How to Meet NHSC Site Eligibility Requirements

Site requirements

Review the NHSC Site Agreement (PDF - 291 KB) and the NHSC Site Reference Guide (PDF - 808 KB) in their entirety. These documents contain the program requirements your site must meet in order to maintain its status as an NHSC-approved site.

Below is a summary of NHSC site requirements.

General

The site must:

• Function as part of a system of care that either offers or assures access to ancillary, inpatient, and specialty referrals.
• Provide services without regard to:
  • The individual’s inability to pay
  • Whether payment for those services would be made under Medicare, Medicaid, or Children’s Health Insurance Program (CHIP)
  • The individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity

Health Professional Shortage Areas (HPSAs)

The site must:

• Be located in, and treat patients from, a federally designated Health Professional Shortage Area (HPSA).
  • In order to recruit an NHSC clinician, NHSC-approved sites must be in and serve a designated HPSA for the specific category in which an NHSC clinician would serve. For example, an NHSC-approved site would need to have a primary care HPSA designation to recruit an internal medicine physician, a mental health HPSA designation to recruit a psychiatrist, or a dental HPSA designation to recruit a dentist.
  • Facilities providing SUD services must be located in a designated mental health or primary care HPSA. For the purpose of the NHSC SUD  Workforce Loan Repayment Program and the NHSC Rural Community Loan Repayment Program, an NHSC site approved for SUD services may use either the primary care or the mental health HPSA scores, even if it does not provide primary care (medical).
  • Centers for Medicaid and Medicare Services-Certified Rural Health Clinics are not required to be in geographic or population Health Professional Shortage Areas to apply for site approval. We designate their facility HPSAs if their application is approved.
• Provide culturally competent and linguistically appropriate comprehensive primary care services (medical, dental, and/or behavioral), which correspond to the designated HPSA type.

Payment for services

NHSC sites (with some exceptions) must: 

• Provide services for free (or, for a nominal charge, consistent with the site’s policy) to individuals and families with annual incomes at or below 100% of the most current federal poverty guidelines.
• Provide services at a discount based on family size and income for individuals and families with incomes above 100% and, at or below 200% of the most current federal poverty guidelines.
• Ensure eligibility for the program is based solely on income and family size. No other factor (for example, assets, insurance application and/or coverage, citizenship, population type) can be used to assess eligibility.
• Make every reasonable effort to secure payment according to the schedule of fees or schedule of discounts and/or any other third party.
• Accept assignment for Medicare beneficiaries and have an appropriate agreement with the applicable state agency for Medicaid and CHIP beneficiaries.
• Prominently display a statement in common areas and on the site’s official website and social media platforms (if one exists) that explicitly states that (a) no one will be denied access to services due to inability to pay, and (b) there is a discounted/sliding fee schedule available based on family size and income, per the NHSC Site Agreement, item 2e. This statement should be translated into the appropriate language/dialect when applicable.
• CAHs are required to implement the NHSC Sliding Fee Discount Program only for primary care services in the emergency room and outpatient/ambulatory clinic. 

Note: If the Sliding Fee Discount Program does not apply to your site, you must provide documentation explaining that no one is charged or billed for services and individuals are not denied service because of inability to pay.

Clinician recruitment and retention

The site must:

• Use a clinician credentialing process that, at a minimum, includes reference review, licensure verification, and a query of the National Practitioner Data Bank (NPDB).
• Adhere to sound fiscal management policies and adopt clinician recruitment and retention policies to help the patient population, the site, and the community obtain maximum benefits.
• Maintain a clinician recruitment and retention plan, including specific strategies to promote clinician resiliency and reduce burnout.

Primary behavioral and mental health and SUD sites

Sites that provide behavioral and mental health services must demonstrate services provided directly to patients on-site and services provided off-site through referral arrangements.