COVID-19: RHC and FQHC lump sum payments information

Rural health clinics (RHCs) and federally qualified health centers (FQHCs) may request lump sum payments for administering COVID-19 vaccines in advance of cost report settlement. CMS will pay you for COVID-19 vaccines and administration at 100% reasonable cost like influenza and pneumonia vaccines. 

To request an interim payment prior to the annual cost report submission / settlement, submit one of the following:

1. Interim Form 2552-10, W/S M-4 (RHC Subunit), Form 222-17, W/S B-1 (RHC Freestanding), or Form 224-14, W/S B-1 (FQHC) for the current FYE to date (preferred); or
2. Estimated total cost of administrating COVID-19 vaccines and the program number of COVID-19 vaccines administered based on 60-90 days of actual COVID-19 data.

Lump sum payments will be processed within 30 days of receipt of the request.

For this request, please use this attached form here

Mail or email (preferred) your information to:

PARD Reimbursement 
First Coast Service Options, Inc.
2020 Technology Parkway, Suite 100
Mechanicsburg, PA 17050
email: InterimReimbReviews@fcso.com