The Division of Quality Assurance (DQA) is issuing Statements of Deficiencies (SOD) electronically using email addresses provided by health care providers. The provider is able to use a Plan of Correction (POC) form to electronically submit this information to DQA. This web page provides information and instructions for the e-SOD/e-POC process.
For most providers the Provider Agreement form is completed at the time of an on-site survey. An authorized representative for a health care provider signs and dates the Provider Agreement form and agrees to accept the results of a survey including Statements of Deficiency (SODs) electronically using an email address they provide. They also agree to submit the Plan(s) of Correction (POCs) using the supplied form and emailing this document back to DQA.
Assisted living providers refer to DQA Memo 13-002 (PDF) for information to participate in the e-SOD/e-POC initiative.
The email sent from DQA containing the e-SOD and attachments will be emailed encrypted to the provider.
The DHS Email Encryption - Reference Guide provides information for how to view an encrypted email by creating an account with the CISCO Registered Envelope Service (CRES).
Email and Attachments
The email sent by DQA will identify documents that are attached and will include basic instructions for saving these files and for returning required documents.
It is important for the provider to confirm receipt of the email and attachments by opening this email and emailing a reply to the DQA sender of the email.
The effective date of service for SODs is the date the transmitting email message is sent from the DQA to the authorized representative identified on the Provider Agreement form.
Listed below are files that may be attached to an email to a provider following a survey.
- Statement of Deficiency Cover Letter – A letter from DQA providing information about a recent survey.
- Statements of Deficiency (SODs) – Form CMS-2567 identifies each citation being issued. Federal and State citations are issued on separate SODs. The first page of the federal SOD must be signed and dated and faxed to the number identified in the email or scanned and emailed back to DQA.
- Plan of Correction (POC) Form (F-00344) – The provider uses this form to document their plan of correction for each citation listed on the SOD.
- Attestation of Correction Form (F-02172) – Only used for assisted living facilities when deficiencies cited are easily corrected by the provider. The provider uses this form to attests that all deficiencies have been or will be corrected by the date entered.
- Identifier Key (F-62552) - Confidential Information. Lists names of residents, patients, clients, staff, complainants, family members. Do NOT email this document back to DQA.
To save email attachments:
- Right click on an attachment in the email and then select Save As... on the pop-up menu.
- To the right of the Save In: box, identify a drive and folder on your computer to save the file to.
- Then click on Save.
- Repeat these steps for each attachment.
Completing the Electronic Plan of Correction
- Open the saved Plan of Correction Form (F-00344) in Word. Do not alter the format of this form. Do not handwrite your plan of correction - use Word or other word processing software to enter information.
- Enter the respective tag number(s) as listed in the first column (x4) of the SOD in the first column (x4) of the ePOC form.
- In the second column, Provider's Plan of Correction, describe the corrective action(s) that have or will be taken to address this deficient practice referenced by this tag number. The cells in the Word form are formatted to expand as necessary to allow entry of multiple lines of text.
- Enter the completion date for that corrective action in the third column (x5).
- Complete this process for all tags issued entering them in the same order as they are listed on the SOD. The first tag should be entered in the first row, the second tag should be entered in the second row, etc. (Do not complete a separate page per tag.)
- Save and close the document.
If multiple SODs are issued, a separate Plan of Correction Form (F-00344) should be completed for each SOD requiring a plan of correction.
Save regularly throughout entry of the POC to avoid loss of information.
Completing the Attestation of Correction
- Open the saved Attestation of Correction Form (F-02172) in Word. Do not alter the format of the form. Don not handwrite your compliance completion date – use Word or other word processing software to enter information.
- Enter one compliance completion date in the third column (x5) to indicate when all deficiencies have been or will be corrected by.
- Save and close the document.
Emailing the Plan of Correction or Attestatation of Correction
- Open the email sent by DQA containing the e-SOD and Reply to this email.
- Attach the completed e-POC form or Attestation of Correction form. (Do not fax this document.)
- For Federal SODs Only - If issued a SOD containing one or more federal deficiencies (including Life Safety Code), print only page one of the SOD and sign and date where indicated. Then either:
- scan page one to create an electronic version of the signed document and attach this document in the email back to DQA along with the completed e-POC form; or
- fax the signed page to the fax number identified in the email from DQA.
- Send the email.
Survey Process - Acceptable Plan of Correction
Refer to the Statement of Deficiency letter for required elements in your plan of correction.
The plan of correction must describe the corrective action the provider will take to address the cited violation or deficiency. Although a provider may include in its plan of correction a statement that it disagrees with the survey findings, a provider may not use the plan of correction to malign the survey team or an individual surveyor. The plan of correction is a public record. Do not include names of residents, patients, clients or facility staff.
Listed below are links to Survey Guides by provider type. These guides provide information about the survey process including the contents for an acceptable Plan of Correction.
- Assisted Living Facility Survey Guide, P-63186 (PDF)
- AODA and Mental Health Program Certification Survey Guide, P-63174 (PDF)
- Facilities Serving People with Developmental Disabilities Survey Guide, P-63051 (PDF)
- Home Health and Hospice Licensure and Certification Survey Guide, P63075 (PDF)
- Hospitals and Other Health Services Providers Survey Guide, P-62033 (PDF)
- Long Term Care Facilities Survey Guide, P-62014 (PDF)
- Personal Care Agency Survey Guide, P-00191 (PDF)
- Survey Guide for Clinical Laboratories, P-01227 (PDF) and refer to the Statement of Deficiency letter for required elements in your plan of correction.
Informal Dispute Resolution (IDR)
Effective August 1, 2017, all Informal Dispute Resolution (IDR) and Independent IDR will be conducted by MAXIMUS Federal. The charge for desk and telephone IDR conducted by a professional reviewer has not changed. Desk review is provided at no charge to the provider; the fee for telephone review is $100.
Additional information including how to submit a request for IDR/Independent IDR is contained in the following publications:
- Informal Dispute Resolution for Nursing Homes and Facilities Serving People With Developmental Disabilities (FDD), P-01856 (PDF)
- Independent Informal Dispute Resolution for Federally Certified Nursing Homes, P-01855 (PDF)
- Informal Dispute Resolution for Medicare-Certified Home Health Agencies, P-01857 (PDF)
Provider Search Application - SODs/POCs
Statements of Deficiency (SODs) and Plans of Correction (POCs) will be available to the public, even for providers that choose not to participate in the e-SOD/e-POC process. Survey information and other provider demographic information can be accessed using the DQA Provider Search Application.
Contact for Assistance
Division of Quality Assurance
P.O. Box 2969
Madison, WI 53701-2969