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HHS/CMS RIN: 0938-AJ17 Publication ID: Spring 2009 
Title: MedicChanges in Conditions of Participation Requirements and Payment Provisions for Rural Health Clinics and Federally Qualified Health Centers (CMS-1910-F2) 
Abstract: This nonmajor final rule reissues the final rule published December 24, 2003, with modifications. This final rule amends the Medicare certification and payment requirements for rural health clinics (RHCs), as required by section 4205 of the Balanced Budget Act of 1997. It changes the definition of a qualifying rural shortage area in which a Medicare RHC must be located; establishes criteria for identifying RHCs essential to delivery of primary care services that we can continue to approve as Medicare RHCs in areas no longer designated medically underserved; and limits nonphysician practitioner staffing requirements. This rule imposes payment limits on provider-based RHCs and prohibits the use of RHC space, professional staff, equipment, and other RHC resources by another Medicare entity. The rule also requires RHCs to establish a quality assessment and performance improvement program. In addition, we are finalizing new policy revisions to the RHC and FQHC programs to improve and strengthen this rural safety net benefit that addresses section 5114 of the Deficit Reduction Act of 2005. 
Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Long-Term Actions 
Major: No  Unfunded Mandates: No 
CFR Citation: 42 CFR 405    42 CFR 491   
Legal Authority: 42 USC 1302    42 USC 1395hh    Deficit Reduction Act of 2005 (PL 109-171), sec 6083   
Legal Deadline:
Action Source Description Date
Final  Statutory  MMA Section 902  06/27/2011 
Timetable:
Action Date FR Cite
NPRM  12/24/2003  68 FR 74792   
Interim Final Rule  09/22/2006  71 FR 55341   
Interim Final Rule Comment Period End  11/21/2006    
Second NPRM  06/27/2008  73 FR 36463   
Final Action  06/00/2011    
Regulatory Flexibility Analysis Required: No  Government Levels Affected: Federal 
Small Entities Affected: Businesses  Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Agency Contact:
John Warren
Health Insurance Specialist
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Centers for Medicare Management, Mail Stop C4-01-15, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-3633
Email: john.warren@cms.hhs.gov