[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR491.5]



[Page 972-973]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 491_CERTIFICATION OF CERTAIN HEALTH FACILITIES--Table of Contents

 

Subpart A_Rural Health Clinics: Conditions for Certification; and FQHCs 

                         Conditions for Coverage

 

Sec.  491.5  Location of clinic.



    (a) Basic requirements. (1) An RHC is located in a rural area that 

is designated as a shortage area.

    (2) An FQHC is located in a rural or urban area that is designated 

as either a shortage area or an area that has a medically underserved 

population.

    (3) Both the RHC and the FQHC may be permanent or mobile units.

    (i) Permanent unit. The objects, equipment, and supplies necessary 

for the provision of the services furnished directly by the clinic or 

center are housed in a permanent structure.

    (ii) Mobile unit. The objects, equipment, and supplies necessary for 

the provision of the services furnished directly by the clinic or center 

are housed in a mobile structure, which has fixed, scheduled 

location(s).

    (iii) Permanent unit in more than one location. If clinic or center 

services are furnished at permanent units in more than one location, 

each unit is independently considered for approval as a rural health 

clinic or for approval as an FQHC.

    (b) Exceptions. (1) CMS does not disqualify an RHC approved under 

this subpart if the area in which it is located subsequently fails to 

meet the definition of a rural, shortage area.

    (2) A private, nonprofit facility that meets all other conditions of 

this subpart except for location in a shortage area will be certified 

if, on July 1, 1977, it was operating in a rural area that is determined 

by the Secretary (on the basis of the ratio of primary care physicians 

to the general population) to have an insufficient supply of physicians 

to meet the needs of the area served.

    (3) Determinations on these exceptions will be made by the Secretary 

upon application by the facility.

    (c) Criteria for designation of rural areas. (1) Rural areas are 

areas not delineated as urbanized areas in the last census conducted by 

the Census Bureau.

    (2) Excluded from the rural area classification are:

    (i) Central cities of 50,000 inhabitants or more;

    (ii) Cities with at least 25,000 inhabitants which, together with 

contiguous areas having stipulated population density, have combined 

populations of 50,000 and constitute, for general economic and social 

purposes, single communities;

    (iii) Closely settled territories surrounding cities and 

specifically designated by the Census Bureau as urban.

    (3) Included in the rural area classification are those portions of 

extended cities that the Census Bureau has determined to be rural.

    (d) Criteria for designation of shortage areas. (1) The criteria for 

determination of shortage of personal health services (under section 

1302(7) of the Public Health Services Act), are:

    (i) The ratio of primary care physicians practicing within the area 

to the resident population;

    (ii) The infant mortality rate;

    (iii) The percent of the population 65 years of age or older; and

    (iv) The percent of the population with a family income below the 

poverty level.

    (2) The criteria for determination of shortage of primary medical 

care manpower (under section 332(a)(1)(A) of the Public Health Services 

Act) are:

    (i) The area served is a rational area for the delivery of primary 

medical care services;

    (ii) The ratio of primary care physicians practicing within the area 

to the resident population; and

    (iii) The primary medical care manpower in contiguous areas is 

overutilized, excessively distant, or inaccessible to the population in 

this area.

    (e) Medically underserved population. A medically underserved 

population includes the following:

    (1) A population of an urban or rural area that is designated by PHS 

as having a shortage of personal health services.

    (2) A population group that is designated by PHS as having a 

shortage of personal health services.

    (f) Requirements specific to FQHCs. An FQHC approved for 

participation in



[[Page 973]]



Medicare must meet one of the following criteria:

    (1) Furnish services to a medically underserved population.

    (2) Be located in a medically underserved area, as demonstrated by 

an application approved by PHS.



    Cross Reference: See 42 CFR 110.203(g) (41 FR 45718, Oct. 15, 1976) 

and 42 CFR Part 5 (42 FR 1586, Jan. 10, 1978).



[43 FR 5375, Feb. 8, 1978. Redesignated at 50 FR 33034, Aug. 16, 1985, 

and amended at 57 FR 24982, June 12, 1992; 61 FR 14658, Apr. 3, 1996; 68 

FR 74816, Dec. 24, 2003; 71 FR 55346, Sept. 22, 2006]