Statement of Deficiencies and
Plan of Correction (CMS-2567)
Extension without change of a currently approved collection
No
Regular
01/07/2022
Requested
Previously Approved
36 Months From Approved
02/28/2022
65,948
65,948
1,187,064
1,210,376
0
0
This Paperwork package provides
information regarding the form used by the Medicare, Medicaid, and
the Clinical Laboratory Improvement Amendments (CLIA) programs to
document a health care facility's compliance or noncompliance
(deficiencies) with regard to the Medicare/Medicaid Conditions of
Participation and Coverage, the requirements for participation for
Skilled Nursing Facilities and Nursing Facilities, and for
certification under CLIA. This form becomes the evidentiary basis
for CMS certification decisions (including termination or denial of
participation), and the form of public disclosure. In December,
2020, Congress passed the Consolidated Appropriations Act, 2021
(CAA, 2021). Section 407 of CAA, 2021, amended Part A of Title
XVIII of the Social Security Act (the Act) at section 1822
establishing hospice program survey and enforcement requirements.
This amendment, in part, now requires the Accrediting Organizations
(AOs) that accredit hospice programs to include the form CMS-2567
to document the findings of their hospice program surveys beginning
on October 1, 2021. As of June 2021, there are three AOs with
CMS-approved hospice accreditation programs: Accreditation
Commission for Health Care, Inc. (ACHC), Community Health
Accreditation Partner (CHAP), and The Joint Commission (TJC). These
three AOs survey approximately half of the over 5,000
Medicare-certified hospice programs, while the SAs survey the
remaining half. To enable AOs to use the form CMS-2567, we must
revise it by adding a field for the AO name. Also, the instructions
must be updated to include AOs as another group which utilizes the
form CMS-2567. We have also included the COI/RIA burden
calculations from CMS-1747-P related to the one-time update needed
to each AO’s proprietary electronic systems in order to use the
form CMS-2567 as directed by the CAA, 2021.
US Code:
42
USC 488.26 Name of Law: Determining Compliance
US Code: 42
USC 488.18 Name of Law: Documentation Findings
US Code: 42
USC 488.28 Name of Law: Providers or Suppliers, other than SNFs
and NFs, with deficiencies
The total annual time burden
has decreased by 23,312 hours, and the total annual cost burden has
decreased by $1,349,706. in the previous PRA package a one-time
cost and time burden added for the time required for the AOs to
incorporate the CMS-2567 format into their proprietary electronic
documentation systems. As this was a one-time burden, we have not
included this time and cost burden in this PRA package.
$0
No
No
No
No
No
No
No
Denise King 410 786-1013
Denise.King@cms.hhs.gov
No
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form CMS-2567 Statement of Deficiencies and Plan of Correction
Response to Public Comment to CMS 2567. 01.04.22.docx
Statement of Deficiencies and Plan of Correction