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In the healthcare landscape of California, ensuring that facilities meet the diverse needs of patients is crucial. The Cec Rps 1B form plays a fundamental role in this process, specifically tailored for requests related to bed counts and services in various health care settings. It is used by adult day health centers, acute psychiatric hospitals, general acute care hospitals, special hospitals, and skilled nursing facilities. When completing this form, applicants need to clearly indicate both existing and requested beds across multiple categories, such as acute respiratory care, pediatric services, and rehabilitation centers. This structured approach helps the California Department of Public Health assess the current service landscape and the demands that are present, facilitating necessary approvals for new facilities or changes to existing ones. Additionally, the form requires applicants to detail the services currently provided and those anticipated, ranging from emergency care to outpatient services. By providing a comprehensive snapshot of what each facility offers and needs, the Cec Rps 1B streamlines the process of expanding or adjusting healthcare services in response to patient demand.

Cec Rps 1B Example

 

 

 

CLEAR

 

State of California-Health and Human Services Agency

California Department of Public Health

 

 

 

 

 

BED OR SERVICE REQUEST

 

Date

 

 

 

 

 

 

 

 

 

This form is intended to identify the types of beds or services requested for adult day health center, acute psychiatric hospitals, general acute care hospitals, special hospitals and skilled nursing facilities. For new facilities, complete the column marked “Requested Beds.” For existing facilities, complete both columns. The form is to accompany the application form (HS 200) for any new facility, change in capacity, service, or bed classification.

Name of facility

Type

Address (number, street)

City

State

ZIP code

Please enter the number of beds requested for each category:

EXISTING BEDS

REQUESTED BEDS

_____ Acute Respiratory Care Services

_____

Acute Respiratory Care Services

_____ Burn Center

_____ Burn Center

_____ Cardiovascular Surgery Service

_____

Cardiovascular Surgery Service

_____ Coronary Care Unit

_____ Coronary Care Unit

_____

General Acute Care (Unspecified)

_____

General Acute Care (Unspecified)

_____ General Nursing (Long-Term)

_____ General Nursing (Long-Term)

_____ Intensive Care (Newborn)

_____

Intensive Care (Newborn)

_____

Intensive Care Unit

_____

Intensive Care Unit

_____

Pediatric Service

_____

Pediatric Service

_____

Perinatal Unit

_____

Perinatal Unit

_____

Psychiatric Unit

_____

Psychiatric Unit

_____

Rehabilitation Center

_____

Rehabilitation Center

_____ Renal Transplant Center

_____

Renal Transplant Center

_____

Respiratory Care Service

_____

Respiratory Care Service

_____

Skilled Nursing Service (DP)

_____

Skilled Nursing Service (DP)

_____ Other (specify) ______________________

_____ Other (specify) ______________________

_____ Other (specify) ______________________

_____ Other (specify) ______________________

_____

APPROVED CAPACITY

_____

APPROVED CAPACITY (For Departmental use only)

___________________________________________________________________________________________________

Please check services which the facility currently provides or is requesting:

EXISTING SERVICES

REQUESTED SERVICES

_____ Adult Day Program (only applies to an ADHC)

_____ Adult Day Program (only applies to an ADHC)

_____ Basic Emergency Physician on Duty

_____ Basic Emergency Physician on Duty

_____

Cardiovascular Surgery

_____

Cardiovascular Surgery

_____

Chronic Dialysis Service

_____

Chronic Dialysis Service

_____ Comprehensive Emergency

_____ Comprehensive Emergency

_____

Dental Service

_____

Dental Service

_____ Nuclear Medicine Service

_____ Nuclear Medicine Service

_____ Occupational Therapy Service

_____ Occupational Therapy Service

_____

Outpatient Service (i.e. Family Practice, Pediatrics,

_____

Outpatient Service (i.e. Family Practice, Pediatrics,

 

Primary Care, Rural Health Clinic, etc.)

 

Primary Care, Rural Health Clinic, etc.)

 

Specify: _____________________________

 

Specify: ____________________________

 

Specify: _____________________________

 

Specify: ____________________________

_____

Physical Therapy

_____

Physical Therapy

_____

Podiatric Service

_____

Podiatric Service

_____ Radiation Therapy

_____ Radiation Therapy

_____

Social Service

_____

Social Service

_____

Speech Pathology and/or Audiology Service

_____

Speech Pathology and/or Audiology Service

_____ Other (specify): _______________________

_____ Other (specify): _______________________

_____ Other (specify): _______________________

_____ Other (specify): _______________________

CDPH 609 (12/11)

Form Characteristics

Fact Name Description
Purpose The Cec Rps 1B form is used to request various types of beds or services for health care facilities in California, including hospitals and nursing facilities.
Submission Requirement This form must be submitted along with application form HS 200 when establishing a new facility or requesting changes in capacity or services.
Facility Information Facilities are required to provide detailed information including the name, address, and the specific types of beds that are being requested.
Governing Laws The use of the Cec Rps 1B form falls under California's health and safety regulations, particularly those outlined by the California Department of Public Health.

Guidelines on Utilizing Cec Rps 1B

Completing the Cec Rps 1B form is crucial for facilities seeking to clarify their bed capacity and services provided. It is essential to gather accurate information about both existing and requested beds and services, ensuring compliance and clarity in your application process.

  1. Begin by entering the date at the top of the form.
  2. Fill in the name of your facility in the designated space.
  3. Indicate the type of facility, whether it is a hospital, skilled nursing facility, or other classifications.
  4. Provide the facility's street address, including the number and street name.
  5. Next, enter the city, state, and ZIP code of your facility.
  6. In the section for beds, record the number of existing beds and the number of requested beds for each category. This includes areas like Acute Respiratory Care Services, Burn Center, and Pediatric Service.
  7. For facilities with approved capacity, include that information in the specified area for departmental use.
  8. Proceed to the services section. Check the boxes for the services your facility currently provides and those you are requesting. Categories include Adult Day Program, Physical Therapy, and others.
  9. If additional space is needed for specifying other types of beds or services, do so in the provided spaces labeled "Other."
  10. Review the completed form for accuracy before submission.

Once the form is filled out, it should accompany the HS 200 application form as part of your submission process. Doing this helps ensure that your request smoothly transitions to the approval stage. Maintain a copy for your records as well.

What You Should Know About This Form

What is the purpose of the Cec Rps 1B form?

The Cec Rps 1B form is designed to identify the types of beds or services requested for various health facilities, including adult day health centers and acute hospitals. It helps facilitate the application process for new facilities or existing ones that wish to change their service capacity or bed classification.

Who needs to fill out the Cec Rps 1B form?

This form must be completed by administrators or authorized personnel from health facilities. It is necessary for new facilities seeking approval or for existing facilities looking to modify their operations, capacity, or classification of services they provide.

What information is required in this form?

The form requests information such as the name, type, address, and ZIP code of the facility. Additionally, it requires the number of existing and requested beds in various categories, as well as a list of currently provided and requested services.

Where should the completed Cec Rps 1B form be submitted?

The completed form should accompany the application form HS 200, which is submitted to the California Department of Public Health. Both forms should be sent to the relevant department for processing and approval.

Are there specific categories for beds and services listed in the Cec Rps 1B form?

Yes, the form has specific categories for different types of beds, such as Acute Respiratory Care Services, Burn Center, and Psychiatric Unit, among others. It also includes a range of existing and requested services, like Adult Day Program and Physical Therapy.

What happens if a facility submits incorrect information on the Cec Rps 1B form?

If incorrect details are provided, it may lead to delays in the approval process or even rejection of the application. It is crucial for facilities to ensure that all information is accurate and up-to-date before submitting the form.

Common mistakes

Filling out the Cec Rps 1B form can seem straightforward, but many individuals make common mistakes that could delay their application. One mistake is failing to match existing beds with requested beds. When applying for a new facility or modifying an existing one, it’s crucial to provide accurate numbers in both columns. Not doing so can lead to confusion and potential rejections.

Another frequent error is overlooking the specific categories for services and beds requested. Each section of the form requires attention to detail. For example, some applicants may forget to specify which type of acute care or rehabilitation services they are seeking. This can result in an incomplete application, which is often returned for corrections, wasting valuable time.

Many people also forget to include their facility's full address and proper identification. Omissions like the city, state, or ZIP code can easily slip through the cracks. Without a complete address, your application may not reach the correct department, causing unnecessary delays.

Additionally, another common issue is not checking the current services provided by the facility. Submitting an outdated list can mislead reviewers. Always ensure that your current offerings align with what you’re requesting, as discrepancies could jeopardize your request for additional services.

Another point of concern is incorrectly interpreting the “Other” sections. It’s essential to clearly specify any services that do not fit within the defined categories. Vague descriptions can leave the application open to interpretation, which may lead to misunderstandings.

Lastly, many applicants forget to sign and date their forms. This step might seem minor, but an unsigned form may be considered invalid. Always review your application before submission to ensure that all parts are filled out correctly, signed, and dated.

Documents used along the form

The Cec Rps 1B form serves as an essential document for health facilities in California to request specific types of beds and services. It is often accompanied by various other forms and documents that facilitate healthcare facility applications and documentation. The following list presents some of the common forms used alongside the Cec Rps 1B form, providing a brief description of each.

  • Application Form (HS 200): This form is a foundational application for establishing or modifying healthcare facilities. It details the necessary information for obtaining approval from the California Department of Public Health.
  • Facility License Application (CDPH Form 200): This document is required for licensure of healthcare facilities. It includes comprehensive information about the facility and its operations.
  • Provider Agendas: These frequently include summaries of planned services or treatments offered at a facility, ensuring compliance with health standards and objectives.
  • Patient Care Policies: This document outlines the policies and procedures related to patient care at the facility, focusing on quality and safety regulations.
  • Staffing Plans: These plans detail the staffing requirements and considerations for various departments within a healthcare facility, ensuring that adequate personnel are available to meet patient needs.
  • Financial Viability Assessment: This document assesses the financial status of a new or existing facility, demonstrating the ability to sustain operations and provide the requested services.
  • Health and Safety Inspections Report: Generated by state or federal agencies, this report outlines compliance with health and safety standards, necessary for approval processes.
  • Emergency Preparedness Plan: This plan details how a facility prepares for, responds to, and recovers from emergencies or disasters affecting patient care and safety.

These forms and documents play a critical role in illustrating compliance with regulatory requirements and ensuring that facilities can meet the health-related needs of the communities they serve. They support the application process and provide clarity on the operational status of healthcare facilities within California.

Similar forms

  • Application for a Certificate of Need: This document is used to assess the need for a new health care facility or service. Similar to the Cec Rps 1B form, it requests information about the facility and the services it intends to offer.
  • Facility License Application: Required for operating licensed health care facilities, this form collects details about the type of services and capacity, mirroring the bed and service requests found in the Cec Rps 1B.
  • Plan of Operation: This document outlines the proposed operations of a health care facility. It parallels the Cec Rps 1B in identifying the services the facility intends to provide and its capacity.
  • Change of Ownership Application: When a facility is sold or transferred, this document must be submitted. It requires information about existing services and bed capacity, similar to what is requested on the Cec Rps 1B.
  • Annual Renewal Application for Health Facilities: This form is submitted yearly to maintain a facility’s license. It assesses current capacity and services, resembling the reporting aspects of the Cec Rps 1B.
  • Medicare Provider Enrollment Application: This application is used by facilities seeking Medicare reimbursement. It requests information about services offered, akin to the Cec Rps 1B's focus on service requests.
  • Hospital Cost Report: Hospitals submit this report to provide data on capacity and types of services rendered. It shares commonalities with the Cec Rps 1B by detailing bed utilization and service offerings.
  • Emergency Preparedness Plan: Required for health facilities, this document includes details about available services during emergencies. The structure mirrors the Cec Rps 1B in identifying existing and requested services.

Dos and Don'ts

When filling out the CEC RPS 1B form, it is important to follow certain guidelines to ensure accuracy and compliance. Here are ten things to keep in mind:

  • Do use clear and legible writing or type your responses to avoid any misunderstandings.
  • Don't leave any sections blank; all requested information must be provided.
  • Do double-check the names and addresses of facilities to confirm they are spelled correctly.
  • Don't use abbreviations unless they are commonly recognized and accepted.
  • Do specify the number of beds requested in the appropriate sections for both existing and requested beds.
  • Don't make assumptions about services; ensure you check the boxes that accurately reflect current and requested services.
  • Do review the form for any errors or omissions before submission.
  • Don't forget to sign and date the form, as missing this step can delay processing.
  • Do keep a copy of the completed form for your records.
  • Don't submit the form without confirming all required documents are included, such as the HS 200 application form.

Following these tips will help facilitate a smoother submission process for the CEC RPS 1B form. Careful attention to detail is essential in this undertaking.

Misconceptions

Misconceptions about the Cec Rps 1B form can lead to confusion regarding its purpose and usage. Here are ten common misunderstandings clarified:

  1. The form is only for new facilities. This is incorrect. Existing facilities must also fill out the form, indicating both existing and requested beds.
  2. All requested services must be currently provided. Not true. Facilities can request services they do not currently offer, as long as they specify them on the form.
  3. There is no need to complete the 'Requested Beds' section for existing facilities. This is a misconception. Existing facilities are required to fill out both existing and requested beds.
  4. The form is complicated and lengthy. While the form contains many options, it is straightforward. Facilities simply check the relevant boxes and provide the necessary details.
  5. Submission of the form guarantees bed approval. This is a misunderstanding. Filling out the form does not ensure that requested beds will be approved; the Department reviews applications based on several criteria.
  6. Only certain types of facilities need this form. Actually, all adult day health centers, acute psychiatric hospitals, general acute care hospitals, special hospitals, and skilled nursing facilities may use this form.
  7. Facilities can skip specifying the 'Other' category. This is incorrect. If a facility requires additional services not listed, they should specify their needs to ensure clarity.
  8. The form does not require a date. This is incorrect. A date must be recorded on the form as it is essential for processing timelines.
  9. Only administrators need to submit the form. While administrators often handle the form, any authorized staff can complete it as long as they have the necessary information.
  10. Once submitted, there is no way to request changes. This is a misconception. Facilities can contact the Department to make necessary adjustments after submission if needed.

Key takeaways

Filling out the Cec Rps 1B form can be straightforward if you keep a few key considerations in mind. Here are some essential takeaways to guide you through the process:

  • Purpose of the Form: This form identifies requested types of beds or services for various health facilities, such as adult day health centers and hospitals.
  • Completing the Form: For new facilities, only fill out the "Requested Beds" column. Existing facilities must complete both the "Existing Beds" and "Requested Beds" columns.
  • Application Requirement: The Cec Rps 1B form must accompany the application form (HS 200) for new facilities or any changes to existing capacities or service classifications.
  • Contact Information: Ensure all facility information, including name, type, and address, is accurate and complete to avoid delays.
  • Bed Categories: Enter the number of beds needed for specific services, such as Intensive Care Units or Rehabilitation Centers, under both existing and requested categories.
  • Service Identification: Check off the services currently provided by your facility, as well as those you are requesting.
  • Clear Specifications: If you have “Other” services or beds to specify, clarify them in the provided spaces to ensure your requests are understood.
  • Departmental Use Only: There is a section marked for departmental use; make sure you do not fill out this area, as it is meant for officials handling your application.

By following these takeaways, you can complete the Cec Rps 1B form accurately and efficiently, paving the way for your facility's needs to be evaluated appropriately.