For entitlement to the special payment rules, a specified provider-based RHC (grandfathered RHC) is an RHC that:
• As of December 31, 2020, was in a hospital with less than 50 beds and
• After December 31, 2020, was in a hospital that continues to have less than 50 beds (not taking into account any increase in the number of beds pursuant to a waiver during the COVID-19 Public Health Emergency (PHE), and 1 of the following circumstances:
• As of December 31, 2020, was enrolled in Medicare (including temporary enrollment during the PHE) or
• Submitted a Medicare enrollment application (or a request for temporary enrollment during the PHE) that we got before January 1, 2021.
Policy For CY 2023
The RHC payment limit per visit for CY 2023 is $126.00 for independent RHCs and provider based RHCs in a hospital with 50 or more beds Specified (grandfathered) provider-based RHCs with an April 1, 2021, established payment limit that continue to meet the qualifications in Section 1833(f)(3)(B) of the Act, the payment limit per visit for CY 2023 is an amount equal to the greater of:
• The payment limit per visit starting January 1, 2022, increased by the MEI 3.8% for primary care services provided as of the first day of CY 2023 (3.8 %*), or
• The RHC national statutory payment limit per visit for CY 2023 ($126 per visit) For specified provider-based RHCs that no longer meet the qualifications in Section 1833(f)(3)(B) of the Act, the payment limit per visit for CY 2023 is the national statutory payment limit per visit for CY 2023 ($126 per visit)
https://www.cms.gov/files/document/mm12999-rural-health-clinic-all-inclusive-rate-cy-2023-update.pdf