The Rural Health Clinic (RHC) certification is given to those clinics that are either in rural areas or places with a shortage of healthcare providers. Clinics with the designation receive enhanced Medicare and Medicaid reimbursement for most services.
Rural health clinics could be getting overpaid, report cautions
Of the 3,521 RHCs OIG examined in its report, 434, or 12%, no longer meet one or both of the qualifications to maintain the designation. Fifty-nine percent of these RHCs are in areas not designated as shortage areas. Another 39% are in urbanized areas. The final 2% were in areas that were neither rural nor designated as shortage areas. Medicare and beneficiaries paid approximately $132 million to the 434 RHCs not meeting the requirements in 2012.
One step the CMS could take to mitigate this issue is to promulgate final regulations clarifying that RHCs should continue to qualify as RHCs and receive enhanced reimbursement if they are determined to be essential providers. This term is given to clinics that are not in rural areas, but are in areas that would otherwise be underserved should the clinics not be there.
Congress asked the CMS more than 16 years ago to issue regulations to ensure that RHCs determined to be essential providers remain certified. More than eight years have elapsed since the CMS told OIG that it planned to issue the regulations. The agency has released several proposed rules in the past, but those proposals have expired without enactment, so at this point, the CMS would have to restart the rulemaking process, the OIG states. Staff members at the CMS told OIG they are not currently working on any new rulemaking, the report says.
In the report, the CMS thanked the OIG for the research, but made no commitment to release new policy.
Neither the CMS nor the National Rural Health Association responded to a request for comment by deadline.
Follow Virgil Dickson on Twitter: @MHvdickson
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