Look-Alike Renewal of Designation Compliance Assessment Guide

This guide lists the specific Health Center Program Compliance Manual (Compliance Manual) elements and corresponding application components that HRSA will assess during the fiscal year (FY) 2024 Health Center Program look-alike Renewal of Designation (RD) application review. In the RD Notice of Look-alike Designation (NLD), HRSA notes these application components with a bolded, underlined asterisk (_*_).

If HRSA places conditions on your look-alike designation due to noncompliance with any of the Compliance Manual elements noted here, you will receive a 1-year designation period.

Table 1 presents the information in the order found in the Compliance Manual.

Table 2 presents the same information in the order found in the RD Instructions available on the RD technical assistance webpage.

Table 1: RD compliance assessment by Compliance Manual chapter and element

Compliance Manual Chapter	Element	Project Narrative (PN), Form, or Attachment Noted with _ *_
Chapter 9: Sliding Fee Discount Program	b. Sliding Fee Discount Program Policies	PN Response section, items 5a – e
Chapter 9: Sliding Fee Discount Program	c. Sliding Fee for Column I Services	Attachment 9: Sliding Fee Discount Schedule(s)
Chapter 9: Sliding Fee Discount Program	e. Incorporation of Current Federal Poverty Guidelines	Attachment 9: Sliding Fee Discount Schedule(s)
Chapter 11: Key Management Staff	b. Documentation for Key Management Staff Positions	Attachment 4: Position Descriptions for Key Management Staff
Chapter 11: Key Management Staff	d. CEO Responsibilities	PN Resources/Capabilities section, item 3b Form 2: Staffing Profile Attachment 3: Project Organizational Chart Attachment 4: Position Descriptions for Key Management Staff
Chapter 14: Collaborative Relationships	a. Coordination and Integration of Activities	PN Collaboration section, items 1a – c Attachment 8: Collaboration Documentation
Chapter 14: Collaborative Relationships	b. Collaboration with Other Primary Care Providers	PN Collaboration section, item 2 Attachment 8: Collaboration Documentation
Chapter 16: Billing and Collections	c. Participation in Insurance Programs	PN Resources/Capabilities section, item 5b
Chapter 16: Billing and Collections	h. Policies or Procedures for Waiving or Reducing Fees	PN Resources/Capabilities section, item 5a
Chapter 17: Budget	a. Annual Budgeting for Scope of Project	Attachment 10: Budget Narrative Form 3A: Look-Alike Budget Information
Chapter 17: Budget	b. Revenue Sources	Form 3: Income Analysis Attachment 10: Budget Narrative Form 3A: Look-Alike Budget Information
Chapter 19: Board Authority	a. Maintenance of Board Authority Over Health Center Project	PN Governance section, items 3a – c Form 8: Health Center Agreements Attachment 2: Bylaws Attachment 3: Project Organizational Chart Attachment 6: Co-Applicant Agreement
Chapter 19: Board Authority	b. Required Authorities and Responsibilities	PN Governance section, items 2a – g Attachment 2: Bylaws Attachment 6: Co-Applicant Agreement
Chapter 20: Board Composition	a. Board Member Selection and Removal Process	Attachment 2: Bylaws
Chapter 20: Board Composition	b. Required Board Composition	PN Governance section, items 1a – g Attachment 2: Bylaws Attachment 6: Co-applicant Agreement
Chapter 20: Board Composition	c. Current Board Composition	Form 6A: Board Member Characteristics
Chapter 20: Board Composition	e. Waiver Requests	Form 6B: Request for Waiver of Board Member Requirements

Table 2: Compliance Manual chapter and element for each item noted for Compliance assessment

Project Narrative, Form, or Attachment Noted with _ *_	Compliance Manual Chapter	Elements
Project Narrative Response section, items 5a ⁠–⁠ e	Chapter 9: Sliding Fee Discount Program	b. Sliding Fee Discount Program Policies
Project Narrative Collaboration section, items 1a – c	Chapter 14: Collaborative Relationships	a. Coordination and Integration of Activities
Project Narrative Collaboration section, item 2	Chapter 14: Collaborative Relationships	b. Collaboration with Other Primary Care Providers
Project Narrative Resources/Capabilities section, item 3b	Chapter 11: Key Management Staff	d. CEO Responsibilities
Project Narrative Resources/Capabilities section, item 5a	Chapter 16: Billing and Collections	h. Policies or Procedures for Waiving or Reducing Fees
Project Narrative Resources/Capabilities, item 5b	Chapter 16: Billing and Collections	c. Participation in Insurance Programs
Project Narrative Governance section, items 1a – g	Chapter 20: Board Composition	b. Required Board Composition
Project Narrative Governance section, items 2a – g	Chapter 19: Board Authority	b. Required Authorities and Responsibilities
Project Narrative Governance section, items 3a – c	Chapter 19: Board Authority	a. Maintenance of Board Authority Over Health Center Project
Attachment 10: Budget Narrative	Chapter 17: Budget	a. Annual Budgeting for Scope of Project b. Revenue Sources
Form 3A: Look-Alike Budget Information	Chapter 17: Budget	a. Annual Budgeting for Scope of Project b. Revenue Sources
Form 2: Staffing Profile	Chapter 11: Key Management Staff	d. CEO Responsibilities
Form 3: Income Analysis	Chapter 17: Budget	b. Revenue Sources
Form 4: Community Characteristics (new applicants)	Chapter 20: Board Composition	c. Current Board Composition
Form 6A: Board Member Characteristics	Chapter 20: Board Composition	c. Current Board Composition
Form 6B: Request for Waiver of Board Member Requirements	Chapter 20: Board Composition	e. Waiver Requests
Form 8: Health Center Agreements	Chapter 12: Contracts and Subawards	e. HRSA Approval for Contracting Substantive Programmatic Work f. Required Contract Provisions g. HRSA Approval to Subaward h. Subaward Agreement
Form 8: Health Center Agreements	Chapter 19: Board Authority	a. Maintenance of Board Authority Over Health Center Project
Attachment 2: Bylaws	Chapter 19: Board Authority	a. Maintenance of Board Authority Over Health Center Project b. Required Authorities and Responsibilities
Attachment 2: Bylaws	Chapter 20: Board Composition	a. Board Member Selection and Removal Process b. Required Board Composition
Attachment 3: Project Organizational Chart	Chapter 11: Key Management Staff	d. CEO Responsibilities
Attachment 3: Project Organizational Chart	Chapter 19: Board Authority	a. Maintenance of Board Authority Over Health Center Project
Attachment 4: Key Management Staff Positions	Chapter 11: Key Management Staff	b. Documentation for Key Management Staff Positions d. CEO Responsibilities
Attachment 6: Co-Applicant Agreement	Chapter 19: Board Authority	a. Maintenance of Board Authority Over Health Center Project b. Required Authorities and Responsibilities
Attachment 6: Co-Applicant Agreement	Chapter 20: Board Composition	b. Required Board Composition
Attachment 8: Collaboration Documentation	Chapter 14: Collaborative Relationships	a. Coordination and Integration of Activities b. Collaboration with Other Primary Care Providers
Attachment 9: Sliding Fee Discount Program Schedule(s)	Chapter 9: Sliding Fee Discount Program	c. Sliding Fee for Column I Services e. Incorporation of Current Federal Poverty Guidelines

Date Last Reviewed:

July 2023