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Critical Access Hospital Eligibility

Medicare law allows establishment of a Medicare rural hospital flexibility program by any state that has submitted the necessary assurances and complies with the statutory requirements for designation of hospitals as critical access hospitals (CAHs). 

To be eligible as a CAH, a facility must be a:

  • Participating Medicare hospital
  • Hospital that ceased operations on or after November 29, 1989 
  • Health clinic or health center that previously operated as a hospital before being downsized to a health clinic or health center 

Critical Access Hospital Designation

A hospital that already participates in Medicare and seeks CAH status must meet the following criteria to be certified and remain certified as a CAH: 

  • Be located in a State that established a State rural health plan for the State Flex Program; 
  • Be located in a rural area or be treated as rural under a special provision that allows qualified hospital providers in urban areas to be treated as rural; 
  • Demonstrate compliance with the conditions of participation at 42 CFR Part 485 subpart F at the time of application for CAH certification and all times subsequent to the initial certification; 
  • Furnish 24-hour emergency care services 7 days a week, using either on-site or on-call staff, with specific on-site response timeframes for on-call staff; 
  • Maintain no more than 25 inpatient beds that may also be used for swing bed services. It may also operate a distinct part rehabilitation and/or psychiatric unit, each with up to 10 beds; 
  • Have an annual average length of stay of 96 hours or less per patient for acute care (excluding swing bed services and beds that are within distinct part units); and, 
  • Must be: 
    • Located more than a 35-mile drive from any hospital or other CAH; 
    • Located more than a 15-mile drive from any hospital or other CAH in an area with mountainous terrain or only secondary roads; 
    • Certified as a CAH prior to January 1, 2006, based on State designation as a “necessary provider” of health care services to residents in the area. 

 

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