In 1977, the U.S. Congress passed legislation that set criteria for the establishment of federally certified Rural Health Clinics (RHC). Public Law 95-210 supports and encourages access to health care by rural residents.

Many people have the impression that rural living is idyllic, and it can be. But there is also a significant amount of poverty, a high proportion of elderly and a lack of infrastructure in rural areas. Often, older, retiring providers aren’t replaced by younger physicians, therefore creating shortage areas.

Rural Health Clinics have increased over the last 10 years due to decreasing reimbursements from the standard fee-for-service system. Because Rural Health Clinics receive cost-based reimbursement, providers are turning to Rural Health Clinic programs to be able to continue services to the rural poor and elderly.

RHC regulations distinguish between two types of clinics; independent and provider-based. The independent RHC is a free-standing practice that is not part of a hospital, skilled nursing facility or home health agency. However, independent RHC's may be owned by one of these groups. The provider-based RHC in an integral and subordinate part of a hospital, skilled nursing facility, or home health agency operated with other departments of the provider under common licensure, governance and professional supervision. Provider-based clinics are reimbursed as a cost center of a hospital or other provider.

• Must be located in rural and shortage-designated area
• May be not-for-profit or for profit
• Must offer the following core services:
• Must utilize mid-level practitioners for 50% of the clinical schedule
• Basic laboratory services on site (arrangements for other lab)
• Emergency ("first response") care
• X-ray (provided through arrangement, may be provided on site)
• Inpatient/specialty care (through arrangements)
• Hospital admitting privileges (through arrangements)
• Written clinical protocols

Health care provision to rural populations through Rural Health Clinic certification (1) allows access in areas that otherwise would not have sustainable health care; (2) encourages mid-level providers to be an integral part of the health care delivery system; (3) gives rural citizens the opportunity to learn and accept the skills of mid-level providers; and (4) allows the potential for additional services in rural areas that might not be available in a private practitioner’s office, such as dietitian, social services and physical therapy services.

For more detailed information about Rural Health Clinics, contact the National Rural Health Association at www.NRHArural.org