Significant Payment Cap Changes for New Rural Health Clinics (RHCs)
On December 27, 2020, President Trump signed into law the Consolidated Appropriations Act, 2021. The $900 billion stimulus relief portion includes Section 130 Improving Rural Health Clinic Payments, which increases the Medicare All-Inclusive Rate (AIR) cap for independent RHCs to $100 per visit and provides for annual increases to the cap up to $190 per visit in 2028, at which time the rate will be increased by the Medicare Economic Index (MEI) thereafter.

Please note, if an RHC’s cost per visit is less than the cap, then the RHC is paid the lesser amount.

Impact on Provider-Based RHCs

All RHCs (including those with less than 50 beds) certified after December 31, 2019, will now be subject to this cap. This will have a significant reimbursement impact on new RHCs or RHC projects in process.
Provider-based RHCs (less than 50 beds) certified on or before December 31, 2019, will not be subject to a single uniform cap. Instead, all uncapped RHCs enrolled in Medicare as of December 31, 2019, are grandfathered in at the clinic’s 2020 all-inclusive rate.
Each uncapped RHC will have a clinic specific cap based on their 2020 AIR which will grow annually at the rate of the Medicare Economic Index.
Contact your ACT client service representative with questions about this new legislation and how it might impact your Rural Health Clinic, or email us at