Critical Access Hospitals

In 1997, Congress, through the Balanced Budget Act, authorized creation of what is called the Medicare Rural Hospital Flexibility (MRHF) Program. This program has led to the creation of what is being called the Critical Access Hospital. By establishing limited service hospitals and rural health networks, these acute care facilities can provide outpatient, emergency, and limited inpatient services. The Department of Health and Human Services/Division of Health has developed a Critical Access Hospital plan in consultation with the Arkansas Hospital Association. That plan was approved and funded by the Health Care Financing Administration, now known as the Centers for Medicare and Medicaid Services (CMS). There are currently 28 hospitals in the state that are designated as Critical Access Hospitals.

Each Critical Access Hospital is required by the plan:

• To meet certain staffing requirements and to enter into a patient referral and transfer agreement with a larger, more viable acute care hospital (referred to as an Affiliate Hospital).
  
• To participate in the development and implementation of a communication system with its network hospitals.
  
• To enter into a transport agreement for emergency and non-emergency transportation with the area Emergency Medical Service.
  
• To ensure the quality of its services. (Quality assurance and credentialing will be performed by the Affiliate Hospital with which the CAH has contracted).

To satisfy state requirements for designation as a CAH, the plan specifies that a hospital must first agree to meet all Federal requirements for designation. The hospital must submit an Application for Final Designation as a member of a rural health network along with other supporting documentation. The application must include a completed community needs assessment, local health services delivery plan and a financial feasibility study with cost projections for at least a three-year period.

This new program provides more opportunity for States and their rural communities to improve access to essential health care services, especially for communities that cannot support a fully operational facility. The CAH, recognized by Medicare as a new type of provider, is eligible for reimbursement. This will allow rural not-for-profit or public hospitals to become eligible for conversion to CAHs. See the attached CAH Map.pdf for locations.

Resources

Funding Opportunities | August 2008

Rural News and Announcements

http://www.rupri.org - 2007-03-30 - New Document from the National Rural Network

Why Rural Matters III: The Rural Impact of the Administration's FY08 Budget Proposal (PDF)

National Rural Health Association
The National Rural Health Association (NRHA) (www.nrharural.org) is the voice of rural health, promoting leadership, communication, education, research, and advocacy since 1978. Some of the latest information available through NRHA include:

Rural Hospital Replacement Facility Study – a report that covers the impact of new Critical Access Hospitals (CAH) on local use of services, quality and performance improvement, as well as financial performance.

2006 Rural Hospital Replacement Facility Study (PDF)
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: 2006

Farm Bill Reauthorization: Implications for the Health of Rural Communities Overview of the impact the Farm Bill has on rural health and rural communities, with recommendations for the 2007 reauthorization of the Farm Bill. http://nrharural.org/advocacy/sub/PolicyBrf.html (scroll down to Issue Papers) Organization: National Rural Health Association Date: 11 / 2006

What is Rural? And Why Does It Matter? (PDF)
Brief description of why the definitions of rural used by policymakers and researchers are important. Organization: Rural New York Initiative
Date: 01/2007

Rural Health Fact Sheets - Rural health information guides, tools, brochures, and fact sheets are now available, free of charge, in downloadable format from the Centers for Medicare & Medicaid Services' Medicare Learning Network (MLN). www.cms.hhs.gov/home/outreacheducation.asp .