A bipartisan group of senators has introduced the Nursing Home Ownership Transparency Act of 2026, legislation that would significantly expand disclosure requirements for skilled nursing facility ownership structures, with a particular focus on private equity-backed operators and complex multi-entity arrangements. The bill, introduced on January 8 with four co-sponsors from both parties, marks the most ambitious federal effort to date to address what advocates call the “opacity problem” in nursing home ownership.
What the Bill Requires
The legislation would mandate disclosure of all direct and indirect owners of nursing facilities, including private equity firms, real estate investment trusts (REITs), and management companies with ownership stakes. Current CMS requirements only capture direct owners and managing entities, leaving complex ownership chains largely opaque to regulators and the public.
Specific provisions include: annual disclosure of all entities with a 5% or greater direct or indirect ownership interest (down from the current 25% threshold), mandatory reporting of all related-party transactions exceeding $10,000 annually, including management fees, real estate lease payments, and vendor contracts with affiliated entities, public disclosure of operator-level financial data aggregated across all facilities under common ownership, and a prohibition on structuring ownership arrangements primarily to shield assets from regulatory enforcement or liability claims.
The Private Equity Question
The bill emerges from growing scrutiny of private equity’s role in the nursing home sector. Research published in leading medical journals has linked private equity ownership to increased mortality rates, higher deficiency citations, and lower staffing levels, though the industry disputes these findings and points to methodological limitations in the studies.
Private equity firms have invested heavily in skilled nursing over the past decade, attracted by the sector’s stable, government-funded revenue streams and opportunities for operational and real estate optimization. The bill’s sponsors argue that the complex ownership structures commonly used in PE-backed acquisitions—separating real estate from operations, layering management companies and sub-entities—make it difficult for regulators to follow the money and hold responsible parties accountable.
Industry Reaction
The American Health Care Association has taken a measured stance, supporting “reasonable transparency” while cautioning against requirements that could create “excessive administrative burden” or discourage investment in the sector. AHCA has noted that many of the disclosure requirements in the bill already exist in some form at the state level, and has advocated for a federal-state harmonization approach rather than new standalone requirements.
Private equity trade groups have been more critical, arguing that the bill unfairly targets one type of ownership and that its disclosure requirements could expose proprietary financial information to competitors. The American Investment Council has called the related-party transaction reporting threshold “unworkable” and predicts it would generate “millions of pages of disclosures that regulators have no capacity to review.”
Prospects for Passage
Despite bipartisan sponsorship, the bill faces an uncertain path. Similar transparency proposals have been introduced in previous congressional sessions without advancing to a vote. However, supporters point to increasing public and media attention to nursing home quality issues, a more receptive CMS leadership, and the recent release of a Government Accountability Office (GAO) report recommending enhanced ownership transparency as factors that could build momentum.
Even if the full bill does not pass, individual provisions could be incorporated into must-pass legislation such as appropriations bills or Medicare/Medicaid extender packages. The related-party transaction disclosure requirement, in particular, has drawn interest from lawmakers on both sides of the aisle and could advance independently.