[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR491.3]



[Page 962-963]

 

                         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 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.



[[Page 963]]



    (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    (2) RHCs with outdated shortage area designations will have 120 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    (3) RHCs located in service areas with outdated shortage area 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]