Critical access hospitals (CAHs) eligibility overview

The following providers may be eligible to become CAHs:

• Currently-participating Medicare hospitals;
• Hospitals that ceased operations on or after November 29, 1989; or
• Health clinics or centers (as defined by the state) that previously operated as a hospital before being downsized to a health clinic or center.

A Medicare-participating hospital must meet the following criteria to be designated by CMS as a CAH:

• Be located in a state that has established a state Medicare rural hospital flexibility program;
• Be designated by the state as a CAH;
• Be located in a rural area or an area that is treated as rural;
• Be located either more than 35 miles from the nearest hospital or CAH or more than 15 miles in areas with mountainous terrain or only secondary roads; or prior to January 1, 2006, were certified as a CAH based on state designation as a "necessary provider" of health care services to residents in the area;
• Maintain no more than 25 inpatient beds that can be used for either inpatient or swing-bed services;
• Maintain an annual average length of stay of 96 hours or less per patient for acute inpatient care (excluding swing-bed services and beds that are within distinct part units);
• Demonstrate compliance with the CAH conditions of participation (CoPs) found at 42 CFR (Code of Federal Regulations) Part 485 subpart F; and
• Furnish 24-hour emergency care services seven days a week;

A CAH may also be granted "swing-bed" approval to provide post-hospital skilled nursing facility-level care in its inpatient beds.

Please refer to the CMS website for additional information on CAHs.