RHC Payment Limit

70.2 - RHC Payment Limit (Rev. 11803; Issued: 01-26-23; Effective: 01-01-23; Implementation: 02-27-23) Prior to April 1, 2021, the RHC payment limit was set by Congress in 1988 and was adjusted annually based on the Medicare Economic Index (MEI). The payment limit was released annually via Recurring Update Notifications. Prior to April 1, 2021, a provider-based RHC that is an integral and subordinate part of a hospital (including a CAH), as described in regulations at 42 CFR 413.65, could receive an exception to the per- visit payment limit if: • the hospital had fewer than 50 beds as determined at 42 CFR 412.105(b); or • the hospital's average daily patient census count of those beds described in 42 CFR 412.105(b) did not exceed 40 and the hospital meets both of the following conditions: o it was a sole community hospital as determined in accordance with 42 CFR 412.92 or an essential access community hospital as determined in accordance with 42 CFR 412.109(a), and o it was located in a level 9 or level 10 Rural-Urban Commuting Area (RUCA). (For additional information on RUCAs, see http://depts.washington.edu/uwruca/. The exception to the payment limit applied only during the time that the RHC met the requirements for the exception.