Health Center Regulatory Issues

CMS Issues Proposed Rule Impacting FQHC Medicare Service Rules

On February 7, 2013, CMS issued a Proposed Rule on Medicare and Medicaid Programs: Part II – Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction. This proposed rule contains some proposed changes to Medicare FQHC services rules. The two major proposed changes are:

RHC/FQHC definition of physician: The definition of a ‘‘physician’’ in the RHC/FQHC regulations does not conform to the definition of a ‘‘physician’’ in the rules governing payment and Medicare agreements. CMS proposes to revise the regulation to conform to the definition in the payment regulations to eliminate possible confusion in the provider community. CMS proposes to revise the definition as follows:

“Physician means a practitioner who meets the requirements of sections 1861(r) and 1861(aa)(2)(B) and (aa)(3)(B) of the Act and includes (1) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which the function is performed; and (2) within limitations as to the specific services furnished, a doctor of dental surgery or of dental medicine, a doctor of optometry, a doctor of podiatry or surgical chiropody or a chiropractor (see section 1861(r) of the Act for specific limitations).”

CAH and RHC/FQHC Physician Responsibilities: CMS proposes to revise the CAH and RHC/FQHC regulations to eliminate the requirement that a physician must be onsite at least once in every 2-week period. For RHCs and FQHCs, CMS proposes that physicians would periodically review the clinic or center’s patient records, provide medical orders, and provide medical care services to the patients of the clinic or center.

NACHC will be reviewing these provisions closely and commenting on them. The comment deadline will be 60 days from publication in the Federal Register, likely in early April.

For more information, contact Roger Schwartz at or 202-296-0158.