I’m back!
I have not been prudent about my blogging for several weeks and for that I am truly sorry. It has not been for lack of “material”, but I have been enjoying spending time with my family.
Since I returned form Alaska last February I have accomplished a few “honey do list” things, spent a week cruising the Western Caribbean, got to watch my son at his Trap meets, went on a few dates with my wife, and worked a few weekends at various facilities in North Dakota.
Now as I prepare to return to Alaska for the summer, it is time to get back to blogging. I have made a list of questions that you have been asking that I will be trying to answer as I go along. I have even been asked to do a product review (to Ralph that was a challenge to “tear something up”) on a new design Cherokee scrub top that I will be posting next week. Some of you have asked me to tell you about the facilities I work in and/or the communities where I work. And finally, I get asked a lot of questions about critical access hospitals and “what they actually are”.
So for today, I will share a little history about critical access hospitals and what they mean to our healthcare system.
BACKGROUND
For those of you that have been around a while, you will remember the days in the 80s and early 90s when hospitals were closing across the country. These closings were rampant in large cities as well in rural areas. When a hospital closed in a large city, there were usually several other hospitals in the area to absorb the patient load. Two examples of this are West Paces Ferry Hospital in Atlanta and Baptist Hospital in Memphis. In both instances, there were multiple “other choices” for health care. When these closings happened in rural areas, it presented a different dilemma. There were not other hospitals close by and patients were forced to go long distances for hospital services. Many of the rural hospitals were not able to stay open due to the rising cost of services and the declining reimbursement rates. This resulted in inaccessibility to healthcare for many citizens.
In 1997, the Balanced Budget Act authorized States to establish a State Medicare Rural Hospital Flexibility Program (Flex Program) by which certain facilities that participate in Medicare would become Critical Access Hospitals (CAHs). The Critical Access Hospitals (CAH) program is designed to improve rural health care access and reduce hospital closures. Critical Access Hospitals provide essential services to a community and are reimbursed by Medicare on a "reasonable cost basis" for services provided to Medicare patients.
REQUIREMENTS TO BE A CRITICAL ACCESS HOSPITAL
A Medicare participating hospital must meet the following criteria to be designated as a CAH:
.Be located in a State that has established a State rural health plan for the State Flex Program (as of September 2011, only Connecticut, Delaware, Maryland, New Jersey, and Rhode Island did not have a 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 for purposes of becoming a CAH;
.Demonstrate compliance with the CoPs found at 42 CFR Part 485 subpart F at the time of application for CAH status;
.Furnish 24-hour emergency care services 7 days a week, using either on-site or on-call staff;
.Provide no more than 25 inpatient beds that can be used for either inpatient or swing bed services; however, it may also operate a distinct part rehabilitation or psychiatric unit, each with up to 10 beds;
.Have an average annual 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
.Be located either more than a 35-mile drive from the nearest hospital or CAH or a 15-mile drive in areas with mountainous terrain or only secondary roads OR 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.
Critical Access Hospital (CAH) Payments
Medicare pays CAHs for most inpatient and outpatient services to Medicare patients at 101 percent of reasonable costs.
For purposes of payment for ambulance services, if a CAH or an entity owned and operated by the CAH is the only provider or supplier of ambulance services located within a 35-mile drive of that CAH, the CAH or the CAH-owned and operated entity is paid 101 percent of the reasonable costs of the CAH or entity in furnishing ambulance services. Additionally, if there is no other provider or supplier of ambulance services within a 35-mile drive of the CAH but the CAH owns and operates an entity furnishing ambulance services that is more than a 35-mile drive from the CAH, that CAH-owned and operated entity can be paid 101 percent of reasonable costs for its ambulance services as long as it is the closest provider or supplier of ambulance services to the CAH.
CAHs are not subject to the Inpatient Prospective Payment System (IPPS) and the Hospital Outpatient Prospective Payment System (OPPS).
CAH services are subject to Medicare Part A and Part B deductible and coinsurance amounts.
What this means for rural areas is they have a “local hospital”. Obviously, not all services are available at critical access hospitals, many tertiary hospitals offer “outreach” services for the smaller facilities. Additionalyl, with the advent of telemedicine, many additional services are becoming available in rural communities
Resources
http://www.raconline.org/topics/critical-access-hospitals/
The chart below provides CAH resource information.For More Information About…
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Resource
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Critical Access Hospitals
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http://www.cms.gov/Center/Provider-Type/Critical-Access-Hospitals-Center.html on the CMS website
“Medicare Claims Processing Manual” (Publication 100-04) located at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html on the CMS website
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Health Professional Shortage Areas
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http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses on the CMS website
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Compilation of Social Security Laws
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http://www.ssa.gov/OP_Home/ssact/title18/1800.htm on the U.S. Social Security Administration website
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“Code of Federal Regulations”
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http://www.gpo.gov/fdsys/browse/collection.action? collectionCode=FR on the U.S. Government Printing Office website
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All Available MLN Products
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“Medicare Learning Network® Catalog of Products” located at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MLNCatalog.pdf on the CMS website or scan the Quick Response (QR) code on the right
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Provider-Specific Medicare Information
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MLN publication titled “MLN Guided Pathways to Medicare Resources Provider Specific Curriculum for Health Care Professionals, Suppliers, and Providers” booklet located at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/Guided_Pathways_Provider_Specific_Booklet.pdf on the CMS website
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Medicare Information for Beneficiaries
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http://www.medicare.gov on the CMS website
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