1. ISSUES IN RURAL HEALTH PLANNING WEBINAR 2 THURSDAY, JULY 21, 2011 1:00 – 2:00 PM UNDERSTAND THE PROS AND CONS OF RURAL HEALTH CLINICS

2. Learning Objectives  Understand the role and function of a Rural Health Clinic  Identify the primary benefits of opening a Rural Health Clinic  Learn the process of being certified as a Rural Health Clinic  Explore the downside of opening a Rural Health Clinic 2

3. Definition of a RHC  Established through Public Law 95-210, the Rural Health Clinic Services Act, 1977, to increase the provision of primary care services for Medicare and Medicaid patients residing in rural communities.  RHC can be provider-based or independent (freestanding).  Provider-Based: integral part of a hospital, nursing home, home health agency  Independent: stand alone clinics  Status can be public, private, or not-for-profit 3

4. Requirements for a RHC  Staffed with a mid-level practitioner practicing at least 50% of the time  Provide basic laboratory services  Develop written clinical protocols and operational policies and procedures  Conduct an annual evaluation  Gain certification by Medicare 4

5. RHC Location Requirements  Must be in a Health Professional Shortage Area (HPSA) or Geographic Primary Care or  Must be in a Medically Underserved Area/Population (MUA/P)  Designation must be less than 3 years old 5

6. Benefits of Opening a Rural Health Clinic  Potential of significant higher reimbursement (looking at all payors in the aggregate)  Increased coordination between hospital and physicians  Increased clinical integration with hospital  Greater flexibility in financing and efficiencies with administration and shared staff 6

7. Potential Downsides of Operating a RHC  Increased costs related to hospital wage and benefits  More facility costs  Less effective cost management  Decreased physician control of practice staff  Less control of financial accountability and productivity

8. Steps Necessary for RHC Certification  Confirm site eligibility  Evaluate financial feasibility  Assess cost of hiring needed staff  Complete a RHC application and a CMS provider enrollment form  Receive RHC certification inspection by ADHS  File a CMS cost report to have the Medicare rate determined

9. Current RHC Reimbursement Rate ??  Current RHC maximum encounter rate - $78.07

10. Important Resources  Center for Medicare and Medicaid  Web Site: https://www.cms.gov/center/rural.asphttps://www.cms.gov/center/rural.asp  National Association of Rural Health Clinics  Web Site: www.narhc.orgwww.narhc.org  Listserve: http://www.narhc.org/members/members_listserve.phphttp://www.narhc.org/members/members_listserve.php  Rural Assistance Center  Web Site: www.raconline.orgwww.raconline.org  Toll Free #: 1.800.270.1898  Revised Arizona Rural Health Clinic Manual, 2011 (available soon)

11. Questions + Contacts  Connie Belden, Team Leader, ADHS Licensing  Connie.Belden@azdhs.gov Connie.Belden@azdhs.gov  Joyce Hospodar, Rural Health Office  hospodar@u.arizona.edu; 520.626.2432 hospodar@u.arizona.edu  Ron Smith, CFO, Wickenburg Community Hospital  Ron.Smith@wickhosp.com; 928.684.5421 Ron.Smith@wickhosp.com 11