42 C.F.R. § 491.3 RHC procedures.
Title 42 - Public Health
(a) General. (1) CMS processes Medicare participation matters for RHCs as specified in §§405.2402 through 405.2404 of this chapter, and with the applicable procedures in part 486 of this chapter. (2) If CMS approves or disapproves the participation request of a prospective RHC, CMS notifies the State agency for that RHC. (3) CMS deems an RHC that is approved for Medicare participation to meet the standards for certification under Medicaid. (b) Current designation. (1) Participating RHCs and an applicant requesting entrance into the Medicare program as an RHC must be located in a current shortage area for which a designation is made or updated within the current year or within the previous 3 years. (2) RHCs with outdated shortage area designations will have 120 days, from the date CMS notifies the facility that its designation is no longer current, to submit an application to update its medically underserved designation. (3) RHCs located in service areas with outdated shortage area designations will be protected, for 120 days, from RHC disqualification while their applications for updating the medically underserved designations are under review by HRSA. (c) Exception process. (1) An RHC's location fails to satisfy the definition of a shortage area if it is no longer designated by the Secretary or by the chief executive officer of the State as medically underserved, or if it is no longer designated as nonurbanized by the Census Bureau. (2) An existing RHC may apply for an exception from disqualification by submitting a written request to a CMS regional office within 180 days from the date CMS notifies the RHC that it is no longer located in a shortage area. The request must contain all information necessary to establish whether an exception is warranted. (3) The CMS regional office may grant a 3-year exception based on its review of an RHC request and other relevant information, if the CMS regional office determines that the RHC is essential to the delivery of primary care services that otherwise are not available in the geographic area served by the RHC as specified in §491.5(b). (4) Clinics can renew their essential provider status by submitting written assurances to the CMS regional office that they continue to meet the conditions at §491.5. (5) CMS terminates an ineligible clinic from participation in the Medicare program as an RHC, effective the final day of the 6th month from the date CMS notifies the clinic of a final determination of ineligibility (including denial of any exception request submitted). CMS may terminate RHC status earlier based on noncompliance with other certification requirements. [68 FR 74816, Dec. 24, 2003]
Title 42: Public Health
PART 491—CERTIFICATION OF CERTAIN HEALTH FACILITIES
Subpart A—Rural Health Clinics: Conditions for Certification; and FQHCs Conditions for Coverage
§ 491.3 RHC procedures.
