Current through September 2, 2024
Section 16.03.09.826 - RURAL HEALTH CLINIC (RHC) SERVICES: REIMBURSEMENT METHODOLOGY01.Payment. Payment for Federally Qualified Health Center and Rural Health Clinic services must be made in accordance with Section 702 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, P.L. 106-554, 42 USC Section 1396a(bb), Subsections (1) through (4).02.RHC Encounter. An encounter, for RHC payment purposes, is a face-to-face contact for the provision of a medical or mental service between a clinic patient and a provider as specified in 823.01 through 823.06 of these rules.a. Each contact with a separate discipline of health professional (medical or mental) on the same day at the same location is considered a separate encounter.b. Reimbursement for services is limited to two (2) encounters per participant per day.c. As an exception to Subsection 826.02.a. of this rule, a second encounter with the same professional on the same day may be reimbursed; ord. As an exception to Subsection 826.02.b. of this rule, an additional encounter may be reimbursed, if the encounter is caused by an illness or injury that occurs later in time than the first encounter and requires additional diagnosis or treatment.e. A core service ordered by a health professional who did not perform the service but was performed by support staff is considered a single encounter.f. Multiple contacts with clinic staff of the same discipline (medical, mental) on the same day related to the same illness or injury are considered a single encounter.Idaho Admin. Code r. 16.03.09.826