Rural Health Clinic (RHC)

Key facts

Created by

Rural Health Clinic Services Act of 1977 (Public Law 95-210)

Certification rules

42 CFR Part 491, Subpart A

Location

Area not urbanized per the Census Bureau and designated as a shortage area

Staffing

NP, PA or certified nurse-midwife available at least 50 percent of open hours

Ownership

Public, nonprofit or for-profit

What is a Rural Health Clinic?

Congress created the Rural Health Clinic program in 1977 to improve access to primary care for Medicare and Medicaid patients in rural communities that could not attract enough physicians. Certification lets a clinic bill Medicare and Medicaid under a special RHC payment method rather than the standard physician fee schedule.

RHCs can be independent clinics or provider-based clinics owned by a hospital. Unlike Federally Qualified Health Centers, they can be for-profit and do not need a community board or a sliding fee schedule to be certified.

RHC certification requirements

Under 42 CFR Part 491, a certified RHC must:

• Be located in an area that is not an urbanized area as defined by the Census Bureau.
• Be in an area designated as a shortage area, such as a Health Professional Shortage Area or Medically Underserved Area.
• Have a nurse practitioner, physician assistant or certified nurse-midwife available to furnish patient care at least 50 percent of the time the clinic operates, unless CMS grants a temporary waiver.
• Have physician medical direction and provide basic laboratory services and first response emergency care.
• Not be a rehabilitation agency or a facility primarily for mental health treatment.

How RHCs are paid

Medicare pays RHCs an all-inclusive rate per qualifying visit, subject to a per-visit payment limit. The Consolidated Appropriations Act, 2021 changed those limits for independent RHCs and most provider-based RHCs, with scheduled increases over several years, while protecting certain existing provider-based RHCs owned by small hospitals. State Medicaid programs pay RHCs under a prospective payment system or an approved alternative.

Why RHCs matter

RHCs are often the main primary care access point in small towns, and their certification data locates rural prescribers and practitioners that urban-focused analyses miss. RHCs that meet National Health Service Corps site requirements receive automatic facility HPSA designation, which helps them recruit. Hospital ownership of provider-based RHCs is also a useful signal when mapping rural health system footprints.