Skip to main content


U.S. flag
      An official website of the United States government
              Here’s how you know
        Here’s how you knowDot gov**Official websites use .gov**
                 A **.gov** website belongs to an official government organization in the United States.
                  HTTPS**Secure .gov websites use HTTPS**
                 A **lock** (A locked padlock) or **https://** means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites. 
  Menu Close
          HHS Search block
    Search
        








  
  
    

  
      

                                      About HHS
    
                        
                              
      
      
      Programs & Services
    
                        
                              
      
      
      Grants & Contracts
    
                        
                              
      
      
      Laws & Regulations Breadcrumb
    Home
                              About
                              Agencies
                              DAB
                              Decisions
                              ALJ Decisions
                              2021
                              Bucksport Regional Health Center, DAB CR5959 (2021)
 Navigate to:
  Departmental Appeals Board (DAB)
    
                                                  
                                                    
            
      
      
      
      About DAB
                                            
            
            Organizational Overview
    
                                                  
                              
            
      
      
      
      Who are the Judges?
    
                                                  
                              
            
      
      
      
      DAB Divisions
    
                                                  
                              
            
      
      
      
      Contact DAB
    
                                                  
                                                    
            
      
      
      
      Filing an Appeal Online
                                            
            
            DAB E-File
    
                                                  
                              
            
      
      
      
      Medicare Operations Division (MOD) E-File
    
                                                  
                                                    
            
      
      
      
      Different Appeals at DAB
                                            
            
            Appeals to DAB Administrative Law Judges (ALJs)
                          
            
            Forms
    
                                                  
                              
            
      
      
      
      Procedures
    
                                                                
                                                    
            
      
      
      
      Appeals to Board
                          
            
            Practice Manual
    
                                                  
                              
            
      
      
      
      Guidelines
    
                                                  
                              
            
      
      
      
      Regulations
    
                                                  
                              
            
      
      
      
      National Coverage Determination Complaints
    
                                                                
                                                    
            
      
      
      
      Appeals to the Medicare Appeals Council (Council)
                          
            
            Forms
    
                                                  
                              
            
      
      
      
      Fully Integrated Duals Advantage (FIDA) Demonstration Project
    
                                                  
                                                    
            
      
      
      
      Alternative Dispute Resolution Services
                                            
            
            Sharing Neutrals
    
                                                  
                              
            
      
      
      
      ADR Training
    
                                                  
                              
            
      
      
      
      Other ADR Services
    
                                                  
                                                    
            
      
      
      
      DAB Decisions
                                            
            
            Board Decisions
    
                                                  
                              
            
      
      
      
      DAB Administrative Law Judge (ALJ) Decisions
    
                                                  
                              
            
      
      
      
      Medicare Appeals Council (Council) Decisions
    
                                    
                              
            
      
      
      
      Stakeholder Feedback
    
                                                  
                                                    
            
      
      
      
      Careers
                                            
            
            Open Career Opportunities
    
                                                  
                              
            
      
      
      
      Internships & ExternshipsText resize icon

                    




Bucksport Regional Health Center, DAB CR5959 (2021)








  
  
    

  
      
Department of Health and Human Services 
    DEPARTMENTAL APPEALS BOARD
          Civil Remedies Division





Bucksport Regional Health Center
(NPI:  1043271133)
(PTAN:  201940),
Petitioner,

v.

Centers for Medicare & Medicaid Services.
Docket No. C-19-1041Decision No. CR5959October 15, 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.


          /s/
        Carolyn Cozad Hughes

                      Administrative Law Judge
      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 Back to top
    Contact HHS
    
                        
                                            
      
      
      Careers
    
                        
                                            
      
      
      HHS FAQs
    
                        
                                            
      
      
      Nondiscrimination NoticeHHS Archive
    
                        
                                            
      
      
      Accessibility Statement
    
                        
                                            
      
      
      Privacy Policy
    
                        
                                            
      
      
      Viewers & PlayersBudget/Performance
    
                        
                                            
      
      
      Inspector General
    
                        
                                            
      
      
      Web Site Disclaimers
    
                        
                                            
      
      
      EEO/No Fear ActFOIA
    
                        
                                            
      
      
      The White House
    
                        
                                            
      
      
      USA.gov
    
                        
                                            
      
      
      Vulnerability Disclosure Policy
        Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases.

Sign Up
  HHS Headquarters
          200 Independence Avenue, S.W.
                  Washington, D.C. 20201
                  Toll Free Call Center: 1-877-696-6775​ Disclaimer Policy: Links with this icon () mean that you are leaving the HHS website. The Department of Health and Human Services (HHS) cannot guarantee the accuracy of a non-federal website.
                  Linking to a non-federal website does not mean that HHS or its employees endorse the sponsors, information, or products presented on the website. HHS links outside of itself to provide you with further information.
                  You will be bound by the destination website's privacy policy and/or terms of service when you follow the link.
                  HHS is not responsible for Section 508 compliance (accessibility) on private websites. For more information on HHS's web notification policies, see Website Disclaimers.
 Continue
                  Go back