Rural Health Clinics: Pros, Cons, and Certification Process

1. Issues in Rural Health PlanningWebinar 2 Thursday, July 21, 20111:00 – 2:00 PMUnderstand the pros and Cons of Rural health Clinics

2. Learning Objectives • Understand the role and function of a Rural Health Clinic • Identify the primary benefits of opening a Rural Health Clinic • Learn the process of being certified as a Rural Health Clinic • Explore the downside of opening a Rural Health Clinic 2

3. Definition of a RHC • Established through Public Law 95-210, the Rural Health Clinic Services Act, 1977, to increase the provision of primary care services for Medicare and Medicaid patients residing in rural communities. • RHC can be provider-based or independent (freestanding). • Provider-Based: integral part of a hospital, nursing home, home health agency • Independent: stand alone clinics • Status can be public, private, or not-for-profit 3

4. Requirements for a RHC • Staffed with a mid-level practitioner practicing at least 50% of the time • Provide basic laboratory services • Develop written clinical protocols and operational policies and procedures • Conduct an annual evaluation • Gain certification by Medicare 4

5. RHC Location Requirements • Must be in a Health Professional Shortage Area (HPSA) or Geographic Primary Care or • Must be in a Medically Underserved Area/Population (MUA/P) • Designation must be less than 3 years old 5

6. Benefits of Opening a Rural Health Clinic • Potential of significant higher reimbursement (looking at all payors in the aggregate) • Increased coordination between hospital and physicians • Increased clinical integration with hospital • Greater flexibility in financing and efficiencies with administration and shared staff 6

7. Potential Downsides of Operating a RHC • Increased costs related to hospital wage and benefits • More facility costs • Less effective cost management • Decreased physician control of practice staff • Less control of financial accountability and productivity

8. Steps Necessary for RHC Certification • Confirm site eligibility • Evaluate financial feasibility • Assess cost of hiring needed staff • Complete a RHC application and a CMS provider enrollment form • Receive RHC certification inspection by ADHS • File a CMS cost report to have the Medicare rate determined

9. Current RHC Reimbursement Rate ?? • Current RHC maximum encounter rate - $78.07

10. Important Resources • Center for Medicare and Medicaid • Web Site: https://www.cms.gov/center/rural.asp • National Association of Rural Health Clinics • Web Site: www.narhc.org • Listserve: http://www.narhc.org/members/members_listserve.php • Rural Assistance Center • Web Site: www.raconline.org • Toll Free #: 1.800.270.1898 • Revised Arizona Rural Health Clinic Manual, 2011 (available soon)

11. Questions + Contacts • Connie Belden, Team Leader, ADHS Licensing • Connie.Belden@azdhs.gov • Joyce Hospodar, Rural Health Office • hospodar@u.arizona.edu; 520.626.2432 • Ron Smith, CFO, Wickenburg Community Hospital • Ron.Smith@wickhosp.com; 928.684.5421 11