United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1996-11-22 monographic deposited born digital 39 p. GA 1.13:HEHS-97-24 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-97-24 P0b002ee1803a43c6 f:he97024 DGPO 2010-08-12 2011-03-23 GAOREPORTS-HEHS-97-24 machine generated eng fdlp REPORT GAOREPORTS-HEHS-97-24 HEHS-97-24 Community health services Health resources utilization Health centers Medical services rates Eligibility criteria Economically depressed areas Health care programs Health care cost control HHS Health Professional Shortage Area System HHS Rural Health Clinic Services Program Medicare Program Medicaid Program Alabama Kansas New Hampshire Washington Florida Letter Report HEHS Pursuant to a congressional request, GAO reviewed the Rural Health Clinic (RHC) Program, focusing on: (1) whether the RHC program is serving a Medicare and Medicaid population that would otherwise have difficulty obtaining primary care; (2) whether there are controls in place to ensure that costs claimed for reimbursement are reasonable and to target the cost-reimbursement benefit of the program to clinics needing it for financial viability.<p/>GAO found that: (1) the RHC program is generally not focused on serving Medicare and Medicaid populations having difficulty obtaining primary care in isolated rural areas; (2) the additional Medicare and Medicaid payments provided to RHCs increasingly benefit well-staffed, financially viable clinics in suburban areas that already have extensive health care delivery systems in place; (3) most RHCs are conversions of existing physician practices that generally do not need or use the benefits under the program to enlarge the size of the practice or take other actions to expand care provided to underserved portions of the area's population; (4) contributing to this problem are the extraordinarily high reimbursements that RHC providers receive for each patient visit for Medicare and Medicaid services at many clinics, the program's broad eligibility criteria, and the requirement that the Health Care Financing Administration (HCFA) reimburse all RHCs at cost, even if they are already financially viable; (5) HCFA is not using its authority to set maximum payment limits for nearly half of the RHCs that are operated as a part of a hospital or other facility or implementing screens necessary to determine whether claimed costs at independent or facility-based RHCs are reasonable; and (6) once certified, RHCs remain eligible for cost reimbursement indefinitely, even if the area they serve no longer qualifies as rural or underserved. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-97-24/html/GAOREPORTS-HEHS-97-24.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-97-24/pdf/GAOREPORTS-HEHS-97-24.pdf GAO/HEHS-97-24 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-97-24 Letter Report GAO/HEHS-97-24; Rural Health Clinics: Rising Program Expenditures Not Focused on Improving Care in Isolated Areas; Community health services Health resources utilization Health centers Medical services rates Eligibility criteria Economically depressed areas Health care programs Health care cost control HHS Health Professional Shortage Area System HHS Rural Health Clinic Services Program Medicare Program Medicaid Program Alabama Kansas New Hampshire Washington Florida Public Law 95-210 Public Law 101-239