Letter of Agency
The letter of agency (LOA) provides written authorization to the project coordinator of a consortium to act on behalf of each participating health care provider (HCP) or health system not owned or operated by the consortium or organization operating the consortium. The LOA should be addressed to the project coordinator for the consortium leader.
The LOA must include the:
- Name of the entity being authorized to submit application forms (project coordinator or consortium leader).
- Name of the entity on whose behalf the project coordinator is authorized to file (HCP/consortium member).
- Physical location address of the HCP/consortium member site.
- Specific timeframe the LOA covers (start date and end date).
- Signature, title, and contact information (including mailing address, phone number, and email address) of an officer, director, or other employee of the HCP/consortium member who is authorized to act on behalf of the HCP/consortium member.
- For HCPs on Tribal lands: If the health care facility is a contract facility solely run by a Tribal Nation, the appropriate Tribal leader, such as a Tribal Chairperson, President, Governor, or Chief must sign the LOA, unless healthcare responsibilities have been deleted to another Tribal government representative.
- Date of signature.
- Type of services covered by the LOA.
- Relationship of the HCPs listed on the LOA to the entity signing the LOA on their behalf (only for health systems or an HCP that owns multiple locations).
It is recommended that the LOA:
- Be submitted on the letterhead of the participating health system or consortium member.
- Include a statement securing authorization for the consortium to submit the Eligibility and Registration Form (FCC Form 460), submit the Request for Services Form (FCC Form 461), prepare and post the request for proposal, submit a Funding Request Form (FCC Form 462), and manage invoices (FCC Form 463) on behalf of the member.
- Include the following suggested language to eliminate the requirement of TPAs between consortium members and third parties:
- "[HCP Name] hereby authorizes [Consortium Leader Name] and its agents to act on its behalf…"
- "[HCP Name] authorizes [Consortium Leader Name] and its agents to: [HCP Name] authorizes [Consortium Leader Name] and its agents to submit the FCC Form 461…"
- "By this Letter of Agency, [HCP Name] authorizes [Consortium Leader Name] and its agents to make the certifications included in the FCC Form 461…"
Things to Know
No FCC Forms 460 filed by a consortium for consortium members can be processed without an approved LOA. There are two options for submitting an LOA, with or without formal agreements between the consortium leader and HCP consortium members:
- Option One: If there is no existing formal agreement, the consortium leader will assume sole legal and financial responsibility for the activities of the consortium. The consortium leader does not have the authority to make all certifications on the forms and LOA on behalf of the consortium members under this option.
- Option Two: The consortium has a formal written agreement, approved by USAC, allocating legal and financial responsibility to the consortium leader. Under this option, the consortium leader is responsible for certifications on behalf of consortium members.
All LOAs must be submitted to USAC using My Portal. To review the step-by-step process, check out the LOA/LOE Submission User Guide.