CMS SOM App. W, Tag C-0826

The CAH meets the requirements of either paragraph (b)(1) or (b)(2) of this section

or the requirements of paragraph (b)(3), (b)(4), or (b)(5) of this section.

(1) The CAH meets the following requirements:

(i) The CAH is located outside any area that is a Metropolitan Statistical Area,

as defined by the Office of Management and Budget, or that has been recognized

as urban under §412.64(b), excluding paragraph (b)(3) of this chapter;

(ii) The CAH has not been classified as an urban hospital for purposes of the

standardized payment amount by CMS or the Medicare Geographic

Classification Review Board under §412.230(e) of this chapter and is not among

a group of hospitals have been redesignated to an adjacent urban area under

§412.232 of this chapter.

(2) The CAH is located within a Metropolitan Statistical Area, as defined by the

Office of Management and Budget, but is being treated as being located in a rural

area in accordance with §412.103 of this chapter.

(3) Effective for October 1, 2004 through September 30, 2006, the CAH does not

meet the location requirements in either paragraph (b)(1) or (b)(2) of this section

and is located in a county that, in FY 2004, was not part of a Metropolitan Statistical

Area as defined by the Office of Management and Budget, but as of FY 2005 was

included as part of such Metropolitan Statistical Area as a result of the most recent

census data and implementation of the new Metropolitan Statistical Area definitions

announced by the Office of Management and Budget on June 3, 2003.

(4) Effective for October 1, 2009 through September 30, 2011, the CAH does not

meet the location requirements in either paragraph (b)(1) or (b)(2) of this section

and is located in a county that, in FY 2009, was not part of a Metropolitan Statistical

Area as defined by the Office of Management and Budget, but as of FY 2010, was

included as part of such Metropolitan Statistical Area as a result of the most recent

census data and implementation of the new Metropolitan Statistical Area definitions

announced by the Office of Management and Budget on November 20, 2008.

(5) Effective on or after October 1, 2014, for a period of 2 years beginning with the

effective date of the most recent Office of Management and Budget (OMB)

standards for delineating statistical areas adopted by CMS, the CAH no longer

meets the location requirements in either paragraph (b)(1) or (b)(2) of this section

and is located in a county that, prior to the most recent OMB standards for

delineating statistical areas adopted by CMS and the most recent Census Bureau

data, was located in a rural area as defined by OMB, but under the most recent

OMB standards for delineating statistical areas adopted by CMS and the most

recent Census Bureau data, is located in an urban area.

Interpretive Guidelines §485.610(b)

Among other requirements, pursuant to 42 CFR 485.610(b), all CAH applicants and

existing CAHs, including necessary provider CAHs, must either be:

• located in a rural area; or

• treated as rural in accordance with 42 CFR 412.103

in order to be eligible for CAH designation and certification. (The temporary provisions

at 42 CFR 485.610(b)(3) and (4) have expired and no longer apply.)

Only the CMS Regional Office makes the determination whether a CAH applicant or

existing CAH meets the rural location requirement, following the instructions below.

However, State Survey Agencies (SA) may wish to make informal assessments prior to

conducting a survey, following the guidance provided in Section 2256A of the SOM. If

the SA’s informal assessment suggests the CAH applicant or existing CAH is not rural, it

should consult with the RO before conducting a survey.

Survey Procedures §485.610(b)

Conduct an informal assessment of the CAH’s rural status, following the procedures in

Section 2256A of the SOM, and if it appears the CAH no longer has rural status, confer

with the CMS RO prior to scheduling the initial or recertification survey.