This page provides basic information about being certified as a Medicare Critical Access Hospital (CAH) provider and includes links to applicable laws, regulations, and compliance information.

A facility that meets the following criteria may be designated by CMS as a CAH:

• Is located in a State that has established with CMS a Medicare rural hospital flexibility program; and
• Has been designated by the State as a CAH; and
• Is currently participating in Medicare as a rural public, non-profit or for-profit hospital; or was a participating hospital that ceased operation during the 10-year period from November 29, 1989 to November 29, 1999; or is a health clinic or health center that was downsized from a hospital; and
• Is located in a rural area or is treated as rural; and
• Is located more than a 35-mile drive from any other hospital or CAH (in mountainous terrain or in areas with only secondary roads available, the mileage criterion is 15 miles); and
• Maintains no more than 25 inpatient beds; and
• Maintains an annual average length of stay of 96 hours per patient for acute inpatient care; and
• Complies with all CAH Conditions of Participation, including the requirement to make available 24-hour emergency care services 7 days per week.

A CAH may also be granted "swing-bed" approval to provide post-hospital Skilled Nursing Facility-level care in its inpatient beds.

In the case of hospice care, a hospice may contract with a CAH to provide the Medicare hospice hospital benefit.  Reimbursement from Medicare is made to the hospice.  The CAH may dedicate beds to the hospice, but the beds must be counted toward the 25-bed maximum.  However, the hospice patient is not included in the calculation of the 96-hour annual average length of stay.  The hospice patient can be admitted to the CAH for any care involved in their treatment plan or for respite care.  The CAH negotiates reimbursement through an agreement with the hospice.

In addition to the 25 inpatient CAH beds, a CAH may also operate a psychiatric and/or a rehabilitation distinct part unit of up to 10 beds each.  These units must comply with the Hospital Conditions of Participation.

Downloads
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Related Links Inside CMS
State Operations Manual, Chapter 2, Section 2254 (PDF, 1.4MB) Guidance For Laws and Regulations for CAHs Survey and Certification General Enforcement Information
Related Links Outside CMS
Section 1820 of the Social Security Act Section 1861(mm) of the Social Security Act 42 CFR 485.601-645

Page Last Modified: 01/16/2009 2:47:51 PM
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