Starting a Rural Health Clinic - A How-To Manual

Chapter Two

Getting Started

Before engaging in the process of meeting the technical requirements of becoming a Federally-certified Rural Health Clinic, it is necessary to ensure that the site is eligible for RHC designation. There are two basic eligibility requirements for having a site designated as a Rural Health Clinic:

The facility must be located in an area:

1. that is not an urbanized area (as defined by the Bureau of the Census); and,
2. that, within the previous 3-year period,
   
   • has been designated by the chief executive officer of the State and certified by the Secretary as an area with a shortage of personal health services; or,
   • designated by the U.S. Secretary of Health and Human Services as either:
     
     • an area with a shortage of personal health services under section 330(b)(3) or 1302(7) of the Public Health Service Act; or,
     • a health professional shortage area described in section 332(a)(1)(A) of that Act because of its shortage of primary medical care manpower; or,
     • a high impact area described in section 329(a)(5) of that Act; or,
     • an area which includes a population group which the Secretary determines has a health manpower shortage.

According to the Census Bureau, an Urbanized area is:

"An area consisting of a central place(s) and adjacent territory with a general
population density of at least 1,000 people per square mile of land area that
together have a minimum residential population of at least 50,000 people.
The Census Bureau uses published criteria to determine the qualification and boundaries of UAs." (Census Bureau Web site).

The agency goes on to further clarify this definition with the following additional information:

"A densely settled area that has a census population of at least 50,000.
A UA generally consists of a geographic core of block groups or blocks
that have a population density of at least 1,000 people per square mile,
and adjacent block groups and blocks with at least 500 people per square
mile. A UA may consist of all or part of one or more incorporated places
and/or census designated places, and may include area adjacent to the
place(s)."

The above references to the Public Health Services Act refer to Federal Health Professional Shortage Area (HPSA) designations and Medically Underserved Area (MUA) designations. The HPSA and MUA lists are available on the Health Resources and Services Administration's Web site or by contacting the Shortage Designation Branch of the Health Resources and Services Administration's Bureau of Health Professions. The Web address and/or phone numbers for these offices are listed in Appendix F. Although the list is published in the Federal Register, the publication date is unpredictable and infrequent. To determine whether your State's executive officer has designated areas as shortage areas for purposes of establishing rural health clinics, it is recommended that you contact your State Office of Rural Health (SORH). A complete listing of SORHs, including their addresses and phone numbers, can be found in Appendix B.

Please note that by law, the shortage area designation MUST have occurred within the past three (3) years. If the shortage area designation (HPSA, MUA or Governor) is more than three years old, then the site does not qualify for RHC certification. The RHC surveyor will not conduct a survey for initial certification until that designation is updated and deemed current. If you determine that the area is not designated as either a Health Professional Shortage Area or a Medically Underserved Area, you can review the criteria for each designation (Appendix C) to ascertain whether a designation may be possible.

Once you have determined that the site is located in a "non-urbanized area" that is also a shortage area that qualifies for RHC designation, you are then ready to proceed to the next phase: Financial Feasibility Analysis