CMS-359 crosswalk

Revisions to CMS-359 - Comprehensive Outpatient Rehabilitation Facility Report
For Certification to Participate In the Medicare Program
Issue #

Page
#

Section

Action to be performed

Changes to the Application

Reasons for the Change

1

1

General
Instructions

Reformatting of
instructions

The General Instruction section was reformatted
from a double column format in 9 font to a
standards page view format in 11 font. This has
extended the instructions onto a second page.

The instructions were difficult to read
and follow in the previous format. This
change was made to make the
instructions much easier to read and
follow.

2

1

General
Instructions

Edits to the text of the 2nd
sentence of the 2nd
paragraph of this section,
titled “Instructions”

Add the word “Survey” between the words “State”
and “agency”.

To provide the proper terminology for
the State Survey Agency.

3

1

General
Instructions

Edits to the text of the 3rd
sentence of the 2nd
paragraph of this section,
titled “Instructions”

Add the word “Survey” between the words “State”
and “agency”.

To provide the proper terminology for
the State Survey Agency.

4

1

General
Instructions

Edits to the text of the 3rd
bullet under question #1

•

Insert the word “appropriate” before the
acronym “CMS”.

•

Delete the words “Regional Office” and replace
it with the word “Location”

5

1

General
Instructions

6

2

General
Instructions /
PRA
Disclosure
Statement

Edits to the text of the the
3rd bullet under question
#2

Add the word “Survey” between the words “State”
and “agency”.

Edit to the placement of
the PRA disclosure form

•

•

The PRA disclosure statement has been moved
from page 1 to page 2 of the revised
instructions.
Also, the PRA disclosure statement was labeled
with a title and the font was increased to 12
point making it easy to identify and read.

To provide the new terminology for the
CMS Regional Offices, which are now
referred to as “Locations”.

To provide the proper terminology for
the State Survey Agency.
•

•

This change was necessary due to
the reformatting of the General
Instructions section.
Also, the PRA disclosure statement
was wedged into a small box at the
end of the instructions on the

existing CMS-359 form and printed
in very small font. This made the
PRA disclosure statement very hard
to identify and read.
7

2

General
Instructions /
PRA
Disclosure
Statement

Edit to the time estimate
stated in the PRA
disclosure statement

•

•

Correction of an error and update of the time
estimate for the completion of the CMS-359
form.
Remove the existing time estimate of 3 hours
and replace it with 30 minutes.

The time estimate for the completion
of the CMS-359 form stated in the last
PRA package Supporting Statement A
was only 15 minutes. However, on the
CMS-359 form that was published, the
time estimated stated in the PRA
disclosure statement is 3 hours. This is
an error. This is the time estimate for
the CMS-360 form and not the CMS359 form.
Also, in this PRA package, we are
increasing this time estimate to 30
minutes. So, we need to edit the time
estimate in the PRA disclosure
statement for the CMS-359 form to
reflect this.