New Medicare rule ensures rural healthcare access continues

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Medicare beneficiaries who live in rural and underserved areas of the United States would continue to obtain healthcare services from rural health clinics (RHCs), under new rules proposed June 26 by the Centers for Medicare & Medicaid Services (CMS).
“These proposed changes to the rural health clinic program would ensure that Medicare beneficiaries in rural underserved areas have ready access to high-quality primary healthcare from physicians and certain non-physician providers,” said Acting CMS Administrator Kerry Weems. “The flexibilities we are proposing will help to ensure that beneficiaries and Medicare get the best value from RHC providers.”
The proposed regulation would require RHCs to establish quality assessment and performance improvement (QAPI) programs. It would also establish location requirements necessary for a clinic to continue to participate as an RHC, which would ensure that the RHC program kept pace with demographic changes in the service areas and best meet the needs of underserved beneficiaries, according to CMS.

The regulation would also provide opportunities for existing RHCs to apply for exceptions from location requirements, and provide RHCs with more flexibility in staffing requirements and sharing resources with fee-for-service providers in the facility. In line with statutory requirements, the rule also would limit payments for RHCs to 80 percent of reasonable costs, minus beneficiary coinsurance and deductible amounts.

The proposed rule specifically would:

  • Implement statutory requirements that all RHCs be located in areas that were non-urban and demonstrated that there was a shortage of healthcare services. Existing RHCs that do not meet the location requirements but are still providing needed services in rural and underserved areas could be granted an exception as an “essential provider” if they met criteria established by the rule;

  • Improve access to healthcare services in rural areas by providing more flexibility in staffing requirements by allowing an RHC to contract with non-physician practitioners such as physician assistants (PA), nurse practitioners (NP) and certified nurse midwives, as long as one PA or NP was directly employed by the clinic;
  • Clarify when an RHC could share resources with an onsite Medicare or Medicaid fee-for-service provider for flexibility in providing needed services; and
  • Implement a statutory requirement that RHCs establish a QAPI program to help these clinics identify and implement opportunities for improvement, including preventing the transmission of infectious and communicable diseases and ensuring the accuracy of patient health records.

With the regulation we are proposing today, these providers will have better guidance on how to qualify as a rural health clinic,” Weems said.

“Medicare will be better able to ensure that qualified rural clinics are able to seek cost-based payment under the RHC program.”  
Many changes in the proposed rule, such as revisions to the payment methodology, would also apply to federally qualified health centers, which are similar to RHCs but may operate in urban or rural underserved areas.  
Comments on the proposed regulation must be submitted by 5 pm ET on August 27.