CMS Pub. 100-04, ch. 3, § 30

Hospitals (CAHs)

(Rev. 68, 10-16-04)

A3-3610.19, HO-415.19, A3-3610.20, HO-415.20

The 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 currently participating Medicare hospital, a

hospital that ceased operations on or after November 29, 1989, or a health clinic or health

center that previously operated as a hospital before being downsized to a health clinic or

health center. The facility must be located in a rural area of a State that has established a

Medicare rural hospital flexibility program, or must be located in a Metropolitan Statistical

Area (MSA) of such a State and be treated as being located in a rural area based on a law or

regulation of the State, as described in 42 CFR 412.103. It also must be located more than a

35-mile drive from any other hospital or critical access hospital unless it is designated by the

State, prior to January 1, 2006, to be a "necessary provider". In mountainous terrain or in

areas with only secondary roads available, the mileage criterion is 15 miles. In addition, the

facility must make available 24-hour emergency care services, provide not more than 25

beds for acute (hospital-level) inpatient care or in the case of a CAH with a swing bed

agreement, 60used for SNF-level care. The CAH maintains a length of stay, as determined

on an annual average basis, of no longer than 96 hours.

The facility is also required to meet the conditions of participation for CAHs

(42 CFR Part 485, Subpart F). Designation by the State is not sufficient for CAH status. To

participate and be paid as a CAH, a facility must be certified as a CAH by CMS.

A. - Grandfathering Existing Facilities

As of October 1, 1997, no new Essential Access Community Hospital (EACH) designations

can be made. The EACHs designated by CMS before October 1, 1997, will continue to be

paid as sole community hospitals for as long as they comply with the terms, conditions, and

limitations under which they were designated as EACHs.