WHAT IS A "CRITICAL ACCESS HOSPITAL"?
What Makes Us A Critical Access Hospital
Lake District Hospital has been designated a Critical Access Hospital, as defined by the policies and regulations. Part of The Health Resources & Services Administration of the U.S. Department of Health & Human Services.
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.
The Critical Access Hospital (CAH) Program was established to aid in the continuation of healthcare services for rural residents. Georgia has two million rural residents who can benefit from the CAH Program.
- Aids in the continuation of health care services for rural residents
- Enables hospitals to be eligible for cost-based Medicare reimbursement for inpatient and outpatient services
- With a signed MOA, hospitals are eligible to receive enhanced reimbursement from Medicaid and the State Health Benefit Plan (SBHP)
A Critical Access Hospital:
- Can limit services and utilize physician assistants and /or nurse practitioners in an effort to reduce their loss
- May choose to maintain its current services; however, the hospital must agree to the bed size and annual impatient length of stay limits
- Provides small, rural hospitals with a range of opportunities for service enhancement, quality of care improvement, and certain economies of scale through network participation
- Receive enhanced Medicare reimbursement for covered in-patient services
- Receive 100% of allowable costs for Medicaid out-patient services
- Retain any Medicaid payment for inpatient services in excess of charges
- Receive 100% of charges for outpatient services by the State Health Benefit Plan and Board of Regents Health Plan May enroll with SHBP as their group insurance provider.