42 C.F.R. § 405.2462 Payment for rural health clinic services and Federally qualified health clinic services.
Title 42 - Public Health
(a) General rules. (1) RHCs and FQHCs are paid on the basis of 80 percent of an all-inclusive rate per visit determined by the fiscal intermediary for each beneficiary visit for covered services, subject to an annual payment limit. (2) The fiscal intermediary determines the all-inclusive rate in accordance with this subpart and instructions issued by CMS. (3) If an RHC is an integral and subordinate part of a hospital, it can receive an exception to the per-visit payment limit if the hospital has fewer than 50 beds as determined by using one of the following methods: (i) The determination of the number of beds at §412.105(b) of this chapter. (ii) The hospital's average daily patient census count of those beds described in §412.105(b) of this chapter, and the hospital meets all of the following conditions: (A) It is a sole community hospital as determined in accordance with §412.92 or 412.109(a) of this chapter. (B) It is located in a level 8 or level 9 nonmetropolitan county using urban influence codes as defined by the U.S. Department of Agriculture. (C) It has an average daily patient census that does not exceed 40. (b) Payment procedures. To receive payment, an RHC or FQHC must follow the payment procedures specified in §410.165 of this chapter. (c) Mental health limitation. Payment for the outpatient treatment of mental, psychoneurotic, or personality disorders is subject to the limitations on payment in §410.155(c) of this chapter. [69 FR 74816, Dec. 24, 2003]
Title 42: Public Health
PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
Subpart X—Rural Health Clinic and Federally Qualified Health Center Services
Payment for Rural Health Clinic and Federally Qualified Health Center Services
§ 405.2462 Payment for rural health clinic services and Federally qualified health clinic services.
