Introduction
The Rural Health Clinics
(RHCs) program is intended to increase primary care services for
Medicaid and Medicare patients in rural communities. RHCs can be
public, private, or non-profit. The main advantage of RHC status
is enhanced reimbursement rates for providing Medicaid and Medicare
services in rural areas. RHCs must be located in rural, underserved
areas and must use midlevel practitioners.
Frequently Asked Questions
Tools
Am I Rural?
Web site
Helps determine whether a specific location is considered rural based on various definitions of rural, including definitions that are used as eligibility criteria for federal programs. Definitions covered include Rural Urban Commuting Areas (RUCAs), Core Based Statistical Areas, Rural Urban Continuum Codes (RUCC), Federal Communications Commission (FCC), and Urban Influence Codes (UICs).
CMS Rural Health Clinic Center
Web site
Links to all Medicare Fee-for-Service Rural Health Clinic (RHC) specific information available from CMS.
CMS Rural Health Open Door Forum
Web site
Provides information on a series of CMS forums addressing rural health issues. Covers Rural Health Clinic (RHC), Community Access Hospital (CAH) and Federally Qualified Health Center (FQHC) issues, as well as some inclusion of other questions and concerns that occur in clinical practice pertaining to other CMS payment systems that also extend into these settings. Includes call-in instructions for the next call and how to register for the mailing list.
CMS State Survey Agency Directory
Web site
Directory of state agencies that handle survey and certification of certain health care facilities for compliance with the Medicare health and safety standards.
Developing and Implementing a Discount Fee Schedule
Web site
Basic information for clinics and health centers about developing and implementing
a sliding fee schedule for low-income populations.
Health Professional Shortage Area Database
Database
Provides searching for Health Professional Shortage Areas (HPSAs) by region, state, county, designation status, type of service and more. Includes date of latest designation status.
Medically Underserved Area/Medically Underserved Population (MUA/MUP) Database
Database
Allows searching by state, county, or ID number. Includes designation status and date.
Medicare Contracting Reform
Web site
Information and resources concerning the Part A/Part B Medicare Administrative Contractors (MACs), which will replace the current fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
Medicare Part D & Safety Net Providers: Contracting with Prescription Drug Plans
Web site
Information for safety net providers about the impact of the Medicare Prescription Drug Program. Addresses contracting with Prescription Drug Plans (PDPs) and includes a sample pharmacy contract addendum.
Medicare Part D Changes in Enrollment & Eligibility for Low Income Subsidy
Web site
Describes common situations facing safety net patients during the Medicare Part D open enrollment period that ends December 31, 2006 and ways that safety net providers can help.
NARHC Listserve
Other
Email list to improve communication between rural health clinics and the rural health community. Individuals who participate in the listserve can ask questions, post comments and provide feedback.
Regulations.gov
Web site
Supports public participation in the Federal decision-making process by allowing users to view and submit comments on proposed and final regulations.
RHC Quality Improvement Resources
Web site
Lists web sites, reports and journal articles that Rural Health Clinics (RHCs) can use in their quality improvement efforts.
Rural Health Clinics Technical Assistance Conference Call Series
Web site
An ongoing series of technical assistance conference calls for Rural Health Clinics. Includes transcripts from past calls and related resources and tools.
Rural Health Research: Rural Health Clinics (RHCs)
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of Rural Health Clinics (RHCs), produced by the Office of Rural Health Policy's funded rural health research centers.
Rural Health Resource Directory
Database
Directory of consultants, organizations and speakers throughout the United States who provide services to rural healthcare organizations. Searchable by state, organization type and service.
Regulations, Forms & Other Useful Documents
Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases
Sponsoring organization: Centers for Medicare & Medicaid Services
Updates the Medicare upper payment limit per visit for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for 2007.
Date: 01 / 2007
Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
Author(s): John A. Gale, Andrew F. Coburn
Sponsoring organization: Maine Rural Health Research Center
Offers an updated, comprehensive picture of the Rural Health Clinic (RHC) program and the operations of RHCs. Covers characteristics of RHCs, staffing and recruitment, location, and more.
Date: 01 / 2003
CMS Guidance to State Survey Agency Directors and CMS Regional Offices
Sponsoring organization: Centers for Medicare & Medicaid Services
Centers for Medicare & Medicaid Services (CMS) memoranda, letters and instructions to State Survey Agency Directors and CMS Regional Offices.
Code of Federal Regulations. 42 CFR 405.2400-2472: Federal Health Insurance for the Aged and Disabled
Establishes the requirements for coverage
and reimbursement of Rural Health Clinic and Federally Qualified Health Center services under Medicare.
Date: 2002
Code of Federal Regulations. 42 CFR 410.165: Payment for Rural Health Clinic Services and Ambulatory Surgical Center Services: Conditions
Details the forms and other requirements for payment for Rural Health Clinics and Federally Qualified Health Centers.
Date: 2002
Code of Federal Regulations. 42 CFR 440.20: Outpatient Hospital Services and Rural Health Clinic Services
Defines the scope of Rural Health Clinic services, who can provide the services, and what services can be provided.
Date: 2002
Code of Federal Regulations. 42 CFR 491: Certification of Certain Health Facilities
Covers the conditions Rural Health Clinics and Federally Qualified Health Centers must meet to qualify for reimbursement under Medicare
and that Rural Health Clinics must meet to qualify for reimbursement under Medicaid.
Date: 2002
Comparison of the Rural Health Clinic and Federally Qualified Health Center Programs
Sponsoring organization: Health Resources and Services Administration
Provides a general comparison of the financial
components of the Rural Health Clinic (RHC) and Federally Qualified Health Center
(FQHC) programs under Medicare and Medicaid.
Date: 06 / 2006
Frequently Asked Questions about RHC Quality Improvement
Sponsoring organization: Office of Rural Health Policy
Addresses questions that Rural Health Clinics (RHCs) are likely to have about the Quality Assessment and Performance Improvement (QAPI) program.
Date: 03 / 2004
Health Centers and Rural Clinics: State and Federal Implementation Issues for Medicaid's New Payment System
Sponsoring organization: Government Accountability Office
Reviews states' implementation of
the prospective payment
system (PPS) for Medicaid
payments to Federally Qualified
Health Centers (FQHCs) and Rural
Health Clinics (RHCs). Includes recommendations for CMS on guidance and oversight for states.
Date: 06 / 2005
Health Professional Shortage Areas: Problems Remain With Primary Care Shortage Area Designation System
Sponsoring organization: Government Accountability Office
Reviews the number and location of Health Professional Shortage Areas (HPSAs) and federal programs that use HPSA designations to allocate resources or provide benefits. Discusses available research on HPSA designation criteria and methodology. Addresses the impact of a 2002 provision that automatically designates federally qualified health centers (FQHCs) and certain rural health clinics (RHCs) as facility HPSAs.
Date: 10 / 2006
Medicaid Benefits: Rural Health Clinics
Sponsoring organization: Kaiser Family Foundation
State-by-state information on Medicaid coverage of Rural Health Clinic (RHC) services. Includes information on populations covered, copayments, limitations, and reimbursement methodology.
Date: 01 / 2003
Medicare Advantage Organizations Offering PFFS Plans: Payment of Rural Health Clinics and Federally Qualified Health Centers
Sponsoring organization: Centers for Medicare & Medicaid Services
Clarification of CMS payment requirements to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) under private fee-for-service (PFFS) plans.
Date: 09 / 2007
Medicare Benefit Policy Manual: Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services
Sponsoring organization: Centers for Medicare & Medicaid Services
Provides definitions of the Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) programs. Includes definitions of physician services and other services.
Medicare Billing Information for Rural Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Medicare & Medicaid Services
Medicare rural billing charts for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), skilled nursing facilities, home health agencies, and Critical Access Hospitals (CAHs). Provides information on where to submit claims for different services.
Date: 05 / 2007
Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics / Federally Qualified Health Centers
Sponsoring organization: Centers for Medicare & Medicaid Services
Describes the differences between Rural Health Clinics and Federally Qualified Health Centers. Identifies the rules and regulations for processing Medicare claims.
Medicare Program; Rural Health Clinics: Amendments to Participation Requirements and Payment Provisions; and Establishment of a Quality Assessment and Performance Improvement Program; Final Rule
Sponsoring organization: Centers for Medicare & Medicaid Services
Final rule from CMS regarding Medicare certification and payment requirements for rural health clinics (RHCs). Includes information on RHC quality assessment and performance improvement program requirements.
Journal citation: Federal Register Volume 68 Issue 247 Pages: 74791-74818
Date: 12 / 2003
Medicare Program; Rural Health Clinics: Amendments to Participation Requirements and Payment Provisions; and Establishment of a Quality Assessment and Performance Improvement Program; Suspension of Effectiveness
Sponsoring organization: Centers for Medicare & Medicaid Services
This interim final rule with comment period revises the rural health clinic (RHC) regulations to revert to those provisions set forth in regulations before publication of the December 24, 2003 RHC final rule.
Journal citation: Federal Register Volume 71 Issue 184 Pages: 55341-55347
Date: 09 / 2006
Rinehart Clinic Story: How to Provide Access to Ambulatory Healthcare for all Rural Community Members
Author(s): Harry H. Rinehart
Sponsoring organization: National Association of Rural Health Clinics
Describes a successful nonprofit Rural Health Clinic (RHC) in rural Oregon. Discusses the process of becoming a nonprofit and the benefits of nonprofit status in providing services.
Date: 08 / 2005
Rural Health Clinic and Federally Qualified Health Center Manual
Sponsoring organization: Centers for Medicare & Medicaid Services
Medicare manual for Rural Health Clinics and Federally Qualified Health Centers. Covers agreements and terminations, coverage and exclusions, payment and billing procedures. Available as a ZIP file download.
Rural Health Clinic Fact Sheet
Sponsoring organization: Centers for Medicare & Medicaid Services
A general summary about Rural Health Clinics (RHC) program that includes the requirements for a facility to become an RHC, Medicare payments for RHC services, and a list of rural health websites.
Date: 03 / 2007
Rural Health Clinic Interpretive Guidelines
Sponsoring organization: National Association of Rural Health Clinics
Interpretive guidelines for the Medicare regulations governing the Rural Health Clinic (RHC) program. Used by state surveyors to ensure that clinics are in compliance with the technical requirements of the RHC program.
Selecting an EHR: Now What? (Part 1) Rural Health Clinics Technical Assistance Conference Call Transcript, 1/8/2008
Sponsoring organization: Office of Rural Health Policy
Transcript of a January 8, 2008 technical assistance call for Rural Health Clinics (RHCs) about purchasing an Electronic Health Record/Medical Record system. Part one of a two-part series. Audio recording (MP3) of the call.
Date: 01 / 2008
Selecting an EHR: Now What? (Part 2) Rural Health Clinics Technical Assistance Conference Call Transcript, 2/5/2008
Sponsoring organization: Office of Rural Health Policy
Transcript of a February 5, 2008 technical assistance call for Rural Health Clinics (RHCs) about purchasing an Electronic Health Record/Medical Record system. Part two of a two-part series. Audio recording (MP3) of the call.
Date: 02 / 2008
Social Security Act, Section 1832 (a)(2)(D): Scope of Benefits
This section of the Social Security Act lists Rural Health Clinic and Federally Qualified Health Center services as within the scope of benefits.
Social Security Act, Section 1833 (f) and (h): Payment of Benefits
Payment limits for Rural Health Clinics and clinical laboratory services under the Social Security Act.
Social Security Act, Section 1861 (aa): Rural Health Clinic Services and Federally Qualified Health Center Services
Rural Health Clinic Services and Federally Qualified Health Center Services as defined in the Social Security Act. Scroll down to section (aa).
Social Security Act, Section 1902 (bb): State Plans for Medical Assistance
Part (bb) covers state plan requirements for payment for services for Rural Health Clinics and Federally Qualified Health Centers.
Social Security Act, Section 1905 (l): Definitions for RHCs and FQHCs
Definitions of terms used in the Social Security Act related to Rural Health Clinics and Federally Qualified Health Centers.
Starting a Rural Health Clinic: A How-To Manual
Sponsoring organization: Office of Rural Health Policy
Detailed guide describing the Rural Health Clinic (RHC) program. Includes instructions on how to determine eligibility and financial feasibility of RHC status and how to apply to become an RHC. Includes a sample RHC policies and procedures manual.
Date: 04 / 2004
State Medicaid Manual, Part 6, Section 6301 and 6302: Payment for Services, Rural Health Clinic Reimbursement
Sponsoring organization: Centers for Medicare & Medicaid Services
Covers Rural Health Clinic (RHC) Medicaid reimbursement, and lists RHC financial intermediaries.
Status of the Rural Health Clinic Program
Author(s): Daniel R. Levinson
Sponsoring organization: U.S. Department of Health and Human Services
Office of Inspector General report discussing the location status of Rural Health Clinics (RHCs). Includes statistics on the number of RHCs in locations that do not have current shortage designations and RHCs in areas no longer considered rural. Includes historical overview of the RHC location requirements and recommendations for improvement.
Date: 08 / 2005
Organizations
Centers for Medicare & Medicaid Services (CMS)
Federal government
Runs the Medicare and Medicaid programs - two national health care programs that benefit about 75 million Americans. Part of the U.S. Department of Health and Human Services.
National Association of Rural Health Clinics (NARHC)
National organization
Works to improve the delivery of quality, cost-effective health care in rural underserved areas through the Rural Health Clinics (RHC) Program.
Terms & Acronyms
CMS (Centers for Medicare and Medicaid Services) Federal agency responsible for the Medicare and Medicaid programs. Part of the U.S. Department of Health & Human Services.
Cost Report Document prepared annually by each RHC at the end of the fiscal year. Used to reconcile RHC allowable costs and allowable visits with RHC payments.
Fiscal Intermediary (FI) Company designated by CMS to process claims and make payment for services.
Health Professional Shortage Area (HPSA) Geographic regions that have shortages of professionals working in primary medical care, dental or mental health care. HPSAs may be urban or rural areas, population groups or medical or other public facilities. Geographically, HPSAs can be cities or towns, counties or groups of counties. HPSA designations are reviewed and revised annually by the Secretary of Health and Human Services based on criteria set forth in the Public Health Service Act.
Interim Payment Rate Medicare all-inclusive rate calculated by dividing the Medicare allowable costs by number of Medicare allowable encounters. Each RHC receives this amount for each Medicare covered RHC visit throughout the clinic's fiscal year. At the end of the fiscal year, payments for the year are reconciled based on a cost report. The interim payment rate is recalculated annually.
Medically Underserved Area (MUA) Medically Underserved Areas (MUAs) are federal designations derived from the Index of Medical Underservice (IMU). This index ranges from 0 to 100 and is based on four criteria: 1) ratio of primary medical care physicians per 1,000 people, 2) infant mortality rate, 3) percent of the population with incomes below the poverty level and 4) the percent of the population age 65 or older. An IMU of 62.0 or less qualifies an area to be designated a MUA. Geographic areas designated as MUAs can be a whole county or a group of contiguous (adjoining) counties, minor civil divisions (MCD), census county divisions (CCD) or census tracts.
Medicare Administrative Contractor (MAC) Will replace the current Medicare fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
Medicare Economic Index (MEI) Medical inflation rate. Used to adjust reimbursement caps on annual basis.
Provider Identification Number (PIN) Unique number issued by payers to each provider to identify that provider as a credentialed and approved provider. Also known as a Medicare billing number.
Rural Health Clinic (RHC) Clinic certified to receive special Medicare and Medicaid reimbursement. RHCs must be located in underserved rural areas and provide primary care services. RHCs use a team approach of physicians, nurse practitioners, physician assistants, and certified nurse midwives to provide services.
UPIN (Unique Provider Identification Number) Six-character alphanumeric identifier assigned to all Medicare physicians, medical groups and non-physician practitioners.
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