Exhibit 177 2026

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The document is an attestation statement for Federally Qualified Health Centers (FQHCs) outlining the instructions for completing the form, including requirements for entity identification, address, type of FQHC, and compliance with federal regulations. It emphasizes the need for accurate information matching IRS records and mandates a signature from an authorized individual to confirm compliance with relevant laws.

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Click ‘Get Form’ to open exhibit 177 in the editor.
In the 'Name of Entity' field, enter the legal business name of your FQHC as reported to the IRS. Ensure it matches section 2B of Form CMS 855A.
If applicable, fill in the 'D/B/A Name' with any different name your entity operates under. If there is no D/B/A name, leave this field blank.
Enter the complete address in the 'Address' section, matching what you provided in Section 4A of Form CMS 855A, including street number, city, state, and zip code.
Select one option from the 'Type of FQHC' section that best describes your qualification status by checking one of the boxes (A)(i), (A)(ii), (B), or (C).
For the signature section, ensure that an authorized individual signs on behalf of your entity. Include their printed name, title, and date after reviewing relevant regulations.

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How does FQHC funding work?

As a nonprofit and tax-exempt organization, an FQHC can receive grants from the government, the private sector, and donations in addition to Medicare and Medicaid funding. Any patient care center can apply to become an FQHC if the health center meets specific requirements to receive funds from HRSA.

What are the disadvantages of federally qualified health centers?

FQHCs are overwhelmed by patient volume and struggle to stay ahead of rising risks, since FFS does not incentivize preventive care. As a result, they spend more time and money on treating patients at the high end of clinical complexity, which limits their availability for new patients.

What services must a FQHC provide?

Provide a set of comprehensive, high-quality primary care and preventive services regardless of patients ability to pay. Employ interdisciplinary teams and patient-centric approaches. Deliver care coordination and other enabling services that facilitate access to care.

What are the disadvantages of FQHC?

The limited capacity at many FQHCs may not facilitate continuity of care for a population with frequent physician visits. Similarly, older dual-eligibles often have multiple chronic conditions, and FQHCs primary care services may not ensure access to specialists or care coordination among many providers.

Is an FQHc considered a federal contractor?

Being an FQHC doesnt necessarily make a company required to comply with the laws enforced by OFCCP, but it doesnt mean that the company is not a federal contractor either.

cms exhibit 177

Exhibit 177 pdf Fqhc exhibit 177 CMS Form Exhibit 177

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What is the difference between a rural health clinic and a FQHC?

RHCs operate exclusively for the purpose of providing primary care services to Medicare patients located in rural and shortage areas; FQHCs provide primary care services and dental care services to rural/urban areas and shortage areas.

Exhibit 177 2026

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Got questions?

How does FQHC funding work?

What are the disadvantages of federally qualified health centers?

What services must a FQHC provide?

What are the disadvantages of FQHC?

Is an FQHc considered a federal contractor?

Security and compliance

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What is the difference between a rural health clinic and a FQHC?

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