Other Plan of Correction Issues

Facilities can receive multiple documents due to the multiple purposes of visits. The documents may include the same tags or different tags. Each document received requires a PoC.

Below is an example of multiple CMS Form 2567s.

On a complaint investigation, W159 was cited. Three months later, at the annual recertification survey and licensing inspection, W159 was re-cited and noted to be uncorrected.

One CMS Form 2567 will be generated for the follow-up to the complaint investigation, and another one will be generated for the annual recertification survey and licensing inspection. A PoC will be required for both CMS Form 2567s; however, the facility can use the same PoC for both CMS Form 2567s.

Facilities need to ensure that they received all the pages of the CMS Form 2567 and HHSC Form 3724, including blank last pages. In some instances, the federal data system prints a blank last page due to the setup for the last printed line at the bottom of the previous page.

All pages, including blank pages, must be returned to the HHSC office specified in the PoC letter that accompanied the CMS Form 2567 and HHSC Form 3724.

Note: The PoC for each citation must include all five PoC criteria.