What does “CMS-2567” mean?
Short answer
Form CMS-2567 lists each Medicare or Medicaid rule a provider missed. The provider replies on it with a plan to fix them. The public can see it.
Also known as: Form CMS-2567, Statement of Deficiencies and Plan of Correction, 2567
What the form does
The State Operations Manual gives the form four jobs:
- It is the public record of the deficiencies and the fixes.
- It documents each deficiency.
- It records the provider's promised fixes and dates.
- It lets the provider dispute findings with proof.
Each citation shows the tag number, the rule not met, a plain statement that it is not met, and the evidence. For immediate jeopardy (serious, urgent danger), it also records when IJ began, when the entity was told and how it ended.
Timing
For providers other than nursing homes, the State agency mails the form within 10 working days after the survey. The provider has 10 calendar days to return its plan of correction. Nursing homes also have 10 calendar days from receipt (SOM Chapter 7, section 7317).
Without an acceptable plan of correction, the State says it will recommend remedies. 42 CFR 488.456(b) requires ending the provider agreement of a facility that does not file an acceptable plan.
Example: a nursing home's 2567 cites F689 with proof from record review, interviews and observation. The facility answers line by line. Mix-up: the 2567 is the survey agency's statement. The plan of correction is the facility's written reply on it.
Frequently asked questions
Is the CMS-2567 public?
Yes. The State Operations Manual calls it the basic document shared with the public about a provider's deficiencies and fixes.
How long do we have to respond to a CMS-2567?
Ten calendar days from receipt, for nursing homes and other providers. Nursing homes have the same time to ask for informal dispute resolution.
Who signs the plan of correction?
For nursing homes, someone with management authority, who should be the administrator. The director of nursing or a corporate representative may also sign.
Sources
- CMS State Operations Manual, Chapter 2: The Certification Process
- CMS State Operations Manual, Chapter 7: Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities
- CMS State Operations Manual, Appendix Q: Core Guidelines for Determining Immediate Jeopardy
Reviewed against the sources above on Oct 5, 2026. Rules change: confirm current requirements with the issuing body or your counsel before relying on any summary.
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