Rule 23-212-1.1 - DefinitionsThe Division of Medicaid defines:
A. Rural Health Clinic as a provider that has been designated a Rural Health Clinic by the Centers for Medicare and Medicaid Services (CMS) and for purposes of this policy includes both provider-based rural health clinics and freestanding rural health clinics. 1. Free Standing Rural Health Clinic as an independent clinic owned by a provider or a provider entity that does not qualify for, or have not sought, provider-based status, as designated by CMS.2. Provider-Based Rural Health Clinic as a rural health clinic that is owned and operated as an essential part of a hospital, nursing home, or home health agency, as designated by CMS.B. Rural Health Clinic (RHC) encounter as a face-to-face visit for the provision of services provided by physicians, physician assistants, nurse practitioners, nurse midwives, dentists, optometrists, clinical psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), and Board Certified Behavioral Analysts (BCBAs).C. An encounter rate as a prospective payment system (PPS) rate per encounter.D. Clinician Administered Drugs and Implantable Drug System Devices (CADD) as certain physician-administered drugs, with limited distribution or limited access for beneficiaries and administered in an appropriate clinical setting, which were not included in the calculation of the RHC's PPS rate, as determined by the Division of Medicaid.E. Change in the scope of service as a change in the type, intensity, duration and/or amount of services. 1. A change in the scope of services occurs if:a) The RHC has added or has dropped any services that meet the definition of an RHC service as provided in federal regulations.b) The service is included as a covered Medicaid service under the Mississippi Medicaid State Plan.c) A change in the intensity is a change in the amount of health care services provided by the RHC during an average encounter. 2. A change in the scope of service does not mean: a) The addition or reduction of staff members to or from an existing service.b) An increase or decrease in the number of encounters.c) A change in the cost of a service is not considered in and of itself a change in the scope of service.F. Allowable costs as costs that:1. Result from providing covered services,2. Are reasonable in amount and are necessary for the efficient delivery of those services,3. Include the direct cost center component (i.e., salaries and supplies) of providing the covered services, and4. Are an allocated portion of overhead (i.e., administration and facility).G. Co-mingling as the simultaneous operation of an RHC and another physician practice where the two (2) practices share: I. Medical facility as an RHC. 1. The medical facility is limited to an RHC and must have:a) A permanent location, andb) A published telephone number.2. The RHC must have regularly scheduled hours of operation which are posted in the facility.23 Miss. Code. R. 212-1.1
42 C.F.R. § 440.230; Miss. Code Ann. §§ 43-13-117, 43-13-121; SPA 18-0013, SPA 2013-033.Revised eff. 07/01/2014. Updated Miss. Admin. Code Part 212, Rule 1.1 A. 05/01/13 to include 04/01/2012 compilation omission.