Critical Access Hospitals (CAH)
In order to protect small, financially vulnerable hospitals, Congress created Critical Access Hospitals as part of the Rural Hospital Flexibility Program in 1997. The program is designed to help states improve access to health care services in rural areas through the development of limited service hospitals and rural health networks.
A hospital must meet the following criteria to be designated a Critical Access Hospital (CAH):
- Located in a state that has established with CMS a Medicare rural hospital flexibility program;
- Located in a rural area;
- Provide 24-hour emergency care services;
- Average length of stay of 96 hours or less;
- More than 35 miles from a hospital or another CAH or more than 15 miles in mountainous terrain or only secondary roads OR certified by the State as being a necessary provider of health care services to residents in the area (the provision allowing states to waive the distance criteria via State "necessary provider designation" was repealed on January 1, 2006); and
- CAHs may operate up to 25 beds.
Through CAH designation, hospitals are reimbursed at 101% of allowable costs by Medicare. MaineCare reimburses Critical Access Hospitals 117% of costs solely for the purpose of reimbursing the hospitals for the MaineCare "match" as a result of the MaineCare program's hospital tax & match initiative. Cost-based reimbursement does not apply to all services supported by the hospital but allows hospitals to continue to subsidize many of these services that lose money.
Map of Maine's CAHs