How to Meet NHSC Site Eligibility Requirements

Note: If you are unsure of your site type or have questions about your site’s eligibility, contact the Division of Regional Operations (DRO) analyst in your state.

Site Requirements

Review the NHSC Site Agreement (PDF - 291 KB) and the NHSC Site Reference Guide (PDF - 991 KB) in their entirety. These documents contain the program requirements your site must meet the time of application and must continue to meet in order to maintain status as an NHSC-approved site.

Below is a summary of NHSC site requirements.

General

• 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: a) the individual’s inability to pay;  b) whether payment for those services would be made under Medicare, Medicaid, or Children’s Health Insurance Program (CHIP); or c) the individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity.

Health Professional Shortage Areas (HPSAs)

• 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 for an internal medicine physician; a Mental Health HPSA designation to recruit for a psychiatrist; a Dental HPSA designation to recruit a dentist; etc.  
  • Facilities providing SUD services must be located in a designated Mental Health or Primary Care HPSA. For the purpose of the NHSC SUD Workforce LRP and the NHSC Rural Community LRP, 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).
• 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 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 Federal Poverty Guidelines.
• 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 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 emergency room and outpatient/ambulatory clinic primary care services.

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

• 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 aimed at promoting clinician resiliency and reducing burnout.
  • Have a current copy of the plan onsite for review.
  • Adopt and implement recruitment and retention policies and practices to keep up clinical staffing levels to properly serve the community.

Primary Behavioral and Mental Health 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 agreements.