Federally Qualified Health Centers (FQHCs)

10.2.1.4 - Federally Qualified Health Centers (FQHCs) (Rev. 12639; Issued: 05-16-24; Effective: 06-17-24; Implementation: 06-17-24) A. Statutory Background Section 4161(a)(2) of OBRA ‘90 (P.L. 101-508) amended §1861(aa) of the Act and established FQHC services as a benefit under the Medicare program effective October 1, 1991. The statutory requirements that entities must meet to be considered an FQHC for Medicare purposes are at §1861(aa)(4) of the Act. Regulations establishing the FQHC benefit and outlining the Conditions for Coverage for FQHCs were published on June 12, 1992, in the Federal Register (57 FR 24961) and became effective on the date of publication. These regulations were amended on April 3, 1996 (61 FR 14640). Section 13556 of OBRA 1993 (P.L. 103-66) amended §1861(aa) of the Act by adding outpatient health programs or facilities operated by a tribe or tribal organization under the Indian Self-Determination Act or by an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act, as entities eligible to participate in Medicare as FQHCs. B. Requirements FQHCs furnish services such as those performed by physicians, nurse practitioners, physician assistants, clinical psychologists, certified nurse-midwives, and clinical social workers. This also includes certain preventive services like prenatal services, immunizations, blood pressure checks, hearing screenings and cholesterol screenings. (See Pub. 100-02, chapter 13 for more information). To participate in the Medicare program, applicants seeking initial enrollment as an FQHC must submit a Form CMS-855A application to the appropriate Medicare Administrative Contractor (MAC). Even though they complete the Form CMS-855A application, FQHCs are considered Part B certified suppliers and are paid Part B benefits for FQHC services. FQHCs are not required to obtain a state survey. However, FQHCs still must meet all applicable state and local requirements and submit all applicable licenses. Typically, the Health Resources and Services Administration (HRSA) will verify such state/local compliance by asking the FQHC to attest that it meets all state/local laws. FQHCs can be located in a rural or urban area that is designated as either a health professional shortage area or an area that has a medically underserved population. For purposes of Medicare enrollment, an FQHC is defined as an entity that has entered into an agreement with CMS to meet Medicare program requirements under 42 CFR § 405.2434(a), and (as outlined in Pub. 100-07, chapter 9, exhibit 179): • Is receiving a grant under § 330 of the Public Health Service (PHS) Act; • Is receiving funding under a contract with the recipient of a § 330 grant, and meets the requirements to receive a grant under § 330 of the PHS Act; • Is an FQHC “Look-Alike” (i.e., HRSA), has notified it that it meets the requirements for receiving a § 330 grant, even though it is not actually receiving such a grant); • Was treated by CMS as a comprehensive federally funded health center as of January 1, 1990; or • Is 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 receiving funds under Title V of the Indian Health Care Improvement Act. C. Initial FQHC Applications 1. Contractor Review and Required Documents In contrast to both past practice and the process that is normally followed with other certified provider/certified supplier types, the contractor does not make a recommendation for approval to the state/SOG Location for FQHC applications. Instead, the contractor will either approve or deny the application at the contractor level pursuant to the instructions in this section. The following documents must be included with the FQHC’s completed Form CMS-855A application: • Exhibit 177 (Attestation Statement) signed and dated by an authorized official (as defined in 424.502). To attest to being in compliance, the facility must be open and operating when the attestation is signed. Since FQHCs must sign an agreement stipulating that they will comply with § 1861(aa)(4) of the Act and specific FQHC regulations, this statement serves as the Medicare FQHC benefit (or provider/supplier) agreement when it is also signed and dated by PEOG. (See Pub. 100-07, chapter 2, section 2826B.) • HRSA Notice of Grant Award (NOA) or FQHC Look-Alike Designation that: (1) includes an address for the site of the applicant which matches the practice location reported on the Form CMS-855A; and (2) has valid project period and budget period dates (designation period and annual certification period dates for the FQHC Look-Alike document). A Notice of Grant Award by HRSA verifies that the applicant qualifies as a FQHC grant recipient; the FQHC Look-Alike Designation Memo from HRSA verifies look-alike status. • Form CMS-588; Electronic Funds Transfer (EFT) Authorization Agreement. • Clinical Laboratory Improvement Act (CLIA) Certificate (if applicable). Facilities that examine human specimens for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings is considered a laboratory and must meet CLIA requirements. These facilities must apply and obtain a certificate from the CLIA program that corresponds to the complexity of tests performed. Certain types of laboratories and laboratory tests are NOT subject to meeting CLIA requirements. One example would be facilities which serve only as collection stations. A collection station receives specimens to be forwarded to a laboratory performing diagnostics test. Pub. 100-07, chapter 6, section 6002 provides additional details regarding laboratories and laboratory tests NOT subject to CLIA requirements. It is the FQHC’s responsibility to review the CLIA requirements and obtain a CLIA certificate if needed. Neither the contractor nor CMS determines whether the FQHC needs to obtain and submit a CLIA certificate. • Copy of state license (if applicable). The state license must be effective and cannot have expired. The facility name and address must be listed on the license. 2. General Processing Concepts (A) Practice Locations - An FQHC cannot have multiple sites or practice locations. Each location must be separately enrolled and will receive its own CCN. Moreover, an FQHC cannot share a practice location. There must be a suite number, floor, etc. to distinguish it from another facility that shares the same building address. (B) Date on the NOA - The project period (Line 26 of the NOA) and budget period (Line 19 of the NOA) must be valid through the date on which the FQHC’s application was complete (as determined by the contractor). For the HRSA Look-Alike document, the designation period (Line 6) and Annual Certification Period (Line 7) must be valid through the date on which the FQHC’s application was complete (as determined by the contractor). The contractor shall develop for a correct NOA date(s) if either the project period or budget period (or designation period and annual certification period) do not meet the above-mentioned requirement. (In developing for this data, the contractor may (but is not required to) send the “Reminder and Assistance for Health Centers for CMS FQHC Site Enrollment” guidance to the FQHC.) (C) Practice Location Address on NOA - The practice location must be on the HRSA NOA or HRSA Look-Alike document and match the address on the Form CMS-855A. If the location information is not on the current NOA, an expired NOA that has the address in the terms and conditions (or the Self Update print-out) can be referenced alongside the official NOA as supporting documentation. The award number, project period, and budget period on the Self- Update must match the current official NOA and must say ACTIVE. The Self Update print-out by itself is not acceptable in lieu of the official HRSA Notice of Award. (D) Name on Exhibit 177 - The contractor shall ensure that Exhibit 177 contains the same legal business name, DBA or practice location 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. (E) Date on Exhibit 177 - The contractor shall ensure that the date on which the Exhibit 177 was signed is on or after the date the FQHC listed as its effective date in Section 4 on the Form CMS- 855A application. If the Exhibit 177 was signed prior to the listed effective date, the contractor shall (using the development procedures outlined in this chapter) develop for an Exhibit 177 signed on or after the FQHC’s listed effective date; the FQHC should be providing services in order to meet the regulations noted in Exhibit 177. (F) Date Application Complete - When reviewing an initial FQHC application, the contractor shall determine 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, so the contractor requested additional information. The two elements were submitted on March 30. The contractor shall therefore indicate the March 30 date in its approval letter as the CCN/PTAN effective date of the FQHC. The CCN/PTAN effective date cannot be made retroactive (see section 10.6.2). (G) Contractor Jurisdiction - Except for tribal and Urban Indian FQHCs, a freestanding FQHC that is initially enrolling is assigned to the Medicare Administrative Contractor (MAC) that covers the state in which the FQHC is located. An initially enrolling tribal or Urban Indian FQHC is assigned to the Jurisdiction H MAC. (H) Tribal/Urban Indian Organizations – Certain outpatient health programs or facilities may be operated by a tribe or tribal organization or by an Urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act. The contractor shall confirm the applicant’s attestation and tribal/urban Indian status if the FQHC indicates on the application that it has such status; several means are available: • The applicable Indian Health Service (IHS) web link at https://www.ihs.gov/locations/. The contractor can search for the facility by clicking on the “Find Health Care” sub-link https://www.ihs.gov/findhealthcare/?CFID=15011511&CFTOKEN=36378825 or downloading the Excel complete listing of HIS facilities. (These are the highly recommended means of verification.) • Contacting (1) the IHS directly, (2) contacting the applicable SOG Location, or (3) the contractor’s PEOG BFL. (I) Potential RHC Relationship – On occasion, a rural health clinic (RHC) may seek to convert to an FQHC. (A supplier cannot be both an RHC and an FQHC and occupy the same practice location.) Accordingly, in its review of an initial FQHC application, the contractor shall check PECOS to determine whether an RHC is enrolled at the same location. If one is, the contractor shall refer the matter to MedicareProviderEnrollment@cms.hhs.gov. In doing so, the contractor shall furnish to PEOG (1) the names, NPIs, and shared address of the RHC and FQHC, and (2) a copy of all information submitted with the FQHC application; the e-mail’s subject line shall state: “RHC & FQHC shared address”. 3. Determination a. Approval The contractor shall contact PEOG via email at MedicareProviderEnrollment@cms.hhs.gov if it believes that the FQHC’s initial application should be approved. The contractor shall provide to PEOG: (1) a copy of the draft approval letter (see section 10.7.5.1(N) of this chapter for a model FQHC approval letter); (2) the Form CMS-855A application or PECOS Application Data Report (ADR) and all supporting documentation; (3) a copy of the FQHC’s HRSA documentation; (4) Exhibit 177; and (5) the valid state license IF the facility is located in California.. While awaiting PEOG’s final determination---and beginning on the date following the sending of the above-mentioned e-mail---the application processing time clock is stopped. It resumes on the date on which the contractor receives PEOG’s decision. Communication between the contractor and PEOG during this “waiting period” (e.g., PEOG request for additional information from the contractor) does not restart the clock. (As required per section 10.6.21 of this chapter, the e-mail subject line shall include the following: SUBJECT LINE: S&C: Facility Type; Application Type; Facility Name; National Provider Identifier; CCN; Application Receipt Date (MMDDYY*) (*Date the Contractor Received the Application from the Provider/Supplier). (Note, however, that this data need not be duplicated in the e-mail’s body.)) b. Denial If the contractor believes that the FQHC’s application should be denied, the contractor shall notify the applicant of the denial using the appropriate model letter guidance in section 10.7.8 of this chapter. If the contractor is uncertain as to whether a denial is warranted or what the appropriate denial ground under 42 CFR 424.530(a) should be, it may contact its PEOG BFL for guidance. 4. Post-PEOG Review and Response to Contractor If PEOG determines (based on the information the contractor furnished) that the FQHC’s application should be approved, PEOG will: • Assign the CCN, which will be part of the 1000-1199 or 1800-1989 series • Assign the effective date, which will be the date the FQHC application was considered complete by the contractor • Make any necessary revisions to the draft approval letter • Sign and date the attestation using the completion date, which is also the effective date (Exhibit 177) • E-mail all of the foregoing documents and data to the contractor, at which point the aforementioned processing time clock resumes. 5. Post-Approval Contractor Action If PEOG notifies the contractor that the FQHC’s application should be approved, the contractor shall send the approval letter to the FQHC with a copy of the signed Exhibit 177. D. Changes of Information 1. Location Changes a. Verification If an FQHC is changing the physical location of an existing site, the FQHC must submit the following documentation (as applicable to that FQHC) to the contractor: • For §330 grantees, a HRSA Notice of Grant Award approving the physical location change and the new address; or • For look-alikes, an updated Notice of Look-Alike Designation from HRSA approving the physical location change and listing the new address. (Consistent with the instructions in this chapter, the contractor shall develop for this documentation with the FQHC if the latter fails to submit it.) For tribal/Urban Indian organizations, the contractor may confirm the new location via the IHS website or by contacting IHS. (See section 10.2.1.4(C)(2)(G) above for the web link.) In all cases, the new address listed on the notice of grant award (NOA), IHS website, etc., must match that listed on the Form CMS-855A change request. If it does not, the contractor shall develop with the FQHC for clarification consistent with the instructions in this chapter. In addition, both the budget date and the project date on the NOA (or designation period and annual certification period on the Look-Alike document) must be valid through the date on which the FQHC’s change request application was complete (as determined by the contractor). The contractor shall develop for a correct NOA date(s) if either the project period and/or budget period or the designation period and/or annual certification period do not meet the above- mentioned requirement. b. Approval If approving the location change or updating the contact information (as described in section 10.6.1.2 of this chapter), the contractor does not issue a recommendation of approval to the SOG Location, notwithstanding any instruction to the contrary in this chapter; rather, the contractor shall approve the location change in PECOS and issue an approval letter to the FQHC (with an e- mailed copy to PEOG at MedicareProviderEnrollment@cms.hhs.gov (Subject line: FQHC COI—Facility Name, Address Change/Contact Change/Other, NPI, PTAN). PEOG will update ASPEN accordingly.). Beginning on March 15, 2021, tie-in notices will not be issued for address changes. c. Denial If the contractor does not approve the location change (i.e., the FQHC is no longer located in a shortage area, the FQHC fails to submit the applicable HRSA supporting documentation after contractor development (discussed above), or another reason is implicated), the contractor shall refer the matter to PEOG at ProviderEnrollmentRevocations@cms.hhs.gov consistent with all applicable instructions in this chapter and other CMS directives. (The referral shall include, at a minimum, the FQHC’s LBN and NPI as well as a brief explanation of the situation and the reason for referral.) PEOG will review the matter and instruct the contractor on how to proceed. 2. LBN, TIN, or DBA Name Changes Not Involving a CHOW The contractor shall process LBN, TIN, or DBA name changes not involving a CHOW consistent with the instructions in sections 10.6.1.2(B)(1) and (3) of this chapter. No notification to the state or SOG Location regarding the change is needed. 3. All Other Change Requests For all change requests not described in subsections (D)(1) and (2) above, the contractor shall follow the instructions in sections 10.6.1.2(C)(1) and (2) of this chapter. E. Changes of Ownership (CHOWs) This section 10.2.1.4(E) addresses procedures for processing FQHC CHOWs. Except as noted otherwise, these instructions take precedence over those in section 10.6.1.1.3 et seq. of this chapter. For background information on CHOWs (which, for purposes of section 10.2.1.4(E), includes acquisitions/mergers and consolidations) and potential CHOW situations, see sections 10.6.1.1.1 and 10.6.1.1.2 of this chapter. The contractor shall, as needed, refer to these instructions in examining whether a CHOW has occurred. In reviewing said sections, the contractor shall note the following: • The “provider agreement” for FQHCs is the Exhibit 177. • No recommendations to the state or SOG Location are involved. The contractor and PEOG alone will handle the transaction. In particular, the contractor---in lieu of making a recommendation to the state/SOG Location---will send its “final analysis” to PEOG. PEOG will then: (i) review the transaction; (ii) determine whether the CHOW should be approved; (iii) as needed, update ASPEN and perform any other related tasks; and (iv) notify the contractor of the results of its review and provide any required direction. The above- described process, in effect, combines a recommendation to the state/SOG Location and the contractor’s post-recommendation e-mail to PEOG (described in section 10.6.1.1.3.3(B)) into a single step. For purposes of this section 10.2.1.4(E), the term “final analysis” (in the context of FQHC CHOWs) is roughly the equivalent of a recommendation to the state. Accordingly, when sending its “final analysis” to PEOG as described above, the contractor may—but is not required to—change the application’s status in PECOS to “approval recommended.” In addition---and except as otherwise stated---the contractor shall adhere to the following subsections and instructions in sections 10.6.1.1.3 et seq. and 10.6.1.1.4: (i) Section 10.6.1.1.3.1(A) (This does not include the list of documents in section 10.6.1.1.3.1(A)(iii), although all other instructions in section 10.6.1.1.3.1(A)(iii) shall be followed (e.g., development for missing/deficient documents). The required FQHC CHOW documents are identified in this section 10.2.1.4(E).) (ii) Section 10.6.1.1.3.1(B) (Regarding section 10.6.1.1.3.1(B)(4), the contractor shall make this referral to PEOG before (and separate from) sending its final analysis to PEOG.) (iii) Sections 10.6.1.1.3.1.1(A)(1), (A)(2), (A)(3), (B)(1), (B)(2), (B)(3)(a) and (c), (F), and (G). (The contractor can disregard references to state recommendations in these sections.) The remaining topics/instructions in section 10.6.1.1.3.1.1 are either inapplicable to FQHC CHOWs or addressed in this section 10.2.1.4(E). (iv) Sections 10.6.1.1.4(A), (B), (C), (D), (E), (F), (G), and (H) (With respect to the application of 10.6.1.1.4(C) to FQHC CHOWs, receipt of an approval recommendation from the state (as described in 10.6.1.1.4(C)) is the equivalent of the contractor sending its final analysis to PEOG.) The following instructions address FQHC-specific CHOW processing activities that the contractor shall follow in addition to the procedures contained in the section 10.6.1.1 et seq. subsections outlined in (i) through (iv) above. If any inconsistency exists between these two sets of instructions (i.e., recommending approval to the state as described in 10.6.1.1 et seq. versus making a final analysis to PEOG as described below), the latter takes precedence. 1. Special Processing Steps a. Required Documents – The contractor shall ensure that the FQHC submits all documentation otherwise required per this chapter. For FQHC CHOW purposes, this also includes: • Legal Documentation of CHOW - The legal documents that governed the transaction, such as a sales agreement, bill of sale, or transfer agreement. (See section 10.6.1.1.3.1.1(B) for more information on such documents.) • Evidence of state licensure of the new entity, if applicable. (This can be furnished consistent with existing instructions in this chapter concerning submission of evidence of state licensure.) • Exhibit 177 containing the new owner’s information. • HRSA NOA or FQHC Look-Alike Designation containing the new owner’s information. (NOTE: Both the budget date and the project date on the NOA (or designation period and annual certification period on the HRSA Look-Alike document) must be valid through the date on which the FQHC’s CHOW application was complete (as determined by the contractor). The contractor shall develop for a correct NOA date(s) if either the project period and/or budget period or the designation period and/or annual certification period dates do not meet the above-mentioned requirement.) b. Old and New Owner Applications i. Order of Receipt - To the maximum extent practicable, FQHC CHOW applications from the previous and new owners should be processed as they arrive. ii. Non-Receipt of Previous Owner’s Application – Although the contractor shall attempt to collect the old owner’s application, it may make its final analysis without it. c. Relocation of Entity - A new owner may seek to relocate the FQHC concurrent with a CHOW. In such cases, the contractor shall ensure that the FQHC submits (along with the documents in (E)(1)(a) above): • For § 330 grantees, a Notice of Grant Award approving the physical location change and the new address; or • For look-alikes, an updated Notice of Look-Alike Designation from HRSA approving the physical location change and listing the new address. For tribal/Urban Indian organizations, the contractor may confirm the new location via the IHS website or by contacting IHS. (See section 10.2.1.4(C)(2)(H) above for the web link.) The new address listed on the notice of grant award, IHS website, etc., must match that on the Form CMS-855A CHOW application. If it does not, the contractor shall develop with the FQHC for clarification consistent with the instructions in this chapter. Notwithstanding the foregoing, the entire transaction shall be processed as a CHOW rather than a COI. d. Intervening Change of Ownership In situations where the FQHC (1) submits a Form CMS-855 initial application or CHOW application and (2) subsequently submits a Form CMS-855 CHOW application, the contractor shall adhere to the following: Situation 1 – The FQHC submitted an initial application followed by a CHOW application, and the contractor has not yet sent its final analysis to PEOG: The contractor shall return both applications and require the FQHC to re-submit an initial application with the new owner’s information. Situation 2 - The FQHC submitted a CHOW application followed by another CHOW application, and the contractor has not yet sent its final analysis to PEOG regarding the first application: The contractor shall process both applications, preferably in the order they were received. When sending its final analysis to PEOG, the contractor shall explain the dual CHOW application submission. Situation 3 - The FQHC submitted an initial application followed by a CHOW application, and the contactor has sent its final analysis of the initial application to PEOG but before it has notified the FQHC of the approval of the initial application: The contractor shall: • Return the CHOW application. • Notify PEOG via e-mail that a change of ownership has occurred (the new owner should be identified) and that the contractor will require the FQHC to resubmit a new initial application containing the new owner’s information. • Request via letter that the FQHC submit a new initial Form CMS-855 application containing the new owner’s information within 30 days of the date of the letter. If the FQHC fails to do so, the contractor shall return the originally submitted initial application and notify the FQHC accordingly. If the FQHC submits the requested application, the contractor shall process it consistent with the instructions in this chapter; the originally submitted initial application becomes moot. If the newly submitted/second initial application is denied, however, the first submitted application is denied as well; the contractor shall notify the FQHC accordingly. Situation 4 - The FQHC submitted a CHOW application followed by another CHOW application, and the contactor has sent its final analysis of the first CHOW application to PEOG but before it has notified the FQHC of the approval thereof - The contractor shall: • Notify PEOG via e-mail that (1) a subsequent change of ownership has occurred (the new owner should be identified) and (2) the contractor will require the FQHC to resubmit a new CHOW application containing the subsequent/second new owner’s information. • Process the new/second CHOW application as normal. If a final analysis to PEOG is made for this application, the contractor shall explain this situation in its e-mail; the first CHOW application becomes moot. If the newly submitted/second CHOW application is returned or rejected per the instructions in this chapter, the first application should, too, be returned or rejected (as applicable). The contractor shall notify the provider and PEOG accordingly. 2. Post-Initial Review Actions and Scenarios After the contractor completes the tasks described in the above-referenced sections, several results are possible. These are discussed below. Should the contractor encounter a scenario not addressed herein, it may contact its PEOG BFL for guidance prior to its final analysis. As a reminder, nothing in this section 10.2.1.4(E)(2) prohibits the contractor from returning or rejecting the application if otherwise permitted to do so per this chapter. a. The contractor ascertains that the transaction falls within the scope of § 489.18 and that the new owner has accepted assignment – If there are no apparent grounds for denying the CHOW application, the contractor shall send its final analysis to PEOG via e-mail at MedicareProviderEnrollment@cms.hhs.gov with the following information and documents: (1) the Form CMS-855 application or PECOS Application Data Report; (2) a copy of the final sales/transfer agreement; (3) a copy of the provider-signed Exhibit 177; and (4) NOA. PEOG will countersign the Exhibit 177 and assign an effective date of the CHOW based on the date the application was complete (as determined by the contractor). Within 5 business days of receiving from PEOG the signed Exhibit 177 and effective date, the contractor shall: (1) send the CHOW approval letter and a copy of the CMS-countersigned Exhibit 177 to the FQHC; and (2) switch the PECOS record to “approved” consistent with existing instructions. If a denial ground exists, however, the contractor shall refer the matter to its PEOG BFL for guidance notwithstanding any other instruction in this chapter to the contrary. The contractor should include an explanation of the ground(s) it believes exists for the denial (including the regulatory citation); the e-mail referral shall state in the subject line “FQHC Guidance Required.” b. The contractor ascertains that the transaction falls within the scope of § 489.18 but the new owner has not accepted assignment – The contractor shall: (a) return the application; and (b) notify the new owner in the return letter that it must submit the following within 30 days from the date of the return letter: (1) an initial Form CMS-855 application to enroll as a new FQHC; and (2) a voluntary termination application for the existing FQHC. If the new owner fails to do so within 30 days of the request, the contractor shall contact its PEOG BFL via e-mail with this information notwithstanding any other instruction to the contrary in this chapter. PEOG will review the matter and respond to the contractor. c. The contractor ascertains that the transaction does not fall within the scope of § 489.18 (e.g., stock transfer), regardless of whether the new owner accepted assignment - This qualifies as an ownership change under 42 CFR § 424.516 rather than a CHOW under § 489.18. The contractor shall: (A) return the application; and (B) notify the FQHC in the return letter that it must submit a Form CMS-855 application to report the ownership change within 30 days of the return letter and provide all supporting documentation (including a revised NOA and agreement). If the provider fails to do so, the contractor shall contact its PEOG BFL via e-mail with this information notwithstanding any other instruction to the contrary in this chapter. F. Timeframes and Alternatives While awaiting PEOG’s final determination (and beginning on the date following the sending of the aforementioned e-mail) for the applications described in subsections (C), (D), and (E), the application processing time clock is stopped. It resumes on the date on which the contractor receives PEOG’s decision. Communication between the contractor and PEOG during this “waiting period” (e.g., PEOG request for additional information from the contractor) does not restart the clock. In addition, nothing in this section 10.2.1.4 negates other processing alternatives outlined in this chapter that can apply to the processing of FQHC applications. G. Supporting Documentation 1. Revalidations Upon revalidation of an FQHC site, the FQHC must submit --- along with any other supporting documentation required per this chapter --- either an NOA (for awardees) or notice of look-alike designation (NLD, for look-alikes) approving the site. If an NOA or NLD is unavailable for the site, a copy of the FQHC's "Form 5B: Service Sites" list downloaded from HRSA’s Electronic Handbooks documenting all of the provider’s approved FQHC program sites is acceptable. However, any NOA, NLD, or Form 5B must include the physical address of the site in question that matches the physical address on file with CMS and the address submitted on the Form CMS-855A application. If the addresses do not match, the contractor shall develop for additional information. 2. Initial Applications, CHOWs, and Location Changes The contractor cannot accept a copy of the Form 5B as documentation for initial applications, CHOWs, and new/changed FQHC locations. As explained previously, only a valid, “in effect” NOA or NLD is acceptable. H. Revocations and Other Transactions Except as otherwise stated or required by CMS, the contractor shall continue to adhere to the applicable instructions in this chapter and all other CMS directives regarding: • Potential FQHC revocations and referrals (including sending the referral/information to the appropriate PEOG mailbox) • Changes of ownership • Changes of information • Revalidations • Reactivations I. Complaint Investigations The CMS SOG Locations investigate complaints that raise credible allegations of an FQHC’s noncompliance with health and safety standards found at 42 CFR 405 Subpart X, and 42 CFR 491 Subpart A (except for 42 CFR § 491.3). The contractor shall refer such complaints to the SOG Location that has jurisdiction over the FQHC. J. FQHC DPV Errors (This only applies to initial applications (subsection (C)(1) above) and location changes (subsection (D)(1).) A site visit for FQHCs is generally not required. However, the contractor shall order a site visit if there is a DPV error. The site visit shall be ordered before the contractor sends the applicable e-mail described in subsections (C)(3)(a) and (D)(1)(b) above. If the site visit finds that the facility is not open and operational, the contractor shall deny the application. If the facility is open and operational, the contractor can proceed as normal. K. Additional Data 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, subpart X • Pub. 100-07, chapter 2, sections 2825 – 2826H • Pub. 100-07, chapter 9, exhibits 177 and 179 • Admin Info 21 06-ALL – Transitioning FQHC Certification Enrollment Performed by the CMS SOG (Standard Operating Procedures attached) • Pub. 100-04, chapter 9 • Pub. 100-02, chapter 13 For additional information on the appropriate contractor jurisdictions for incoming FQHC enrollment applications, see Pub. 100-04, chapter 1, section 20 as well as Pub. 100-07, chapter 9, exhibit 179.