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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:

Other Resources:

Posted 9/30/2024