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About Critical Access Hospitals

A CAH is a hospital that is reimbursed by Medicare on a cost basis (i.e., for the reasonable costs of providing inpatient, outpatient, and swing bed services). The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures. CAHs are certified under a different set of Medicare Conditions of Participation that are more flexible than the acute care hospital Conditions of Participation.

According to the Centers for Medicare and Medicaid Services, “a facility that meets the following criteria may be designated by CMS as a CAH:
  • Is located in a State that has established with CMS a Medicare rural hospital flexibility program; and
  • Has been designated by the State as a CAH; and
  • Is currently participating in Medicare as a rural public, non-profit or for-profit hospital; or was a participating hospital that ceased operation during the 10-year period from November 29, 1989 to November 29, 1999; or is a health clinic or health center that was downsized from a hospital; and
  • Is located in a rural area or is treated as rural; and
  • 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 criterion is 15 miles); and
  • Maintains no more than 25 inpatient beds; and
  • Maintains an annual average length of stay of 96 hours per patient for acute inpatient care; and
  • Complies with all CAH Conditions of Participation, including the requirement to make available 24-hour emergency care services 7 days per week.

“A CAH may also be granted ‘swing-bed’ approval to provide post-hospital Skilled Nursing Facility-level care in its inpatient beds.”
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