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. 

Qualifying Criteria

Eligible clinics must be in a rural area designated or updated within the past three 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 undeserved by the chief executive officer (Governor) of the state.  Also, RHCs must employ a midlevel provider not less than 50% of the time and meet a set of minimum standards for physical plant and services provided.

Clinics may be decertified after three years.  However, the Centers for Medicare and Medicaid Services (CMS) have not finalized regulations guiding the process for decertification of RHCs.  A number of counties with RHCs in Kansas are "at risk" for loss of certification, but facilities in those counties are still designated at this time, and will not risk loss of status until these regulations are put into effect. It is expected that new regulations will allow current RHCs to retain their designation if they can meet certain criteria (not yet defined).

For information on RHC eligibility, contact Jane Faubion in Rural Health at jfaubion@kdheks.gov or (785) 296-1200. For questions about the application process for RHC certification, contact Tamara Wilkerson in the KDHE Bureau of Child Care and Health Facilities at twilkers@kdheks.gov or (785) 296-1263.