Bucksport Regional Health Center, DAB CR5959 (2021)

DECISION

Petitioner, Bucksport Regional Health Center, is a federally qualified health center, located in Bucksport, Maine, that participates in the Medicare program.  When it acquired a second location in Ellsworth, Maine, it applied to enroll that location in the Medicare program as well.  The Centers for Medicare & Medicaid Services (CMS) granted Petitioner’s enrollment application, effective February 5, 2019.  Petitioner now challenges that effective date.  

CMS moves for summary judgment.  Because I find that the undisputed evidence establishes that CMS appropriately granted Petitioner’s Medicare enrollment effective February 5, 2019, I grant CMS’s motion.

Background

In a letter dated February 6, 2019, CMS advised Petitioner that it approved the health center’s request to participate in the Medicare program as a Federally Qualified Health Center (FQHC), effective February 5, 2019. CMS Ex. 8.  Petitioner sought reconsideration, asking that its effective date of enrollment be changed to September 17, 2018, the day the center began seeing patients. CMS Ex. 10. In a reconsidered determination dated June 25, 2019, CMS denied Petitioner an earlier effective date,

Page 2

concluding that, on February 5, 2019, CMS accepted Petitioner’s signed agreement assuring that the FQHC met all federal requirements, so February 5 is the appropriate effective date of its enrollment. CMS Ex. 11.

Petitioner appealed.  

CMS moves for summary judgment.

With its prehearing brief and motion for summary judgment (CMS Br.), CMS submits 11 exhibits (CMS Exs. 1-11). Petitioner submits its own brief (P. Br.) and five exhibits (P. Exs. 1 5).

Discussion

CMS is entitled to summary judgment because the undisputed evidence establishes that it accepted the FQHC’s signed agreement on February 5, 2019, and, by regulation (42 C.F.R. § 489.13(a)(2)), that is the correct effective date for the FQHC’s Medicare enrollment.1

Summary Judgment.  To grant summary judgment, I must draw all reasonable inferences in the light most favorable to the non-moving party and find that the case presents no genuine issues of material fact and that the moving party is entitled to judgment as a matter of law.  1866ICPayday.com, L.L.C., DAB No. 2289 at 2-3 (2009); Illinois Knights Templar Home, DAB No. 2274 at 3-4 (2009), and cases cited therein.

Program requirements.  To receive payments for services furnished to program beneficiaries, a provider or supplier must be enrolled in the Medicare program.  42 C.F.R. § 424.505.  To enroll in Medicare, a prospective provider or supplier must complete and submit an enrollment application.  42 C.F.R. §§ 424.510(d)(1), 424.515(a).  Enrolling as an FQHC, however, requires some additional preliminary steps.  

The Social Security Act (Act) defines an FQHC as an entity that receives or is qualified to receive a Public Health Services grant or is operated by a tribe or tribal organization funded under the Indian Healthcare Improvement Act.  Act § 1861(aa)(4); 42 C.F.R. § 405.2401.  The entity must show that it meets the statutory definition of an FQHC and that it complies with the requirements of 42 C.F.R. part 491 and 42 C.F.R. subpart X (§§ 405.2400 – 405.2472).  42 C.F.R. §§ 405.2430; 405.2434(a).  

When all requirements are met, “CMS sends the entity two copies of an agreement [referred to as the “Attestation Statement for Federally Qualified Health Centers”].  The

Page 3

entity must sign and return both copies of the agreement to CMS.”  42 C.F.R. § 405.2430(a)(3).  CMS returns one copy, with notice of acceptance, specifying the effective date.  42 C.F.R. § 405.2430(a)(4); see Family Health Services of Darke County, Inc., DAB No. 2269 at 7-8 (2009).

The effective date of CMS’s agreement with an FQHC is the date on which CMS accepts a signed agreement assuring that the FQHC meets all federal requirements.  42 C.F.R. § 489.13(a)(2); see 42 C.F.R. § 405.2434(b).

CMS will not accept that agreement until the Health Resources and Services Administration (HRSA) – an agency of the Department of Health and Human Services – verifies that the entity meets the requirements of the Public Health Services Act.  42 C.F.R. § 405.2430(b); see 42 C.F.R. § 405.2401.2

Where the FQHC provides services at more than one location, each must separately enroll in the Medicare program.  42 C.F.R. § 491.5(a)(3)(iii).  And the same requirements for enrollment apply. 

Here, the undisputed evidence establishes that:

• On November 1, 2018, the Medicare contractor received an application to add Bucksport’s new practice location.  CMS Ex. 2.  However, Petitioner submitted the wrong enrollment form and did not include required documentation. CMS Ex. 2 at 9-10.

• In a notice dated November 6, 2018, the contractor advised Petitioner that it had closed the November 1 enrollment application.  CMS Ex. 2 at 13.  The notice explained that each of Petitioner’s practice locations had to be separately enrolled and directed Petitioner to submit an initial enrollment application. CMS Ex. 2 at 15.  

• More than a month later, on December 11, 2018, Petitioner submitted a new enrollment application.  CMS Ex. 3.  However, the application again did not include required documentation.  CMS Ex. 3 at 5-7.

• By email correspondence, dated December 24 and 31, 2018, the contractor directed Petitioner to submit the missing documentation, including a newly signed and dated certification statement, an attestation statement (“CMS Exhibit 177”), and a HRSA Notice of Grant Award, listing the practice location and current budget period.  CMS Ex. 3 at 17; CMS Ex. 4 at 8.  The contractor warned that it

Page 4

might reject the application if Petitioner did not furnish the required information within 30 days. CMS Ex. 4 at 8. 

• On January 4, 2019, Petitioner submitted some, but not all, of the requested information. CMS Ex. 4 at 20.

• By email, dated January 15, 2019, the contractor again asked Petitioner to submit an attestation statement and Notice of Grant Award and to make some additional changes.  CMS Ex. 4 at 23. Petitioner complied the following day. CMS Ex. 4 at 32; CMS Ex. 5 at 14-17.  

• Petitioner’s submissions required corrections, which Petitioner supplied on January 22, 2019.  The contractor verified the information and forwarded the application to CMS on January 24. CMS Ex. 4 at 37;  CMS Ex. 7.

• On February 5, 2019, CMS accepted Petitioner’s signed agreement assuring that the FQHC met all federal requirements. CMS Ex. 8.

Because CMS accepted Petitioner’s signed agreement on February 5, 2019, by regulation, February 5 is Petitioner’s enrollment date.  42 C.F.R. § 489.13(a)(2).  

Petitioner disputes none of these facts, nor even CMS’s conclusions of law.  Instead, it asks for an earlier date “based on patient and community needs.”  P. Br. at 1.  Petitioner also points to the difficulties it encountered “in obtaining correct application processing” from the contractor and CMS, “which prolonged [its] application [process].”  P. Br. at 1.  

For purposes of summary judgment, I accept as true all of Petitioner’s factual allegations.  I am, however, bound by the effective date provisions of section 489.13 and have no authority waive them, notwithstanding an applicant’s compelling equitable arguments. Family Health Servs. of Darke County, DAB No. 2269 at 19.

Conclusion

Because CMS accepted Petitioner’s signed agreement on February 5, 2019, CMS properly granted its Medicare enrollment effective that date.  I therefore grant CMS’s motion for summary judgment.

1. I make this one finding of fact/conclusion of law.
• back to note 1
2. HRSA’s mission is to “improve health and achieve health equity through access to quality services, a skilled health workforce, and innovative programs.” www.hrsa.gov.
• back to note 2