Dear RHC Community,

On July 10th, the Centers for Medicare and Medicaid Services (CMS) issued the CY 2025 Medicare Physician Fee Schedule (MPFS) Proposed Rule. This year’s 2,248 page rule, contains several Rural Health Clinic (RHC) specific policy proposals, as well as other provisions with implications for the RHC community, including:

• Allowing RHCs to bill for administration of Part B preventive vaccines at time of service, not entirely in a lump sum settlement on cost report
• Elimination of RHC productivity standards
  Complete revision to RHC care management billing with the elimination of the G0511 consolidated code
  • Establishment of new “Advanced Primary Care Management Services”
• Modification of specific lab services RHCs must have the ability to furnish within the facility
• Aims to clarify guidance versus regulatory discrepancies in how “primarily engaged in primary care” is defined and enforced
• Seeks to define “mental diseases” to support RHCs that offer behavioral health services within the confines of outdated statutory language
• Clarification of dental services able to be furnished in RHC setting
• Modified Intensive Outpatient Program (IOP) Services payment, a new billable service in the RHC beginning January 1, 2024
• Telehealth policy clarifications within CMS’ authority (the majority of Medicare telehealth policy extending past December 31, 2024 relies on Congressional action)

“In terms of the sheer number of substantial updates to the Rural Health Clinics program, this has been the biggest proposed rule in at least ten years,” said Nathan Baugh, Executive Director of NARHC. “While we always have more work to do when it comes to clarifying and updating regulations, and there are some things we asked CMS to address that were not included in this rule, many of these proposed changes are huge steps forward for the RHC program and we thank CMS for listening to Rural Health Clinic concerns over the years.”
If these policies are finalized by CMS this November, they would go into effect January 1, 2025, unless otherwise specified. While quite comprehensive, we encourage you to read the entirety of this article on NARHC.org in order to understand the RHC-relevant provisions and NARHC’s perspectives on this year’s proposals!
Additionally, we encourage you to join our Washington, D.C. team for a webinar on August 15, 2024, where we will discuss the proposed rule and hear your feedback about implementation of these various policy proposals. Please register for the webinar and submit any questions you would like addressed during the webinar here.
Please contact Sarah Hohman, NARHC Director of Government Affairs at [email protected] with any questions or other feedback. 

Attached you will find the recording for the RHC Coding and Billing Updates webinar which took place on April 26, 2022 with Charles James, Jr. from North American Healthcare Management Services:
​
https://www.youtube.com/watch?v=bRa1UCPjVZQ

Please join us Tuesday, April 26, 2022 from 11:00 a.m.-12:00 p.m. (PDT)

​In this webinar Charles James, Jr., North American Healthcare Management Services, will cover targeted RHC coding and billing specific to participating RHCs. Topics will include: RHC changes for 2022 made effective this year as part of the CMS Physician Fee Schedule Final Rule.  These include clarifications to the RHC Modernization Act, Updates to Telehealth Services for RHCs and Behavioral Health billing via Telehealth, and other important policy changes that were implemented on Jan. 1, 2022.  
 
Additional covered topics:

• Discuss the status of Mental Health Services via Telehealth
• Review change to RHC Encounter Definition
• Review change to RHC Locations (Hospice)
• Discuss Grandfathered PBRHC rate issues
• Review status of RHC Telehealth Services, Wellness visits, and Telehealth
• Patient Monitoring, can RHCs perform remote patient monitoring?
• Physician Assistants and Medicare

This webinar is for RHC leaders, coders, or anyone who has an interest in 2022 coding and billing updates.

Presenter
Charles James, Jr., is President and CEO of North American Healthcare Management Services, founded in 1992. Charles, David James, and Charles James, Sr. started North American in 1992. Charles and David have overseen development of all RHC, RCM, and EHR processes for North American. Charles has a Bachelor of Science and an MBA from Saint Louis University.
 
Charles is the current President of the National Association of Rural Health Clinics, as well as President of the Illinois Rural Health Association. Charles provides educational sessions and webinars on billing and compliance to state and private organizations across the United States.
 
North American currently provides comprehensive RCM, EHR Hosting, RHC/FQHC compliance, RHC/FQHC Billing, 340B Management/Audit, Provider Enrollment and many other services to physicians, hospitals, RHCs, and FQHCs across the country.

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Chukwuemeka Ndule, MD and V.S. Kaleka, MD share the results of their COVID-19 vaccination efforts after receiving HealthNet grant funding from the California Association of Rural Health Clinics. 

On February 2nd, 2021, the Department of Health Care Services (DHCS) released its telehealth policy recommendations consisting of broad-based telehealth policy changes that would remain permanent fixtures following the eventual termination of the COVID-19 public health emergency (PHE). At a high-level, DHCS is seeking to modify or expand the use of synchronous telehealth, asynchronous telehealth, telephonic/audio-only, and to add remote patient monitoring to create a greater alignment and standardization across delivery systems, as indicated.

DHCS's proposal includes advancing the following telehealth policy

This collection provides a curated set of resources and tools for decision-makers managing healthcare workforce challenges in response to the COVID-19 emergency.

Please refer to CDC's Coronavirus Disease 2019 webpage for the most up-to-date clinical guidance on COVID-19 outbreak management.

Karen Paolinelli, Chief Executive Officer, Madera Community Hospital and President of the California Association of Rural Health Clinics, is presenting the FNP PREP Program at the 42nd Annual California Association of Nurse Practitioners Conference on Thursday, March 14, 2019.

The Family Nurse Practitioner Partner Residency Education Program (FNP PREP) was published in the January edition of the Journal of Nurse Practitioners. Read full text here.

Established in 2017, FNP PREP is a partnership with Fresno Pacific University designed to recruit future healthcare providers to curb the growing demand for practitioners in rural communities. 

Attendees of the 2019 California Rural Health Conference will hear directly for the program designers and learn the essential elements of replicating the program as well as the impact FNP PREP is having on recruitment, retention and quality health outcomes in rural communities.

Register for the California Rural Health Conference today!

New Website
CARHC.org has been refreshed.  Check us out and tell us what you would like us to add: www.carhc.org
 
2018 Conference Presentations:
Needing to review or discover what you missed in 2018?  Some of our favorite presentations are posted at:
 www.carhc.org/2019conference
 
Could wage index reform buoy rural hospitals?
CMS uses wage index data to set hospital payments and they are looking at revamping how this is done.
https://www.modernhealthcare.com/article/20181127/NEWS/181129960
 
Healthcare - Associated Infection Report
CDPH reported in the 2017 Annual HAI Report, California hospitals had 2,602 fewer healthcare-associated infections than in 2016 and statewide incidences for all reportable infection types are now lower than the 2015 baseline. 
Click the link for more info:
 https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/AnnualHAIReports.aspx?_
 
Rural Health Clinic Payment Limit Increase
The RHC payment limit per visit for CY 2019 is $84.70 effective January 1, 2019 through December 31, 2019. 
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network MLN/MLNMattersArticles/Downloads/MM10989.pdf
 
Nominations Sought
CARHC members are invited to submit nominations for a worthy recipient of the California Rural Health Champion Award. This award recognizes and honors an outstanding leader of rural health clinics. Please nominate an individual that has dedicated their time and efforts to advance the health and wellbeing of others through their RHC program. You must be a CARHC member to make a nomination but nominees do not need to be CARHC members. 
 
Click the link below to submit your nomination:
https://www.carhc.org/2019-california-rural-health-conference.html 
 
Poster Presentations   * 2019 CARHC Conference *
CARCH Members are the  true experts in Rural Health.  The 2019 California Rural Health Conference Planning Committee invites you to  share a  best practice and/or innovation, worthy of adoption by other RHC’s. Best practice and innovations in Rural Health will be featured as a poster presentations during the 2019 California Rural Health Conference. Guidelines will be announced soon.
 
Donations to Our Nonprofit Association Would Be VERY Appreciated
Donations to CARHC are tax-deductible and go toward development and maintenance of our website, education programs (CEUs, annual conference) and support of the rural health clinics in California.  The financial support of our members and conference sponsors are greatly appreciated.

​CARHC members are invited to submit nominations for a worthy recipient of the California Rural Health Champion Award. This award recognizes and honors an outstanding leader of rural health clinics. Please nominate an individual that has dedicated their time and efforts to advance the health and wellbeing of others through their RHC program. You must be a CARHC member to make a nomination but nominees do not need to be CARHC members.