CMS Pub. 100-08, ch. 10, § 10.2.1.13

A. General Background Information

An RHC is a facility located in a rural area designated as a shortage area and is neither a

rehabilitation agency nor a facility primarily for the care and treatment of mental diseases. It

must meet all other requirements of the RHC regulations at 42 CFR Part 491, subpart A.

RHCs:

• Are considered to be Part B certified suppliers even though they enroll in Medicare

via the Form CMS-855A.

• Are defined in section 1861(aa)(2) of the Social Security Act as facilities that are

engaged primarily in providing services that are typically furnished in an outpatient

clinic.

• Sign a supplier agreement with CMS (akin to those signed by certified providers).

Specifically, RHCs sign the Health Insurance Benefit Agreement (Form CMS-

1561A).

• Can be either mobile in nature or fixed/permanent locations.

• Can be freestanding or provider-based. (As stated in Pub. 100-07, provider-based

RHCs are an integral and subordinate part of a hospital (including a critical access

hospital (CAH), skilled nursing facility (SNF), or a home health agency (HHA)).

There are certain services performed by RHCs that do not actually qualify as RHC services.

To bill for these services, the clinic must enroll as a Clinic/Group Practice via the Form

CMS-855B. It is not uncommon to see RHCs simultaneously enrolled in Medicare via the

Form CMS-855A (to bill for RHC services) and the Form CMS-855B (to bill for non-RHC

services).

Note that a facility cannot be simultaneously enrolled as an FQHC and an RHC. Though

there are similarities between these two supplier types, there are key differences as well. For

instance, FQHCs can service rural or urban regions. To be eligible for certification as an

RHC, however, a clinic must be located in a non-urbanized area, as determined by the U.S.

Census Bureau, and in an area designated or certified within the previous 4 years by the

Secretary of Health and Human Services (HHS), in any one of the four types of shortage area

designations that are accepted for RHC certification. (See Pub. 100-02, chapter 13, sections

10.1 and 20.) Also: (1) RHCs are surveyed by the state while FQHCs are not; and (2)

FQHCs furnish preventive services while RHCs do not.

B. Additional Information

For more information on RHCs, refer to:

• Section 1861(aa)(1-2) of the Social Security Act

• 42 CFR Part 491, subpart A

• Pub. 100-07, chapter 2, sections 2240 – 2249

• Pub. 100-04, chapter 9

• Pub. 100-02, chapter 13

For guidance on the appropriate contractor jurisdictions for incoming RHC applications, refer

to Pub. 100-04, chapter 1, section 20.