Rural Health Clinic Overview

RHCs were enacted with The Rural Health Clinic Services Act of 1977 (Public Law 95-210) to help address the unserved medical needs of Medicare beneficiaries in rural communities. RHCs provide both primary and preventive services with the goal of improving health access in rural areas. RHCs must be staffed by at least 50% of the time by midlevel practitioners (such as nurse practitioners (NPs), certified nurse midwives (CNM) and physician assistants (PAs)). RHCs are certified to receive special Medicare and Medicaid reimbursement. Currently, there are around 4,000 RHCs. There are two types of RHC clinics, provider-based clinics and independent (freestanding) clinics. The provider-based clinic is owned by either a hospital, skilled nursing facility or a home health agency. The independent or freestanding clinic is owned by a physician, mid-level practitioner or other non-profit entities.

Certification criteria

The following are the RHC certification criteria:

• An RHC must be in compliance with federal, state and local laws.
• The clinic must be in a permanent location or mobile unit with a fixed schedule of locations.
• An RHC must have a physician on staff that provides medical supervision for the clinic’s staff.
• The clinic must employ at least one nurse practitioner, physician assistant or certified nurse midwife who is on duty at least 50% of the time the clinic is open and who is under the general direction of the physician.
• Other required staff members include:
  • Clinic nurse/aide
  • Front desk receptionist
  • Clinic administrator
  • Billing personnel
  • Medical records librarian

The RHC must:

• Provide routine diagnostic and laboratory services.
• Have written policies and procedures.
• Establish arrangements with providers and suppliers participating in the Medicare and/or Medicaid program to furnish medically necessary services not available at the clinic.
• Be able to provide first-response emergency care, including necessary drugs.
• Ensure the maintenance and security of patient records.
• Must maintain appropriate health and safety standards, complying with local state and federal laws.
• Have a mechanism for an annual evaluation of the clinic’s program.
• Have policies and procedures in place for transferring patients in need of acute care.

To become Medicare-certified as an RHC, a provider must submit an application to its local Department of Health. If a hospital provides RHC services at more than one site, each site is considered a clinic. The location of the site, rather than the location of the provider hospital, will determine the eligibility of the RHC.