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

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I. An Introduction to Rural Health Clinics A. Background Information What is a certified Rural Health Clinic Rural Health Clinics (RHCs) provide primary healthcare services in medically underserved areas and are certified under Medicare. Rural Health Clinics also receive an enhanced reimbursement rate from Medicare and Medicaid. What is required to be certified as a Rural Health Clinic To be certified as a Rural Health Clinic (RHC), a clinic must: • Be located in a non-urbanized area as determined by the U.S. Bureau of the Census; • Be located in a federally designated Medically Underserved Area (MUA), a federally designated Health Professional Shortage Area (HPSA), or in an area designated as underserved by the state’s Governor; • Provide outpatient primary care services and basic laboratory services; • Employ at least one midlevel practitioner (Nurse Practitioner, Certified Nurse Midwife, or Physician Assistant) who is on-site and available to see patients at least 50 percent of the time the clinic is open; • Meet health and safety requirements imposed by Medicare and Medicaid; • Must have a physician on staff who provides medical supervision, direction, and consultation; the physician must be present on-site at least one day every two weeks and avail able by telecommunication for assistance at all times. Clinic Ownership: Clinic ownership can be private, non-profit, or public. Provider-Based vs. Independent Rural Health Clinics: • Provider-based Rural Health Clinics are owned and operated by any entity defined by the Medicare statute as a “provider” (hospital, home health agency, or skilled nursing facility). The reimbursement for Provider-based RHCs is handled by the provider associated with the RHC. Provider-based Rural Health Clinics that are owned by a hospital with less than 50 beds are exempt from the per-visit reimbursement cap. The criteria for a facility being defined as “Provider-based” are not specific to the RHC program and apply to any department that seeks to be designated as 4
A. Background Information (con’t) Provider-based. The criteria for Provider-based facilities are available online at: www.cms.hhs. gov/transmittals/downloads/a03030.pdf. • Independent RHCs are clinics not designated as Provider-based. An Independent RHC can be owned and operated by a hospital. Unless the hospital applies for and receives approval for the clinic as Provider-based, it will be considered an Independent RHC. In addition to hospitals, independent RHCs can also be owned by physicians, physician assistants, nurse practitioners, certified nurse midwives, skilled nursing facilities, home health agencies, for-profit cooporations, not-for-profit corporations, or government entities. Independent RHCs are reimbursed through an RHC fiscal intermediary. Sources: National Association of Rural Health Clinics, RHC Technical Assistance, RHC Basics: Part II, http://www. narhc.org/home/RHC.php; Rural Assistance Center, Rural Health Clinics, http://www.raconline.org/info_guides/ clinics/rhc.php; U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy, Starting a Rural Health Clinic: A How-To Manual, http://ruralhealth.hrsa.gov/RHC/ RHCmanual.htm. Rural Health Clinics Act- PL 95-210: An Overview The following is an overview, from the National Association of Rural Health Clinics, of the requirements clinics must meet in order to become certified as a Rural Health Clinic (available online at: http://www.narhc.org/home/RHC.php). The purpose of the Rural Health Clinics program is to encourage and stabilize the provision of out-patient primary care in underserved rural areas through the use of physicians, physician assistants (PAs) , nurse practitioners (NPs) and certifi ed nurse midwives (CNMs). 1. Location - Rural Health Clinics must be located in communities that are both “rural” and “underserved.” For purposes of the Rural Health Clinics Act, the following defi nitions apply to these terms: -Rural Areas - Census Bureau designation as “Non-urbanized” -Shortage Area - a federally designated Health Professional Shortage Area, a federally designated Medically Underserved Area or an Area designation by the state’s Governor as underserved. 2. Physical Plant -May be permanent or mobile -Has a preventive maintenance program -Has non-medical emergency procedures 3. Staffi ng -One or more physicians -One or more PAs, NPs or CNMs -PA, NP or CNM must be on-site and available to see patients 50% of the time the clinic open for patients. 4. Provision of Services •Each Rural Health Clinic must be capable of delivering out-patient primary care services. •The Clinic must maintain written patient care policies: -Developed by a physician, physician assistant or nurse practitioner, and one health practitioner who is not a member of the clinic staff 5
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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
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Page 15 and 16: E. Steps to Becoming a Certified Ru
Page 17 and 18: B. Interpretive Guidelines for Rura
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Page 39 and 40: F. RHC Cost Report The Medicare cos
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Page 45 and 46: G. Important Resources (con’t) -A
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Appendix D. Federal MUAs in Arizona
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Instructions for completing HCI App
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A. PLEASE LIST IN THE SPACE PROVIDE
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MEDICAL FACILITIES LICENSING 150 N.
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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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