Critical Access Hospitals (CAH)
Mid-America offers comprehensive management services to the owners of a CAH (municipalities, counties, foundations, boards, etc.). We provide a full-time administrator and financial/operational support, including preparation and filing of Medicare/Medicaid cost reports. Mid-America’s philosophy is to manage the hospital and be accountable to the board. Our job is to manage the facility in a sound financial and operational manner to insure the long-term provision of health care services to the community and residents the hospital serves.
Understanding Critical Access Hospitals
  • A Medicare hospital designation created by Congress as part of the Balanced Budget Act of 1997 (Medicare Rural Hospital Flexibility Program)
  • Reimbursement on a reasonable cost basis (101%) for both inpatient and outpatient services.
    • Not subject to a lower of cost or charge limitation
    • Not subject to prospective payment (i.e., DRGs or APCs)
  • Less stringent standards related to staffing and hours of operation.
  • Can close acute care beds when there is not occupancy.
  • Must provide access to emergency care on a 24-hour basis.
  • Certain types of routine care can be provided by a physician assistant (PA) or nurse practitioner, subject to oversight by a physician.
  • Can provide, on a part-time off-site basis, some services otherwise required to be provided by an on-site full-time staff
Critical Access Hospital Qualifications
  • Must be a rural hospital.
  • Acute Care average length of stay limited to 96 hours. There is no limit on swing bed patients.
    • Exceptions for inclement weather or other emergency conditions that prevent patient transfer.
    • Exceptions can be made on a case by case basis by the Peer Review Organization (PRO).
  • Limited to 25 acute care beds. All beds can be classified as swing or acute.
  • Bed count restriction does not include beds of a unit licensed as a distinct part skilled nursing facility (SNU). A 10 bed geropsychiatric unit and 10 bed inpatient rehabilitation unit may be added in addition to the 25 acute/swing beds.
  • Must be located 35 miles (15 miles if in a mountainous area or served by a secondary road) from the nearest hospital or be certified by the state as a Necessary Provider.
Critical Access Hospital Qualifications
  • Necessary Provider criteria established by each state and approved by CMS.
  • Necessary Provider criteria varies from state to state, but always relates to demographics of the county (i.e., percent of population over 65, percent of population under the federal poverty level, designated as a Health Care Professional Shortage Area (HPSA), average death rates, etc.)
  • Some states require that an applicant meet only one of the Necessary Provider criteria.
  • A CAH must be a member of a rural health network - an organization consisting of at least one CAH and one acute care supporting hospital.
  • The CAH and the supporting hospital must establish the following:
    • Communications system for sharing of patient data, telemetry and medical records (may be by fax or other electronic means).
    • A system for emergency and non-emergency patient transport between the CAH and the supporting hospital.
    • An agreement for credentialing and quality assurance.