Rural Health Clinics

COVID-19 Resources for Pennsylvania Rural Health Clinics

Prior to the pandemic, Rural Health Clinics (RHCs) were only able to serve as the originating site for telehealth services.  This meant that the patient needed to be located in the RHC and communicating with a provider, likely a specialist, at another site.  In light of the COVID-19 pandemic and the need to avoid person-to-person contact, Pennsylvania Medicaid made the decision to allow RHCs to serve as the distant site for telehealth services, making it possible for patients to seek care via telehealth from their own home.  The Pennsylvania Department of Human Services (DHS) provided additional details on telemedicine and Medicaid on this fact sheet.  Please note that while Rural Health Clinics are not specifically mentioned, we have verified that RHCs are covered under this guidance and should continue to bill using the T1015 modifier.  Also, RHCs are only able to serve as the distant site for telehealth services until the end of the declared public health emergency.

As part of the CARES Act, Medicare will also pay for services delivered using telehealth, with the RHC serving as the distant site.  CMS released a fact sheet with additional details.  On April 20, 2020, the National Association of Rural Health Clinics hosted a webinar to discuss RHCs billing for telehealth services.  The webinar has been recorded and is available on demand.

What is a Rural Health Clinic?

In 1977, Rural Health Clinics (RHCs) were established to address the shortage of physicians serving patients with Medicare in rural areas. The establishment of RHCs would also help to increase the use of non-physician providers, including Nurse Practitioners (NPs), Physician Assistants (PA-Cs), and Certified Nurse Midwifes (CNMs), in rural areas. Rural Health Clinics are federally designated through the Centers for Medicare and Medicaid Services (CMS).

RHCs must be located in a non-urbanized area per U.S. Census Bureau definitions while also falling within a Primary Care Geographic Health Professional Shortage Area (HPSA), a Primary Care Population-Group HPSA, a Medically Underserved Area (MUA), or a Governor-designated and Secretary-certified shortage area.

Rural Health Clinics may be provider based (linked to a hospital) or independent (stand-alone). RHCs receive reimbursement through an All-Inclusive Rate (AIR) and in most circumstances the clinic may only be reimbursed for one encounter, per patient, per day. A cost report must be filed annually.

Rural Health Clinic Locations

The primary focus of the practice must be primary care services. A non-physician provider must furnish patient care services at least 50 percent of the time. At least one non-physician provider must be employed by the RHC. RHCs are required to furnish six basic laboratory tests on site. For locations and more information on RHCs, visit the links below.