Introduction
A current listing of Medicare Certified Rural Health Clinics by state and county can be found at the CMS Rural Health Clinics Center website.
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 one or more physician assistants or nurse 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).
Benefits by Service: Rural Health Clinic Services (October 2006)
Web site
State-by-state information on Medicaid coverage of Rural Health Clinic (RHC) services. Includes information on populations covered, copayments, limitations, and reimbursement methodology.
CMS Certification and Compliance: Rural Health Clinics
Web site
Provides basic information about being certified as a Medicare and/or Medicaid rural health clinic (RHC) provider and includes links to applicable laws, regulations, and compliance information.
CMS Recovery Audit Contractor (RAC)
Web site
Provides information on the Recovery Audit Contractor (RAC) project, implementation strategies, who the RACs are, RAC jurisdictions, RAC expansion and provider outreach schedules, and FAQs.
CMS Rural Health Clinics 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 extends 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.
Code of Federal Regulations (CFR)
Web site
A searchable database of the Code of Federal Regulations (CFR); the codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the Federal Government.
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.
Find Shortage Areas: HPSA by State & County
Database
Provides searching for Health Professional Shortage Areas (HPSAs) by region, state, county, designation status, and type of service- primary medical care, dental, and mental health. Includes date of latest designation status.
Healthcare Facility Design
Web site
Intended for community health centers and other safety net clinics that are planning upgrades to their facilities and was developed by The Center for Health Design (CHD). Offers literature reviews, best practice clinic design examples, recommended design and operational strategies, and tips from the field.
HHS.gov/Recovery
Web site
Provides information and resources on the programs invested in improving health and human services supported by the American Recovery and Reinvestment Act.
HRSA Information Center
Web site
Provides publications, information, resources, and referrals about health care services for medically underserved individuals and populations.
Innovators' Guide to Navigating CMS
Web site
Assist stakeholders in understanding the processes used to determine coverage, coding, and payment for new technologies under the Medicare fee-for-service program. Guide is intended as a general summary.
Medically Underserved Area/Medically Underserved Population (MUA/MUP) Database
Database
Allows searching by state, county, or ID number. Includes designation status and date.
Medicare Certified Rural Health Clinics
Web site
Provides a list of all RHCs in each of the 50 states. Includes provider number, name, address, city-state-zip, phone number, and county.
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.
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.
Quality Improvement & Risk Management Training
Tutorial
Five training modules on integrating quality and risk management led by George Rust, MD, MPH, deputy director of the National Center for Primary Care at Morehouse School of Medicine.
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 FP Community
Web site
Information and resources for family physicians, health care providers and others who serve the nation's rural families.
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.
Shortage Designation: HPSAs, MUAs & MUPs
Web site
Provides information about health care shortage designations: Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas and Populations (MUAs/MUPs). Includes information on how to apply for these designations and how to find shortage areas.
State Health Facts Online
Database
The latest state-level data on demographics, household income, health, and health policy, including health coverage, access, financing, and state legislation. Individual state profiles and 50-state comparisons. Includes statistics by state on medical malpractice and Medicare.
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 Disease Control and Prevention
Provides general information about payment rate increases for Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Journal citation: MLN Matters: Information for Medicare Providers Issue MM6218
Date: 10 / 2008
CMS Issues Proposed Changes in Conditions of Participation Requirements and Payment Provisions for Rural Health Clinics and Federally Qualified Health Centers
Sponsoring organization: Centers for Medicare and Medicaid Services
Proposed rule to update certification and participation regulations and payment provisions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Date: 06 / 2008
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 them.
Date: 2007
Code of Federal Regulations. 42 CFR 491: Certification of Certain Health Facilities
Establishes the conditions Rural Health Clinics and Federally Qualified Health Centers must meet to qualify for reimbursement under Medicare, as well as those that Rural Health Clinics must meet to qualify for reimbursement under Medicaid.
Date: 2007
Code of Federal Regulations: 42 CFR 447.371 Services Furnished by Rural Health Clinics
Details Medicare payment requirements for Rural Health Clinic services.
Date: 2007
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
Doing Ethics in Rural Health Care Institutions
Author(s): Jacqueline J. Glover
Sponsoring organization: Board of Trustees of Dartmouth College
This fourth chapter of "Handbook for Rural Health Care Ethics," provides basic information about ethics and ethics deliberation and the challenges to ethics deliberation in rural areas. Provides a model template for ethical decision-making plus three mechanisms for supporting ethics deliberation.
Date: 2009
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
Health, United States, 2008: With Special Feature on the Health of Young Adults
Author(s): Michael O. Leavitt, Julie Louise Gerberding, Edward J. Sondik
Sponsoring organization: National Center for Health Statistics
Uses tables and narrative to present trends and information regarding the Nation's physical and mental disability status, level of education and income, demographic distribution, health insurance coverage and expenditures, health behaviors and risk factors, and the utilization and access to health care. Includes data on Rural Health Clinics and on non-metropolitan (rural) areas.
Date: 12 / 2008
Medicare Advantage Organizations Offering PFFS Plans: Payment of Rural Health Clinics and Federally Qualified Health Centers
Sponsoring organization: Centers for Medicare and 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 and Medicaid Participating Facilities: CMS Needs to Reexamine Its Approach for Funding State Oversight of Health Care Facilities
Sponsoring organization: Government Accountability Office
Reports on a survey and complaint investigation done by the states on the Medicaid program.
Date: 02 / 2009
Medicare Benefit Policy Manual: Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services
Sponsoring organization: Centers for Medicare and 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.
Date: 10 / 2009
Medicare Billing Information for Rural Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Disease Control and Prevention
Medicare billing charts and information on where to submit claims for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Skilled Nursing Facilities, Home Health Agencies, Critical Access Hospitals, and Swing Bed services.
Date: 10 / 2008
Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics / Federally Qualified Health Centers
Sponsoring organization: Centers for Medicare and Medicaid Services
Describes the differences between Rural Health Clinics and Federally Qualified Health Centers. Identifies the rules and regulations for processing Medicare claims.
Date: 10 / 2009
Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 6 - Provider Customer Service Program
Sponsoring organization: Centers for Disease Control and Prevention
Addresses the requirements and general instructions for Medicare contractors' Provider Customer Services Program (PCSP).
Date: 01 / 2008
Medicare Contractor Beneficiary and Provider Communications Manual: Chapter 3 - Provider Inquiries
Sponsoring organization: Centers for Disease Control and Prevention
Addresses the general instructions and requirements for Medicare carriers, including Durable Medical Equipment Regional Carriers (DMERCs), and intermediaries for processing provider inquiries.
Date: 01 / 2008
Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Medicare and Medicaid Services
Offers Medicare providers, suppliers, and physicians rural health information and resources including Ambulance Services, CAH's, FQHC's, HPSA, Home Health, Hospice, Medicare, Prescription Drug Plan, Quality Improvement, RHC's, Sole Community Hospital, Swing Bed, and Telehealth.
Date: 04 / 2007
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 and 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 Community Health Centers: Building Creative Partnerships to Meet the Workforce Challenge
Sponsoring organization: National Rural Health Association
Reports on the second meeting of the National Rural Task Force making recommendations to the NRHA the special needs of rural providers and to promote the long term growth and substance or rural health centers.
Date: 07 / 2008
Rural Health Clinic - Rules and 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.
Rural Health Clinic and Federally Qualified Health Center Manual
Sponsoring organization: Centers for Medicare and 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 Billing: RHC Technical Assistance Conference Call
Sponsoring organization: Office of Rural Health Policy
Transcript of the RHC Technical Assistance Conference Call: Rural Health Clinic Billing, January 13, 2009.
Date: 01 / 2009
Rural Health Clinic Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Presents facts about the Rural Health Clinics 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: 04 / 2009
Rural Health Clinics Issue Paper
Sponsoring organization: National Rural Health Association
Provides an overview of the history of the federal Rural Health Clinic (RHC) program. Discusses RHC program requirements and how RHCs impact health care access in rural areas.
Date: 01 / 2007
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 and 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 and 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.
RHC Accreditation
National organization
A rural health clinic (RHC) accreditation and inspection 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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