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Rural Health Clinic Update

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Date: March 10, 2000 DSL-BQA-00-027

To: Rural Health Clinics RHC 08

From: Jan Eakins, Chief, Provider Regulation and Quality Improvement Section

cc:  Susan Schroeder, Director, Bureau of Quality Assurance

The purpose of this memo is to provide new information in light of changes occurring with the Balanced Budget Act of 1997 and to provide a reminder of some specific provider responsibilities.

Rural Health Clinics (RHCs) are required by federal regulation 42.CFR 491.8(a)(6) to have a nurse practitioner or a physician assistant available to furnish patient care services at least 50% of the scheduled operating hours. Sections 4205(c) and 4205(d) of the Balanced Budget Act of 1997 eliminated for new applicants the possibility of receiving a waiver for this staffing requirement. Providers certified prior to January 1, 1998 may request a waiver of the mid-level staffing requirement.

In accordance to 42 CFR 489.18, all providers are required to notify the federal Health Care Financing Administration (HCFA) about changes of ownership. Rural Health Clinic providers must promptly notify the Bureau of Quality Assurance in writing of significant changes such as changes of ownership, location, provider name, administrator and mid-level staffing. Frequently, Bureau staff find these notifications are not occurring.

During recertification surveys, many providers do not have a copy of the current federal Rural Health Clinic (RHC) regulation. The Conditions for Certification are found in 42 CFR Part 491, Subpart A. A copy is attached. Additional copies of the regulation can be found at the following web site: (exit DHS)

If you have further questions regarding this information, please contact Lois Jensen, Human Services Program Coordinator [retired, replaced by Valerie Brinkman, (608) 261-6730], or either of these supervisors in the Health Services Section, Juan Flores [replaced by Cremear Mims, (414) 227-4556], or Jane Walters [replaced by Jan Heimbruch, (608) 243-2086].

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