Medicare-Designated Rural Health Clinics

Background

A Rural Health Clinic (RHC) is a clinic certified to receive special Medicare and Medicaid reimbursement. The purpose of the RHC program is improving access to primary care in underserved rural areas.

Designated Rural Health Clinics (are reimbursed based on a reasonable cost formula for Medicare visits, and on a modified cost-based formula or prospective payment for Medicaid visits. Many rural providers find that their reimbursement is significantly enhanced under this system.

For more information about Rural Health Clinics check out:

Rural Location Definition

Rural Health Clinics must be located in rural areas with current health care shortage designations.

Not in an Urbanized Area

Any area that is not in a U.S. Census-designated "urbanized area" is considered rural. To see if your location is in a rural area you can use the to Rural Health Information Hub's Am I Rural?.

Shortage Areas

Eligible clinics must be in a rural area designated or updated within the last four years by the U.S. Health Resources and Services Administration. There are four types of shortage areas that qualify:

  • Geographic-based HPSA (Health Professional Shortage Area)
  • Population-based HPSA
  • MUAs (Medically Underserved Area)
  • Governor Designated medically underserved area

To see if your location is in a federally designated Health Professional Shortage Area or Governor-Designated medically Underserved Area go to the Health Workforce website.

Rural Health Clinic Certification

The final determination of eligibility is made by your state agency responsible for RHC certification and the CMS regional office. For information on RHC eligibility, contact KDHE´s Bureau of Community Health Systems at 785-296-1200.

Requirements for Rural Health Clinics

Rural Health Clinics must comply with Medicare regulations to meet conditions of certification.

Rural Health Clinics are required to use a team approach of physicians and mid-level practitioners such as nurse practitioners, physician assistants, and certified nurse-midwives to provide services. The clinic must be staffed at least 50% of the time with a midlevel practitioner.

Rural Health Clinics are required to provide outpatient primary care services and basic laboratory services.

To view Medicare´s RHCs regulations and interpretative guidelines go to the Centers for Medicare and Medicaid Services - Rural Health Clinic Center webpage.

Becoming a Rural Health Clinic

To receive special Medicare and Medicaid reimbursement; a clinic must gain Medicare certification as a Rural Health Clinic. This process first begins by applying for Medicare certification through the Kansas Department of Health and Environment, Bureau of Child Care and Health Facilities.

For more information or questions about the application process for RHC certification, email Tamara Wilkerson or call 785-296-1263.