Institutional Providers: Revised CMS-855A Version (09/24) Medicare Enrollment Application 

Available now is the revised CMS-855A (09/24) paper application that includes a section for SNF to comply with the 2023 Final rule in reporting ownership, management and related party data. Starting 10/1/2024, all SNF providers must only submit the revised form CMS-855A (09/24). For all other Part A provider types, you must use the revised form CMS-855A (09/24) starting 12/1/2024.

The CMS website has information to assist with the attachment section and will post updates for guidance:

• Guidance for SNF attachment on Form CMS-855A
• Become a Medicare Provider or Supplier

Other Related Content

• MLN Connects® Newsletter: September 19, 2024, Skilled Nursing Facilities: Report Your Expanded Ownership, Management, & Related Party Data
• NGS website for Part A provider visit Enrollment for articles about submitting an application.
• Provider Enrollment, Chain, and Ownership System (PECOS) (SNF Attachment 1 PECOS Job Aid under System Notifications)

Revised 2/3/2025