Certified Rural Health Clinics are primary healthcare providers able to bill at cost for Medicare and/or Medicaid visits as a result of an onsite inspection and compliance with rules of operation as determined by the Secretary of Health and Human Services.  Rural Health Clinics encourage and stabilize the provision of outpatient primary care in underserved rural areas through the use of physicians, physician assistants, nurse practitioners, and certified nurse midwives. To become certified as a Rural Health Clinic, a practice must be located in a community that is both rural (Census Bureau designation as "non-urbanized") and underserved (a Health Professional Shortage Area or Medically Underserved Area federal designation).  Certification as a Rural Health Clinic may benefit an existing medical practice in one of these areas as RHCs receive reimbursement based on actual costs for Medicaid and Medicare patients.