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Last Modified: 11/2/2018 Location: FL, PR, USVI Business: Part A

All inclusive payment for rural health centers (RHCs) and federally qualified health centers (FQHCs)

Rural health clinics (RHCs) are clinics that are located in areas designated by the Bureau of the Census as rural and by the Secretary of Department of Health and Human Services (DHHS) or the state as medically underserved. RHCs have been eligible for participation in the Medicare program since March 1, 1978. Services rendered by approved RHCs to Medicare beneficiaries are covered under Medicare effective with the date of the clinic’s approval for participation.
Section 4161 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 amended 1861(aa) of the Social Security Act external link to establish federally qualified health centers (FQHCs) as entities to provide a new Medicare benefit effective October 1, 1991. The FQHC services also include preventive primary health services. The law defines Medicare preventive services as the preventive primary health services that an FQHC is required to provide under section 330 of the Public Health Service (PHS) Act. Payments for covered RHC/FQHC services furnished to Medicare beneficiaries are made on the basis of an all-inclusive rate per covered visit (except for pneumococcal and influenza vaccines and their administration, which is paid at 100 percent of reasonable cost). The term “visit” is defined as a face-to-face encounter between the patient and a physician, physician assistant, nurse practitioner, certified nurse midwife, visiting nurse, clinical psychologist, or clinical social worker during which an RHC/FQHC service is rendered.
Please refer to the CMS website for additional information on RHCs external link and FQHCs external link.
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