Critical Access Hospital Program Myron E Bloom MD MMM Medical Director, Rural Healthcare Quality Network Critical Access Hospital Program Created by Congress in 1997 as part of the Balanced Budget Act to support “limited-service hospitals” located in rural areas.
Myron E Bloom MD MMM
Rural Healthcare Quality Network
or “cost-based reimbursement” for
inpatient and outpatient services
Enhancements made in the:
To qualify the CAH had to be a:
Changed length of stay to an annual average of 96 hour patient stay,
Increased the opportunity for small hospitals to join the CAH program.
After January 1, 2004 for Method I
And after January 1, 2005,
on-call emergency room providers:
nurse practitioners, and certified nurse specialists.
And after January 1, 2004,
3 day qualification for transfer to ECF.
And after October 1, 2004
The PPS CoP catch up to CAH CoP
Regulations and Interpretive Guidelines for Critical Access Hospitals (CAHs)
Each CAH shall have an agreement with respect to credentialing and quality assurance with:
(1) A hospital member of the network;
(2) QIO or equivalent entity; or
(3) Another appropriate qualified entity identified in the State rural health plan.
A doctor of medicine or osteopathy, a physician assistant, or a nurse practitioner on call and immediately available on site 24-hour a day within:
20 minutes for trauma
30 minutes non-trauma
or 60 minutes if the CAH is a frontier area (less than 6 residents per square mile), the State has determined that longer than 30 minutes is the only feasible method of providing emergency care to residents, and maintains that 60 minutes is justified because other alternatives would increase the time needed to stabilize a patient in an emergency.
All CAH patients
but a site visit is not required if no patients have been treated since the latest site visit.
Whenever a patient is admitted by a nurse practitioner, physician assistant, or clinical nurse specialist,
an MD/DO on the staff of the CAH is notified of the admission.
CMS regulations require that Medicare and Medicaid patients admitted by a mid-level practitioner be under the care of an MD/DO if any medical or psychiatric problem during hospitalization is outside the scope of practice of the admitting practitioner.
CRNA anesthetist must be under the supervision of the operating practitioner unless the Governor in the State in which the CAH is located requests exemption by submitting a letter to CMS.
Dayton January 2000
South Bend April 2000
McCleary July 2000
Davenport August 2000
Deer Park November 2000
Grand Coulee January 2001
Odessa January 2001
Chewelah August 2001
Newport October 2001
Ritzville January 2002
Prosser January 2002
Leavenworth January 2002
Ilwaco February 2002
White Salmon March 2002
Goldendale April 2002
Ephrata April 2002
Othello July 2002
Morton July 2002
Quincy October 2002
Tonasket November 2002
Brewster December 2002
Port Townsend January 2003
Forks January 2003
Republic January 2003
Colville June 2003
Colfax August 2003
Omak October 2003
Sedro-Wolley January 2004
Sunnyside January 2004
Pullman June 2004
Clarkston August 2004
Ellensburg October 2004
Chelan October 2004
Enumclaw November 2004
Shelton January 2005
Pasco February 2005
Considering Conversion to CAH
Wenatchee Valley Medical Center
Walla Walla GeneralWashington State’s 37 CAH