The Wright Center Medical Group, CR6426 (2024)

DECISION

Petitioner, The Wright Center Medical Gro up, is a federally qualified health center (FQHC), located in Wilkes Barre, Pennsylvania, that applied to enroll in the Medicare program.  The Centers for Medicare & Medicaid Services (CMS) granted Petitioner’s enrollment application, effective February 22, 2023.  Petitioner now challenges that effective date. 

For the reasons discussed below, I find that CMS appropriately granted Petitioner’s Medicare enrollment effective February 22, 2023. 

Background

In a letter dated April 11, 2023, the Medicare contractor, Novitas Solutions (acting on behalf of CMS) advised Petitioner that it approved the health center’s request to participate in the Medicare program as an FQHC, effective February 22, 2023.  CMS Ex. 8.  Petitioner sought reconsideration, asking that its effective date of enrollment be changed to January 16, 2023.  Petitioner argued that the contractor’s inaction delayed approval of its application:  “If [the contractor’s employee] had returned our call on January 16th[,] this could have been resolved that day.”  CMS Ex. 9. 

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In a reconsidered determination, dated June 29, 2023, CMS denied Petitioner an earlier effective date, concluding that, on February 22, 2023, CMS accepted Petitioner’s signed agreement assuring that the FQHC met all federal requirements, so February 22 is the appropriate effective date of its enrollment.  CMS Ex. 10. 

Petitioner appealed, and the matter is now before me. 

CMS moves for summary judgment.  However, because neither party proposes any witnesses, an in-person hearing would serve no purpose.  See Acknowledgment and Pre-hearing Order at 4, 5-6, (¶¶4(c)(iv), 8-10) (August 29, 2023).  I may therefore decide this case based on the written record, without considering whether the standards for summary judgment are satisfied. 

CMS submits its motion and brief (CMS Br.) with ten exhibits (CMS Exs. 1-10).  Petitioner submits a response to CMS’s motion and brief (P. Response) with ten exhibits (P. Exs. 1-10).  Petitioner’s exhibits are not marked as directed by my order.  Pre-hearing Order at 4 (¶5).  Moreover, with one exception, Petitioner duplicates CMS’s exhibits.  P. Exs. 2-7 duplicate CMS Exs. 1-6; and P. Exs. 8-10 duplicate CMS Exs. 8-10.  I decline to admit duplicate exhibits.  In the absence of objections, I admit into evidence CMS Exs. 1-10 and P. Ex. 1.  

Discussion

CMS accepted the FQHC’s signed agreement on February 22, 2023, and, by regulation (42 C.F.R. § 489.13(a)(2)), that is the correct effective date for the FQHC’s Medicare enrollment.¹

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 – 405.2470).  42 C.F.R. §§ 405.2430; 405.2434(a). 

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

Here, the undisputed evidence establishes that:

• On January 9, 2023, the Medicare contractor received Petitioner’s application to enroll in the Medicare program as an FQHC.  CMS Ex. 1. 
• In a letter dated January 13, 2023, the contractor asked Petitioner for additional information:  a signed and dated copy of the Attestation Statement (Exhibit 177), explaining that the statement submitted did not have a valid legal business name.³  CMS Ex. 3 at 1.  The notice warned that, if Petitioner did not submit the requested information within 30 calendar days from its postmarked/emailed date, the contractor might reject the application.  Id.  
• On January 24, 2023, Petitioner submitted another Attestation Statement, but the new submission did not correct the problem with the business name.  CMS Ex. 4 at 4. 
• In a letter dated February 14, 2023, the contractor rejected Petitioner’s enrollment application, stating the applicant “failed to provide a signed and dated copy of the

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Attestation for Federally Qualified Health Center (Exhibit 177) with a valid Legal Business Name.” CMS Ex. 5 at 1.

• Petitioner submitted its corrected Attestation Statement on February 22, 2023. CMS Ex. 7. The contractor accepted the signed agreement, which assured that the FQHC met all federal requirements. CMS Ex. 8.

Because CMS accepted Petitioner’s signed agreement on February 22, 2023, by regulation, February 22 is Petitioner’s enrollment date.  42 C.F.R. § 489.13(a)(2). 

Petitioner disputes none of these facts, but complains that, although it contacted CMS “on several occasions,” trying to find out how to correct its Attestation Statement, the contractor did not respond.  “It was the continued and inexplicable lack of responsiveness” that delayed Petitioner’s submitting a corrected statement.  P. Br. at 4.  Petitioner also points to its services to the community and its significant financial losses.  P. Br. at 10. 

The regulations do not allow for an effective date earlier than the date the applicant has complied with all federal requirements.  I am bound by the effective date provisions of section 489.13 and have no authority to waive them, notwithstanding an applicant’s compelling equitable arguments.  Family Health Servs. of Darke County, DAB No. 2269 at 19-20. 

Petitioner asks that, at a minimum, it be granted a retrospective billing date of January 23, 2023, as authorized by 42 C.F.R. § 424.521(a)(1)(i).  Under that provision, CMS may allow certain provider and supplier types to bill retrospectively for up to 30 days prior to the effective date “if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries.”  42 C.F.R. § 424.521(a)(1)(i).  But nothing in the regulations gives me the authority to review CMS’s determinations regarding retrospective billing, even if I consider that a better outcome (which I do).  See 42 C.F.R. § 498.3(b) (listing initial determinations, which are therefore reviewable). 

Conclusion

Because CMS accepted Petitioner’s signed agreement on February 22, 2023, CMS properly granted its Medicare enrollment effective that date.  I therefore affirm CMS’s determination. 

Endnotes

¹ I make this one finding of fact/conclusion of law. 

² HRSA’s mission is to “improve health outcomes and achieve health equity through access to quality services, a skilled health workforce, and innovative, high-value programs.”  https://www.hrsa.gov/about. 

³ The applicant’s name had been misspelled.  Instead of “The Wright Center Medical Group,” the statement read “The Wright Center Medical Goup.”  CMS Ex. 2 at 1.  Petitioner complains that the mistake was harmless.  That the mistake was minor does not make it harmless, particularly with a program as vast as Medicare, which must rely on electronic record-keeping. A missing letter can make it impossible to find the entity through an electronic search of records.