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Rural Health Clinics |
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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
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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
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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. |
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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
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Medical Direction |
On site Medical director
(Physician) at least once every two-weeks
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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
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Emergency Care Services |
Care for common
life-threatening injuries and acute illnesses
availableDrugs used
commonly in life-saving procedures available
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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 |
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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 |
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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. |
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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 |
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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. |
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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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