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MLN006398 - Information for Rural Health Clinics

This revised product comprises Subregulatory Guidance for Rural Health Clinics (RHC), and its content is based on publically available content at,, and

CMS policy or operation subject matter experts also reviewed/cleared this product. This product educates RHCs about the role of RCH providers, patient services including Virtual Communication Services, RHC certification requirements, payments, cost reports, telehealth, mental health visits, and annual reconciliation.

Revisions for this product include the following content updates:

• Chronic pain management information (page 5)
• More cost report information (page 8)
• COVID-19 monoclonal antibody therapies & vaccines (page 10)
• Clarified definition of telehealth (page 10)
• Information about Medicare distant site services (page 11)
• Information about consent for care management and virtual communication services (page 12)
• A delay for the in-person visit requirements for mental health visits (page 12)
• A revision of bed count methodology for determining provider-based RHCs exemption to the RHC payment limit (page 13)

Download the Guidance Document


Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 30, 2023

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.