Arizona Rural Health Clinic Designation Manual - Arizona Center for ...

E. Steps to Becoming a Certified Rural Health Clinic
Step 1: Determine Eligibility for Certification. The interpretive guidelines for Rural Health
Clinics are listed in section II. B. Interpretive Guidelines for Rural Health Clinics of this manual.
Step 2: Financial Feasibility Assessment. A financial study should assess the actual (for existing
clinics) or estimated (for new clinics) data on payor mix (Medicare, Medicaid, and other). Experts
say that a good rule of thumb to follow is if at least thirty-five to forty percent of your patients are
combined Medicare and Medicaid patients, then becoming a certified RHC could be financially
beneficial. Additionally, if an existing practice does not currently employ an NP, PA, or CNM, the
practice must decide whether the cost of hiring one would be offset by increased revenue.
Step 3: File an RHC Application.
If the site is already licensed as an Outpatient Treatment Center by the state of Arizona, the site
must send a letter to the Arizona Department of Health Services, Division of Licensing Services,
Office of Medical Facilities Licensing (http://www.azdhs.gov/als/medical) stating that the site
would like to be certified as a Rural Health Clinic. The letter should also include a request for an
RHC application packet. It is important that the site contact their Medicare fiscal intermediary
before completing the CMS 855A provider/supplier enrollment application form. If the site does
not know who their fiscal intermediary is, they may check the Centers for Medicare and Medicaid
Service’s Intermediary Carrier Directory website (http://www.cms.hhs.gov/ContractingGeneralInformation/Downloads/02_ICdirectory.pdf)
or they may contact the Arizona Department of Health
Services, Division of Licensing Services, Office of Medical Facilities Licensing.
If the site is not already licensed as an Outpatient Treatment Center by the state of Arizona, the site
must send a letter to the Arizona Department of Health Services, Division of Licensing Services,
Office of Medical Facilities Licensing (http://www.azdhs.gov/als/medical) stating that the site
would like to be licensed as an Outpatient Treatment Center and certified as a Rural Health Clinic.
In the letter, the site should request both a licensing packet and an RHC application packet. It is
important that the site contact their Medicare fiscal intermediary before completing the CMS 855A
provider/supplier enrollment application form (this form can be obtained from the following website:
http://www.cms.hhs.gov/CMSForms). If the site does not know who their fiscal intermediary
is, they may check the Centers for Medicare and Medicaid Service’s Intermediary Carrier Directory
website (http://www.cms.hhs.gov/ContractingGeneralInformation/Downloads/02_ICdirectory.
pdf).
Please note: Facilities located on an Indian Reservation do NOT have to be licensed as an Outpatient Treatment Center
in order to apply for Rural Health Clinic certification. In addition, private practice clinics not providing urgent care
services may not be required to be licensed as an Outpatient Treatment Center in order to apply for Rural Health Clinic
certification. Contact the Arizona Department of Health Services, Division of Licensing Services, Office of Medical
Facilities Licensing for more information.
Step 4: RHC Certification Inspection. The site should contact the Arizona Department of
Health Services, Division of Licensing Services, Office of Medical Facilities Licensing, in writing,
and indicate when the site would be ready for an inspection. To be ready for the inspection, the site
needs to be in compliance with RHC requirements and have seen patients at the site. The
14