Defining Scope of Project & Policy for Requesting Changes, Footnotes

1 Organizations that are designated under the FQHC Look-Alike Program that are seeking a change to their approved scope of project should follow the process outlined in PIN for FQHC Look-Alikes.  

2 A subrecipient is an organization that “(ii)(I) is receiving funding from such a grant under a contract with the recipient of such a grant, and (II) meets the requirements to receive a grant under section 330 of such Act . . .” (§1861(aa)(4) and §1905(l)(2)(B) of the Social Security Act). Subrecipients must be compliant with all of the requirements of section 330 to be eligible to receive FQHC reimbursement from both Medicare and Medicaid. The subrecipient arrangement must be documented through a formal written contract/agreement (Section 330(a)(1) of the PHS Act). 

3 Note: a "change in scope of project" under section 330 is not the same as "change in the scope of services" in Medicaid as defined in the Benefits Improvement and Protection Act (BIPA) of 2000, Section 702. The Centers for Medicare and Medicaid Services (CMS) and State Medicaid Agencies define the term “change in the scope of services” as a mechanism for adjusting the Medicaid reimbursement rate of a FQHC due to “a change in the type, intensity, duration and /or amount of services.” A State approved “change in the scope of service” can result in an increase or decrease in FQHC Medicaid reimbursement. "Change in the scope of services" is defined differently in each State's Medicaid Plan. The State Medicaid Agency must be contacted directly if a change in scope of services is being requested by a health center. Please see Section VI.B. - Scope of Project and FQHC Medicaid PPS or Alternative Methodology Reimbursement of this PIN for additional information.

4 For more information regarding the operation of health centers, please refer to the health center program requirements.

5 All Program Information Notices (PINs) and Program Assistance Letters (PALs) are available on the HRSA web site at Policy Information Notices and Program Assistance Letters

6 Here and throughout this document “established arrangements” are intended to mean an arrangement where a service is provided through a formal written contract or cooperative arrangements (Section 330(a)(1) of the PHS Act). 

7 Note the statutory requirement in section 330(k)(3) of the PHS Act that “primary health services of the center will be available and accessible in the catchment area of the center promptly, as appropriate, and in a manner which assures continuity.” In addition, note the regulatory requirement in 42 CFR 51c.303(m) that community health centers “must be operated in a manner calculated ... to maximize acceptability and effective utilization of services.” 

8 Section 330(b)(2) of the PHS Act. 

9 Section 330(k)(3)(G) of the PHS Act., 42 C.F.R. Part 51c.303(f).

10 Section 330 (a)(1) of the PHS Act. 

11 45 C.F.R. Part 74. f

12 For health centers funded under section 330(e) and/or section 330(g), please see PIN 1998-24: Amendment to PIN 1997-27 Regarding Affiliation Agreements of Community and Migrant Health Centers for further discussion of affiliation arrangements.

13 Primary health services of the center must also be provided “in a manner which assures continuity.” (PHS Act, section 330(k)(3)(A).)

14 This requirement is not applicable to health centers requesting or receiving funding only under section 330(g), (h), and/or (i) of the PHS Act, since those centers are applying to serve populations already recognized as underserved.

15 Section 330(a)(1) of the PHS Act. 

16 Section 330(a)(1)(B) of the PHS Act.

17 Section 330(a)(2) of the PHS Act.

18 Any activity that results in significant re-budgeting also requires prior approval. See Department of Health and Human Services Grants Policy Statement (HHS GPS): page II-55.

19 All approved change in scope requests to add a new service site must be reported to the State Medicaid Agency and the Medicare Fiscal Intermediary within 90 days of approval. See Section VI: Additional Scope of Project Policy Issues of this PIN for further information regarding notification to the State Medicaid Agencies and the Medicare Fiscal Intermediary.

20 Section 330(k)(3)(B) of the PHS Act.

21 Required for health centers funded under section 330(e).

22 Based on applicable section 330 program regulations, 42 CFR Part 51c.107(c), 45 CFR Parts 74 and 92, and HHS Grants Policy Statement.

Date Last Reviewed:  August 2018