[Code of Federal Regulations]
[Title 42, Volume 3]
[Revised as of October 1, 2004]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR491.3]

[Page 961-962]
 
                         TITLE 42--PUBLIC HEALTH
 
  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 
                  HEALTH AND HUMAN SERVICES (CONTINUED)
 
PART 491_CERTIFICATION OF CERTAIN HEALTH FACILITIES--Table of Contents
 
Subpart A_Rural Health Clinics: Conditions for Certification; and FQHCs 
                         Conditions for Coverage
 
Sec. 491.3  RHC procedures.

    (a) General. (1) CMS processes Medicare participation matters for 
RHCs as

[[Page 962]]

specified in Sec. Sec. 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    (2) RHCs with outdated shortage area designations will have 120 
days, from the date CMS notifies the facility that its designation is no 
longer current, to submit an application to update its medically 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    (3) RHCs located in service areas with outdated shortage area 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 Sec. 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 Sec. 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]