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41.4.2 Freestanding and Hospital-Based RHC Services
An RHC must be located in an area designated by the federal government as a health-care shortage area.
The following services are benefits of RHCs under the Texas Medicaid Program:
• Physician services.
•Services and supplies furnished as incidental to physician services.
•Services provided by an NP, a CNS, a CNM, a clinical social worker, or PA services.
•Services and supplies furnished as incidental to the NP's or PA's services.
•Visiting nurse services on a part time or intermittent basis to homebound clients in areas determined to have a shortage of home health agencies. A homebound client is someone who is permanently or temporarily confined to his place of residence, not including a hospital or a skilled nursing facility, because of a medical condition.
When an RHC bills for visiting nurse services, the written plan of treatment to be used for the visiting nurse must be developed by the RHC supervising physician. It must be approved and ordered by the client's treating physician if different from the supervising physician. The plan of treatment must be reviewed and approved at least every 60 days by the supervising physician of the clinic.
A visit is a face-to-face encounter between an RHC client and a physician, PA, NP, CNS, CNM, visiting nurse, or clinical NP. Encounters with more than one health professional and multiple encounters with the same health professional that take place on the same day and at a single location constitute a single visit, except where one or the other of the following conditions exists:
•After the first encounter, the client suffers illness or injury requiring additional diagnosis or treatment.
•The RHC client has a medical visit and an other health visit.
An other health visit includes, but is not limited to, a face-to-face encounter between an RHC client and a clinical social worker.
For freestanding RHCs, all laboratory services provided in the RHC's laboratory are included in the encounter. This includes the basic laboratory tests as well as any other laboratory tests provided in the RHC laboratory. Consequently, there is no separate billing for laboratory services. However, if the RHC laboratory becomes a certified Medicare laboratory with its own supplier number, and enrolls in Medicaid as an independent laboratory, all laboratory tests (except the basic laboratory tests) performed for RHC and non-RHC clients can be billed to Medicaid. The claim should be filed under their independent laboratory Medicaid provider identifier and using the appropriate Healthcare Common Procedure Coding System (HCPCS) codes.
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