For most physicians and practice managers, even those with many years of experience in running successful private practices, CMS physical plan requirements are difficult to navigate an understand. The most important thing to understand is that "In Return" for Medicaid reimbursement, CMS and in turn State Health Departments, will hold a potential operator to much higher construction standards.  The net effect is that you will need more space for your clinic an you will incur higher construction costs to implement the many infrastructure improvements need to gain state approval and open your doors.