Rural Health Clinic (RHC) Location Determination Guidance Updated

RHC Eligibility Determinations:
• The Centers for Medicare & Medicaid Services (CMS) Regional Office (RO) Survey and
Certification staff are responsible for making RHC applicant eligibility determinations related to
the RHC rural location and shortage area criteria. Although State Survey Agencies (SAs) make
preliminary assessments of eligibility when planning their survey schedule, the authority to make a
determination may not be delegated to the SA or other non-CMS entities. The SA must not communicate
a finding on the eligibility of the applicant’s location to the applicant. In making a
determination, ROs rely upon publicly available information from the U.S. Census Bureau and the
U.S. Department of Health and Human Services Health Resources and Services Administration
(HRSA).
o S&C-13-30, issued May 10, 2013, provided instructions to guide ROs on using the U.S.
Census Bureau’s American Fact Finder with respect to rural location. This memo provides
instructions on using HRSA’s Data Warehouse with respect to shortage areas, including when it is
necessary to contact HRSA for additional information. Although the instructions are
meant primarily for ROs making RHC location determinations, they may be of interest to
others as well.
• ROs must not provide any advance determinations on location eligibility, whether labeled
preliminary or not, to any initial applicant seeking to enroll in Medicare as an RHC or to any
existing RHC considering relocating.
o A determination whether an initial applicant meets the rural and shortage area eligibility
criteria may not be made by the RO before it receives a recommendation for enrollment approval by
the Medicare Administrative Contractor (MAC), based on the MAC’s review of the applicant’s
completed Form CMS-855A. The clinic must already be open and operating before the RO may make a
determination.
• Existing RHCs that relocate must submit a CMS-855A updating their location information to the
appropriate MAC within 90 days after the relocation occurs. The RHC must also submit a Form CMS-29
reflecting its new location to the SA at the same time, and the SA then forwards it to the RO.
After receiving notice of the relocation the RO will determine whether the RHC continues to meet
the location requirements at the new location and will take action to terminate the RHC’s Medicare
agreement if it does not. In addition, the RO has the discretion to require an on-site survey to
confirm compliance with the other RHC Conditions for Certification at the new location.