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A Brief History

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Title: A Brief History


1
A Brief History
  • Rural Health Clinic Services Act of 1977
  • (P.L. 95-210)
  • Enacted to address the inadequate supply of
    physicians serving Medicare beneficiaries and
    Medicaid recipients in rural areas.

2
Rural Health Clinic Services Act of 1977
  • Amended the SSA by adding Sec.1861(aa) to extend
    Medicare and Medicaid entitlement and payment for
    primary and emergency care services furnished at
    an RHC by physicians, NPs, and PAs, for services
    and supplies incidental to their services

3
Rural Health Clinic Services Act of 1977
  • Authorized CMS and States to pay qualifying
    clinics on a cost related basis for these
    services.
  • Required that clinics be located in an area that
    is designated by the Census Bureau as non-urban,
    and designated or certified by HRSA as a shortage
    area.
  • Contained grandfather clause -
  • Once an RHC, always an RHC

4
Balanced Budget Act of 1997 (BBA)
  • Amended Section 1861(aa)(2) of the Social
    Security Act
  • Specifies location requirements for new and
    existing RHCs
  • Permits exceptions to the location requirements
    for an existing RHC if the RHC can show that it
    is essential to the delivery of primary care in
    the service area

5
Regulation to Implement BBA Changes
  • Proposed Rule February 2000
  • Final Rule December 2003
  • Suspension of Final Rule Sept 2006

6
New RHC Regulation
  • New Proposed Regulation
  • CMS Clearance -gt
  • HHS Clearance -gt
  • OMB Clearance -gt
  • Publication in the Federal Register -gt
  • 60 Day Comment Period -gt
  • Publication of Final Rule

7
Current RHC Requirements
  • RHC Regulations published prior to the 2003 Final
    Rule
  • Provisions in other regulations that Impact RHCs
  • Self-implementing provisions of statutes
  • Policies issued through manual instructions or
    Program Memorandum

8
  • National Provider Identifier (NPI)

9
National Provider Identifier (NPI)
  • The NPI replaces your RHCs current provider
    number
  • RHCs must have an entity type 2 (organizational)
    NPI in order to bill for its services

10
NPI Contd
  • Within an organization any individual provider
    who must be identified on a transaction must
    obtain an NPI
  • Groups must also have an NPI in order to bill for
    their services

11
NPIs for Hospital-Based RHCs with Multiple
Locations
  • Sites that file separate transactions must have
    separate NPIs for each site

12
NPI Information
  • http//www.cms.hhs.gov/NationalProvIdentStand/03_a
    pply.aspTopOfPage
  • https//nppes.cms.hhs.gov
  • 800-465-3203

13
  • CMS Resources and Information

14
CMS Rural Health Fact Sheets
  • Critical Access Hospital Fact Sheet
  • Rural Health Clinic Fact Sheet
  • Rural Referral Center Fact Sheet
  • Sole Community Hospital Fact Sheet
  • Medicare Guide to Rural Health Services
    Information for Providers, Suppliers, and
    Physicians

15
New CMS Fact Sheet
  • Medicare Billing Information for Rural Providers,
    Suppliers, and Physicians
  • Billing charts for
  • RHCs, FQHCs, SNFs, HHAs, CAHs

16
CMS Information
  • Medicare Learning Network
  • Fact Sheets
  • Guides
  • Booklets
  • Training Presentations
  • Audio/Video
  • Job Aids

17
CMS Rural Health Information
  • Medicare Learning Network Products
  • http//www.cms.hhs.gov/MLNProducts
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