Look-Alike Initial Designation Technical Assistance
Create your application in HRSA EHB anytime (rolling deadline)
Updated Look-Alike Initial Designation Instructions and Technical Assistance Materials Coming Soon
The recently-released Health Center Program Compliance Manual is a consolidated compliance resource that applies to all health centers applying for or receiving Health Center Program funding or designation. The look-alike initial designation instructions are being updated to align with the Compliance Manual. Applications created in the HRSA Electronic Handbook (EHB) after the release of the revised instructions must follow the revised instructions, however, the Compliance Manual is effective immediately. Please note that Health Center Program award recipients are no longer eligible to apply for look-alike initial designation. It is imperative that look-alike initial designation applicants carefully review the Compliance Manual to ensure compliance with all Health Center Program requirements at the time of application.
The purpose of the look-alike initial designation application is to establish new look-alike service delivery sites under the Health Center Program to provide comprehensive primary health care services to underserved and vulnerable populations. Look-alikes were established to maximize access to care for medically underserved populations and communities by allowing entities that do not receive Health Center Program funding to apply to become part of the Health Center Program and, once designated, become eligible for Medicaid and Medicare Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) reimbursement and other related programs.
Who Can Apply?
Organizations eligible to apply for look-alike initial designation include public or nonprofit health centers that currently provide comprehensive primary care to underserved populations. See the Eligibility section of the Look-Alike Initial Designation Application Instructions (PDF - 545 KB) for the full list of eligibility criteria. Applicants must demonstrate eligibility and compliance with the Health Center Program requirements both in the initial designation application and during the onsite compliance review (see the Application Review section in the instructions for details).
How to Apply
Initial designation applications are accepted on a rolling basis and must be submitted via the HRSA Electronic Handbooks (EHBs). See the Look-Alike Initial Designation Application Instructions (PDF - 545 KB) and the EHBs Look-Alike Initial Designation User Guide for details on how to submit in EHBs.
Technical Assistance Resources
- Initial Designation Technical Assistance Webinar Slides (PDF - 724 KB)
Note: Since the posting of this webinar, the Look-Alike Initial Designation Application in EHB and Instructions posted above have been revised slightly. Specifically, Form 1C was removed and two clinical performance measures have been updated (Cervical Cancer Screening and Ischemic Vascular Disease). See the Look-Alike Initial Designation Application Instructions for a summary of changes.
- Initial Designation Applicant Technical Assistance Webinar Recording
- EHBs Look-Alike Initial Designation User Guide
- Health Center Program Requirements Resources (PDF - 79 KB)
- Available Data Sources (PDF - 190 KB)
- Health Center Program Site Visit Guide
Sample Application Components
The following samples and templates are for planning purposes only. Applicants must upload attachments and enter information into EHB according to the initial designation instructions.
- Attachment 2: Instructions for Service Area Map and Table (PDF - 2 MB)
- Form 1A: General Information Worksheet (PDF – 211 KB)
- Form 2: Staffing Profile (PDF – 285 KB)
- Form 3: Income Analysis (PDF – 276 KB)
- Form 3A: Look-Alike Budget Information (PDF – 126 KB)
- Form 4: Community Characteristics (PDF – 280 KB)
- Form 5A: Services Provided (PDF – 247 KB)
- Form 5B: Service Sites (PDF – 114 KB)
- Form 5C: Other Activities/Locations (PDF – 120 KB)
- Form 6A: Current Board Member Characteristics (PDF – 125 KB)
- Form 6B: Request for Waiver of Governance Requirements (PDF – 138 KB)
- Form 8: Health Center Agreements (PDF – 164 KB)
- Form 10: Emergency Preparedness Report (PDF – 206 KB)
- Form 12: Organization Contacts (PDF – 139 KB)
- 2017 Performance Measures (PDF - 258 KB)
- Clinical Performance Measure Form Field Guide and Sample (PDF - 105 KB)
- Financial Performance Measures (PDF - 93 KB)
- Performance Measure Fillable Form (PDF - 60 KB)
For more information on performance measures, see:
- Health Center Data for information on the Uniform Data System (UDS), the reporting system for Health Center Program performance measures and patient data
- UDS Resources for presentations on UDS reporting and the most recent UDS Manual
- Healthy People 2020 (PDF - 204 KB) for a table outlining the Healthy People 2020 objectives related to Health Center Program performance measures
To make sure you receive our reply email, add 'BPHCAnswers@hrsa.gov' to your address book.
Look-Alike Application Response Team
HRSA Bureau of Primary Health Care
Office of Policy and Program Development
BPHC Helpline Questions Web Form (select Applicant as Requestor type and Look-Alike (LAL) Application/Submission: Instructions/Requirements as the Issue type, with the subcategory of Initial Designation) | 301-594-4300
EHBs Application Assistance
BPHC Helpline Questions Web Form (select Applicant as Requestor Type and Look-Alike (LAL): EHB System Questions as the Issue Type) | 877-974-2742 ext. 3
Health Center Program Support Networks (PCAs and NCAs)
State Primary Care Offices (PCOs)
EHBs Account Access Questions:
HRSA Contact Center
CallCenter@hrsa.gov or 1-877-464-4772, Monday Friday, 9 a.m. to 5:30 p.m. ET (excluding federal holidays)