in these systems is organized by the event or activity that triggers reporting by a hospital-initial enrollment and revalidation of enrollment in Medicare; a change of ownership (CHOW), merger, acquisition, or consolidation; and the annual cost report submission required by some hospitals and other health care providers, though not all. Limitations of these data sources are also discussed, focusing on limitations for purposes of robust congressional oversight of hospital ownership. PECOS and MCReF data generally are available free of charge. There are also nongovernment sources of ownership information that require paid subscriptions; these data sources are outside the scope of this In Focus. Hospital Enrol ment in Med care Social Security Act (SSA) Section 18660) gives CMS authority to collect information from hospitals (and other providers) for purposes of enrolling and periodically revalidating in Medicare. Under this authority, CMS promulgates regulations that, among other things, specify the kinds of information it collects; this includes ownership. Hospitals submit this information to CMS electronically through PECOS or by transmitting a completed Form CMS- 855 by mail. This data collection activity is subject to the Paperwork Reduction Act (PRA; 44 U.S.C. §§3501-3521) and thus receives Office of Management and Budget review and clearance. (For information about PRA, see CRS In Focus IF1 1837, The Paperwork Reduction Act and Federal Collections of Information: A Brief Overview.) The information hospitals report includes their Internal Revenue Service (IRS) designation (proprietary, nonprofit, or disregarded entity); business structure (corporation, limited liability company, partnership, sole proprietor, other, federal or state government); and whether the hospital is an Indian Health Service (IHS) facility or physician-owned. (For further detail about physician ownership, physician self-referral, and Stark law, see CRS Report RS22743, Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview.) Hospitals must disclose any entities and individuals with a 5% or greater direct, indirect, or mortgage/security ownership interest. Hospitals also must report all general, limited, and non-limited partnerships, regardless of the percentage ownership interest. CMS instructs hospitals to report ownership information that includes investment firms, such as private equity and real estate investment trusts, banks and bank holding companies, and trusts and their trustees. Hospitals also must submit an organizational chart that identifies the entities listed above, their relationship to the hospital, and their relationship to each other. If the hospital is organized as a corporation, it also must report the names of its officers and directors. The aforementioned ownership types are defined in regulation or other CMS documents, such as the Form CMS-855 for purposes of Medicare. Hospita Change of Ownersh p, Merger and Acquisition, and Consolidation CMS requires hospitals to report CHOWs, mergers, acquisitions, and consolidations electronically through PECOS or by mail on a completed Form CMS-855. For a CHOW, the new owners report ownership information as if the hospital were newly enrolling in Medicare; this information includes the legal name of the acquired and the acquiring hospital/organization, the locations of main campuses and any off-campus services and departments, and contact information. Hospitals that merge with, or are acquired by, other hospital(s) report the legal business name of the acquiring and acquired hospital(s).

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