Sunday 16 October 2016

Federally Qualified Health Centers (FQHCs)

Federally Qualified Health Centers (FQHCs)
FQHCs furnish services such as those performed by physicians, nurse practitioners, physician assistants, clinical psychologists, and clinical social workers. This also includes certain preventive services like prenatal services, immunizations, blood pressure checks, hearing screenings and cholesterol screenings. (See CMS Publication 100-02, chapter 13, for more information). Even though they complete the Form CMS-855A application, FQHCs are considered Part B certified suppliers.

FQHCs are not required to obtain a State survey; there is no State agency involvement with FQHCs. As such, the contractor will either deny the application or make a recommendation for approval and forward it directly to the RO. The RO will then make the final decision as to whether the entity qualifies as a FQHC. Generally, in order to so qualify, the facility must be receiving, or be eligible to receive, certain types of Federal grants (sometimes referred to as “grant status”), or must be an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act or by an Urban Indian organization. The Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services (DHHS) may assist the RO in determining whether a particular supplier meets FQHC standards, since HRSA maintains a list of suppliers that met certain grant requirements. (See CMS Pub. 100-07, chapter 2, sections 2825-2826D for more information.)

NOTE: Additional information about FQHCs:
• As stated above, there is no State agency involvement with FQHCs. However, FQHCs still must meet all applicable State and local requirements and submit all applicable licenses. Typically, HRSA will verify such State/local compliance by asking the FQHC to attest that it meets all State/local laws.
• FQHCs can be based in a rural or urban area that is designated as either a shortage area or an area that has a medically underserved population.
• To qualify as an FQHC, the facility must, among other things, either (1) furnish services to a medically underserved population or (2) be located in a medically underserved area.
• The FQHC must submit a signed and dated Attestation Statement for Federally Qualified Health Centers (Exhibit 177). This attestation serves as the Medicare FQHC benefit (or provider/supplier) agreement. (See Pub. 100-07, chapter 2, section 2826B.) The FQHC must also submit, as indicated above, a HRSA “Notice of Grant Award” or Look-Alike Status. A completed FQHC crucial data extract sheet (Exhibit 178), however, is no longer required.
• The contractor shall ensure that the attestation statement (Exhibit 177) contains the same legal business name and address as that which the FQHC provided in section 2 and section 4, respectively, of the Form CMS-855A. If the attestation contains a different name, the contractor shall develop for the correct name.
• An FQHC cannot have multiple sites or practice locations. Each location must be separately enrolled and will receive its own CMS Certification Number.
• If an FQHC submits a change of information request to change its location, the contractor may wish to contact the RO to see whether the change (1) is such that an initial enrollment is required (i.e., the change constitutes the establishment of a new FQHC) or (2) makes the clinic no longer eligible for enrollment as an FQHC (i.e., the change is to a location that is neither a shortage area nor an area with a medically underserved population).

When sending a recommendation for approval letter to the RO for an initial FQHC application, the contractor shall indicate in the letter the date on which the FQHC’s application was complete. To illustrate, assume that the FQHC submitted an initial application on March 1. Two data elements were missing; the contractor thus requested additional information. The two elements were submitted on March 30. The contractor shall therefore indicate the March 30 date in its letter as the date the application was complete.

See CMS Publication 100-07, chapter 2, section 2826F for information regarding the effective date of an FQHC’s agreement with CMS.

For additional general information on FQHCs, refer to:
• Section 1861(aa)(3-4) of the Social Security Act
• 42 CFR Part 491 and 42 CFR Part 405.2400
• Pub. 100-07, chapter 2, sections 2825 – 2826H
• Pub. 100-07, Exhibit 179
• Pub. 100-04, chapter 9 (Claims Processing Manual)
• Pub. 100-02, chapter 13 (Benefit Policy Manual)

For information on the appropriate contractor jurisdictions for incoming FQHC enrollment applications, see:
• Pub. 100-04, chapter 1, section 20
• Pub. 100-04, chapter 9, section 10.3

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