Rural Health Clinics (RHCs) Overview

How do I get certified as an RHC?

Complete the RHC application and the CMS provider enrollment form – Contact your state agency responsible for RHC certification for an RHC application packet. The CMS-29, Verification of Clinic Data – Rural Health Clinic Program and CMS 855A Medicare Enrollment Application - Institutional Providers forms are available on the CMS website.

Yes. An RHC must:

- Employ at least one nurse practitioner (NP) or physician assistant (PA) - Have an NP, PA, or certified nurse midwife (CNM) working on-site to see patients at least 50% of the time the clinic is open. Other staff may work under contract.

How does Medicare reimburse RHCs?

Medicare pays RHCs 80% of a flat, all-inclusive rate (AIR) for medically necessary medical, behavioral health, and qualified preventive visits delivered on the same day; the remaining 20% is charged to patients as coinsurance. The AIR is subject to payment limits, meaning an RHC will not be paid beyond the prospectively set limit, regardless of the actual cost of the visit.

How do states reimburse RHCs through Medicaid?

All state Medicaid programs are required to recognize RHC services. The states may reimburse RHCs under one of two different methodologies as outlined in a 2016 CMS letter to state health officials: - Prospective payment system (PPS) – Under this methodology, the state calculates a per visit rate based on the reasonable costs of the services provided. Each year, the per visit baseline rate is increased by the MEI factor and adjusted to reflect any change in scope of services. - Alternative payment methodology (APM) – Under this methodology, there are only two requirements: 1) the RHC must agree to the methodology, and 2) the payment must at least equal the payment it would have received under the PPS.

Can RHCs be reimbursed for telehealth services?

RHCs can be an "originating site" for telehealth services. An originating site is the location where an eligible patient gets telehealth services with a provider in a different location. RHCs serving as an originating site can bill Medicare for an originating site facility fee.

How has telehealth reimbursement for RHCs evolved?

The CY 2022 Medicare Physician Fee Schedule Final Rule updated federal regulations to permanently enable RHCs to be reimbursed by Medicare for mental health visits that use interactive, real-time audio-visual and audio-only technology. RHCs are paid for these services at the same rates they are billed for other services.