Certification - 1539 - The State Agency (SA) uses the form 1539 to certify findings to the Centers for Medicare and Medicaid Services (CMS) Regional Office (RO) or to the State Medicaid Agency (SMA) with respect to a facility’s compliance with health and safety requirements. Form 1539 is also a transmittal cover sheet for the certification packet.

Correspondence - CMS - Correspondence the State Agency (SA) receives from the Centers for Medicare and Medicaid (CMS) Regional Office (RO) regarding the facility.

Correspondence - Misc - Correspondence the State Agency (SA) receives regarding the facility that is not of a confidential nature.

Court-Administrative Order

License - The facility’s license and correspondence from the Licensure Division regarding the facility’s license.

Survey Documents - Annual survey/inspections and any complaint investigation s, correspondence to the facility regarding the findings and any penalties or remedies that will be imposed, and the facility’s plan of correction of how they will correct the deficiencies.