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

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A. State Licensing II. Licensing and Certification Requirements A site must be licensed by the Arizona Department of Health Services, Division of Licensing Services, Office of Medical Facilities Licensing as an Outpatient Treatment Center in order to become a certified Rural Health Clinic in Arizona. If a site is interested in becoming both licensed and a certified Rural Health Clinic, then the site may request both a licensing application packet and an RHC application packet from the Arizona Department of Health Services, Division of Licensing Services, Office of Medical Facilities Licensing (see Appendix A. Important Contact Information). The requirements for licensing medical facilities are according to Title 9, Chapter 10 of the Arizona Administrative Code. To see the sections of the code pertaining to the licensing of health institutions in its entirety, please visit the following website http://www.azsos.gov/public_services/Title_09/9-10.htm The forms required for licensing (see Appendix E. Licensing Forms) can be printed from the internet from the Arizona Department of Health Services, Division of Licensing Services, Office of Medical Facilities Licensing’s website (http://www.azdhs.gov/als/medical). If the site is applying for an initial license, the site must complete the “Initial Application for a Health Care Institution License.” The initial application is for a new facility just being licensed for the first time or for an already licensed facility that has had a change in location or ownership. If the site is applying for a renewal of their license, the site must complete the “Renewal Application for a Health Care Institution License.” In addition, an Outpatient Facility Information sheet must accompany the initial or renewal application. An important aspect of licensing is that the facility’s floor plan must be contiguous. For example, if a patient must pass through a hallway in order to get to another area of the clinic, and that hallway is not licensed, then the patient of the clinic cannot pass through that hallway. Therefore, once the patient comes into the licensed area, the patient must be able to stay in the licensed area for the duration of the visit. It is important to note that the Arizona Department of Health Services, Division of Licensing Services, Office of Medical Facilities Licensing must be notified, in writing, if any changes are made to the site’s building, administration, or to the services offered by the site. 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. Source: Arizona Department of Health Services, Division of Licensing Services, Office of Medical Facilities Licensing, http://www.azdhs.gov/als/medical. 16
B. Interpretive Guidelines for Rural Health Clinics A site must comply with the following guidelines in order to become a certified Rural Health Clinic. These interpretive guidelines are available online from the National Association of Rural Health Clinics at: http://www.narhc.org/uploads/pdf/RHCmanual1.pdf The forms required for certification as a Rural Health Clinic are listed in Appendix F. Certification Forms. INTERPRETIVE GUIDELINES - RURAL HEALTH CLINICS Conditions for Certification I. COMPLIANCE WITH FEDERAL, STATE, AND LOCAL LAWS (42 CFR 491.4) The RHC and its staff are in compliance with applicable Federal, State, and local laws and regulations. A. Federal Laws and Regulations.--The Federal regulations governing the certifi cation of RHCs were published in the Federal Register on July 14, 1978, 43 FR 136. Conditions for certifi cation under those regulations are the subject of these guidelines. B. State Laws and Regulations. All States have practice acts that govern the activities of health professionals. While there is considerable variation in the States’ practice acts concerning physician assistants, nurse practitioners and certifi ed nurse-midwives, there is a broad mandate in the medical practice acts of all States giving physicians authority to diagnose and treat medical conditions. The extent to which the physician may delegate these responsibilities and to whom, and under what conditions, varies in the states. Some States have updated their practice acts since the advent of the physician assistant, nurse practitioner and certifi ed nurse-midwife health care professionals. In some instances, these updated practice acts have included defi nitions and specifi c references to permitted/prohibited activities, supervision/guidance required by a physician, and location/situations in which nurse practitioners, certifi ed nurse-midwives and physician assistants may function. In some States where nurse practice acts have not been signifi cantly updated, some functions of the nurse practitioner are viewed as an extension of the traditional nursing role as being covered by the existing nurse practice act. Rural health clinics can be certifi ed only if the State permits--that is, does not explicitly prohibit--the delivery of primary health care by a nurse practitioner, certifi ed nurse-midwife or a physician assistant. The surveyor will encounter wide variations in the wording, interpretation, and application of States’ practice acts as they affect the physician assistant, nurse practitioner and certifi ed nurse-midwife in the RHC setting. In situations where the State law is silent, or where the state law does not specifi cally prohibit the functioning of a physician assistant, nurse practitioner or certifi ed nurse-midwife with medical direction by a physician and with the degree of supervision, guidance, and consultation required by the RHC regulations, the surveyor may consider this condition as being met. Interpretations needed on specifi c aspects of the State’s practice act should be sought through the State regulatory agency or board(s) dealing with the practice and profession. II. LOCATION OF CLINIC (42 CFR 491.5) Consult with the Regional Offi ce (R.O.) to preliminarily ascertain that a clinic meets the basic requirement of location prior to scheduling a survey. The clinic must be located in a rural area that is designated as a shortage area. Applicants determined not qualifi ed under this requirement should be sent a letter (see Exhibit.27) with the appropriate notation. A. Rural Area Location. The law requires the clinic to be located in an area “that is not an urbanized area as defi ned by the Bureau of the Census.” The Bureau has published both a narrative defi nition of an urbanized 17
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 and 14: D. Frequently Asked Questions (con
Page 15: E. Steps to Becoming a Certified Ru
Page 19 and 20: 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
Page 65 and 66: 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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