Developing Rural Health Clinics

Opening a New Rural Health Clinic in Louisiana

Access to primary care has been a driving force in establishing health clinics in rural communities, better known as rural health clinics. A rural health clinic is a primary care clinic located in a non-urbanized area that has been shown to have a shortage of healthcare services or providers. Rural health clinics function as a team approach of physicians working with non-physician providers such as nurse practitioners (NP), physician assistants (PA) and certified nurse midwives (CNM) to provide services.

Although establishing a rural health clinic is a lengthy and challenging process, once certified, the clinic serves as a large portion of the safety net for our rural residents in Louisiana. Providing quality healthcare and services to rural communities, rural health clinics also provide recruitment and retention of healthcare providers and ongoing contributions to the long-term economic and health factors of rural and underserved areas.

Types of Rural Health Clinics

Rural health clinic regulations distinguish between independent and provider-based clinics. The independent rural health clinic is a freestanding practice that is not part of a hospital, skilled nursing facility, or home health agency. The provider-based rural health clinic is an integral and subordinate part of a hospital, skilled nursing facility, or home health agency.

Benefits of Rural Health Clinics

  • Access to primary care that would otherwise be limited or non-existent
  • Provides local basic emergency care and life-saving services
  • Combats physician shortages by using mid-level providers

Determining Rural Health Clinic Eligibility

Well-Ahead Louisiana advises to confirm the potential rural health clinic location to ensure it meets rural and HPSA requirements. Well-Ahead uses these sources to verify the address is in a rural/HPSA area:

Using the Am I Rural? Tool

  1. Visit RHIhub’s online Am I Rural? Tool.
  2. Enter the full address of the potential RHC location and click the “Locate” button.
  3. A map of the location will appear. Click on the “Run Report” button.
  4. Scroll down to the “Program Eligibility” section of the report.
    1. If “CMS – Rural Health Clinics (RHC) Program” is listed as YES, move to step 5.
    2. If “CMS – Rural Health Clinics (RHC) Program” is listed as NO, this address does not qualify for RHC designation.
  5. Scroll down to the “Shortage Destinations” section of the report.
    1. If “Primary Care” is listed as YES, view the “Last Updated” date.
      1. If the date is within the last 3 years, the address qualifies for RHC designation.
      2. If the date is not within the last 3 years, the HPSA will need to be renewed in order to qualify. Email Beth.Butler@la.gov to request an updated HPSA designation.
    2. If “Primary Care” is listed as NO, this address does not qualify for RHC designation.

If an address indicates YES for both the “CMS – Rural Health Clinics (RHC) Program” and “Primary Care,” it can proceed with the RHC designation process. A formal Site Verification Letter should be requested when a clinic is ready to submit their license to the Health Standards Section of the Louisiana Department of Health. A Site Verification Letter will be considered invalid 6 months after its issue date.

  • Eligibility Criteria

    Rural is defined by the Bureau of the Census, as an area that is not an urbanized area. To be classified as a rural health clinic, the facility:

    • Must be located in a rural area and not in an urbanized area. An urbanized are is defined by two methods:
      • Comprises one or more places (central place) and the adjacent densely settled surrounding territory (urban fringe) that together have a minimum of 50,000 persons (urbanized area)
      • Meets one of the following definitions:
        • Census designated places of 2,500 or more persons which are incorporated as cities, villages, boroughs (except in Alaska and New York), or towns (except in New England, New York and Wisconsin), but excluding the rural portions of extended cities
        • Census designated places of 2,500 or more persons
        • Other territories, incorporated or unincorporated, included in an urbanized area
        • Located in either a currently medically underserved area/population (MUA/MUP), health professional shortage area (HPSA) or governor designated area. Find out if you are in a HPSA.
    • Must employ a mid-level practitioner (MLP) at least 50% of the time the practice is open
    • May be either for profit or non-profit; public or private
    • May be any primary care practice (FP, PED, OB/GYN, IM)
    • Must have a Community Advisory Committee that meets at least annually
    • Must be certified by Well-Ahead
  • Required Scope of Services

    The rural health clinic must offer the following services/requirements:

    • Primary care services delivered by both physicians and MLPs
    • First response emergency care
    • X-ray services
    • Arrangements with other Medicare/Medicaid providers for inpatient/specialty care
    • Physicians licensed by the State
    • Hospital services must be available to patients
    • Provide the following minimum lab services on site:
      • Chemical examination of urine by stick or tablet
      • Exam stool specimens for occult blood
      • Primary cultures for transmittal to a certified lab
      • Hemoglobin or hematocrit
      • Blood sugar/glucose testing
      • Pregnancy tests
    • Other lab services required through arrangements
    • 2017 CMS requirement: Emergency Preparedness Plan. All rural health clinics must have an emergency plan in place. Click here to view required emergency preparedness information.
    • CMS Emergency Preparedness Survey Checklist: The CMS Emergency Preparedness Survey Checklist is a tool rural health clinics can use in creating an effective emergency plan.
    • Kaiser Permanente Medical Center Hazard and Vulnerability Analysis (Emergency Preparedness): The Hazard and Vulnerability Analysis (HVA) for emergency preparedness planning can be used to determine the types of disasters clinics may face. The worksheets provide a method to rate the possibilities of natural disasters, technological hazards, human hazards, and hazardous material that may impact the clinic.
  • Not Required of Rural Health Clinics
    • Primary care for all lifecycles
    • Transportation
    • Preventive dental
    • Specific hours of operation (you set them)
    • Case management
    • After hour coverage (as required by Medicaid plans)
    • Preventive health
    • Sliding fee scale
    • Pharmacy
  • Relocating a Rural Health Clinic

    If the established rural health clinic is being relocated, you must contact the Health Standards Section of the Louisiana Department of Health and Well-Ahead for eligibility of the new location site to be determined.


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