Financial Issue Report Form
The Office of Health Care Quality licenses and oversees health care facilities and community-based programs. A provider’s financial difficulties may eventually result in decreased quality of care and services. In order to detect financial difficulties before quality is affected, OHCQ implemented the Financial Issue Report Form (FIRF) on September 1, 2015.
This protocol applies to all provider types licensed, certified, or surveyed by OHCQ except where providers in the licensure category have financial oversight by another State agency or entity. The following provider types are not routinely included in this protocol:
- Developmental Disability providers, including ICF/IID
- Behavioral Health providers
- Hospitals, including Hospitals within Correctional Facilities
- Forensic Laboratories
- Health Maintenance Organizations
Complete and Submit a FIRF to OHCQ
The completion of a FIRF is incorporated into OHCQ’s relicensure, recertification, and renewal surveys. At the onset of the survey, the surveyor will show the provider the link on the OHCQ website. The provider must complete the online form by the conclusion of the on-site survey. If OHCQ has concerns about a provider’s financial status, OHCQ may request that a provider complete the form at any time.
If the form has one or more positive responses, then OHCQ will determine the appropriate follow-up. OHCQ may request a written explanation, supporting documentation, and/or a written plan to address the issues.
The information on a FIRF is confidential and will only be shared as appropriate for the licensure, certification, and surveying of OHCQ-licensed providers.
To submit a FIRF, please complete the FIRF Form.
Contact OHCQ
Phone (410) 402-8055 | (877) 402-6005 | TTY (800) 735-2258
Fax (410) 402-8211
Tia Witherspoon, Executive Director
