RHC Medicare Certification

The Health Care Regulation and Quality Improvement (HCRQI) Section of the Oregon Health Authority (OHA) has an agreement with the Center for Medicare and Medicaid Services (CMS), to assist in determining whether health care facilities meet, and continue to meet, required conditions of participation. Questions about the application and survey may be directed to John Pilmer | HCRQI | (971) 673-0540 |.

  1. Complete and return the following forms to HCRQI Program FAX: (971) 673-0556
    • Health Insurance Benefit Agreement: HCFA 1561 A (2 signed originals required)
    • Request to Establish Eligibility: HCFA 29
    The following is also required for Provider-based RHCs:
    • Assurance of Compliance with Title VI of the Civil Rights Act: HHS 690 (2 signed original copies required)
    • Civil Rights Packet: Healthcare providers applying for participation in the Medicare Part A program must receive a civil rights clearance from Office for Civil Rights
  2. Complete the Medicare Enrollment Application: This must be completed and approved prior to scheduling a survey. The initial enrollment fee is currently $542 – see PECOS online payment.

    Two options:
    1. Use Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS) for faster processing time and online payment.
    2. or

    3. Download and complete forms CMS-588 and CMS-855A and submit to Noridian (Oregon regional MAC)

    Once the HCRQI program office has received approval of your application CMS-855A from Noridian, submit a written request to the HCRQI Program for a survey of your clinic. All forms must be complete, signed and submitted prior to scheduling the survey. Please note this will be an unannounced onsite survey. It is very important to carefully and adequately prepare for the RHC accreditation inspection. Failure of this inspection can substantially delay certification of your clinic for RHC status. In addition, if your clinic should fail the initial OHA – HCRQI inspection, you will be required to use a private contractor for a follow-up certification inspection. To assure that you meet certification inspection criteria, you will need to:

    1. Develop a RHC Policy and Procedure Manual (a sample version is available in Appendix D of the “Starting a Rural Health Clinic – A How-To Manual” or provider-based clinics can use this template)
    2. Ensure clinic lab services are in place and licensedCLIA Application

      Contact: The Oregon Laboratory Compliance Section (503-693-4100) Your clinic must have the ability to perform the following lab procedures onsite:
      • Chemical examination of urine by stick or tablet method or both
      • Hemoglobin or hematocrit
      • Blood sugar
      • Examination of stool specimens for occult blood
      • Pregnancy tests
      • Primary culturing for transmittal to a certified laboratory
  3. Ensure that you meet all conditions of certification the HCRQI survey staff are directed to assess:
    1. Review CMS rules to surveyors
    2. Review the survey preparation checklist from HCRQI Program office (see page 6-12) will assist you in preparing for the survey.
    3. Conduct practice inspections:
      • Our office can arrange to perform a mock inspection of your clinic to identify areas of improvement necessary prior to the official HCRQI Program survey. Please contact Stacie Rothwell, Program Manager | | 971-235-3978.
      • If you plan to conduct practice inspections yourself, ORH and Wipfli created a detailed survey preparation checklist for your use. This checklist details the specific items of focus needed to meet Federal RHC certification.

    Alternative Vendor Certification options: There are potentially faster alternative accreditation options for clinics that are willing/able to pay. Two companies, American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAASF) and The Compliance Team, are authorized by the Center for Medicare and Medicaid Services to offer certification services. Please view this document for more details.