Critical Access Hospital

The Critical Access Hospital program is a federal program established in 1997 as part of the Balanced Budget Act. The program aims to offer small hospitals in rural areas to serve residents that would otherwise be a long distance from emergency care.

To receive federal funding, Critical Access Hospitals must adhere to several guidelines. They may have no more than 25 beds and must have an average duration of hospital stay under 96 hours. They must also be more than 35 miles from another hospital, with exceptions allowed for areas with poor roads or difficult terrain. CAHs have more flexibility than other hospitals in staffing requirements. They must offer 24/7 emergency care and have a physician on-call available to be on-site within 60 minutes. They are required to have a Registered Nurse on site at all times when acutely ill patients are in the hospital. At other times, an LPN may fill in.

As of October 2016, there are 1,337 certified Critical Access Hospitals in 45 states. Connecticut, Delaware, Maryland, New Jersey and Rhode Island do not have any CAHs.

The program was created with the Balanced Budget Act of 1997, and modified with the Balanced Budget Refinement Act of 1999. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 increased reimbursement for CAHs to 101% of care costs. The Medicare Improvements to the Patients and Providers Act of 2008 expanded grants available to CAHs and further incentivized reimbursement.

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