Per the Centers for Medicare and Medicaid Services (CMS), Survey and Certification (S&C) Letter 17-34, providers are no longer required to write their POC on the right side of the CMS Form 2567. Providers may now submit their POC as a separate document attachment or continue to document the POC on the right side of the CMS Form 2567. Long-term care (LTC) facilities may also submit their POC using the ePOC process.

The California Department of Public Health is extending this practice to state-issued 2567s. Effective immediately, providers may now also submit their POC as an attachment to state-issued 2567s.

The CMS Form 2567 and POC are publically releasable documents, so providers must omit any protected health information for compliance with the Privacy Act and Health Insurance Portability and Accountability Act. If a provider includes such information, the district office will request an amended POC from the provider.

Pursuant to Title 42 Code of Federal Regulations section 483.10(g), LTC facilities must post the most recent CMS Form 2567 and any POC in effect; therefore, LTC facilities choosing to attach their POC as a separate attachment must post the POC with the publically available CMS Form 2567.

If you have any questions about the content of this AFL, please contact your local district office.

Sincerely,
Original signed by Jean Iacino

Jean Iacino
Deputy Director