CMS recently issued a letter to all nursing homes and debt collectors regarding debt collection practices. The focus behind the letter is to draw attention to the prohibited practice outlined in the Nursing Home Reform Act (NHRA) of nursing facilities requesting or requiring that a third party personally guarantee payment to the facility as a condition of a resident’s admission or continued stay in the facility. CMS reminds nursing facilities that violations of such requirements may be subject to enforcement action by state agencies and CMS. Inappropriate practices have been identified in facility admission agreements. These agreements may include terms that aim to hold a third party personally liable for the resident’s nursing facility costs or to hold both residents and their caregivers personally liable for payment or unpaid bills if the resident’s Medicaid application is deemed inaccurate, untimely, or incomplete.