CMS SOM App. G, Tag J-0081

(1) The clinic . . . has a health care staff that includes one or more physicians . . .

(2) The physician member of the staff may be the owner of the rural health clinic,

an employee of the clinic . . ., or under agreement with the clinic . . . to carry out the

responsibilities required under this section.

§491.2 Definitions. As used in this subpart, unless the context indicates

otherwise:

Physician means the following:

(1) As it pertains to the supervision, collaboration, and oversight requirements in

sections 1861(aa)(2)(B) and (aa)(3) of the Act, a doctor of medicine or osteopathy

legally authorized to practice medicine or surgery in the State in which the function

is performed; and

(2) Within limitations as to the specific services furnished, a doctor of dental surgery

or of dental medicine, a doctor of optometry, a doctor of podiatry or surgical

chiropody or a chiropractor (see section 1861(r) of the Act for specific limitations).

Interpretative Guidelines § 491.8(a)(1) & (2)

An RHC must, at a minimum, have a health care staff that includes one or more

physicians; if the clinic has only one physician, that physician must be either an MD or a

DO in order to perform the responsibilities of the clinic’s medical director. The

physician must hold a current license issued or recognized by the State in which the RHC

is located.

The physician(s) may be the clinic’s owner (who may also be an employee of the clinic at

the same time), an employee of the clinic, or providing services to the clinic under a

contractual arrangement. CMS interprets an “employee” to be an individual to whom the

clinic issues an IRS Form W2, Tax and Wage Statement (See 79 FR 25462, May 2,

2014). If the physician is not responsible for medical supervision nor the medical

direction of the clinic, contractual arrangements may either be directly between the clinic

and an individual physician, or between the clinic and a third-party entity that supplies

the clinic with physician services, such as a locum tenens agency.

In all cases the RHC must have sufficient practitioners, both physician and non-physician, to furnish the volume of RHC services it provides to its patients, consistent

with accepted standards of practice.

Survey Procedures § 491.8(a)(1) & (2)

• Confirm that the clinic has at least one physician who is providing physician services.

Confirm that the physician has a current license issued or recognized by the State in

which the RHC is located.