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Rural Health Clinics

This page provides basic information about being certified as a Medicare participating rural health clinic (RHC) supplier and includes links to applicable laws, regulations, and compliance information.

An RHC is a clinic that is located in a rural area designated as a shortage area, is not a rehabilitation agency or a facility primarily for the care and treatment of mental diseases, and meets all other requirements of 42 CFR 405 and 491.

The State Survey Agency reviews and evaluates the information on the Request to Establish Eligibility, Form CMS-29 and documents submitted with the request, and consults with the CMS Regional Office (RO) to obtain a determination whether the basic requirements discussed below are met. (The RO will seek the assistance of the Census Bureau when making a rural area determination and the Health Resources and Services Administration (HRSA) when making a shortage area determination) These are some basic requirements:

Location of Clinic

The clinic must be located in a rural area that is designated as a shortage area.

Medical Direction

The physician providing medical direction may be the owner of the RHC, an employee of the clinic or under agreement with the clinic to carry out the physician responsibilities located at 42 CFR 491.8(a)(6)(b).

Physician Assistant, Nurse Practitioner, and/or Certified Nurse Midwife Staff

A nurse practitioner, a physician assistant, or certified nurse-midwife must be available to furnish patient care services at least 50 percent of the time the clinic operates. A existing clinic may request a temporary waiver of these staffing requirements for a one-year period, if it demonstrates that it has been unable to hire a physician assistant, nurse-practitioner, or a certified nurse-midwife in the previous 90-day period.

A subsequent request for a waiver cannot be made less than 6 months after the expiration date of any previous waiver of the mid-level staffing requirements for the clinic.