April 2, 2024

Ms. Becky Dolin

Health Financial Systems

8109 Laguna Boulevard

Elk Grove, CA 95758

Dear Ms. Dolin:

We reviewed your cost report software program, MCRIF32 (the trade name of your system), for the Rural Health Clinic (RHC) Cost Report (Form CMS-222-17) as well as the electronic cost report (ECR), the healthcare cost report information system (HCRIS), and print image (PI) files you submitted from the software program for RHC cost report Transmittal 5 (T5) for cost reporting periods ending on or after January 1, 2024. Based on our review, we approve MCRIF32, subject to the terms and conditions in CMS Pub. 15-2, chapter 1, as accurately reflecting and incorporating the T-5 revisions to the cost report instructions, forms, electronic reporting specifications, and HCRIS requirements.

Your approved vendor code E05, and the electronic cost report specification date of 2024001 (01/01/2024) must appear in the first record of all transmitted electronic files (locations 38 through 40 and 52 through 58, respectively). We also request that your providers have working knowledge of Table 5 - Cost Center Coding, pages 46-528 - 46-532 in §4695 of CMS Pub. 15-2, chapter 46.

We will notify all Medicare Administrative Contractors (MACs) as necessary. Attached are the one (1) of your associates, which is authorized to market your system. State agencies may accept the computerized worksheets for titles V and XIX in those States that use the CMS cost reporting worksheets for Medicaid. Our approval does not apply to any alternatives to the bases, or the sequence of allocation recommended for cost finding in the official CMS forms. Providers can find the procedures to seek MAC approval of variations in the bases or the sequence of allocation in CMS Pub. 15-1, chapter 23, §2313.

Page 2 - Ms. Dolin

Sincerely,

Leonard Fisher

Leonard Fisher

Health Insurance Specialist

Division of Cost Reporting

Chronic Care Policy Group

Center for Medicare and Medicaid Services

Enclosures

cc: Melvin Bowens and Tari Barker

Myers and Stauffer, LC

10200 Grand Central Avenue, Suite 200

Owings Mills, Maryland 21117