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Rural Health Clinics

 

RHC Technical Assistance Conference Calls

RHC Reimbursement

RHC Initial Certification Requirements

Converting/Maintaining RHC Status

Latest News on New RHC Rule from CMS

Rural Health clinic Initiative

The Rural Health Clinics program was established to stabilize access to outpatient primary care in underserved rural areas and encourage the use of physicians, physician assistants, nurse practitioners, and certified nurse midwives. Under the program, the U.S. Center for Medicare and Medicaid Services (CMS) designates private and non-profit clinics meeting certain conditions for certification as Rural Health Clinics (RHCs). RHCs are eligible for enhanced Medicare and Medicaid reimbursement.

In Washington State, the Office of Community and Rural Health provides technical assistance and assesses initial eligibility. CMS contracts with Washington Department of Health's Facility and Services Division to survey clinics to determine whether they meet federal requirements. Medicare reimbursement policies are established through federal legislation and administered by CMS. The Health and Recovery Services Administration (formerly Medical Assistance Administration), Office of Professional Rates administers enhanced Medicaid reimbursements.

As of September 1, 2008 there were 132 Rural Health Clinics providing services in Washington.

Map of Washington's Rural Health Clinics

List of Rural Health Clinics


For questions about initial and continued eligibility or the application process contact:

Laura Olexa
Health Care Access Analyst
360-236-2811

Regarding preparation for your initial RHC survey:

Susan Kelly, RN MN
Nurse Consultant
425-736-1115

Regarding other questions about RHC regulations and operations:

John Hanson
Rural Health Clinic Consultant
360-236-2819

Regarding your RHC Medicaid reimbursement rates: 

Irina Lusby
RHC Program Manager, Health and Recovery Services Administration
360-725-1882

Some of the files on this page may require a viewer.
To obtain a publication send us an email message at crhmail@doh.wa.gov with your mailing address in the body of the message and the name of the publication in the subject line.

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Rural Health Clinics Technical Assistance Conference Call Series

Designed to provide Rural Health Clinic staff with valuable technical assistance and RHC-specific information

Sponsored jointly by the Office of Rural Health Policy and the National Association of Rural Health Clinics

Next call: October 21, 2009 11a.m. Pacific Time

Subject: H1N1 Flu - Obtaining the vaccine, when to use it, how to pay for it, and how to get reimbursed for vaccine administration

Speakers: Dr. Suchita Lorick of the Centers for Disease Control (CDC) will give a general overview presentation, and Megan C. Lindley, MPH, also of the CDC will give a presentation on H1N1 financing.  A representative from CMS will talk about RHC billing and reimbursement for administration of the H1N1 vaccine.

Toll-free phone #: 1-877-757-0918

Access code: 795445

PowerPoint slides will be sent out on the email list.  If you are not a member of that list, sign up below.

Speaker(s) will answer live questions during the last 15 minutes of the call. You may also submit questions ahead of time to info@narhc.org. Put "RHC TA question" in the subject line.

To sign up to receive call-in number, access code, and copies of presentations for future calls:
ORHP / RHC Conference Call Series

For material from earlier calls, including transcripts: Rural Health Clinics Technical Assistance Conference Call Series

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Requirements for Initial Rural Health Clinic Certification
 
Location in
  • A rural or non-urbanized area as defined by the Census Bureau
  • A Federal Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA) which has been approved or updated in the past four calendar years
  • Organizational Affiliation and Governance
  • May be profit or non-profit, public or private
  • Reimbursement and application procedures are influenced by affiliation. Provider-based RHCs are certified as a unit of a hospital, skilled nursing facility, or home health agency. Critical Access Hospital  based RHCs are certified as a unit of a Critical Access Hospital. All other RHCs are classified as Free-standing.
  • Staffing Requirements
  • At least one Nurse Practitioner, Physician Assistant or Certified Nurse Midwife must be on-site and available to see patients 50% of the time the clinic is open to see patients. A waiver of this requirement is possible
  • Medical Direction
  • On site Medical director (Physician) at least once every two-weeks
  • Required On-site Services
  • Provide commonly furnished outpatient diagnostic and therapeutic primary care services
  • Basic laboratory services including chemical examinations of urine, hemoglobin or hematocrit and blood sugar; and examination of stool specimens for occult blood, pregnancy test and primary culturing for transmittal
  • Emergency Care Services
  • Care for common life-threatening injuries and acute illnesses
  • available
  • Drugs used commonly in life-saving procedures available
  • Required Services That May be Provided by Arrangement Arrangements in place for in-patient hospital care, specialized physician services, specialized diagnostic and laboratory services, interpreter for foreign languages, interpreter for the deaf, and devices to assist communication with the blind
    Policies and Procedures for Patient Care The clinic must maintain written patient care policies developed by a physician, physician assistant or nurse practitioner with participation review of at least one professional (e.g.. lawyer, accountant, or provider) who is not a clinic staff member. Policies at a minimum should describe services provided by clinic and through arrangement, provide guidelines for medical management of health problems, and provide for annual review
    Patient Health Records Must maintain basic patient health record system guided by written policies and procedures. Written procedures must specifically address maintenance of confidentiality, safeguards against loss, destruction or unauthorized use, procedures for governing removal and release of information and patient consent

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    Rural Health Clinic Reimbursement

    Obtaining Rural Health Clinic certification can have significant positive affects on clinic revenues. Reimbursement levels and financial impacts of RHC conversion depend on both the type of clinic and patient and payer mix.

    Clinic Type Medicare Medicaid
    Private Office RBRVS fee schedule

    Managed care fees are negotiated with plans

    Fee for Service - Medicaid Fee Schedule

    Healthy Options - Fees negotiated with Managed Care Plan

    Free-standing RHC

    Cost-based reimbursement capped at $76.84 per encounter as of 1/1/2009

    Fee for Service Prospective Payment System (PPS) - Prospective encounter rate based on Medicare cost report data.

    Healthy Options - Negotiated fees from managed care plans supplemented by a monthly capitated payment designed to ensure that total payments are at least equal to PPS rates.

    Provider-based RHC Same as above except that hospital overhead included in costs. No cap if hospital under 50 beds Same as above
    Critical Access Hospital Based RHC Same a provider-based but same physician can cover hospital emergency department Same as above, but same physician can cover (bill) in the hospital emergency department

    Converting to Rural Health Clinic Status
    We encourage clinics to take a thoughtful, considered approach to RHC conversion as it may involve changes in staffing and practice management. We recommend that interested clinics conduct a financial assessment or consult with an accountant familiar with RHC conversions. The following document is a very useful resource: Starting a Rural Health Clinic - A How-To Manual (527KB). We have outlined the Process for Becoming a Medicare Certified Rural Health Clinic. The entire certification process from inquiry to effective billing date typically takes about one year. Additional delays can occur if prospective clinics are not prepared for the survey, location requirements are not met, or survey resources at the Washington Department of Health Facility and Services Division are not available.

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    Proposed Rules on Hold

    January 21, 2009 - According to the National Association of Rural Health Clinics (NARHC), all agencies are to cease work on all proposed rule changes until the new Administration has had an opportunity to review the work. As a result, no further work on the RHC rule will take place in CMS until the review is complete.

    NARHC plans to seek meetings with the new officials to express their views on the strengths and weaknesses of the proposed changes.

    See CMS Fact Sheet and the Proposed Rules (282 kb), also DOH comments (46 kb).

     

    Rural Health Clinic Initiative
    The Rural Health Clinic Initiative is a collaborative effort funded by Washington's State Office of Rural Health grant to increase understanding and effectiveness of Washington's Rural Health Clinics.  Begun in 2002 the project was a joint effort by the Office of Community and Rural Health, the Western Washington Area Health Education Center, the Eastern Washington Area Health Education Center, and East-West Consulting.  The final report (PDF 1.9 MB) was written by the Area Health Education Centers and East-West Consulting.  For more information, contact John Hanson, Rural Health Specialist at 360-236-2819.

    Useful Resources*

    National Association of Rural Health Clinics

    National Rural Health Association

    Rural Health Clinic Association of Washington

    Rural Assistance Center Online

    * Links to external resources are intended to provide comprehensive information on rural health care issues. Any political views that may appear on these sites are not endorsed by the Washington State Department of Health.

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    Telephone: 360-236-2800 TDD: 1-800-833-6388
    Fax: 360-664-9273 Speech to Speech 1-877-833-6741
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    Washington State Department of Health Office of Community and Rural Health
    Rural Health Programs Department of Health
    PO Box 47834 243 Israel Road SE
    Olympia, WA  MS 7834
    98504-7834 Tumwater, WA  98501

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