Certification of a Rural Health Clinic

Purpose: This procedure describes the steps necessary to obtain certification for a rural health clinic. Rules governing the certification of Rural Health Clinics are contained in the Code of Federal Regulations (CFR) at 42 CFR Part 491.4 - 491.11 (PDF, 381 KB).

Please be aware that there may be variations in the process since individual projects may have special circumstances. The outline is intended to be a general guide to aide the applicant in completing the overall project.

Contacts: For questions regarding any part of this process, please contact the appropriate section within the N.C. Department of Health and Human Services.

Acute and Home Care Licensure and Certification Section 919-855-4620
Office of Rural Health and Community Care 800-533-8847


  1. Determine rural health status: Office of Rural Health and Community Care
    1. Before becoming certified, the clinic must first qualify for rural health status. The applicant contacts the Office of Rural Health and Resource Development to learn if the location is considered a medically underserved area or if there is a health professional shortage and rural area.
  2. Obtain certification: Acute and Home Care Licensure and Certification Section
    1. The applicant contacts the Acute and Home Care Licensure and Certification Section three months prior to operation for an application packet.
    2. The applicant completes the information and returns it to the section.
    3. As soon as the clinic is ready for operation, the applicant contacts the section for an on-site survey.
    4. The Medicare application (CMS Form 855) is forwarded by the provider to the fiscal intermediary for approval. An initial survey will be scheduled with approval of the application by the fiscal intermediary.
    5. The effective date of licensure is the date of survey of which the facility is determined to be in compliance. If the applicant has deficiencies during the initial survey, then the effective date for participation will be the date the section receives an acceptable plan of correction signed by the applicant.
    6. The section forwards all information to the Atlanta Centers for Medicare & Medicaid Services Regional Office for approval.
    7. The regional office assigns the Center for Medicare & Medicaid Services Certification Number (CCN) and notifies the fiscal intermediary.