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.

Are there special staffing requirements for RHCs?

- 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. RHCs receive an interim AIR payment per visit during the RHC's fiscal year, which is reconciled through cost reporting at the end of the year.

How do states reimburse RHCs through Medicaid?

All state Medicaid programs are required to recognize RHC services. States may reimburse RHCs under either Prospective Payment System (PPS) or Alternative Payment Methodology (APM), per a 2016 CMS letter. PPS involves a per-visit rate based on reasonable costs with MEI adjustments; APM requires the RHC to agree to the methodology and guarantees at least the PPS payment.

Can RHCs be reimbursed for telehealth services?

RHCs can be an 'originating site' for telehealth services and may bill Medicare for an originating site facility fee. Recent rule updates allow reimbursement for mental health visits via real-time audio-visual or audio-only technology at the same rates as in-person visits.