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What are critical access hospitals (CAH)?

A Critical Access Hospital (CAH) is a hospital certified under a set of Medicare Conditions of Participation (CoP), which are structured differently than the acute care hospital CoP. Some of the requirements for CAH certification include having no more than 25 inpatient beds; maintaining an annual average length of stay of no more than 96 hours for acute inpatient care; offering 24-hour, 7-day-a-week emergency care; and being located in a rural area, at least 35 miles drive away from any other hospital or CAH (fewer in some circumstances). The limited size and short stay length allowed to CAHs encourage a focus on providing care for common conditions and outpatient care, while referring other conditions to larger hospitals. Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates. This reimbursement has been shown to enhance the financial performance of small rural hospitals that were losing money prior to CAH conversion and thus reduce hospital closures. CAH status is not ideal for every hospital and each hospital should review its own financial situation, the population it serves, and the care it provides to determine if certification would be advantageous.

Resources:

• CMS CAH fact sheet (PDF - 1MB)
• CMS list of CAH criteria
• Critical Access Hospital FAQs, Tools, Funding, Regulations and other Resources
• The Community Impact of Critical Access Hospitals (PDF - 914KB)
• Developing Indicators to Document the Community Impact of CAHs (PDF - 165KB)
• Critical Access Hospitals Map
• CAH Financial Indicators Report: Summary of Indicator Medians by State (PDF - 512KB)