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

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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
E. Steps to Becoming a Certified Rural Health Clinic (con’t) Arizona Department of Health Services, Division of Licensing Services, Office of Medical Facilities Licensing will then conduct a survey. Step 5: Rural Health Clinic Cost Report. Once a clinic has received its Medicare Provider Letter from the Centers for Medicare and Medicaid Services, the clinic then files a projected cost report in order to have its Medicare Rate determined. Independent Rural Health Clinics complete the CMS-222-92 Form and Provider-based Rural Health Clinics complete Worksheet M of the CMS-2552-96 Form. These forms are available from the CMS Web site (http://www.cms.hhs. gov/CMSForms/). Adapted from: Rural Assistance Center, Rural Health Clinics, http://www.raconline.org/info_guides/clinics/rhc.php. 15
Page 1 and 2: Arizona Rural Health Clinic Designa
Page 3 and 4: Community Environment & Policy 1295
Page 5 and 6: A. Background Information (con’t)
Page 7 and 8: B. Rural Health Clinics in Arizona
Page 9 and 10: C. Number of Rural Health Clinics i
Page 11 and 12: D. Frequently Asked Questions (con
Page 13: D. Frequently Asked Questions (con
Page 17 and 18: B. Interpretive Guidelines for Rura
Page 29 and 30: D. Preparing for the Certification
Page 37 and 38: 30 Most Common RHC Survey/Certifica
Page 39 and 40: F. RHC Cost Report The Medicare cos
Page 41 and 42: F. RHC Cost Report (con’t) •Wor
Page 43 and 44: F. RHC Cost Report (con’t) 11) Li
Page 45 and 46: G. Important Resources (con’t) -A
Page 47 and 48: Appendix A. Important Contact Infor
Page 49 and 50: Appendix B. Definitions for Rural H
Page 51 and 52: Appendix C. Federal Primary Care HP
Page 53 and 54: Appendix • C. Federal Primary Car
Page 55 and 56: Appendix D. Federal MUAs in Arizona
Page 57 and 58: Instructions for completing HCI App
Page 59 and 60: A. PLEASE LIST IN THE SPACE PROVIDE
Page 61 and 62: MEDICAL FACILITIES LICENSING 150 N.
Page 63 and 64: ARIZONA DEPARTMENT OF HEALTH SERVIC
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MEDICAL FACILITIES LICENSING 150 N.
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http://www.azdhs.gov/als/forms/otcs
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Appendix F. Certification Forms 1.
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3. Has successfully completed a for
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DEPARTMENT OF HEALTH AND HUMAN SERV
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DEPARTMENT OF HEALTH AND HUMAN SERV
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According to the Paperwork Reductio
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MEDICARE ENROLLMENT APPLICATION INS
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2990 (Cont.) Form CMS 222-92 03-02
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RURAL HEALTH CLINIC SURVEY REPORT F
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NAME CODE YES NO N/A EXPLANATORY ST
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