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Numerator

Number of Critical Access Hospitals participating in the Medicare program

Methodology

A Critical Access Hospital (CAH) is a hospital that is certified to receive cost-based reimbursement from Medicare. The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures. Each hospital must review its own situation to determine if CAH status would be advantageous. CAHs were created as part of the Balanced Budget Act of 1997.

"CAHs must be located in a rural area and meet one of the following criteria: •Over 35 mile distance from another hospital, or 15 miles from another hospital in mountainous terrain or areas with only secondary roads."

CAHs may have a maximum of 25 acute care inpatient beds. For CAHs with swing bed agreements, any of its beds may be used for either inpatient acute care or swing bed services. Any hospital-type bed located in or adjacent to any location where the bed could be used for inpatient care counts toward the 25 bed limit. Certain beds do not count toward the 25 bed limit, including examination or procedure beds, stretchers, operating room tables, and others. For a complete list of beds that do not count toward the 25 bed limit, please see Section C-0211, §485.620(a) Standard: Number of Beds: Interpretive Guidelines of the CMS State Operations Manual: Appendix W.

CAHs must provide 24-hour emergency services, with medical staff on-site; or on-call and available on-site within 30 minutes, 60 minutes if certain frontier area criteria are met. The staff on-site or on call must meet state licensure requirements, but Medicare Conditions of Participation specify the coverage could be a doctor of medicine or osteopathy, a physician assistant, a nurse practitioner, or a clinical nurse specialist, with training or experience in emergency care. In certain very limited circumstances, the coverage could be provided temporarily by a registered nurse.

Zip codes for Medicare participating critical access hospitals were aggregated to hospital referral region (HRR).

State aggregates for Medicare participating critical access hospitals are based on state codes coded from first two positions of the provider number.

References

Rural Assistance Center Frequently asked questions

HRR documentation is posted at Dartmouth Atlas-Appendix on the Geography of Health Care in the United States

State code documentation is posted in the State Operations Manual, section 2779A1 at CMS, State Operations Manual, Chapter 2 - The Certification Process