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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. Furthermore, they must have a Sliding Fee Schedule and a completed Certificate of Eligibility.

Required Steps

Review the steps required of Centers for Medicare and Medicaid Services (CMS) certified Rural Health Clinics (RHCs) to be designated as an Automatic “Auto” HPSA

Meet Location Requirements

The RHC must be located in:

  • A non-urbanized area, as defined by the U.S. Census Bureau; and
  • An area currently designated within the last 4 years as one of the following types of shortage areas:
    • Primary Care Geographic or Population-Group HPSA
    • Medically Underserved Area
    • Governor-designated, Secretary-certified shortage area under Sec. 6213(c) of the Omnibus Budget Reconciliation Act of 1989.

Submit a Certificate of Eligibility Form

If the RHC wants to become an eligible National Health Service Corps (NHSC) site, the RHC may request an Automatic HPSA designation by submitting a “Certificate of Eligibility” (PDF - 22 KB) form and a Sliding Fee Schedule to HRSA.

Submit a Certificate of Eligibility document for each individual RHC site, even if part of a larger organization. The information provided will be checked against the list of certified RHCs posted by CMS or RHC download in the HRSA Data Warehouse to confirm RHC status, and if there are any discrepancies, additional information may be requested.

View detailed instructions on how to fill out the Certificate of Eligibility form. (PDF - 22 KB)

Meet Specific Requirements

The RHC must also meet these specific requirements:

  • 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.
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)