St. Francis House NWA, Inc. d/b/a various Federally Qualified Health Centers, DAB CR6855 (2026)

DECISION

Petitioner, St. Francis House NWA, Inc. d/b/a various Federally Qualified Health Centers, operates several federal qualified health care centers (FQHC) in Oklahoma and  Arkansas.  Petitioner applied on behalf of its health centers to enroll in the Medicare program and the Centers for Medicare and Medicaid Services (CMS) granted Petitioner’s enrollment applications with various effective dates.  Petitioner filed seven appeals which were consolidated. For the reasons discussed below:  

• I find that CMS appropriately determined Petitioner’s Medicare enrollment effective date to be April 17, 2024 for Family Medical Center, TruHealth Family Care, and Gentry Medical Center, the Petitioners in the cases originally docketed as C-25-184, C-25-185, C-25-189.
• I find that CMS appropriately determined Petitioner’s Medicare enrollment effective date to be May 7, 2024 for Broadhurst Street Medical Clinic, Kansas Medical Clinic, Sager Creek Pediatrics & Family Care, and Siloam Springs Medical Center, the Petitioners in the cases originally docketed as C-25-183, C-25-186, C-25-187, C-25-188.  

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I. Background and Procedural History

From May 23, 2024 to June 5, 2024, Novitas Solutions, a Medicare contractor acting on behalf of CMS, sent Petitioner a series of letters informing Petitioner that it had approved its health centers’ requests to participate in the Medicare program as FQHCs.  CMS Exs. 3, 9, 14, 19, 25, 31, 36.  The effective date determined for each center is set forth in the third column in the table below: 

Petitioner timely filed for reconsideration for each of the seven initial determinations.  CMS Exs. 4, 10, 15, 20, 26, 32, 38.  Petitioner’s reconsideration requests argued that it was not at fault for the practice location number not being verified for its applications and requested an earlier effective date of April 1, 2024, which is the date that the applications were submitted.  Id.  

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CMS issued reconsidered determinations in each case, denying Petitioner’s request for earlier effective dates, concluding that the appropriate effective date is the date that CMS determined that Petitioner complied with Medicare enrollment requirements for FQHCs, not the date that the applications were submitted.  CMS Exs. 5, 11, 16, 21, 27, 33, 39. 

Petitioner timely filed requests for hearing (RFHs) before an administrative law judge (ALJ).  Petitioner explained that Novitas was responsible for the enrollment delay, and its applications were complete on the day they were submitted and thus, the effective date should be the date the applications were submitted.  RFHs.  On December 16, 2024, the Civil Remedies Division issued a letter acknowledging Petitioner’s RFHs and the assigned ALJ’s Order Consolidating the cases separately docketed as C-25-183 through C-25-189 and Standing Order1.  CMS filed a prehearing brief and motion for summary judgment (CMS Br.) along with 39 exhibits (CMS Exs. 1-39).  Petitioner filed a prehearing brief and response in opposition to CMS’s motion for summary judgment (P. Br.) and 8 exhibits (P. Exs. 1-8).2  Finally, Petitioner filed a request for determination based on the written record and waiver of right to oral hearing.  CMS did not file an objection or show good cause to convene an oral hearing. 

II. Admission of Evidence and Decision on the Record

Petitioner did not object to any of CMS’s proposed exhibits.  I therefore admit CMS Exs. 1-39 into the record.  Standing Prehearing Order ¶ 11; CRD Procedures § 14(e).  CMS filed a notice stating that it did not object to any of Petitioners proposed exhibits.  CRD Dkt. Entry No. 10; Standing Prehearing Order ¶ 11.  I therefore admit Petitioner’s Exs. 1-8 into the record.  

I render this decision based on the written record pursuant to Petitioner’s waiver.  42 C.F.R. § 498.66(a), (b).  There is also no need for me to address the legal criteria for summary judgment; I find that this case is ripe for adjudication based on the written record.

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III. Issue

Whether Novitas, acting on behalf of CMS, properly established the effective dates of Petitioner’s enrollments as FQHCs in the Medicare program. 

IV. Jurisdiction

I have jurisdiction to hear and decide this case. 42 C.F.R. §§ 498.3(b)(15), 498.5(l)(2); see also Social Security Act § 1866(j)(8) (codified at 42 U.S.C. § 13955cc(j)(8)). 

V. Legal Framework

The Social Security Act (Act) authorizes the Secretary of Health and Human Services to promulgate regulations governing the enrollment process for providers and suppliers.  Act §§ 1102, 1866(j) (42 U.S.C. §§ 1302, 1395cc(j)).  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 requires additional preliminary steps.  The Act defines an FQHC as an entity that receives or qualifies to receive a Public Health Service grant or is operated by a tribe or tribal organization receiving funds 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 is in compliance 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 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).  Then, CMS returns one copy, with a notice of acceptance that includes the effective date.  42 C.F.R. § 405.2430(a)(4); see Family Health Servs. of Darke Cty., 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 the agreement until the Health Resources and Services Administration (HRSA) – an agency of the Department of Health and Human Services –

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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. § 405.2401.3 

VI. Findings of Fact, Conclusions of Law, and Analysis

1. CMS accepted the FQHCs’ signed agreements for Family Medical Center, TruHealth Family Care, and Gentry Medical Center on April 17, 2024.  Additionally, CMS accepted the FQHCs’ signed agreements for Kansas Medical Clinic, Broadhurst Street Medical Clinic, Sager Creek Pediatrics & Family Care, and Siloam Springs Medical Center on May 7, 2024.  By regulation (42 C.F.R. § 489.13(a)(2)), those dates, respectively, are the correct effective dates for the FQHCs’ Medicare enrollments.4 

The undisputed evidence shows that the Medicare contractor received Petitioner’s applications to enroll in the Medicare program as FQHCs on April 1, 2024.  CMS Exs. 1, 6, 12, 17, 22, 28, 34.  In letters from Donna Munro, a provider enrollment representative for Novitas, dated April 15, 2024, the contractor asked Petitioner for additional information for the FQHCs:  provide a verifiable practice location telephone number(s) in the Practice Location Information Section of your applications.  CMS Exs. 7, 23, 29, 35; P. Exs. 2, 3, 4.  The letters informed Petitioner that Novitas was “unable to verify your practice location information calling the practice location number(s) provided.”  Id.  Additionally, the letters included a warning that the contractor might reject the applications if the required information was not provided within 30 calendar days.  Id.  

Upon receiving the letters, Petitioner attempted to follow up with Novitas.  Testimony from Kathleen Bowen, Petitioner’s lead credential specialist, asserts that she emailed Guidewell Source and was called by Ashley, an employee of Guidewell.  P. Ex. 7 at 2 ¶¶ 7-8.  Ms. Bowen recounts that Ashley “informed me that there was no reason Ms. Munro could not have verified the Telephone Number . . . and that the Telephone Numbers, along with the automated system met the verification requirement and should not have been rejected.”  Id. ¶ 9.  Ms. Bowen asserts that Ms. Munro called her and she verified Petitioner’s telephone numbers for each FQHC on April 17, 2024.  Id. ¶ 10. 

CMS accepted Petitioner's signed agreements for Family Medical Center, Gentry Medical Center, and TruHealth Family Care on April 17, 2024.  CMS Exs. 14, 19, 36.  CMS accepted Petitioner's signed agreements for Kansas Medical Clinic, Broadhurst Street

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Medical Clinic, Sager Creek Pediatrics & Family Care, and Siloam Springs Medical Center on May 7, 2024.  CMS Exs. 3, 9, 25, 31.  Because April 17, 2024 and May 7, 2024 are the dates that CMS accepted the signed agreements, these are the effective enrollment dates.  42 C.F.R. § 489.13(a)(2).  The regulations do not permit an earlier date than the date that CMS has accepted the signed agreements.  I am bound by the effective date provisions of section 489.13 and do not have the authority to waive them, notwithstanding an applicant’s arguments.  Family Health Servs. of Darke Cty., Inc., DAB No. 2269 at 18-19 (2009).  Although I accept Petitioner’s assertions that it was not the cause of any delay and that it submitted what it thought were complete applications, these assertions provide no basis for relief, and I am bound by the regulatory authority.  

VII. Conclusion

Because CMS accepted Petitioner’s signed agreements for Family Medical Center, TruHealth Family Care, and Gentry Medical Center on April 17, 2024, CMS properly granted its Medicare enrollments effective that date.  Additionally, because CMS accepted Petitioner’s signed agreements for Kansas Medical Clinic, Broadhurst Street Medical Clinic, Sager Creek Pediatrics & Family Care, and Siloam Springs Medical Center on May 7, 2024, CMS properly granted its Medicare enrollments effective that date.  I therefore affirm CMS’s determinations.