The Rural Health Clinics (RHC) 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, under-served areas and must use one or more physician assistants or nurse practitioners.
The Centers for Medicare and Medicaid Services (CMS) publishes a listing of Certified Rural Health Clinics by state and county.
Related Guides
Frequently Asked Questions
Tools
Accountable Care Organizations: Commonwealth Fund Resources
Web site
Provides an annotated list and links to Commonwealth Fund publications on Accountable Care Organizations (ACOs).
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.
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 Program
Web site
Provides information on the Recovery Audit program, to reduce Medicare improper payments through detection and collection of overpayments, the identification of underpayments and the implementation of actions to prevent future improper payments.
Code of Federal Regulations (CFR)
Web site
Codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the Federal Government. It is divided into 50 titles that represent broad areas subject to Federal regulation. Each volume of the CFR is updated once each calendar year and is issued on a quarterly basis.
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.
Health IT - Meaningful Use Resources
Web site
Resource devoted to helping hospital leaders better understand the Medicare and Medicaid electronic health records incentive programs and their associated "meaningful use" requirements.
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.
HealthCare.gov Implementation Center
Web site
Materials related to the implementation of the Affordable Care Act, including regulations, authorities and requests for comment.
HRSA Geospatial Data Warehouse
Web site
Provides access to HRSA program data and other health related - including rural health - raw data for download and permits the user to selectively filter, sort, and choose data columns to create customized maps and reports. Also, presents charts, reports and maps and tools that address specific health data topics.
HRSA Information Center
Web site
Provides publications, information, resources, and referrals about health care services for medically underserved individuals and populations.
HRSA: Office of Regional Operations
Web site
HRSA’s Office of Regional Operations (ORO) website that includes a directory of the ten regional offices and key staff working to improve health care systems and safety net, increase access to quality care, reduce disparities, and advance public health.
HRSA: Rural Health (Office of Rural Health Policy)
Web site
Provides rural health resources that include grant information, technical assistance, and research publications.
Impact of ICD-10 on Safety Net Providers (Webinar)
Web site
Provides technical assistance and examples of how safety net providers from various settings have begun planning to comply with the new coding system for the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
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
Provides information and resources concerning the Part A/Part B Medicare Administrative Contractors (MACs).
NARHC Listserve
Other
Email list to improve communication between rural health clinics and the rural health community. Individuals who participate in the listserv can ask questions, post comments and provide feedback.
Primary Care Association (PCA) Web Sites
Web site
Links to each state's Primary Care Association (PCA). PCAs work to promote, expand, and optimize access to primary care in each state.
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.
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 Center
Web site
Provides links to manuals, billing codes, enrollment and certification information, legislation, regulations, and contacts related to Medicare and Medicaid services in the rural health clinics.
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 Open Door Forum
Web site
Provides information on CMS teleconference forums addressing rural health issues. Covers Rural Health Clinic (RHC), Community Access Hospital (CAH) and Federally Qualified Health Center (FQHC) issues. Includes call-in instructions for the next forum and how to register for the mailing list.
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: Health Professional Shortage Areas & Medically Underserved Areas / Populations
Web site
Describes and provides information on how to apply for and locate shortage designations: Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas and Populations (MUAs/MUPs).
State Health Facts Online
Database
Contains state-level data on demographics, household income, health status, 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.
State Survey Agency Directory
Web site
Contains a directory of state agencies that handle survey and certification of certain health care facilities for compliance with the Medicare health and safety standards. Updated quarterly.
Version 5010 and ICD-10: Closer Than You Think (Webinar)
Web site
Webinar, presented by Christi Dant of the CMS Office of E-Health Standards & Services along with Bill Finerfrock of the National Association of Rural Health Clinics, discusses the transition to Version 5010 and ICD-10 from the provider and the facility perspectives.
Workflow Assessment for Health IT Toolkit
Web site
Assists people and organizations interested or involved in the planning, design, implementation, and use of health IT in ambulatory care to conduct a workflow analysis and redesign before, during, and after health information technology implementation.
Funding
USAC Rural Health Care Service Discounts
Provides discounts to rural health care providers to obtain Internet and telecommunications access.
William Randolph Hearst Foundations Health Grants
Supports well-established nonprofit organizations that address important issues within their major areas of interests – education, health, culture, and social service – and that primarily serve large demographic and/or geographic constituencies.
Inactive Funding
Inactive Funding Opportunities -
Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.
Regulations, Forms & Other Useful Documents
ACO Toolkit
Sponsoring organization: National Association of Community Health Centers
Provides a path forward for the implementation of Accountable Care Organizations (ACOs) for a diverse range of health care provider groups across the country.
Date: 01 / 2010
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 Issue MM6218
Date: 10 / 2008
Are Rural Health Clinics Part of the Rural Safety Net? (Policy Brief)
Author(s): David Hartley, John Gale, Al Leighton, Stuart Bratesman
Sponsoring organization: Maine Rural Health Research Center
Since Rural Health Clinics (RHCs) are located in underserved rural areas and serve vulnerable populations, many consider them to be safety net providers. Reports that 86% of independent Rural Health Clinics offer free care, sliding fee scales, or both; 97% were currently accepting new Medicaid/SCHIP patients; RHCs' patient mix has a higher proportion of Medicaid/SCHIP patients in counties not served by a federally funded Community Health Center (CHC).
Date: 09 / 2010
Clinic Considerations for: Provider-Based (PB) Clinics, Rural Health Clinics (RHC), Federally Qualified Health Clinics (FQHC)
Author(s): Robert Ellis
Sponsoring organization: Stroudwater Associates
Provides a comparison of organizational and programmatic options available to rural health
care entities for the delivery of primary health care services.
Date: 12 / 2010
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 447.371 Services Furnished by Rural Health Clinics
Details Medicare payment requirements for Rural Health Clinic services.
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
COGME Twentieth Report: Advancing Primary Care
Author(s): Jerry Kruse, Mark Kelley, Tom Keane, et al.
Sponsoring organization: Council on Graduate Medical Education
Makes recommendations related to the ideal number of primary care physicians, primary care physician reimbursement, as well as their education and distribution. Addresses rural and underserved areas, Rural Health Clinics (RHCs), and Community Health Centers (CHCs).
Date: 12 / 2010
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
Designating Health Professional Shortage Areas and Medically Underserved Populations / Medically Underserved Areas: A Primer on Basic Issues to Resolve
Author(s): Andrew F. Coburn, Jennifer P. Lundblad, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
Purpose of this paper is to help interested parties consider issues related to the designation of MUAs, MUPs, and HPSAs. Paper includes narrative describing key issues and a table summarizing how the designations establish eligibility for programs important to rural medical care delivery.
Date: 08 / 2010
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
Encouraging Rural Health Clinics to Provide Mental Health Services
Author(s): John Gale, David Hartley, Barbara Shaw, Stephanie Loux
Sponsoring organization: Maine Rural Health Research Center
Examines changes in the delivery of mental health services by Rural Health Clinics (RHCs), their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services.
Date: 05 / 2010
Fact Sheet: Medicare Shared Savings Program and Rural Providers
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides an overview of Accountable Care Organizations (ACOs) for rural providers. Discusses rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients.
Date: 10 / 2011
Health Care Broadband in America: Early Analysis and a Path Forward
Sponsoring organization: Federal Communications Commission
Addresses the content presented in Section 10.5 of the National Broadband Plan, entitled, Closing the Health IT Broadband Connectivity Gap. This paper further analyses and explains assumptions and methodology used and intends to solicit feedback and new ideas to enhance the understanding of health care connectivity issues. Includes aspects of the connectivity gap as it applies to rural areas and Rural Health Clinics.
Date: 08 / 2010
Health Care Shortage Designations: HPSA, MUA, and TBD
Author(s): Eileen Salinsky
Sponsoring organization: National Health Policy Forum
Reviews the methodologies utilized in the Health Professional Shortage Area (HPSA) and the Medically Underserved Area (MUA) designations, identifies federal programs that use these designations to allocate resources, describes proposals to consolidate and improve these designations, and discusses the Affordable Care Act provision to harmonize the two designations.
Date: 06 / 2010
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
Innovators' Guide to Navigating Medicare
Sponsoring organization: Centers for Medicare and Medicaid Services
Discusses 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.
Date: 2010
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 and Suppliers
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides 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: 09 / 2011
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
Provides 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: 09 / 2005
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
Medicare Shared Savings Program: Accountable Care Organizations, Final Rule
Sponsoring organization: American Academy of Family Physicians
Summarizes segments of the rule on Medicare Accountable Care Organizations (ACOs) as they affect family practitioners in small and medium-sized practices, including Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs).
Date: 11 / 2011
Medicare’s Accountable Care Organization Regulations: How Will Medicare Beneficiaries who Reside in Medically Underserved Communities Fare?
Author(s): Sara Rosenbaum, Peter Shin
Sponsoring organization: George Washington University Department of Health Policy
Examines impact of ACO rule on medically underserved areas.
Date: 04 / 2011
National Health Service Corps Site Reference Guide
Sponsoring organization: Health Resources and Services Administration
Provides clarity on NHSC site eligibility requirements, qualification factors, compliance, roles and responsibilities, as well as a number of other key elements on becoming an NHSC-approved site. Serves as an additional resource to supplement the information contained in the Site Application and the Site Application Instructions.
Date: 03 / 2012
Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas: Appendices and Addenda
Sponsoring organization: Health Resources and Services Administration
Represents the views of certain members of the Negotiated Rulemaking (NRM) Committee with information in support of several key Committee decisions related to the designation process presented in the full Committee report.
Date: 10 / 2011
Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas: Appendices and Addenda: Attachments
Sponsoring organization: Health Resources and Services Administration
Contains supportive material for developing recommendations and influencing methodologies used to determine medically underserved populations (MUPs) and health professional shortage areas (HPSAs) as presented in the full Negotiated Rulemaking (NRM) Committee report.
Date: 10 / 2011
Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas: Final Report to the Secretary
Sponsoring organization: Health Resources and Services Administration
Contains recommendations and documentation of the Negotiated Rulemaking (NRM) Committee to influence methodologies used to determine medically underserved populations (MUPs) and health professional shortage areas (HPSAs).
Date: 10 / 2011
Providing Underserved Patients with Medical Homes: Assessing the Readiness of Safety-Net Health Centers
Author(s): Katie Coleman, Kathryn Phillips
Sponsoring organization: Commonwealth Fund
Surveys safety-net health centers (public hospitals and clinics, federally qualified health centers, rural health centers, and free clinics for the medically underserved) to determine their potential to become patient-centered medical homes (PCMHs).
Date: 05 / 2010
Provision of Mental Health Services by Rural Health Clinics
Author(s): John A. Gale, Barbara Shaw, David Hartley, Stephenie Loux
Sponsoring organization: Maine Rural Health Research Center
Reports on a study that examined changes in the delivery of mental health services by RHCs, operational characteristics of these services, barriers and challenges experienced by RHCs, and policy options to encourage more RHCs to deliver mental health services.
Date: 05 / 2010
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 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 Manual: Medicare Part A
Sponsoring organization: TrailBlazer Health Enterprises, LLC
Overview of the Rural Health Clinic program including the history and certification of program and the requirements regarding health care professionals, covered services and Medicare.
Date: 02 / 2012
Rural Health Clinic: Rural Health Fact Sheet Series
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: 10 / 2011
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide
Sponsoring organization: Centers for Medicare and Medicaid Services
Describes the information FQHCs are required to submit for a Prospective Payment System (PPS), and it explains how RHCs should bill for certain preventive services under the Affordable Care Act.
Date: 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
Safety Net Activities of Independent Rural Health Clinics
Author(s): David Hartley, John Gale, Al Leighton, Stuart Bratesman
Sponsoring organization: Maine Rural Health Research Center
Explores to what extent independent Rural Health Clinics (RHCs) are serving a safety net role and whether the proximity of a Federally Qualified Health Center (FQHC) has an effect on the extent to which an Rural Health Clinic serves the safety net role.
Date: 09 / 2010
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
Summary of Health Information Technology Incentives and Resources
Sponsoring organization: National Rural Health Resource Center
Summarizes the Medicare and Medicaid incentives available to eligible professionals and hospitals for the implementation of certified electronic health record (EHR) technology. Included are definitions, information on meaningful use, certified technology, and helpful health information technology resources.
Date: 02 / 2011
Organizations
AAAASF Rural Health Clinic Medicare Accreditation (AAAASF/RHC)
National organization
Provides private accreditation for rural health clinics (RHCs), to meet the compliance requirement of CMS.
American Association for Accreditation of Ambulatory Surgery Facilities, Inc (AAAASF)
National organization
An accreditation program to standardize and improve the quality of medical and surgical care in ambulatory surgery facilities while assuring the public of high standards for patient care and safety in an accredited facility.
Centers for Medicare and Medicaid Services (CMS)
Federal government
Operates the Medicare and Medicaid programs - two national health care programs that benefit millions of Americans. Part of the U.S. Department of Health and Human Services. Website includes access to research, statistics, and data related to their programs.
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.
Partnership for Patients
Federal government
Public-private partnership that works to improve the quality, safety, and affordability of health care for all Americans. Brings together leaders of hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in a shared effort to make hospital care safer, more reliable, and less costly.
RHC Accreditation
National organization
A rural health clinic (RHC) accreditation and inspection program.
Terms & Acronyms
Accountable Care Organization (ACO) Team of doctors, hospitals, and other health care providers working together to coordinate and optimize care for enrolled Medicare recipients.
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.
Co-location Different health units, such as a CAH and a FQHC, situated on the same site sharing resources and facilities.
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.
Patient Navigator (PN) A health care worker who provides assistance to patients who are facing a medical diagnosis or chronic disease. Patient navigators address the issues of health disparities and help racial and ethnic minorities and underserved populations who do not always receive appropriate advice and care when confronted with a potentially serious disease. They possess knowledge of the local community, effective communication skills, and cultural and health literacy sensitivity to their areas.
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. Payment is based on a cost-related basis for outpatient physician and certain nonphysician 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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