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Learn The Lingo

Learn the Lingo: Key Terms for Navigating the Value Based Care World

With the shift toward value-based payment models, pharmacists are seizing new opportunities to improve patient care in medical homes, accountable care organizations, and other innovative care models. This resource includes acronyms and terminology commonly used when practicing in or discussing innovative practice models. Each term includes a short description and references so you can further your practice in a value based care world. This is the first of multiple volumes that will be published by the Medical Home/ACO SIG.

James Keagy
/ Categories: Learn the Lingo

Rural Health Clinics (RHCs)

Definition: Rural Health Clinics (RHCs) is a specific designation from Centers for Medicare and Medicaid Services (CMS). To receive this designation, the clinic has to increase access to primary care services for patients in rural, underserved communities.

RHCs can be public, nonprofit, or for-profit health care facilities. RHCs are required to use a team approach of physicians working with non-physician providers such as nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs) to provide services.1

The RHC designation is different one from a Federally Qualified Health Center (FQHC); please refer to the previous Learn the Lingo on FQHCs for more information.

How it relates to ACO/PCMH/Care of Underserved Patients

Clinics that receive RHC status are able to collect higher reimbursement rates for government-funded individuals (including Medicare and Medicaid services).1 RHCs are eligible to apply and receive patient-centered medical home (PCMH) designation; however, there are no existing financial incentives or benefits that specifically encourage this.1 RHCs are able to participate in the Medicare Shared Savings program and become an Accountable Care Organization (ACO) or join an existing ACO.

Pharmacists work in RHCs across the country. Unlike FQHCs, RHCs are not required to provide pharmacy services, but many RHCs do. In RHCs, pharmacists can be involved directly in patient care by dispensing medications and providing a variety of related-patient care services, including medication management and immunizations. In those facilities where pharmacy services are externalized, pharmacists may be involved in quality improvement initiatives, manage complex 340B formularies, and/or connect patients to affordable local pharmacies.

Involved organizations/oversight: To be certified as an RHC, clinics must meet location guidelines designated by the U.S. Census Bureau and the Health Resources and Services Administration (HRSA).2 RHCs must also adhere to applicable state and federal regulations, including Medicaid guidelines overseen by the individual states and Medicare rules and regulations set forth by CMS.3

Resources

  1. Rural Health Information Hub. Rural Health Clinics (RHCs). Grand Forks, ND: Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/topics/rural-health-clinics. Accessed March 14, 2023.
  2. CMS. Rural Health Clinic. Baltimore: CMS. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/RuralHlthClinfctsht.pdf. Accessed March 14, 2023.
  3. CMS. Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) services. In: CMS. Medicare Benefit Policy Manual. CMS; 2023.

Contributing authors:

Emily Kosirog, PharmD, BCACP
Director of Clinical Pharmacy
Salud Family Health Centers
Fort Lupton, CO

Morgan Stewart, PharmD, BCACP, BC-ADM
Clinical Assistant Professor
University of Texas at Austin College of Pharmacy

Marsha Gilbreath, PharmD
Staff Pharmacist
Ascension Rx, Ascension St. Vincent’s Blount

Last Updated 3/1/2023

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