Chapter One
Overview of RHC Program
The following is an overview of the major requirements clinics
must meet in order to become certified as a Rural Health Clinic.
Each of the subjects addressed in this overview are discussed in
further detail in this manual.
Location - Rural Health Clinics must be located in communities
that are both "rural" and "underserved". For
purposes of the Rural Health Clinics Act, the following definitions
apply to these terms:
- Rural Area - Census Bureau designation as "non-urbanized"
- Shortage Area - A Federally-designated Health Professional
Shortage Area, a Federally-designated Medically Underserved Area
or an Area designated by the State's Governor as underserved.
Unlike some other programs that are not concerned about the location
of the facility but rather the types of patients seen by the facility,
the RHC program ties certification to the location of the facility.
A non-urbanized area is any area that does not meet the Census Bureau's
definition of urbanized. The Census bureau definition of an Urbanized
Area can be found in Chapter 2.
Physical Plant - The Rural Health Clinic program does not
place any restrictions on the type of facility that can be designated
as an RHC. A Rural Health Clinic may be either a permanent location
that is a stand alone building or a designated space within a larger
facility. The clinic can also be a mobile facility that moves from
one community to another community.
Staffing - The Rural Health Clinic program was the first
Federal initiative to mandate the utilization of a team approach
to health care delivery. Each Federally-certified Rural Health Clinic
must have:
- One or more physicians; and
- One or more PAs, NPs or CNMs; and,
- The PA, NP or CNM must be on-site and available
to see patients 50 percent of the time the clinic is open for
patients.
Provision of Services - Each Rural Health Clinic must be
capable of delivering out-patient primary care services, although
Clinics are not limited to primary care services. The Clinic must
also maintain written patient care policies that:
- Are developed by a physician, physician assistant or nurse practitioner, and one
health practitioner who is not a member of the clinic staff.
- Describe the services provided directly by the clinic's staff or through arrangement.
- Provide guidelines for medical management of health problems.
- Provide for annual review of the policies.
A copy of a sample Policy and Procedures manual that describes
this requirement has been included in Appendix D.
Direct Services - These are services that the clinic's staff
must provide directly. Clinic staff must provide diagnostic and
therapeutic services commonly furnished in a physician's office.
Each Rural Health Clinic must be able to provide the following six
laboratory tests.
- Chemical examinations of urine
- Hemoglobin or Hematocrit
- Blood sugar
- Examination of stool specimens for occult blood
- Pregnancy test
- Primary culturing for transmittal
Emergency Services - Rural Health Clinics must be able to
provide "first response" services to common life-threatening
injuries and acute illnesses. In addition, the clinic must have
access to those drugs used commonly in life-saving procedures.
Services Provided through Arrangement - In addition to the
services that clinic staff must provide directly, the Rural Health
Clinic may provide other services utilizing individuals other
than clinic staff. Those services that a clinic may offer that can
be provided by non-RHC staff are:
- In-patient hospital care
- Specialized physician services
- Specialized diagnostic and laboratory services
- Interpreter for foreign language if indicated
- Interpreter for deaf and devices to assist communication with blind patients
Patient Health Records - Each clinic must maintain an accurate
and up-to-date record keeping system that ensures patient confidentiality.
A description of the Clinic's system must be included in the policy
and procedures manual (see Appendix D). Clinic staff must be involved
in the development of this record keeping system.
Records must include the following information:
Identification data |
Physicians orders |
Physical exam findings |
Consultative findings |
Social data |
Diagnostic and laboratory reports |
Consent forms |
Medical history |
Health status assessment |
Signatures of the physician or
other health care professionals |
Protection of Record Information Policies - In addition
to maintaining the confidentiality of patient information, the clinic
must have written policies and
procedures that govern the use, removal and release of information.
The policy and procedures manual must also document the mechanism
through which a patient can provide consent for the release of his
or her medical records. RHCs like all other Medicare providers,
must also be compliant with the HIPAA privacy standards
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