Hailey Tran
Critical Access Hospitals (CAHs) are located across 45 states in the U.S. and are defined by specific criteria. CAHs are typically located in rural areas, often more than 35 miles from the nearest hospital, and are limited to 25 acute care inpatient beds. They must maintain an average length of stay of 96 hours or less for acute care patients and provide 24-hour emergency care services. CAHs are also associated with quality assurance agreements and have staffing flexibility, requiring at least one MD or DO physician. Various resources and data tools are available to compare CAHs, including the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) and HRSA Data Explorer.
| Characteristics | Values |
|---|---|
| Number of Critical Access Hospitals (CAHs) in the U.S. | 45 states have CAHs |
| Number of beds | 25 inpatient beds, with a maximum of 10 additional beds for psychiatric and/or rehabilitation units |
| Annual average length of stay | 96 hours or less for acute care patients |
| Physician requirement | At least one MD or DO physician, but they are not required to be onsite |
| Medicare status | Separate provider type with its own Medicare Conditions of Participation (CoP) and payment method |
| Quality assurance | May have an agreement with a referral hospital or another organization for quality assurance |
| CAH locations | Flex Monitoring team tracks and updates CAH locations |
| CAH data sources | CMS reports, state Flex Coordinators, North Carolina Rural Health Research Program on hospital closures |
| CAH recognition | NRHA Top 20 Critical Access Hospitals recognized by the National Rural Health Association |
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What You'll Learn
Critical Access Hospitals (CAHs) are located in 45 US states
Critical Access Hospitals (CAHs) are a specific type of hospital with their own Medicare Conditions of Participation (CoP) and payment methods. They are located in 45 states across the US and are tracked and monitored by the Flex Monitoring team. CAHs are typically situated in rural areas, and 64.3% of them managed rural health clinics in 2021, with 36.2% providing skilled nursing care.
CAHs are subject to several requirements and regulations. For instance, they must maintain an annual average length of stay of 96 hours or less for acute care patients, and they can have a maximum of 25 acute care inpatient beds. These hospitals must also offer 24-hour emergency care services seven days a week. Additionally, CAHs have greater staffing flexibility and are only required to have one MD or DO physician on staff, who does not need to be onsite.
Some notable CAHs include the Coleman County Medical Center in Texas, the Edgerton Hospital and Health Sciences in Wisconsin, and the Towner County Medical Center in North Dakota. These hospitals are recognized for their performance and contributions to rural healthcare.
CAHs play a crucial role in providing healthcare services to residents in rural or remote areas. Their presence ensures that individuals living outside of major metropolitan areas have access to essential medical care. The Flex Monitoring team's efforts to track and update CAH locations help ensure that these vital healthcare resources are accessible to those who need them.
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CAHs must maintain an average acute inpatient stay of 96 hours or less
Critical Access Hospitals (CAHs) are located in 45 states across the US. These hospitals are typically located in rural areas, more than 35 miles from another hospital, and are designed to meet the acute and post-acute care needs of residents in these areas.
CAHs have a limit of 25 acute care inpatient beds, and any hospital-type bed located in or adjacent to the facility counts towards this limit. However, certain beds, such as examination or procedure beds, stretchers, and operating room tables, do not count towards this limit.
One of the critical requirements for a hospital to be designated as a CAH is to maintain an annual average length of stay of 96 hours or less for acute inpatient care. This requirement ensures that CAHs provide efficient and timely care to their patients. The 96-hour limit is calculated as an annual average, and certain cases, such as hospice care, are not included in this calculation.
By maintaining this average length of stay, CAHs can optimize their resources and ensure that their services are accessible to those who need them. This requirement also helps to manage patient flow and prevent prolonged hospital stays, freeing up beds for other patients who require acute care.
It is important to note that CAHs with swing bed agreements have the flexibility to use their beds for either inpatient acute care or swing bed services, allowing them to adapt to the varying needs of their patients.
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CAHs can have a maximum of 25 acute inpatient beds
Critical Access Hospitals (CAHs) are located across 45 states in the US, and they are subject to certain regulations and requirements. One such requirement is that CAHs can have a maximum of 25 acute inpatient beds. This limit includes any hospital-type bed located in or adjacent to any area where inpatient care is provided. However, certain beds do not count towards this limit, such as examination or procedure beds, stretchers, and operating room tables.
CAHs play a crucial role in providing healthcare services to rural communities. They are required to maintain an annual average length of stay of 96 hours or less for their acute care patients. This average excludes patients receiving hospice care, who can be admitted to the CAH for any treatment plan or respite care. CAHs also have the flexibility to provide skilled nursing care and operate rural health clinics.
In addition to the 25 inpatient beds, a CAH may operate a psychiatric and/or rehabilitation unit with up to 10 beds each. These units must comply with the Hospital Conditions of Participation, which provide guidance to personnel conducting surveys and ensure compliance with federal regulations. CAHs also have staffing flexibility, requiring at least one MD or DO physician, who is not mandated to be onsite.
The location of CAHs is strategically planned. They must be more than 35 miles from the nearest hospital or 15 miles in areas with challenging terrain. CAHs are certified as Medicare providers and have their own Medicare Conditions of Participation (CoP) and payment methods. The Flex Monitoring team regularly tracks and updates CAH locations, providing current data on their websites.
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CAHs must be located more than 35 miles from the nearest hospital
Critical Access Hospitals (CAHs) are designated by Medicare to ensure healthcare access in remote areas. CAHs are located in 45 states across the US, with the Flex Monitoring team tracking and updating CAH locations.
CAHs are subject to specific requirements. One such requirement is that they must be located more than 35 miles from the nearest hospital or another CAH. This requirement came into effect on January 1, 2008, and applies to all CAHs, including Necessary Provider CAHs with off-campus facilities.
There are exceptions to this rule. In areas with mountainous terrain or only secondary roads, a CAH must be more than 15 miles from another hospital. This exception was clarified in 2022 by CMS, specifying that the 35-mile requirement applies to primary roads, including federal and state highways with two or more lanes each way.
The 35-mile distance requirement is an important factor in CAH status, as it ensures that these hospitals serve remote areas where access to healthcare may be limited. This requirement also impacts the reimbursement of ambulance services, which are typically not reimbursed at-cost except in very remote areas where ambulance agencies are greater than 35 miles apart.
In summary, the 35-mile rule for CAHs is a key aspect of their designation, ensuring that they provide critical access to healthcare services in remote or underserved communities.
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CAHs must provide 24-hour emergency care 7 days a week
Critical Access Hospitals (CAHs) are located in 45 states across the US. They are required to provide 24-hour emergency care 7 days a week, including inpatient acute care. CAHs may have a maximum of 25 acute care inpatient beds, with an average length of stay of 96 hours or less for acute care patients.
CAHs are subject to Medicare Conditions of Participation (CoP), which grant them greater staffing flexibility. For instance, while a Critical Access Hospital must have at least one MD or DO physician, this person is not required to be onsite. CAHs may also have agreements with referral hospitals or other organisations for quality assurance.
In addition to the 25 inpatient beds, a CAH may operate a psychiatric and/or rehabilitation unit of up to 10 beds each. These units must comply with Hospital Conditions of Participation, and survey protocols and interpretive guidelines are in place to provide guidance to personnel conducting surveys.
CAHs play an important role in providing healthcare services to residents in rural or remote areas, often being located more than 35 miles from the nearest hospital or CAH. They are also involved in community-benefit measures at a county and state level, with data available for comparison through the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS).
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Frequently asked questions
Critical Access Hospitals are located in 45 states across the U.S. and are defined by specific criteria, such as maintaining an annual average length of stay of 96 hours or less for acute inpatient care and having a maximum of 25 acute care inpatient beds.
CAHs have their own Medicare Conditions of Participation (CoP) and a separate payment method. They must be located more than 35 miles from the nearest hospital or 15 miles in areas with challenging terrain. CAHs also have greater staffing flexibility and are not required to have a physician onsite.
You can use the HRSA Data Explorer tool to create custom data reports and view HRSA grant totals at the county and state levels. The Flex Monitoring team also tracks and updates CAH locations, providing a list of CAHs with current data.
The National Rural Health Association (NRHA) has recognized several top Critical Access Hospitals, including Towner County Medical Center in Cando, ND, and Edgerton Hospital and Health Sciences in Edgerton, WI.
