Oregon lawmakers examine opaque nursing home ownership as federal rules take effect

Senators on the Oregon Senate Committee on Healthcare heard that ownership of nursing facilities has grown more complex and less transparent, and that state systems need upgrades to collect and publish the new data required by federal rules.

Alyssa Halperin, owner and principal consultant at Halperin Health Policy Solutions, told the committee on Jan. 17 that “ownership transparency” means knowing who owns nursing homes, how they are financed, and how ownership relates to staffing, quality and enforcement. Halperin said the national trend is toward for‑profit and private‑equity ownership and more layered corporate structures that can hide who ultimately controls facilities. She noted that “about 72% of nursing homes are owned by for profit corporations” and that ownership structures now often split property ownership, management and service contracts among different entities.

The committee’s nut graf: state agencies, Medicaid payers and consumers rely on ownership data to vet license applicants, enforce rules, identify conflicts of interest and decide where public dollars should go. Committee members and agency witnesses agreed Oregon already collects several ownership data points but will need rule changes, system upgrades and public‑facing displays to comply with federal disclosure requirements finalized in January 2024 and to make the information usable for regulators and families.

Halperin summarized why ownership information matters: without it, a licensure agency cannot “fully evaluate the owners’ experience and expertise,” verify whether owners have been excluded from Medicare or Medicaid, or trace related‑party transactions that could divert money away from resident care. She said recent federal guidance and Office of Inspector General reports underscore the need for clearer reporting of related‑party transactions and consolidated ownership structures.

Nikisha Nycoyle, director of the Office of Aging and People with Disabilities (APD) at the Oregon Department of Human Services, described an internal reorganization intended to improve regulatory oversight and incident response. Nycoyle said the agency has co‑located licensing, adult protective services and emergency response functions under one deputy to create “streamlining and efficiencies” that should support greater transparency and accountability.

Carissa Neufeld, deputy director for safety and regulatory oversight at APD, gave the committee a baseline of what Oregon already collects and what it lacks. She said Oregon licenses 128 nursing facilities and that “in 2024 calendar year, 22 or 17 percent of the 128 nursing facilities in Oregon changed ownership.” Neufeld listed data APD now requires from applicants and new owners, including business name and contact information, property owner information, federal employer identification numbers, Social Security numbers for owners with 5% or more interest (when Medicaid or Medicare clients are served), workers compensation carrier data, liability insurance, lists of other facilities owned or managed by owners with 5%+ interest, background checks and financial history.

Neufeld said the federal regulations finalized Jan. 16, 2024 expand the scope of reportable interests to include stakes held by private equity firms and real‑estate investment trusts and require disclosure of entities that exercise financial control, governing‑board members and officers. She noted CMS intends states to start collecting the new data once state Medicaid agencies establish collection mechanisms. In Oregon, APD will need to amend Oregon Administrative Rules, update the Nursing Facility Licensing Ownership Disclosure form and enhance its licensing database (known as CALMS) because it currently cannot store all of the new data fields.

Fred Steele, the state long‑term care ombudsman, spoke for consumers and families who call his office seeking help choosing facilities and understanding changes in ownership. Steele said prospective residents and family members increasingly ask, “Where’s where’s my money going? That lifetime of savings, is it going to my care?” He pointed committee members to the department’s facility search site and the Quality Measurement Council reports as existing transparency tools and urged more accessible, consumer‑oriented displays of ownership and financial information.

Senators on the committee pressed agency witnesses on two lines of follow‑up: (1) whether existing state disclosure and vetting are sufficient to determine owner qualifications before issuing a license and (2) whether the public should be given easier access to consolidated ownership information collected by the state. APD staff acknowledged that while Oregon collects many ownership data points, the growing complexity of ownership arrangements—including out‑of‑state and publicly traded owners—has made it harder to process and use the data in licensing and complaint investigations.

The discussion included several references to national research and federal work showing links between ownership models and quality outcomes. Halperin cited studies that found lower staffing and worse resident outcomes in some for‑profit and private‑equity owned facilities and referenced recent U.S. Department of Health and Human Services Office of Inspector General reports about related‑party cost reporting and consolidation in health care.

Committee members and agency staff agreed on next steps: APD will review its licensing rules, revise the ownership disclosure form, upgrade CALMS to hold the new fields required by CMS, and consider how to present ownership composition in clear, plain language on a public website. APD said it will continue to work with state Medicaid staff to implement the federal disclosure timeline once Oregon’s collection tools are ready.

The committee did not take formal votes during the informational hearing. Members scheduled additional committee meetings and public hearings on unrelated bills later in the week.