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Rural Health Clinic Automatic HPSA Process


The Health Care Safety Net Amendments of 2002, P.L. 107-251, contained a number of provisions related to the designation of Health Professional Shortage Areas (HPSAs). The most significant change for Federally Certified Rural Health Clinics (RHCs) is the eligibility for an automatic HPSA designation as having a shortage of health professionals to provide primary, dental, and mental health care services. In order to be eligible for the automatic designation, these clinics must demonstrate that they meet the requirements of Section 334 of the PHS Act, Charges for Services by Entities Using Corps Members.


The requirements are that any site in which a member of the National Health Service Corps (NHSC) serves must be accessible to people regardless of their ability to pay for services. While a HPSA designation does not guarantee an NHSC placement, and may be used for other programs, the legislation requires the same level of accessibility for entities to benefit from the automatic designation process. These requirements include:

  • Entity cannot deny requested health care services, and shall not discriminate in the provision of services to an individual whose services are paid by Medicare, Medicaid, or State Child Health Insurance Program (SCHIP).
  • Entity shall prepare a schedule of fees or payments consistent with locally prevailing rates or charges.
  • Entity shall prepare a corresponding schedule of discounts (including waivers) to be applied to such fee or payments, with adjustments made on the basis of the patient’s ability to pay.
  • Entity shall make a reasonable effort to secure from patients fees and payments for services, and fees should be sufficiently discounted in accordance with the schedule described above.
  • Entity shall accept assignment for Medicare beneficiaries, shall enter into agreements with state agencies that administer Medicaid and SCHIP to assure coverage of beneficiaries of these programs.
  • Entity shall take reasonable and appropriate steps to collect all payments due for services.

Application Process

Any RHC that wishes to request an automatic HPSA must submit the Office of Shortage Designation (OSD) Certificate of Eligibility document. This document details the requirements from the legislation and allows the Rural Health Clinic Administrator to certify that the clinic meets these requirements. The policies regarding availability of a sliding fee scale and other provisions are to be incorporated into the Policy and Procedures Manual of the sites. When Survey and Certification reviews are conducted, as required by the Centers for Medicare and Medicaid Services (CMS), the presence and implementation of these policies and procedures will be evaluated. We will also be coordinating this effort with the Primary Care Offices (PCOs) in each state, since they have extensive knowledge of the health workforce needs and issues, and are frequently involved in placement of National Health Service Corps, J-1 Visa waiver providers, and other similar programs.

The Certificate of Eligibility document must be submitted for each individual RHC site, even if they are part of a larger organization. The information submitted on the Certificate of Eligibility document will be checked against the list of certified RHCs posted by CMS to confirm RHC status, and if there are any discrepancies, additional information may be requested. If you have other questions about the process, please see the attached CMS Survey and Certification Regional Office Contacts listing for RHCs.

To request an auto HPSA for your CMS-certified RHC, please complete the Certificate of Eligibility document and send it via fax, email, or regular mail to:

Shortage Designation Branch
Bureau of Health Workforce
5600 Fishers Lane, 11SWH03
Rockville, Maryland 20857
Phone: (301) 594-4462, (301) 594-3151 or (301) 594-5168
Fax: (301) 443-2111 or

Once the Certificate of Eligibility document is reviewed and approved, sites that meet these requirements will be considered a HPSA facility and added to the HPSA database, which is accessible online at These HPSA facilities will also be scored using data available at the national level; the NHSC scores HPSAs to prioritize placements into areas of greatest need. More information on the auto HPSA scoring process can be found at:

RHCs already located in areas or serving populations that have been designated as a HPSA through the traditional application process are eligible for the NHSC placements and other programs based on the existing designation and may use the scores for these HPSA(s) in the current NHSC placement process. More information on the National Health Service Corps can be found at or 1-800-221-9393.

If you have any questions about the OSD-specific Certificate of Eligibility document please contact Tracey Martin of OSD at 301 594-4462.

Learn More

Rural Health Clinics Certification & Compliance (Centers for Medicare & Medicaid Services)

Certified Rural Health Clinics (Centers for Medicare & Medicaid Services)

Rural Health Clinic Regional Contacts (PDF - 243 KB) (Centers for Medicare & Medicaid Services)