Form CMS-1513, the “Ownership and Control Interest Disclosure Statement,” is no longer in use for Medicare. CMS discontinued the form on June 15, 2003, and folded ownership disclosures into the CMS-855 enrollment applications submitted on paper or through the online PECOS system.1Centers for Medicare & Medicaid Services. Discontinuance of Forms HCFA-1513 and HCFA-2572 The underlying legal duty to report who owns and controls your entity did not go away; it still runs through Section 1124 of the Social Security Act.2Social Security Administration. Social Security Act Section 1124 If a state Medicaid agency has handed you a document that looks like the old CMS-1513, that is the state’s own version — some agencies were allowed to keep a modified copy for their Medicaid enrollment work. For Medicare, use the CMS-855.
What Replaced the CMS-1513
When CMS retired the form in 2003, the agency’s stated purpose was to reduce paperwork by consolidating ownership disclosures into the enrollment applications providers already had to file.1Centers for Medicare & Medicaid Services. Discontinuance of Forms HCFA-1513 and HCFA-2572 Everything the CMS-1513 used to collect now lives inside the CMS-855 series. There is no standalone federal ownership form to download.
State Medicaid programs are a separate matter. A state may still use a modified version of the old form for its own Medicaid enrollment, and if that is what you received, complete it and return it to the state agency that sent it. That state form does not satisfy Medicare, and the CMS-855 you file with Medicare does not automatically satisfy the state.
Who Has to Disclose Ownership
The disclosure duty covers every provider and supplier participating in Medicare or Medicaid. It comes from two parallel sets of regulations: 42 CFR Part 420, Subpart C for Medicare, and 42 CFR Part 455, Subpart B for Medicaid.3eCFR. 42 CFR Part 455 Subpart B – Disclosure of Information by Providers and Fiscal Agents Hospitals, skilled nursing facilities, home health agencies, hospices, clinics, group practices, individual practitioners, DMEPOS suppliers, and fiscal agents all fall inside the requirement. Nursing facilities carry additional reporting obligations, including information on governing body members and each officer, director, partner, trustee, and managing employee.4eCFR. 42 CFR 455.104 – Disclosure by Medicaid Providers and Fiscal Agents Medicare Part B will not pay a provider that has not submitted complete ownership information.5Social Security Administration. Social Security Act Section 1124A – Disclosure Requirements for Other Providers Under Part B of Medicare
What to Gather Before You File
The disclosure asks about three overlapping groups: owners, managing employees, and related parties. Pulling this information together before you open the application saves a return trip.
Owners and Controlling Parties
Identify every individual or entity holding a direct or indirect ownership interest of 5 percent or more in your organization.6eCFR. 42 CFR 420.206 – Disclosure of Information on Ownership and Control For individuals: full name, home address, date of birth, and Social Security Number. For entities: legal name, every business address, and Employer Identification Number.4eCFR. 42 CFR 455.104 – Disclosure by Medicaid Providers and Fiscal Agents
Indirect ownership catches multi-layered structures. You calculate it by multiplying the ownership percentages at each level; if the product exceeds 5 percent, it is reportable.7eCFR. 42 CFR Part 420 Subpart C – Disclosure of Ownership and Control Information
Managing Employees, Officers, and Partners
Every managing employee must be disclosed whether or not they hold any equity. That includes anyone with operational or managerial control over the entity or part of it. If the organization is a corporation, list every officer and director. If it is a partnership, list every partner regardless of ownership percentage.8Centers for Medicare & Medicaid Services. CMS-855B Medicare Enrollment Application for Clinics and Group Practices
Family Ties, Sanctions, and Subcontractors
The disclosure asks whether any two people you are reporting are related as spouse, parent, child, or sibling. It also asks whether your disclosed owners or managing employees hold, or have held within the last three years, an ownership or control interest in any other Medicare or Medicaid provider. If any of those other entities has been convicted of a program-related crime or sanctioned, report that too.6eCFR. 42 CFR 420.206 – Disclosure of Information on Ownership and Control Subcontractors count when your entity owns 5 percent or more of the subcontractor; gather the same identifying details for those owners.2Social Security Administration. Social Security Act Section 1124
Which CMS-855 Application to Use
Pick the version that matches your provider type:
- CMS-855A for institutional providers: hospitals, skilled nursing facilities, home health agencies, and hospices.
- CMS-855B for clinics, group practices, and certain other suppliers.
- CMS-855I for individual physicians and non-physician practitioners.
- CMS-855S for DMEPOS suppliers.
In the CMS-855A and CMS-855B, ownership disclosures live in Section 5 (organizations with a 5 percent or greater interest or managing control) and Section 6 (individuals with ownership or managing control). Skilled nursing facilities also complete Attachment 1 during initial enrollment, revalidation, and any change of ownership.9Centers for Medicare & Medicaid Services. CMS-855A Medicare Enrollment Application – Institutional Providers For each person or entity, enter identifying information, mark the role (owner, partner, officer, director, managing employee), confirm the ownership percentage, flag family relationships, and list any other disclosing entities. An authorized official signs, certifying accuracy under penalty of perjury.
Submitting Through PECOS
The fastest path is PECOS, the Provider Enrollment, Chain, and Ownership System. PECOS applications process faster than paper and require no mailing.10Centers for Medicare & Medicaid Services. Manage Your Enrollment Ownership entries go into the “Organizations with Ownership Interest and/or Managing Control” section. When one organization holds more than one role, for instance both a 5 percent owner and a managing controller, enter each role separately using the “Add Information” button on the summary page.11Medicare Provider Enrollment, Chain, and Ownership System. PECOS Frequently Asked Questions If you file on paper instead, send the completed CMS-855 to your Medicare Administrative Contractor. Paper applications take about twice as long to process.
Application Fee
Institutional providers and certain suppliers, including DMEPOS suppliers and opioid treatment programs, owe a $750 application fee for the 2026 calendar year when enrolling, revalidating, or adding a practice location.12Centers for Medicare & Medicaid Services. Medicare Provider Enrollment The fee is adjusted each year for the Consumer Price Index.13eCFR. 42 CFR 424.514 – Application Fee Physicians, non-physician practitioners, and their group organizations are exempt. A written hardship exception is available with supporting documentation. The fee is nonrefundable unless the hardship exception is granted or the application is rejected before screening starts.
Processing Times
PECOS applications that need no site visit or fingerprinting typically process in about 15 calendar days. Add screening (site visit, fingerprint background check, or supplemental documentation) and PECOS runs closer to 50 days. Paper submissions run around 30 days for straightforward cases and 65 days when screening is triggered. Missing information stops the clock, so incomplete filings take longer.
How CMS Screens Your Disclosed Owners
After submission, CMS assigns your application a risk level, and screening scales with it.14eCFR. 42 CFR 424.518 – Screening Levels for Medicare Providers and Suppliers
- Limited risk: license verification and database checks before and after enrollment.
- Moderate risk: everything above, plus an on-site visit to confirm the practice location.
- High risk: everything above, plus fingerprint-based FBI background checks for every individual holding a 5 percent or greater ownership interest.
For high-risk applications, if any owner does not submit fingerprints within 30 days of the contractor’s request, CMS will deny the enrollment or revoke existing billing privileges.14eCFR. 42 CFR 424.518 – Screening Levels for Medicare Providers and Suppliers Before you file, make sure every disclosed owner at that 5 percent threshold knows fingerprints may be required.
Keeping Disclosures Current
Report a change of ownership to your Medicare contractor within 30 days.15eCFR. 42 CFR 424.516 – Additional Provider and Supplier Requirements This covers new owners, changes in managing employees, and shifts in control interest. Missing the 30-day window can lead to revocation of your Medicare billing privileges.
Most providers and suppliers also revalidate their entire enrollment, including all ownership information, every five years. CMS will contact you when the time comes; you then have 60 calendar days to submit a complete application with current information and supporting documents.16eCFR. 42 CFR 424.515 – Requirements for Reporting Changes and Periodic Revalidation DMEPOS suppliers and ambulance service providers follow their own renewal schedules rather than the five-year cycle. Institutional providers pay the $750 fee again at revalidation.
Penalties for False or Missing Disclosures
Knowingly making a false statement in connection with furnishing items or services to a federal healthcare program is a felony, punishable by fines up to $100,000, imprisonment up to 10 years, or both. A person who assists or counsels a false statement without directly furnishing items or services faces a misdemeanor with fines up to $20,000 and up to one year of imprisonment.17Office of the Law Revision Counsel. 42 USC 1320a-7b – Criminal Penalties for Acts Involving Federal Health Care Programs
Failure to disclose at all is a separate problem. CMS treats missing ownership disclosures as a disqualifying deficiency and can deny enrollment or terminate an existing provider agreement on that basis. Keep your ownership records current year-round so that when enrollment, revalidation, or a change of ownership triggers a filing, the information is ready.