RHC and FQHC Cost Report Forms

80.3 – RHC and FQHC Cost Report Forms (Rev. 12832; Issued: 09-12-24; Effective:01-01-24; Implementation:10-14-24) RHCs and FQHCs use one of the following cost report forms: RHCs: RHCs: Form CMS-222-17, Independent Rural Health Clinic Cost Report. Hospital-based RHCs: Worksheet M of Form CMS-2552-10, Hospital and Hospital Care Complex Cost Report. FQHCs: FQHCs: Form CMS-224-14, Federally Qualified Health Center Cost Report. Information on these cost report forms is found in Chapters 44, 46, and 40, of the “Provider Reimbursement Manual - Part 2” (Publication 15-2), which can be located on the CMS Website at http://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Paper-Based-Manuals.html.