Health Center Regulatory Issues

HRSA Issues Guidance on Application of Progressive Action Process to FQHC Look-Alike Entities

| by Susan Sumrell

On November 14, 2014, HRSA issued Program Assistance Letter (PAL) 2014-11: Applicability of PAL 2014-08: Health Center Program Requirements Oversight to Look-Alikes, which addresses application of the existing grantee Progressive Action Process for non-compliance with Health Center Program Requirements (set forth in PAL 2014-08) to “Health Center Program Look-Alike” entities. PAL 2014-08 applied solely to entities that receive federal funds from HRSA. As part of its continuing goal of aligning the grantee and Look-Alike programs, HRSA issued PAL 2014-11 to clarify that the Progressive Action Process and associated enforcement actions apply equally to Look-Alike entities. The new PAL clarifies and summarizes the distinctions between the processes applicable to grantees and to Look-Alike entities, including:

• Since Look-Alike entities do not receive Notices of Award through HRSA’s Electronic Handbook (EHB), the following actions will occur through the EHB email rather than through the EHB module itself: (1) HRSA notification to the Look-Alike entity of conditions and response deadlines; (2) submission of responses by the Look-Alike; and (3) HRSA notification of its approval of submitted responses and/or need for further action. HRSA is working on enhancements to EHB to generate a Notice of Look-Alike Designation (NLD) and thus align the Look-Alike notification process with the grantee process.
• Similar to grantees, HRSA will determine a Look-Alike entity’s non-compliance with Program Requirements through the Look-Alike application process or an Operational Site Visit, or through any other processes described in PAL 2014-08.
• HRSA may terminate an entity’s Look-Alike designation period before the current period expires or may not renew the entity’s Look-Alike designation if it materially fails to comply with the Program Requirements.
• HRSA will not renew an entity’s Look-Alike designation if the entity has received two consecutive one-year designations and the renewal of designation application will result in a third one-year designation.
• If HRSA terminates an entity’s Look-Alike designation period before the current period expires or if the entity is denied renewal of its designation, the entity may reapply for a new Look-Alike designation through the initial designation process.

The PAL was effective upon issuance. Thus, HRSA intends to apply the Progressive Action Process to all new and existing look-Alike conditions, beginning with the initial 90-day phase.