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:
- that is not an urbanized area (as defined by the Bureau of the
Census); and,
- 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
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