Specifically, the Centers for Medicare & Medicaid Services (“CMS”) require that applicants requesting entrance into the Medicare program as a rural health clinic be located in a current shortage area for which a designation is made or updated within the current year or within the previous three years. In other words, to be a current designation, the designation cannot be more than four years old. And, of course, state licensure regulations also require that the RHC be located in a health professional shortage area or a medically underserved area and must be operated in compliance with federal, state and local law.
Despite the Medicare certification requirement that federal designations be current (i.e., updated every 4 years), the U.S. Department of Health and Human Services (“DHHS”), Health Resources and Services Administration (“HRSA”) has failed within the last four years to update the federal designations, including Health Professional Shortage Areas (“HPSA”), Medically Underserved Areas (“MUA”), and Medically Underserved Populations (“MUP”), for many Kentucky counties.
Some counties, including counties ranked as having the worst health outcomes and/or health factors in Kentucky, have previously been designated as a HPSA, MUA and/or MUP, but those designations are 12-15 years old. Consequently, no RHCs may be established in those service areas and meet both the Medicare Conditions of Participation and state licensure requirements until that designation has been updated.
Thus, the delays in updating HPSA, MUA, and MUP designations in Kentucky counties have significant consequences for RHCs. RHCs in a community with an old designation (over four years old) risk losing their Medicare certification and ability to provide services to Medicare patients, which will result in Medicare patients losing access to desperately needed RHC services. Another consequence of HRSA delays in updating designations is that communities will not attract new RHCs and the Medicare population will be denied access to additional RHC services.
However, there is hope for updating the old HPSA and MUA designations despite HRSA and State delays. Federal regulations permit the Governor of the Commonwealth of Kentucky to recommend that the Secretary of DHHS designate a county or area as a HPSA and/or MUA.
Emily M. Hord
McBrayer, McGinnis, Leslie & Kirkland, PLLC
 42 CFR § 491.5(a).
 Id. at § 491.3.
 902 KAR § 20:145.
 42 CFR 1 Part 5.3