Ala. Admin. Code r. 560-X-8-.01

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-8-.01 - Independent Rural Health Clinic Services

(1) Independent Rural Health Clinics must be Medicare certified and contracted with the Alabama Medicaid Program, and be in compliance with Federal, State and Local Laws.

(2) Services covered under the Independent Rural Health Clinic Program are any medical service typically furnished by a physician in an office or in a physician home visit. Limits are the same as for the Physician Program.

(3) Independent Rural Health Clinic services are reimbursable if:

(a) performed by a physician,

(b) performed by a nurse practitioner, physician assistant, certified nurse midwife, or clinical social worker as an incident to a physician's service,

(c) a physician, nurse practitioner, physician assistant, or certified nurse midwife is available to furnish patient care at all times the clinic operates, and

(d) a nurse practitioner, physician assistant, or certified nurse midwife is available to furnish patient care at least 50 percent of the time the clinic operates.

(4) Independent Rural Health Clinic Services must also conform to any state requirements for the nurse practitioner, physician assistant, and certified nurse midwife regarding the scope or conditions of their practice.

(5) The Independent Rural Health Clinic must be under the medical direction of a physician. Except in extraordinary circumstances, the physician must be physically present for sufficient periods of times, at least every 72 hours for non-remote sites and every seven (7) days for remote sites (a remote site being defined as a site more than 30 miles away from the primary supervising physician's principal practice location), to provide medical care services, consultation, and supervision in accordance with Medicare regulations for Rural Health Clinics. When not physically present, the physician must be available through direct telecommunication for consultation, assistance with medical emergencies, or patient referral. The extraordinary circumstances must be documented in the records of the clinic.

(6) The fiscal agent will be responsible for enrolling all Title XVIII (Medicare) certified Independent Rural Health Centers that wish to enroll as Qualified Medicare Beneficiary (QMB) only providers.

(7) In order to participate in the Title XIX Medicaid Program and to receive Medicaid payment, an Independent Rural Health Clinic (IRHC) must:

(a) Request an enrollment packet from Fiscal Agent as an IRHC Provider. Services to be provided should be identified in the enrollment application.

(b) Submit a copy of the following documentation of Medicare certification; the Centers for Medicare and Medicaid Services (CMS) letter assigning the Medicare Provider number and establishing the initial encounter rate. A copy of the facilities budget cost report must be sent to Medicaid's Alternative Services Division.

(c) Submit a copy of the CMS Clinical Laboratory Improvement Amendments of 1988 (CLIA) certificate of waiver.

(d) Be operating in accordance with applicable Federal, State, and local laws.

(e) Certify compliance with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and with the Age Discrimination Act of 1975.

(f) Execute a provider contract with the Alabama Medicaid Agency.

(8) The effective date of the enrollment of an IRHC will be the latter of the following: the first day of the month in which the written request for enrollment was received; or the date of Medicare certification.

Author: Ginger Collum, Program Manager, Clinic/Ancillary Services

Ala. Admin. Code r. 560-X-8-.01

Rule effective October 1, 1982. Amended: Effective July 13, 1989; June 14, 1990; effective May 11, 1993. Amended: Filed August 6, 1993; effective September 10, 1993. Amended: Filed February 7, 1996; effective March 14, 1996. Amended: Filed July 7, 1997; effective August 11, 1997. Amended: Filed March 14, 2002; effective April 18, 2002. Amended: Filed September 11, 2003; effective October 16, 2003.

Statutory Authority: State Plan; 42 C.F.R. §§491.8, et seq.; Title XIX, Social Security Act; Medicare Catastrophic Coverage Act of 1988 ( Public Law 100-360 ); §6213 Omnibus Budget Reconciliation Act of 1989.