December 2000

Information Bulletin 00-34
Hosp-25

Critical Access Hospitals

Purpose:

The purpose of this bulletin is to address questions that are frequently raised about regulatory requirements for Critical Access Hospitals (CAH). The 1997 federal Medicare Rural Hospital Flexibility Program was developed to promote rural health planning and network development, promote regionalization or rural health services in the state, and improve access to hospital and other health services for rural residents of the state. A Rural Health Network must include a Critical Access Hospital.

Clarification:

1. What is a Rural Health Network?

   A Rural Health Network is an organization that must include at least one CAH and one hospital that furnishes acute care services.

2. What is a Critical Access Hospital?

A Critical Access Hospital must meet the following criteria:

• Is a rural public or nonprofit hospital located in a state that has established a Medicare Rural Hospital Flexibility Program;

• Is located more than a 35-mile drive from any other hospital or CAH (in mountainous terrain or in areas with only secondary roads available, the mileage criteria is 15 miles), or certified by the state as being a necessary provider of health care services to residents in the area;

• Makes available 24-hour emergency care services;

• Provides not more than 15 beds for acute (hospital-level) inpatient care; An exception to the 15-bed requirement is made for swing-bed facilities, which are allowed to have up to 25 inpatient beds that can be used interchangeably for acute or SNF-level care, provided that not more than 15 beds are used at any one time for acute care;

• Keeps each inpatient for no longer than 96-hours, unless a longer period is required because of inclement weather or other emergency conditions, or a PRO or other equivalent entity, on request, waives the 96-hour time limit.

3. Is the Critical Access Hospital required to be in compliance with the same Conditions of Participation as the acute hospitals?

No. Critical Access Hospitals are surveyed under their own Conditions of Participation which are different than acute hospitals.

4. Do the new Medicare hospital Conditions of Participation of Patient Rights and Organ Procurement for acute hospitals apply to Critical Access Hospitals?

No. There is a new Condition of Participation for Organ Procurement being written for CAH's, but it hasn't been issued yet. However, CAH's are required by 1138 of the Social Security Act to have an agreement with an Organ Procurement Organization (OPO) and written protocols for identification of potential organ donors. They are required to assure that families are made aware of the option for organ or tissue donation, encourage discretion and sensitivity toward families, and notify the OPO of potential organ donors.

The Patient's Rights Condition of Participation for acute hospitals does not apply to Critical Access Hospitals. The CAH's must be in compliance with the Minnesota patient Bill of Rights (Minnesota Statutes 144.651.) Those CAH's that choose to provide swing bed services must be in compliance a portion of the Long Term Care Services Bill of Rights, which is delineated in the CAH Conditions of Participation.

5. Where can I get a copy of the Critical Access Hospital Conditions of Participation?

The Critical Access Hospital Conditions of Participation are in Appendix W, can be viewed and printed from the Health Care Financing (HCFA) web site at:

CMS Online Manual System
Click on the link for Appendices Part S-W
Scroll down to Page 156 in the file to view Appendix W.

Please Note: The new CMS website addresses are subject to change. As MDH becomes aware of these changes addresses will be updated.]

If you have any questions regarding this Information Bulletin, please contact in writing:

Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
PO Box 64900
St. Paul, MN 55164-0900
Voice: (651) 201-4200