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

More documents

Recommendations

Info

NAME CODE YES NO N/A EXPLANATORY STATEMENTS J10 ■ MET ■ NOT MET (b) Does the facility meet location eligibility in a rural health shortage area through either of the following exceptions. J11 J12 (1) A facility certified under this subpart will not be disqualified if the area in which it is located subsequently fails to meet the definition of rural, shortage area. (2) A private, nonprofit facility that meets all other conditions of this subpart except for location in a shortage area will be certified if, on July 1, 1977, it was operating in a rural area that is determined by the Secretary (on the basis of the ratio of primary care physicians to the general population) to have an insufficient supply of physicians to meet the needs of the area served. Determinations on these exceptions will be made by the Secretary upon application by the facility. J13 ■ MET ■ NOT MET (c) The facility meets rural area requirements under one of the following criteria. J14 (1) Rural areas are areas not delineated as urbanized areas in the last census conducted by the Census Bureau. J15 (2) Included in the rural area classification are those portions of extended cities that the Census Bureau has determined to be rural. Form CMS-30 (05/78) EF 10/2004 3 86
NAME CODE YES NO N/A EXPLANATORY STATEMENTS J16 ■ MET ■ NOT MET (d) The facility meets the shortage area requirements under one of the following criteria. J17 (1) Determination of shortage of personal health services (under section 1302(7) of the Public Health Service Act). J18 (2) Determination of shortage of primary medical care manpower (under section 332(a) (1) (A) of the Public Health Service Act). Form CMS-30 (05/78) EF 10/2004 4 87
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 and 16:
E. Steps to Becoming a Certified Ru
Page 17 and 18:
B. Interpretive Guidelines for Rura
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
D. Preparing for the Certification
Page 31 and 32:
Page 33 and 34:
Page 35 and 36: 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.
Page 67 and 68: http://www.azdhs.gov/als/forms/otcs
Page 69 and 70: Appendix F. Certification Forms 1.
Page 71 and 72: 3. Has successfully completed a for
Page 73 and 74: DEPARTMENT OF HEALTH AND HUMAN SERV
Page 75 and 76: DEPARTMENT OF HEALTH AND HUMAN SERV
Page 77 and 78: According to the Paperwork Reductio
Page 79 and 80: MEDICARE ENROLLMENT APPLICATION INS
Page 81 and 82: 2990 (Cont.) Form CMS 222-92 03-02
Page 83 and 84: RURAL HEALTH CLINIC SURVEY REPORT F
Page 85: NAME CODE YES NO N/A EXPLANATORY ST
Page 89 and 90: NAME CODE YES NO N/A EXPLANATORY ST
show all

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

Create successful ePaper yourself

Delete template?

Save as template?