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Agenda. * Kinds of Surveys * Rural Health Clinic Locations * Budget Issues * Helpful Web Sites. Here is your survey. No big deal. Or is it?. This is the CMS-2567 Statement of Deficiency. How to be a recipient of a 2567.

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* Kinds of Surveys

* Rural Health Clinic Locations

* Budget Issues

* Helpful Web Sites

how to be a recipient of a 2567
How to be a recipient of a 2567
  • In order to receive a prestigious CMS-2567 suitable for framing, KDHE will need to conduct an on-site survey. Surveys are generally one of three types:
    • Re-Survey
    • Complaint
    • Validation Survey
why complete the cms 2567
Why complete the CMS-2567?
  • The Statement of Deficiencies

Surveyors visit your facility, write any deficiencies on the Statement of Deficiencies form, and then provide it to you. Write your plans for corrections on the form and return it to KDHE. The Statement of Deficiencies:

•Is the basic document available to the public about your facility's deficiencies and what is being done to remedy them.

• Provides an opportunity for you to furnish documentation that requirements have been met.

rural health clinic rhc
Rural Health Clinic (RHC)

42 CFR 491.2 …. Means a clinic that is located in a rural area designated as a shortage area, is not a rehabilitation agency or a facility primarily for the care and treatment of mental disease, and meets all other requirements of this subpart.

CMS has advised KDHE that a RHC can operate

one rural health clinic from separate suite numbers within the same building with the same street address.

for example one or more rhc s on the first floor of this building and or
For example , one or more RHC’s on the first floor of this building and/or ……

RHC #1 17-8918

RHC #2 17-8918

a rhc on the second floor could operate with a single medicare provider numbers
… a RHC on the second floor could operate with a single Medicare Provider Numbers.

RHC #3


42 cfr 491 5 location of clinic
42 CFR 491.5 Location of Clinic

If clinic or center services are furnished at permanent units in more than one location, each unit is independently considered for approval as a rural health clinic.

Each RHC requires their

own provider number if they are located in separate buildings.

the key to our or cms determination about whether or not one number will suffice is this
The key to our (or CMS) determination about whether or not one number will suffice is this …

As long as both RHCs are provider-based and located on the campus of the main provider, they could be considered as one location.

The clinic would need to ensure the requirements located at 42 CFR 491.6(a) are met. Specifically, the clinic must be "constructed, arranged, and maintained to insure access to and safety of patients, and provides adequate space for the provisions of direct services."

health facility survey staff
Health Facility Survey staff
  • October 1, 2008

11 FTE’s

  • July 10, 2009

8 FTE’s

federal funds
Federal Funds
  • Since federal funding was only sufficient at the outset to support approximately 6.5 FTE’s, KDHE has opted to conduct more risk management surveys and not replace staff that have terminated in 2009. Our federal fiscal year ends September 30, 2009.
one time special funds for
One time special funds for …..
  • Kansas has applied for one time funding from CMS to assist in conducting surveyors for providers that have no accrediting body to turn to for certification surveys. This would include such entities as RHC, ESRD, OPPT, Swing Beds, etc.

The priority with which we conduct surveys is categorized into TIER’s.TIER-I is the first and highest priority.

the tiers are contained in the budget that is also referred to as

The Tiers are contained in the budget that is also referred to as …


tier structure
Tier I

Tier II

Tier III

Tier IV

High (do first)

HHA, Hospital Val & complaints

High Medium

10% ASC, 5% hospitals & 10% ESRDs, 5% Targ. Samples.


Non AO initials, 4 & 7 year requirements

Lowest Priority

Remaining initials and greater Freq

Tier Structure
interpretive guidelines
  • The Interpretive Guidelines and Survey Procedures for various providers or suppliers are located in the Appendices to the State Operations Manual (SOM). For example: Hospitals = Appendix A, Psychiatric Hospitals = Appendix AA, EMTALA= Appendix V, or Critical Access Hospitals = Appendix W. There are many other appendices. One way to obtain a specific Appendix is to go to the webpage for the Table of Contents page for the Appendices to the SOM. Once at that page ‘click’ on the Appendix you wish to access. The Table of Contents Page for the SOM is found at:
survey and certification letters
  • CMS Survey and Certification (S&C) releases information related to survey and certification guidance for various providers and suppliers to its Regional Offices and the State Survey Agencies through communications called Survey and Certification Letters. The letters are released on an ongoing basis. Once a letter is released, it is posted on the CMS website. The letters are organized by Federal fiscal years. For example, the first letter released for fiscal year 2009 would be labeled “S&C 09-01”. The S&C letters can be obtained at:
cms home page
cms survey and certification home page
  • The page provides general information regarding the activities of CMS Survey and Certification. The Interpretive Guidelines and S&C letters may also be accessed from this page.
electronic cfr e cfr
  • The e-CFR is an electronic version of the Code of Federal Regulations (CFR). The CFR is divided into “Titles”, with “Title 42 Public Health”, containing CMS regulations. The Federal Register within the Government Printing Office publishes the CFR of an annual basis. The e-CFR is updated on an ongoing basis. The web address for the e-CFR is:
social security act
  • The laws that apply Medicare, Medicaid and other CMS programs are located in the Social Security Act (referred to as “The Act” or “SSA”). The Act is divided up into “Titles”. Medicare is Title XVIII and Medicare is Title XIX. The web address to obtain the online SSA is:

Who to call:Charles Moore, Director Medical ServicesBureau of Child Care & Health Facilities1000 SW Jackson, Suite 200Topeka, KS 66612e-mail: cmoore@kdhe.state.ks.usCharles Direct Line 785-296-0131FAX: 785-291-3419


Web site for Critical Access Hospital (CAH) Federal Regulations and Guidelines Appendix W on Bureau of Health Facilities and then forms to get to the above.


Other contacts in our Bureau:Anita Hodge RN, State Survey Manager 296-0127Lynn Searles, Risk Management Specialist 291-3552Tamara Wilkerson, Licensure & Certification 296-1263 CoordinatorLois Wilkins, Sr. Admin Assist-Licensure 296-1258Theresa Carter, Sr. Admin Assist-Certification 296-1249(all are Area code 785)