This bill aims to amend Title XVIII of the Social Security Act, specifically to prevent hospitals and skilled nursing facilities (SNFs) owned or controlled by certain firms from participating in the Medicare program. It explicitly prohibits Medicare payments to facilities under the ownership or control of "covered firms," which are defined to include private equity funds , corporations controlled by private equity, and real estate investment trusts (REITs) . However, facilities already owned by such firms at the time of enactment are granted a three-year grace period to comply with the new regulations. The legislation establishes an enforcement mechanism, ensuring that any facility found in violation is entitled to reasonable notice, a hearing, and judicial review. Crucially, it introduces joint and several liability , making the covered firm or its affiliate directly responsible for any penalties or obligations incurred by a non-compliant hospital or SNF. The bill broadly defines "control" to encompass the power to direct management or policies, including through ownership of 10 percent or more of voting securities, to address various ownership structures effectively.