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Rural Health Clinics

This page provides basic information about being certified as a Medicare and/or Medicaid rural health clinic (RHC) provider and includes links to applicable laws, regulations, and compliance information.

An RHC is a facility located in a rural area designated as a shortage area and is neither a rehabilitation agency nor a facility primarily for the care and treatment of mental diseases.  A clinic located on an island may be eligible to be certified as an RHC even though it does not have a physician assistant, nurse practitioner, or certified nurse-midwife.  (See §6213 of OBRA 1989.)

The State Survey Agency reviews and evaluates the information on the Request to Establish Eligibility, Form CMS-29 and documents submitted with the request, and as necessary consults with the CMS Regional Office (RO) to obtain a determination whether the basic requirements discussed below are met.  (The RO will seek the assistance of the Health Resources and Services Administration (HRSA) in this matter.)  These requirements are:

Location of Clinic

The clinic must be located in a rural area that is designated as a shortage area. 

Medical Direction

The physician(s) providing medical direction must be a member of the clinic’s staff or under agreement with the clinic to carry out the responsibilities required of a physician.

Physician Assistant, Nurse Practitioner, and/or Certified Nurse Midwife Staff

A nurse practitioner, a physician assistant, or certified nurse-midwife must be available to furnish patient care services at least 50 percent of the time the clinic operates.  A clinic may request a temporary waiver of these staffing requirements for a one-year period, if it demonstrates that it has been unable to hire a physician assistant, nurse-practitioner, or a certified nurse-midwife in the previous 90-day period.

A subsequent request for a waiver cannot be made less than 6 months after the expiration date of any previous waiver of staffing requirements for the facility.


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Related Links Inside CMS

State Operations Manual Chapter 2, Sections 2240 - 2249

Guidance for Laws and Regulations for RHCs

Survey and Certification General Enforcement Information
Related Links Outside CMSExternal Linking Policy

Section 1861(aa) of the Social Security Act

42 CFR Part 491

Page Last Modified: 05/31/2006 2:00:00 PM
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