Rural Health Clinic - Initial Licensure

There are 3 ways that a Rural Health Clinic can be licensed and certified in Louisiana.  Please select the option that you are requesting from the following choices:

1.      An independently licensed RHC that is independently certified as a RHC

a.      This type will not be associated with a hospital.

b.      This type will have its own independent license which is not linked with any other facility type.

c.      This type will submit a Rural Health Clinic license application to become a licensed RHC (not a hospital license application)

d.      This type will submit a CMS 855A to become a certified Rural Health Clinic and check off that it is enrolling as a “Rural Health Clinic”

2.      An independently licensed RHC that is certified as an independent RHC but provider based to the hospital

a.      This type will be associated with a hospital.

b.      This type will have its own independent license which is not linked with any other facility type.

c.      This type will submit a Rural Health Clinic license application to become a licensed RHC (not a hospital license application)

d.      This type will submit a CMS 855A to become a certified Rural Health Clinic, check off that it is enrolling as a “Rural Health Clinic” (not a hospital), and indicate that it will be provider based to the hospital.

e.      Please keep in mind that this type must be able to demonstrate compliance with provider based requirements if asked by CMS

3.      A RHC that is licensed as an outpatient department of the hospital, certified as an independent RHC but provider based to the hospital.

a.      Only Hospitals with fewer than 50 beds can be considered for this option.

b.      This type will have a HOSPITAL license with “RHC” included in the license number.  Please remember that this type must demonstrate that it is 100% owned by the hospital and can’t operate separately from the hospital.  Example: If the hospital closed, the RHC will automatically close.

c.      This type will submit a Hospital license application to become a licensed offsite campus outpatient department of the hospital (not a Rural Health Clinic license application)

d.      This type will submit a CMS 855A to become a certified Rural Health Clinic, check off that it is enrolling as a “Rural Health Clinic” (not a hospital), and indicate that it will be provider based to the hospital.  (Do Not submit a CMS 855A to become a practice location of the hospital)

e.      Please keep in mind that this type must be able to demonstrate compliance with provider based requirements if asked by CMS