Critical Access Hospitals

• Currently participating Medicare hospitals;

• Hospitals that ceased operation after November 29,1989; or Health clinics or centers (as defined by the State) that previously operated as a hospital before being downsized to a health clinic or center.

• Be located in a State that has established a State rural health plan for the State Flex Program (as of September 2011, only Connecticut, Delaware,Maryland, New Jersey, and Rhode Island did not have a State Flex Program);

• Be located in a rural area or be treated as rural under a special provision that allows qualified hospital providers in urban areas to be treated as rural for purposes of becoming a CAH;

• Demonstrate compliance with the CoPs found at 42 CFR Part 485 subpart F at the time of application for CAH status;

• Furnish 24-hour emergency care services 7 days a week, using either on-site or on-call staff;

• Provide no more than 25 inpatient beds that can be used for either inpatient or swing bed services;however, it may also operate a distinct part rehabilitation or psychiatric unit, each with up to 10 beds;

• Have an average annual length of stay of 96 hours or less per patient for acute care (excluding swing bed services and beds that are within distinct part units); and

• Be located either more than a 35-mile drive from the nearest hospital or CAH or more than a 15-mile drive in areas with mountainous terrain or only secondary roads OR certified as a CAH prior to January 1, 2006, based on State designation as a“necessary provider” of health care services to residents in the area (CMS)

• A Medicare reimbursement program that provides reasonable cost-based reimbursement for Medicare-certified CAHs, which is administered by CMS; and

• A State grant program that supports the development of community-based rural organized systems of care in participating States, which is administered by the Health Resources and Services Administration through the Federal Office of Rural Health Policy.To receive funds under the grant program, States must apply for the funds and engage in rural health planning through the development and maintenance of a State Rural Health Plan that:

• Designates and supports the conversions to CAHs;Promotes emergency medical services (EMS) integration initiatives by linking local EMS with CAHs and their network partners;

• Develops rural health networks to assist and support CAHs;

• Develops and supports quality improvement initiatives; and

• Evaluates State programs within the framework of national program goals.