CMS Pub. 100-02, ch. 13, § 30.1

In addition to the location requirements, an RHC must:

• Employ an NP or PA; and

• Have an NP, PA, or CNM working at the clinic at least 50 percent of the time the

clinic is operating as an RHC.

The employment may be full or part time, and is evidenced by a W-2 form from the

RHC. If another entity such as a hospital has 100 percent ownership of the RHC, the W-

2 form can be from that entity as long as all the non-physician practitioners employed in

the RHC receive their W-2 from this owner.

The following are examples of situations that would NOT satisfy the employment

requirement:

• An NP or PA who is employed by a hospital that has an ownership interest in the

RHC but is not physically present and working in the RHC;

• A CNM who is employed by the RHC;

• An Advanced Practice Registered Nurse who is not an NP or PA; or

• An NP or PA who is working as a substitute in an arrangement similar to a locum

tenens physician.

An RHC practitioner is a physician, NP, PA, CNM, CP, CSW, MFT or MHC. At least

one of these practitioners must be present in the RHC and available to furnish patient care

at all times the RHC is in operation. A clinic that is open solely to address administrative

matters or to provide shelter from inclement weather is not considered to be in operation

during this period and is not subject to the staffing requirements.

An NP, PA, or CNM must be available to furnish patient care at least 50 percent of the

time that the RHC is open to provide patient care. This requirement can be fulfilled

through any combination of NPs, PAs, or CNMs as long as the total is at least 50 percent

of the time the RHC is open to provide patient care. Only the time that an NP, PA, or

CNM spends in the RHC, or the time spent directly furnishing patient care in another

location as an RHC practitioner, is counted towards the 50 percent time. It does not

include travel time to another location, or time spent not furnishing patient care when in

another location outside the RHC (e.g. home, SNF, etc.).

A clinic located on an island that otherwise meets the requirements for RHC certification

is not required to employ an NP or PA, although it is still required to have an NP or PA at

least 50 percent of the time that the RHC is in operation (OBRA ’89, Sec 4024). An

island is a body of land completely surrounded by water, regardless of size and

accessibility (e.g., bridges).

As of July 1, 2014, RHCs may contract with non-physician practitioners (PAs, NPs,

CNM, CPs or CSWs and MFTs and MHCs effective January 1, 2024) if at least one NP

or PA is employed by the RHC (subject to the waiver provision for existing RHCs set

forth at section 1861(aa)(7) of the Act).

It is the responsibility of the RHC to assure that all staffing requirements are met and that

RHC practitioners provide services in accordance with state and federal laws and

regulations.

See section 80.4 of this chapter for information on productivity standards for RHCs.