facebook tracking Blue Oak Post-Acute, Santa Rosa CA: CMS Ratings
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Blue Oak Post-Acute

All states › California › Santa Rosa › Blue Oak Post-Acute

850 Sonoma Ave Santa Rosa, CA 95404 · Sonoma County

(707) 544-7750

All 7 nursing homes in Santa Rosa, CA (5 take Medicaid)

Cited for abuse Accepts Medicare Accepts Medicaid 181 certified beds For profit

CMS certification number 056090 · See this home on Medicare Care Compare

CMS abuse icon CMS marks this nursing home with its abuse icon. CMS shows the icon for homes with abuse citations in recent inspections: an abuse citation where residents were harmed (scope and severity G or higher) within the past year, or abuse citations at D or higher (potential for harm) in each of the last two years. Shown as of October 2026. Details on Care Compare.

Ratings come from CMS and are updated monthly; these are from October 2026. Check the latest inspection report and visit in person before you decide.

Is Blue Oak Post-Acute a good nursing home? Reviews, ratings and inspection record

There are no official resident reviews of nursing homes: Medicare's Care Compare publishes inspections, staffing and quality data instead. Here is what that record shows for Blue Oak Post-Acute as of October 2026.

CMS rates it 1 out of 5 stars overall, below the California average of 3.2. Inspectors issued 67 citations in the last three years. CMS imposed 2 penalties, including $36,892 in fines, in that time. For short-term rehab patients CMS rates quality 2 out of 5; for long-term residents, 5 out of 5. Those results differ a lot, so ask about the unit your family member would be on. CMS currently shows its abuse icon for this home (see above).

Online reviews from families and residents are on Google Maps and other sites; they reflect individual experiences and aren't checked by CMS. The full inspection reports, including what inspectors observed, are on Medicare Care Compare.

Staffing

Nursing staff spend about 3.34 hours per resident per day at Blue Oak Post-Acute, below the California median of 4.27 (US median: 3.72). About 0.46 of those hours are from registered nurses. On weekends it falls to 3.00 hours, 10% below its all-week average. 32% of nursing staff left within a year (California median 36%).

Nursing care per resident per day 3.34 hours
Below the California median of 4.27 Registered nurses, licensed practical nurses and aides combined, from payroll records.
Registered nurse hours 0.46 per resident a day RNs handle assessments, medications and changes in condition.
Weekend nursing care 3.00 hours Per resident a day. A big drop from weekdays can mean thin weekend staffing.
Nursing staff turnover 32% a year Share of nursing staff who left over a year. Lower usually means steadier care.
Registered nurse turnover 42.1% a year Share of registered nurses who left over a year.
Administrators who left 1 in the past year Frequent leadership changes are worth asking about on a visit.

About this nursing home

Certified beds181
Residents per day 172 About 95% of beds filled, on average
OwnershipFor profit - Corporation
Payment acceptedMedicare and Medicaid
Certified sinceFebruary 1974
Part of a chainSpyglass Healthcare
Legal business nameMACAO HOLDINGS LLC

Paying for care at Blue Oak Post-Acute: Medicare and Medicaid

Blue Oak Post-Acute is certified for both Medicare and Medicaid. Medicare Part A can cover a short skilled-nursing or rehab stay here after a qualifying hospital stay of at least three inpatient days (observation days don't count), for up to 100 days per benefit period. Medicaid can pay for long-term care for residents who meet California's income and asset rules. Being certified doesn't guarantee a Medicaid bed is open, so ask whether the home accepts residents whose Medicaid application is still pending.

In 2026 Medicare covers days 1–20 in full after the Part A deductible ($1,736 per benefit period); for days 21–100 you pay $217 a day; after day 100 you pay all costs. Medicare doesn't pay for long-term custodial care. Medicare's coverage rules.

Health inspections

The most recent standard inspection was on November 25, 2025 and found 15 deficiencies, plus 13 from complaint inspections in the same period. In total, inspectors issued 67 citations in the last three years.

Each citation has a scope and severity letter from A to L. A–C: potential for minimal harm. D–F: potential for more than minimal harm. G–I: actual harm. J–L: immediate jeopardy to resident health or safety.

What the inspections found

Over the last three years, inspectors issued 67 citations at Blue Oak Post-Acute across 17 inspection dates, 24 of them from complaint investigations. 2 were at the actual-harm level (G–I), most recently on December 11, 2025. The most common areas cited were freedom from abuse, neglect, and exploitation (13) and resident assessment and care planning (10). The most serious was cited under the CMS rule to "protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody" (tag F0600, level G, December 11, 2025). 13 citations were under CMS's abuse, neglect and exploitation rules.

July 29, 2026 · 2 citations · includes complaint inspection

DEnsure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0627 · Complaint inspection · Deficient, Provider has date of correction (Sep 4, 2026)

DProvide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0628 · Complaint inspection · Deficient, Provider has date of correction (Sep 4, 2026)

June 10, 2026 · 2 citations · includes complaint inspection

DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Complaint inspection · Deficient, Provider has date of correction (Jul 13, 2026)

DEnsure services provided by the nursing facility meet professional standards of quality.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0658 · Complaint inspection · Deficient, Provider has date of correction (Jul 13, 2026)

May 1, 2026 · 1 citation · includes complaint inspection

DProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (Jun 4, 2026)

April 16, 2026 · 1 citation · includes complaint inspection

EProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 · Complaint inspection · Deficient, Provider has date of correction (Apr 17, 2026)

April 2, 2026 · 2 citations · includes complaint inspection

DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Complaint inspection · Deficient, Provider has date of correction (Apr 3, 2026)

DMake sure that a working call system is available in each resident's bathroom and bathing area.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0919 · Complaint inspection · Deficient, Provider has date of correction (Apr 3, 2026)

January 7, 2026 · 2 citations · includes complaint inspection

ETimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Jan 8, 2026)

DEnsure services provided by the nursing facility meet professional standards of quality.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0658 · Complaint inspection · Deficient, Provider has date of correction (Jan 8, 2026)

December 22, 2025 · 1 citation · includes complaint inspection

DProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 · Complaint inspection · Deficient, Provider has date of correction (Jan 6, 2026)

December 11, 2025 · 2 citations, includes actual harm · includes complaint inspection

GProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Actual harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 · Complaint inspection · Deficient, Provider has date of correction (Jan 5, 2026)

DRespond appropriately to all alleged violations.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0610 · Complaint inspection · Deficient, Provider has date of correction (Jan 5, 2026)

November 25, 2025 · 15 citations

EKeep residents' personal and medical records private and confidential.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0583 · Deficient, Provider has date of correction (Dec 3, 2025)

EEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Deficient, Provider has date of correction (Dec 3, 2025)

EEnsure each resident receives and the facility provides food prepared in a form designed to meet individual needs.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0805 · Deficient, Provider has date of correction (Dec 3, 2025)

EEnsure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0806 · Deficient, Provider has date of correction (Dec 3, 2025)

EProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0812 · Deficient, Provider has date of correction (Dec 3, 2025)

EProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has date of correction (Dec 3, 2025)

EMake sure that a working call system is available in each resident's bathroom and bathing area.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0919 · Deficient, Provider has date of correction (Dec 3, 2025)

DProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 · Deficient, Provider has date of correction (Dec 3, 2025)

DEnsure each resident receives an accurate assessment.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0641 · Deficient, Provider has date of correction (Dec 3, 2025)

DEnsure services provided by the nursing facility meet professional standards of quality.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0658 · Deficient, Provider has date of correction (Dec 3, 2025)

DProvide enough food/fluids to maintain a resident's health.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0692 · Deficient, Provider has date of correction (Dec 3, 2025)

DProvide safe and appropriate respiratory care for a resident when needed.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0695 · Deficient, Provider has date of correction (Dec 3, 2025)

DProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0755 · Deficient, Provider has date of correction (Dec 3, 2025)

DDispose of garbage and refuse properly.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0814 · Deficient, Provider has date of correction (Dec 3, 2025)

DEducate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0887 · Deficient, Provider has date of correction (Dec 3, 2025)

September 8, 2025 · 1 citation · includes complaint inspection

DProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 · Complaint inspection · Deficient, Provider has date of correction (Sep 22, 2025)

July 22, 2025 · 3 citations · includes complaint inspection

DHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0550 · Complaint inspection · Deficient, Provider has date of correction (Aug 26, 2025)

DTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Aug 26, 2025)

DEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Complaint inspection · Deficient, Provider has date of correction (Aug 26, 2025)

May 8, 2025 · 1 citation · includes complaint inspection

DHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0550 · Complaint inspection · Deficient, Provider has date of correction (Jun 5, 2025)

April 16, 2025 · 1 citation · includes complaint inspection

DRespond appropriately to all alleged violations.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0610 · Complaint inspection · Deficient, Provider has date of correction (Apr 28, 2025)

January 7, 2025 · 1 citation, includes actual harm · includes complaint inspection

GEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Actual harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Jan 23, 2025)

March 29, 2024 · 1 citation · includes complaint inspection

DAssist a resident in gaining access to vision and hearing services.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0685 · Complaint inspection · Deficient, Provider has date of correction (Apr 24, 2024)

November 17, 2023 · 21 citations · includes complaint inspection

EHonor the resident's right to be treated with respect and dignity and to retain and use personal possessions.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0557 · Deficient, Provider has date of correction (Jan 5, 2024)

EThe resident has the right to receive notices in a format and a language he or she understands.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0574 · Deficient, Provider has date of correction (Jan 5, 2024)

EHonor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0584 · Deficient, Provider has date of correction (Jan 5, 2024)

ETimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Jan 5, 2024)

EDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Deficient, Provider has date of correction (Jan 5, 2024)

EProvide care and assistance to perform activities of daily living for any resident who is unable.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0677 · Deficient, Provider has date of correction (Jan 5, 2024)

EProvide safe, appropriate pain management for a resident who requires such services.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0697 · Deficient, Provider has date of correction (Jan 5, 2024)

EProvide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

Potential for more than minimal harm · Nursing and Physician Services Deficiencies · Tag F0725 · Deficient, Provider has date of correction (Jan 5, 2024)

EEnsure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0804 · Deficient, Provider has date of correction (Jan 5, 2024)

EHire a qualified full-time social worker in a facility with more than 120 beds.

Potential for more than minimal harm · Administration Deficiencies · Tag F0850 · Deficient, Provider has date of correction (Jan 5, 2024)

EMake sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0921 · Deficient, Provider has date of correction (Jan 5, 2024)

EGive their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0943 · Complaint inspection · Deficient, Provider has date of correction (Jan 5, 2024)

DImmediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0580 · Deficient, Provider has date of correction (Jan 5, 2024)

DProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 · Complaint inspection · Deficient, Provider has date of correction (Jan 5, 2024)

DProvide enough food/fluids to maintain a resident's health.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0692 · Deficient, Provider has date of correction (Jan 5, 2024)

DProvide safe, appropriate dialysis care/services for a resident who requires such services.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0698 · Deficient, Provider has date of correction (Jan 5, 2024)

DEnsure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0803 · Deficient, Provider has date of correction (Jan 5, 2024)

DProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0812 · Deficient, Provider has date of correction (Jan 5, 2024)

DProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has date of correction (Jan 5, 2024)

DEducate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0887 · Deficient, Provider has date of correction (Jan 5, 2024)

DKeep all essential equipment working safely.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0908 · Deficient, Provider has date of correction (Jan 5, 2024)

February 7, 2022 · 10 citations

EHonor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0561 · Deficient, Provider has date of correction (Apr 5, 2022)

EEncode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0640 · Deficient, Provider has date of correction (Apr 5, 2022)

EDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0657 · Deficient, Provider has date of correction (Apr 5, 2022)

EObserve each nurse aide's job performance and give regular training.

Potential for more than minimal harm · Nursing and Physician Services Deficiencies · Tag F0730 · Deficient, Provider has date of correction (Apr 5, 2022)

EEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Deficient, Provider has date of correction (Apr 5, 2022)

EHave a plan that describes the process for conducting QAPI and QAA activities.

Potential for more than minimal harm · Administration Deficiencies · Tag F0865 · Deficient, Provider has date of correction (Apr 5, 2022)

EProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has date of correction (Apr 5, 2022)

DDevelop and implement policies and procedures to prevent abuse, neglect, and theft.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0607 · Deficient, Provider has date of correction (Apr 5, 2022)

DEnsure services provided by the nursing facility meet professional standards of quality.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0658 · Deficient, Provider has date of correction (Apr 5, 2022)

CConduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

Potential for minimal harm · Administration Deficiencies · Tag F0838 · Deficient, Provider has date of correction (Apr 5, 2022)

Questions to ask on a tour of Blue Oak Post-Acute

  1. Inspectors cited the home at the actual-harm level on December 11, 2025 under the rule on freedom from abuse, neglect, and exploitation. What changed afterwards, and can I see the plan of correction?
  2. CMS cited the home under its abuse and neglect rules on April 16, 2026. How are staff trained, and how are concerns reported?
  3. CMS rates short-stay quality 2 out of 5. How often do rehab patients go back to the hospital, and how many therapy sessions a week are typical?
  4. Do you have a Medicaid bed open now, and will you admit someone whose Medicaid application is still pending?
  5. When is the first care-plan meeting, and can family attend?

Questions come from this home's CMS data: its inspections, staffing and ownership record.

Fines and payment denials

2 penalties in the last three years, including $36,892 in fines.

DateTypeAmount or length
Dec 11, 2025 Fine $28,614
Jan 7, 2025 Fine $8,278

Rating history

CMS monthOverallInspectionStaffingQuality
October 2026 1/5 1/5 3/5 3/5
August 2026 2/5 1/5 5/5 3/5
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Location

Hospitals near Blue Oak Post-Acute

The Medicare-certified hospitals closest to this nursing home, with their CMS data. Ask the home which hospital it usually sends residents to.

Hospital ratings, ER visit times and more at Hospitals In Each State
Source: CMS Care Compare. Distances are approximate.

Nearby nursing homes

Northvine Postacute Care Santa Rosa · 1.3 mi away ★☆☆☆☆ Inspection 1/5 · Staffing 3/5 62 beds · Medicaid
Santa Rosa Post Acute Santa Rosa · 2.2 mi away ★★★☆☆ Inspection 2/5 · Staffing 4/5 99 beds · Medicaid
Park View Post Acute Santa Rosa · 2.4 mi away ★★★☆☆ Inspection 2/5 · Staffing 3/5 116 beds · Medicaid
Arbol Healthcare Center of Santa Rosa Santa Rosa · 2.7 mi away ★★★★★ Inspection 4/5 · Staffing 5/5 45 beds
Summerfield Health Care Center Santa Rosa · 2.7 mi away ★★★★★ Inspection 5/5 · Staffing 4/5 70 beds · Medicaid

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Other Spyglass Healthcare nursing homes in California

Affiliation comes from CMS's affiliated-entity data, October 2026. All 14 Spyglass Healthcare nursing homes ›

Source: CMS Provider Data Catalog (provider information, health deficiencies, penalties), October 2026. Inspection citations and penalties cover the last three years. Nursing Homes In Each State is independent and not affiliated with CMS or Medicare. About the data · Report a problem with this listing. Is this your nursing home? Feature it here.

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https://www.nursinghomesineachstate.com/california/santa-rosa/blue-oak-post-acute/ · Data: CMS, October 2026 · Nursing Homes In Each State, not affiliated with CMS or Medicare.