A Brief History

1. A Brief History • Rural Health Clinic Services Act of 1977 (P.L. 95-210) Enacted to address the inadequate supply of physicians serving Medicare beneficiaries and Medicaid recipients in rural areas.

2. Rural Health Clinic Services Act of 1977 Amended the SSA by adding Sec.1861(aa) to extend Medicare and Medicaid entitlement and payment for primary and emergency care services furnished at an RHC by physicians, NPs, and PAs, for services and supplies incidental to their services

3. Rural Health Clinic Services Act of 1977 Authorized CMS and States to pay qualifying clinics on a cost related basis for these services. Required that clinics be located in an area that is designated by the Census Bureau as non-urban, and designated or certified by HRSA as a shortage area. Contained ‘grandfather clause’ - “Once an RHC, always an RHC”

4. Balanced Budget Act of 1997 (BBA) Amended Section 1861(aa)(2) of the Social Security Act • Specifies location requirements for new andexisting RHCs • Permits exceptions to the location requirements for an existing RHC if the RHC can show that it is essential to the delivery of primary care in the service area

5. Regulation to Implement BBA Changes • Proposed Rule – February 2000 • Final Rule – December 2003 • Suspension of Final Rule – Sept 2006

6. New RHC Regulation • New Proposed Regulation CMS Clearance -> HHS Clearance -> OMB Clearance -> Publication in the Federal Register -> 60 Day Comment Period -> Publication of Final Rule

7. Current RHC Requirements • RHC Regulations published prior to the 2003 Final Rule • Provisions in other regulations that Impact RHCs • Self-implementing provisions of statutes • Policies issued through manual instructions or Program Memorandum

8. National Provider Identifier (NPI)

9. National Provider Identifier (NPI) • The NPI replaces your RHC’s current provider number • RHCs must have an entity type 2 (organizational) NPI in order to bill for its services

10. NPI – Cont’d • Within an organization any individual provider who must be identified on a transaction must obtain an NPI • Groups must also have an NPI in order to bill for their services

11. NPI’s for Hospital-Based RHCs with Multiple Locations • Sites that file separate transactions must have separate NPIs for each site

12. NPI Information • http://www.cms.hhs.gov/NationalProvIdentStand/03_apply.asp#TopOfPage • https://nppes.cms.hhs.gov • 800-465-3203

13. CMS Resources and Information

14. CMS Rural Health Fact Sheets • Critical Access Hospital Fact Sheet • Rural Health Clinic Fact Sheet • Rural Referral Center Fact Sheet • Sole Community Hospital Fact Sheet • Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians

15. New CMS Fact Sheet Medicare Billing Information for Rural Providers, Suppliers, and Physicians Billing charts for: RHCs, FQHCs, SNFs, HHAs, CAHs

16. CMS Information • Medicare Learning Network • Fact Sheets • Guides • Booklets • Training Presentations • Audio/Video • Job Aids

17. CMS Rural Health Information • Medicare Learning Network Products • http://www.cms.hhs.gov/MLNProducts