A Rural Health Clinic is a facility located in a rural area designated as a Health Professional Shortage Area (HPSA) or a Medically Underserved Area (MUA) and is neither a rehabilitation agency nor a facility primarily for the care and treatment of mental diseases. A Rural Health Clinic must provide primary health care, including laboratory services to its patients. The Rural Health Clinic’s laboratory services are subject to the Clinical Laboratory Improvement Amendments Act.
Facilities seeking certification as a Rural Health Clinic must ensure the area has been designated as a shortage area within the prior three years. The Shortage Designation Branch of the Health Resources and Service Administration (HRSA) can be accessed for current designation status. Please refer to HRSA - Shortage Areas for HPSA designations and HRSA - Medically Underserved Areas/Populations for MUA/P designations.
Additionally, for information specifically related to the Idaho State review schedule, please contact the State Office of Rural Health and Primary Care at 208-334-0669.
If the area has been designated as a shortage area, then individuals seeking Medicare Certification of a Rural Health Clinic must complete and submit an application packet. Application materials may be found below or requested through the Bureau of Facility Standards at 208-334-6626, option 4.
The application packet includes what must be submitted and approved prior to an initial survey (items #1 - #3) and resource information related to Rural Health Clinics (items #4 - #9) as follows:
- Request to Establish Eligibility - CMS form 29,
- Health Insurance Benefits Agreement - CMS form 1561A (two originals required),
- Fiscal year ending date form,
- Appendix G - Guidance to Surveyors: Rural Health Clinics,
- Appendix Z – Emergency Preparedness (EP),
- Appendix Q – Core Guidelines For Determining Immediate Jeopardy
- CMS Letter S&C-08-13, Initial Surveys for RHCs and SNFs
- Federal Register Granting Deeming Authority
- Rural Health Clinic Survey Report - CMS form 30,
Additionally, if the proposed RHC is provider-based you must complete the “Office of Civil Rights Clearance for Medicare Certification” (OCR) form. This form must be submitted, on line, via https://ocrportal.hhs.gov/ocr/aoc/instruction.jsf. You will receive an e-mail from the OCR stating that you completed the civil rights submission. The e-mail will contain an OCR number. Submit a copy of this e-mail with your other application materials.
You may mail a completed application to:
Department of Health and Welfare
Bureau of Facility Standards
P.O. BOX 83720
BOISE, ID 83720-0009
PLEASE KEEP A COPY FOR YOUR RECORDS.
To become an Idaho Medicaid provider, you must submit an Idaho Medicaid provider enrollment application to Gainwell, Idaho’s Medicaid Management Information Systems (MMIS) vendor. To submit an Idaho Medicaid provider enrollment application, go to www.idmedicaid.com and register for a trading partner account. A step-by-step user guide can be found by selecting Reference Material, User Guides, New Provider Enrollment Guide. Additional provider enrollment help is available by contacting your Provider Relations Consultant or Provider Services. Contact information can be found at www.idmedicaid.com or call 866-686-4272.
Applying to be an Idaho Medicaid provider is a separate process from federal certification and state licensure.
Medicare/Medicaid reimbursement is not retroactive and usually becomes effective only after your enrollment application is approved, the survey is completed, and you are in compliance with all regulations or have submitted an acceptable plan of correction.