Providers participating in the NMAP as FQHCs must submit an annual cost report to the Department.
The Medicare cost report form CMS- 222-92 can be found in the Provider Reimbursement Manual-Part-2 ( Pub. 15-2), Chapter 29 located at http://www.cms.hhs.gov/manuals/PBM/list.asp on the CMS website.
Each FQHC must report and supply the Department with necessary documentation, cost reports, and any other documentation when requested.
471 Neb. Admin. Code, ch. 29, § 005