Critical Access Hospitals

Introduction

The Critical Access Hospitals (CAH) program was designed to improve rural health care access and reduce hospital closures. Critical Access Hospitals provide essential services to a community and are reimbursed by Medicare on a "reasonable cost basis" for services provided to Medicare patients.

Tools

AHA CAH Resources
Web site
Provides links to publications, organizations, and other resources for Critical Access Hospitals (CAHs).
Sponsoring organization: American Hospital Association

AHA Issues: Critical Access Hospitals
Web site
Information on American Hospital Association (AHA) advocacy activities related to Critical Access Hospitals (CAHs). Includes news, resources, and more.
Sponsoring organization: American Hospital Association

AOA Healthcare Facilities Accreditation Program
Web site
Information on the AOA survey process for certification of healthcare facilities, including Critical Access Hospitals (CAHs).
Sponsoring organization: American Osteopathic Association

CAH Financial Performance Indicators by State
Web site
State-level reports on the financial condition and performance of Critical Access Hospitals (CAHs).
Sponsoring organization: Flex Monitoring Team

CAH Information
Web site
Lists Critical Access Hospitals (CAHs) for the entire country and by state, as well as a map of CAH locations and quarterly data by state on conversion to the CAH program.
Sponsoring organization: Flex Monitoring Team

CMS Critical Access Hospitals Center
Web site
Federal regulations and notices, press releases, program memorandums, and other information from CMS related to the Critical Access Hospitals (CAH) program.
Sponsoring organization: Centers for Medicare & Medicaid Services

CMS Rural Health Open Door Forum
Web site
Provides information on a series of CMS forums addressing rural health issues. Covers Rural Health Clinic (RHC), Community Access Hospital (CAH) and Federally Qualified Health Center (FQHC) issues, as well as some inclusion of other questions and concerns that occur in clinical practice pertaining to other CMS payment systems that also extend into these settings. Includes call-in instructions for the next call and how to register for the mailing list.
Sponsoring organization: Centers for Medicare & Medicaid Services

CMS State Survey Agency Directory
Web site
Directory of state agencies that handle survey and certification of certain health care facilities for compliance with the Medicare health and safety standards.
Sponsoring organization: Centers for Medicare & Medicaid Services

EMS Resource Guide for Critical Access Hospitals
Web site
Provides information and resources to Critical Access Hospitals (CAHs) to help them strengthen and improve rural emergency medical services (EMS) capacity in local communities. Covers infrastructure, human resources, funding sources, legislation and regulation, and more.
Sponsoring organization: Wisconsin Office of Rural Health

Joint Commission: Critical Access Hospital Accreditation
Web site
Information on the Joint Commission survey process for certification of Critical Access Hospitals (CAHs).
Sponsoring organization: Joint Commission

Medicaid Treatment of CAHs by State
Other
Lists Medicaid payment information for Critical Access Hospitals (CAHs) by state, in an Excel spreadsheet format.
Sponsoring organization: Rural Health Resource Center Technical Assistance and Services Center

Medicare Modernization Act
Web site
Information on CMS implementation of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Includes links to CMS fact sheets and press releases, as well as other resources for understanding the impact of the MMA.
Sponsoring organization: Centers for Medicare & Medicaid Services

Regulations.gov
Web site
Supports public participation in the Federal decision-making process by allowing users to view and submit comments on proposed and final regulations.

Rural Health Research: Critical Access Hospitals and Rural Hospital Flexibility Program
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of Critical Access Hospitals and the Rural Hospital Flexibility Program, produced by the Office of Rural Health Policy's funded rural health research centers.
Sponsoring organization: Rural Health Research Gateway

Rural Health Resource Directory
Database
Directory of consultants, organizations and speakers throughout the United States who provide services to rural healthcare organizations. Searchable by state, organization type and service.
Sponsoring organization: Rural Health Resource Center

Rural Hospital Performance Improvement Education and Training Gateway
Web site
Lists distance and web-based educational resources for rural hospitals.
Sponsoring organization: Rural Health Resource Center

Technical Assistance and Services Center Web Site
Web site
TASC provides technical assistance to 47 states that administer the Medicare Rural Hospital Flexibility Program. The TASC web site includes a variety of tools, publications and resources on the Flex Program, as well as contact information for further assistance.
Sponsoring organization: Rural Health Resource Center Technical Assistance and Services Center

Funding

HUD 242 (FHA Section 242) - Helping Hospitals Get Capital Financing
Loan program to help hospitals finance new construction, refinancing, and modernization or to purchase major movable equipment such as hospital beds, wheeled equipment, and office machines.

Iowa Medicare Rural Hospital Flexibility Program (FLEX) Conference Grant
Funding for Iowa Critical Access Hospitals interested in sending their on-site staff to national out-of-state conferences.

Medicare Rural Hospital Flexibility Program Evaluation-Cooperative Agreement
The evaluation project will continue to assess the effectiveness of implementing the grant program in States and in rural communities and to provide recommendations for increasing the impact of the program to improve healthcare in rural America.

Patient Navigator Outreach and Chronic Disease Prevention Program
Grants to develop and implement patient navigator programs.

USAC Rural Health Care Service Discounts
Provides discounts to rural health care providers to obtain Internet and telecommunications access.

USDA Community Facilities Loan and Grant Program
Funding to construct, enlarge, or improve essential community facilities for health care, public safety, and public services in rural areas.

Inactive Funding

Inactive Funding Opportunities - Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.

Maps & Map Collections

Critical Access Hospitals (CAHs)
Geographic coverage: United States
Printable map that shows the location of CAHs nationwide. Data source: Flex Monitoring Team, October 5, 2006.
Sponsoring organization: Rural Assistance Center
Date: 2006

Location of Critical Access Hospitals
Geographic coverage: United States
U.S. map showing CAHs. Updated quarterly.
Sponsoring organization: Flex Monitoring Team
Date: 2007

Regulations, Forms & Other Useful Documents

2004 CAH Survey National Data
Author(s): Michelle Casey, Jill Klingner
Sponsoring organization: Flex Monitoring Team
Describes the results of a national telephone survey of 500 Critical Access Hospital (CAH) administrators between January and April 2004. Includes trends in health care services offered by CAHs in the past two years, changes in CAHs' organizational relationships, quality improvement and patient safety activities, CAHs' access to capital, and community impact.
Date: 08 / 2004

2007 Rural Hospital Replacement Facility Study: How Replacement Facilities Impact Operations and the Bottom Line: Findings From the Field
Author(s): Stroudwater Associates
Reports on rural communities that replace aging hospital facilities with new Critical Access Hospitals. Covers impact of new facilities on local use of services, quality and performance improvement, and financial performance.
Date: 2007

AHA Section for Small or Rural Hospitals CAH Annual Report - 2006
Author(s): AHA Section for Small or Rural Hospitals
Sponsoring organization: American Hospital Association
Describes advocacy and other efforts taken by the American Hospital Association and its Section for Small or Rural Hospitals in 2006 to address the needs of Critical Access Hospitals.
Date: 2006

Availability and Use of Capital by Critical Access Hospitals
Author(s): Walter Gregg
Sponsoring organization: Flex Monitoring Team
Examines the experiences of Critical Access Hospitals (CAHs) in meeting their capital needs. Discusses efforts to obtain capital, sources of capital, uses of capital, technical assistance resources, and current capital needs. Includes information on state capital programs available to CAHs.
Date: 03 / 2005

CAH Financial Indicators Report: Summary of Indicator Medians by State
Sponsoring organization: Flex Monitoring Team
Presents 20 financial indicators for Critical Access Hospitals (CAHs). Includes state and national medians for indicators addressing profitability, liquidity, capital structure, revenue, cost, and utilization.
Date: 08 / 2007

CMS State Operations Manual: Appendix W
Sponsoring organization: Centers for Medicare & Medicaid Services
Detailed information about the state survey process for Critical Access Hospitals (CAHs).

Code of Federal Regulations. 42 CFR 485.601-645: Subpart F, Conditions of Participation: Critical Access Hospitals (CAHs)
Sets forth the conditions that a hospital must meet to be designated as a Critical Access Hospital (CAH).

Community Impact of Critical Access Hospitals
Author(s): John A. Gale, Andrew F. Coburn, Victoria Freeman, Walter R. Gregg, Rebecca Slifkin
Sponsoring organization: Flex Monitoring Team
Discusses the findings of a project to understand the community involvement and impact of Critical Access Hospitals (CAHs) and the Medicare Rural Hospital Flexibility Program (Flex Program).
Date: 02 / 2007

Community Involvement of Critical Access Hospitals: Results of the 2004 National CAH Survey
Author(s): Stephanie Poley, Rebecca Slifkin
Sponsoring organization: Flex Monitoring Team
Describes the ways in which Critical Access Hospitals (CAHs) are engaged with their communities. Discusses CAHs involvement in community needs assessment, outreach and formal health promotion programs, relationships with other community organizations, free or reduced cost health care, and hospital activities in support on special populations.
Date: 03 / 2005

Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
Summarizes the experience of CAH administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms administrators have been offered, their experiences negotiating with MA plans, and their advice for others dealing with this issue.
Date: 12 / 2005

Critical Access Hospital Patient Safety Priorities and Initiatives: Results of the 2004 National CAH Survey
Author(s): Michelle Casey, Ira Moscovice, Jill Klingner
Sponsoring organization: Flex Monitoring Team
Describes patient safety activities at Critical Access Hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. Includes information on patient safety priorities, challenges CAHs face in implementing patient safety interventions, and pharmacy staffing and computer systems to prevent medication errors.
Date: 09 / 2004

Critical Access Hospital Program Fact Sheet
Sponsoring organization: Centers for Medicare & Medicaid Services
A general summary about the Critical Access Hospital (CAH) program that includes, the requirements for a facility to become a CAH, Medicare reimbursement for CAHs, and a list of rural health websites.
Date: 03 / 2007

Critical Access Hospital Prototype
Sponsoring organization: Health Resources and Services Administration
A guide to assist in the planning, design and construction of a Critical Access Hospitals (CAH). Includes information on the process and program requirements, examples of floor plans for 25-bed and 15-bed CAHs, budget information, and more.

Critical Access Hospital Quality Improvement Activities and Reporting on Quality Measures: Results of the 2007 National CAH Survey
Author(s): Michelle Casey
Sponsoring organization: Flex Monitoring Team
Indicates that Critical Access Hospitals continue to be actively involved in a wide range of quality improvement initiatives, with patient safety and medication safety in particular as major areas of focus.
Date: 03 / 2008

Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results (Briefing Paper)
Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
Sponsoring organization: Flex Monitoring Team
Examines the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures. A policy brief is also available.
Date: 04 / 2007

Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results (Policy Brief)
Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
Sponsoring organization: Flex Monitoring Team
Policy brief examining second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database. A full report is also available.
Date: 05 / 2007

Critical Access Hospitals (CAHs): Distance from Other Providers and Relocation of CAHs with a Necessary Provider Designation
Sponsoring organization: Centers for Medicare & Medicaid Services
September 7, 2007 letter from CMS to State Survey Agency Directors. Explains the criteria to determine whether a Critical Access Hospital (CAH) applicant satisfies the regulatory requirement. Explains the criteria to determine whether a CAH with a necessary provider designation remains essentially the same provider, serving the same service area after relocation. Supersedes the November 14, 2005 guidance on this topic.
Date: 09 / 2007

Critical Access Hospitals' Experience with Medicare Advantage Plans
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Details findings from a survey of 60 critical access hospital (CAH) administrators regarding their experiences with Medicare Advantage (MA) plans.
Date: 03 / 2008

Critical Access Hospitals: Does Inclusion of Long-Term Care Affect Profitability?
Author(s): Don Holley, Helen Stroebel
Sponsoring organization: Idaho State Office of Rural Health and Primary Care
Compared whether or not Critical Access Hospitals with Long-Term Care units different from those CAHs that do not have LTC units.
Date: 11 / 2005

Critical Access Hospitals: The Value of Membership in the American Hospital Association
Author(s): AHA Section for Small or Rural Hospitals
Sponsoring organization: American Hospital Association
Describes the benefits of membership in the American Hospital Association (AHA) for Critical Access Hospitals (CAHs). Includes information on AHA's work in the areas of representation, advocacy, and policy development. Also discusses member benefits for hospitals.
Date: 2007

Current Status of Health Information Technology Use in CAHs
Author(s): Michelle Casey, Jill Klingner, Walt Gregg, Ira Moscovice, Emily Nicholson, Tami Lichtenberg, Terry Hill
Sponsoring organization: Flex Monitoring Team
Examines the use of Health Information Technology (HIT) in Critical Access Hospitals (CAHs). Includes information on HIT infrastructure and the computerization of different functions within CAHs.
Date: 05 / 2006

Exploring the Community Impact of Critical Access Hospitals
Author(s): John Gale, Andrew Coburn, Walt Gregg, Rebecca Slifkin, Victoria Freeman
Sponsoring organization: Flex Monitoring Team
Reports on a series of site visits to six diverse rural communities and Critical Access Hospitals (CAHs) to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs.
Date: 01 / 2007

Financial Indicators for Critical Access Hospitals
Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca Slifkin
Sponsoring organization: Flex Monitoring Team
Discusses the development of a set of financial indicators for the Critical Access Hospital (CAH) program. Includes discussion of the potential usefulness of different types of indicators. Also provides indicator medians for CAHs for 1998-2003.
Date: 05 / 2005

Impact of Conversion to Critical Access Hospital Status on Hospital Financial Performance and Condition
Author(s): Mark Holmes, George H. Pink, Rebecca T. Slifkin
Sponsoring organization: Flex Monitoring Team
Policy brief analyzing financial ratios associated with Critical Access Hospitals' profitability, liquidity, and capital structure.
Date: 11 / 2006

Intensive Care in Critical Access Hospitals
Author(s): Victoria Freeman, Joan Walsh, Matthew Rudolf, Rebecca Slifkin
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Describes what officials at CAHs mean when they report that they provide intensive care and the importance of these services to the hospital and the community it serves.
Date: 03 / 2005

List of Critical Access Hospitals
Sponsoring organization: Flex Monitoring Team
Lists Critical Access Hospitals (CAHs). Includes city, state, zip and effective date. Updated monthly.
Date: 08 / 2007

Medicare Billing Information for Rural Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Medicare & Medicaid Services
Medicare rural billing charts for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), skilled nursing facilities, home health agencies, and Critical Access Hospitals (CAHs). Provides information on where to submit claims for different services.
Date: 05 / 2007

Medicare Payment Basics: Critical Access Hospitals Payment System
Sponsoring organization: Medicare Payment Advisory Commission
Overview of how Critical Access Hospitals (CAHs) are paid by Medicare. Compares differences in Medicare payments for CAHs, Sole Community Hospitals (SCHs), and Medicare-dependent Hospitals (MDHs).
Date: 10 / 2007

Medicare Program: Changes to the Hospital Outpatient Prospective Payment System, Ambulatory Surgical Center System, Graduate Medical Education and Critical Access Hospital; Interim and Final Rule with Comment Period
Sponsoring organization: Centers for Medicare & Medicaid Services
Addresses changes to the Hospital Outpatient Prospective Payment System (OPPS) and CY 2008 Payment Rates, the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates, the Hospital Inpatient Prospective Payment System (IPPS) and FY 2008 Payment Rates. Describes changes relating to the necessary provider designations of critical access hospitals (CAHs) and to the conditions of participation requirements. Also addresses changes to graduate medical education (GME) payments made to teaching hospitals that have Medicare affiliation agreements for certain emergency situations.
Journal citation: Federal Register Volume 72 Issue 227 Pages: 66579-67226
Date: 11 / 2007

Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Final Rule
Sponsoring organization: Centers for Medicare & Medicaid Services
Revises the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs. Implements certain provisions made by the Deficit Reduction Act of 2005 (Pub. L. 109–171), the Medicare Improvements and Extension Act under Division B, Title I of the Tax Relief and Health Care Act of 2006 (Pub. L. 109–432), and the Pandemic and All Hazards Preparedness Act (Pub. L. 109–417). In the Addendum to this final rule with comment period, describes changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs.
Journal citation: Federal Register Volume 72 Issue 162 Pages: 47129-48175
Date: 08 / 2007

Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
Author(s): David Hartley, Erika Ziller, Stephenie Loux, John Gale, David Lambert, Anush Yousefian
Sponsoring organization: Maine Rural Health Research Center
Survey indicates patients with mental health issues represent a significant proportion of the visits to Critical Access Hospital (CAH) emergency rooms. Investigates the types of cases that present with mental health problems, as well as the resources available to emergency room staff in CAHs for addressing such problems.
Date: 09 / 2005

Number of Critical Access Hospitals (CAHs) per State
Sponsoring organization: Flex Monitoring Team
Data by state listing the total number of Critical Access Hospitals (CAHs) for each state, and the number of CAHs in each state with a Psychiatric DPUs (Distinct Part Units) and with Rehabilitation DPUs.
Date: 08 / 2007

Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
Author(s): Michelle Casey, Ira Moscovice, Jill Klingner
Sponsoring organization: Flex Monitoring Team
Describes quality improvement efforts in Critical Access Hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. Includes data on the use of clinical guidelines and quality measures in CAHs, and the role of Medicare Quality Improvement Organizations (QIOs).
Date: 09 / 2004

Quality Improvement Strategies and Best Practices in Critical Access Hospitals
Author(s): Michelle Casey, Ira Moscovice
Sponsoring organization: University of Minnesota Rural Health Research Center
Describes Critical Access Hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. Includes lists of changes made to staffing, training, equipment and other issues related to quality improvement.
Date: 01 / 2004

Report to the Congress: Rural Payment Provisions in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
Sponsoring organization: Medicare Payment Advisory Commission
Examines the impact of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) provisions on rural hospital payments. Present the effect of eight MMA provisions on Medicare inpatient and outpatient payments to traditional (non-CAH) hospitals. Summarizes the MMA changes to Critical Access Hospital (CAH) payment policies discussed in MedPAC's interim report. Examines the effects of higher payments on hospital costs.
Date: 12 / 2006

Review of State Flex Program Plans, 2004-2005
Author(s): Stephenie Loux, John Gale, Anush Yousefian, Andrew Coburn, Walter Gregg
Sponsoring organization: Flex Monitoring Team
Examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states.
Date: 03 / 2006

Role of the Rural Hospital Flexibility Program in Addressing Workforce Issues (with a Special Focus on the Business Office)
Author(s): Amy Hagopian, Karin E. Johnson, Meredith A. Fordyce, Seth Blades, L. Gary Hart
Sponsoring organization: Rural Hospital Flexibility Program Tracking Project Consortium, 1999-2003
Discusses results of a survey of Critical Access Hospitals related to workforce, with information on successful recruitment and retention strategies for different occupations, including nurses and business office staff.
Date: 11 / 2003

Rural Hospital Emergency Department Quality Measures: Aggregate Data Report
Author(s): Jill Klingner, Ira Moscovice
Sponsoring organization: Flex Monitoring Team
Reports findings from a project that tested emergency department quality measures in a voluntary sample of critical access hospitals (CAHs) in Washington State.
Date: 03 / 2007

Scope of Services Offered by Critical Access Hospitals: Results of the 2004 National CAH Survey
Author(s): David Hartley, Stephenie Loux
Sponsoring organization: Flex Monitoring Team
Examines how Critical Access Hospital (CAH) services have changed over time, based on 2000, 2002 and 2004 survey data. Discusses the role of network affiliations in service changes and reasons for reported service expansions.
Date: 03 / 2005

Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
Author(s): Kathleen Dalton, Rebecca Slifkin, Jeongyoung Park, Hilda Ann Howard
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Examines trends in the delivery of skilled nursing facility services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on critical access hospitals (CAHs).
Date: 02 / 2006

Vital Signs of Critical Access Hospitals
Author(s): Fitch Ratings
Provides an overview of the Critical Access Hospital (CAH) program, its benefits, and potential threats to the program's long-term viability. Examines the CAH designation's relative importance to a hospital's credit rating.
Date: 07 / 2006

Journals

AHA Small or Rural Hospitals CAH Update
Newsletter of the AHA Section on Small or Rural Hospitals addressing legislation and regulatory issues of interest to Critical Access Hospitals. Sponsoring organization: American Hospital Association

Organizations

American Hospital Association (AHA)
National organization
Represents and serves all types of hospitals, health care networks, patients and communities.

Centers for Medicare & Medicaid Services (CMS)
Federal government
Runs the Medicare and Medicaid programs - two national health care programs that benefit about 75 million Americans. Part of the U.S. Department of Health and Human Services.

Flex Monitoring Team
National organization
Performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program) conducted by the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine.

National Rural Health Association (NRHA)
National organization
Promotes leadership, ideas, information, communication, education, research, advocacy, and methods to improve rural health. Composed of individual and organizational members who share a common interest in rural health.

NRHA: Hospitals and Community Systems Constituency Group
National organization
National Rural Health Association subgroup focused on hospitals and community systems.

Office of Rural Health Policy (ORHP)
Federal government
Promotes better health care service in rural America. Part of the Health Resources and Services Administration, U.S. Department of Health and Human Services. Focuses on matters affecting rural hospitals and health care, coordinating activities within the department that relate to rural health care, and maintaining a national information clearinghouse.

Rural Health Resource Center Technical Assistance and Services Center (TASC)
National organization
Assists states with all aspects of the Medicare Rural Hospital Flexibility Program (Flex Program), including CAH conversion, networking, EMS and performance improvement. TASC is the technical assistance center for the Flex Program.

Rural Hospital Flexibility Program Tracking Project Consortium, 1999-2003 (RHFP Tracking Project)
Academic/Research
From 1999-2003, monitored the Rural Hospital Flexibility Program implementation and its success in meeting legislative goals. A collaboration of six rural health research and policy analysis centers.

Terms & Acronyms

CMS (Centers for Medicare and Medicaid Services) Federal agency responsible for the Medicare and Medicaid programs. Part of the U.S. Department of Health & Human Services.

Cost-based Reimbursement Method of reimbursing medical services based on the total costs incurred providing services to a patient.

Critical Access Hospital (CAH) Rural hospital that provides essential services to a community and receives cost-based reimbursement from Medicare. Requirements include a maximum of 25 beds (swing or acute care) and a maximum 96 hour average length of stay for acute care patients.

DRG (Diagnosis-related Groups) Reimbursement method where the hospital receives a fixed payment for each type of medical procedure, regardless of the hospital's cost.

Fiscal Intermediary (FI) Company designated by CMS to process claims and make payment for services.

Medicare Conditions of Participation (CoP) CMS conditions that health care organizations must meet to participate in the Medicare and Medicaid programs. Used to improve quality and protect the health and safety of beneficiaries.

Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) Legislation passed in 2003 that included significant Medicare reforms including a prescription drug benefit for Medicare beneficiaries and reimbursement improvements for rural healthcare facilities.

Medicare Rural Hospital Flexibility Program (Flex Program) Federal initiative created by the Balanced Budget Act of 1997 that provides funding to State Governments to strengthen rural health. Requires the development of state rural health plan. Provides funding to States network development, quality improvement, designation of Critical Access Hospitals (CAHs), and improvement of rural EMS.

PIP (Periodic Interim Payment) A regular payment made to a Critical Access Hospital based on an estimate of annual revenue to help maintain cash flow until cost reports from the current cost reporting period are settled and an annual payment adjustment is made.

Prospective Payment System (PPS) Medicare reimbursement method in which rates for services are established in advance, based on the patient's diagnosis.

Quality Improvement Organization (QIO) QIOs review Medicare services. They work with consumers, physicians, hospitals, and other caregivers to make sure patients get the right care at the right time, particularly among underserved populations.

Swing beds Licensed acute-care beds designated by a hospital to provide either acute or long-term care services. A swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has CMS approval to provide post-hospital skilled nursing facility care and meets certain requirements.

TASC (Technical Assistance and Services Center) The technical assistance center for the Medicare Rural Hospital Flexibility Program (Flex Program). Provides information, tools and resources on all aspects of the Flex Program, including CAH, networking, EMS, and quality improvement. TASC is run by the Rural Health Resource Center in Duluth, MN.

Contacts

For initial consultation and ongoing guidance:
State Rural Hospital Flexibility Program Contacts, Technical Assistance and Services Center

For questions about CMS regulations:
CMS Regional Rural Representatives

For survey and certification questions:
CMS State Survey Agency Directory

For technical assistance:
Rural Health Resource Center Technical Assistance and Services Center (TASC)
tasc@ruralcenter.org
218.727.9390

Article Searches & Bibliographies

Critical Access Hospitals: An Annotated Bibliography
Sponsoring organization: Rural Hospital Flexibility Program Tracking Project Consortium

RAC Documents Search: Critical Access Hospitals