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Rural Health Clinics

Background

Designated Rural Health Clinics (RHCs) 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.

Location Eligibility

Eligible clinics must be in a rural area designated or updated within the past four calendar years as having a shortage of primary care physicians. Qualifying designations include Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), High Migrant Impact Area (HMIA), or an area designated as medically underserved by the chief executive officer (Governor) of the state. Also, RHCs must employ a mid-level provider furnishing direct patient services not less than 50% of the time during the clinic’s hours of operation (the hours the clinic provides direct patient services); and must provide services in compliance with the Medicare Conditions of Coverage for rural health clinics.

For information on RHC location eligibility, contact Gloria Vermie at (515)281-7224.

RHC Application and Certification

For complete information about initial Medicare certification for rural health clinics in Iowa, contact Rosemary Kirlin in the Department of Inspections and Appeals at (515)281-4120.

Beginning March 23, 2012 the Centers for Medicare (CMS) approved the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) to conduct initial certification surveys for RHCs seeking initial Medicare certification. Completion of the initial certification survey is only one step in the initial certification process. Rural health clinics seeking initial Medicare certification must first contact the Department of Inspections and Appeals (DIA), and the rural health clinic must complete and submit the required CMS forms to the DIA prior to contacting AAAASF to arrange to have a deemed status survey completed by AAAASF. A successful deemed status survey will be accepted by CMS in lieu of an initial certification survey completed by the State Agency. In addition to certification services, the AAAASF offers several free RHC standards and resources.