Critical Access Hospital (CAH) - JE Part A
Critical Access Hospital (CAH)
On this page, view the below information.
What is a CAH?
Legislation enacted as part of the Balanced Budget Act (BBA) of 1997 authorized States to establish a State Medicare Rural Hospital Flexibility Program (Flex Program) under which certain facilities participating in Medicare can become CAHs
- The Flex Program was designed to improve access and quality and relieve some of the financial pressures on rural hospitals and emergency medical services
- To become a CAH, the enrollment must already be established in Medicare as a hospital
A Medicare participating hospital must meet the following criteria to be designated as a CAH:
- Be in a State that has established a State rural health plan for the State Flex Program (as of September 2011, only Connecticut, Delaware, Maryland, New Jersey, and Rhode Island do not have a State Flex Program);
- Be in a rural area or be treated as rural under a special provision that allows qualified hospital providers in urban areas to be treated as rural for purposes of becoming a CAH;
- Demonstrate compliance with the Conditions of Participation found at 42 CFR Part 485 subpart F at the time of application for CAH status;
- Furnish 24-hour emergency care services 7 days a week, using either on-site or on-call staff;
- Provide no more than 25 inpatient beds that can be used for either inpatient or swing bed services; however, it may also operate a distinct part rehabilitation or psychiatric unit, each with up to 10 beds;
- Have an average annual length of stay of 96 hours or less per patient for acute care (excluding swing bed services and beds that are within distinct part units);
- Be located either more than a 35-mile drive from the nearest hospital or CAH or more than a 15-mile drive in areas with mountainous terrain or only secondary roads or certified as a CAH prior to January 1, 2006, based on State designation as a necessary provider of health care services to residents in the area. ---state verifies
For CAHs to elect to be Method II they need to send in a written statement electing to be Method II no less than 30 days before the start of their cost reporting period, this should state whether the CAH chooses to include any CRNAs in Method II
- CAH may send in an 855R for the providers to be Method II Billing providers this needs to be sent in by paper application to Audit
- If a CAH has received the CRNA exemption (also known as "pass-through") but chooses to include CRNA's in Method II, they give up the exemption for both outpatient as well as inpatient services
- Method II remains in effect until the CAH wishes to terminate
Billing for CAH
- For more information regarding billing, go to the billing portion of the website.
Application Time Frame
- Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to the State Agency and CMS. Below are the time frames in which Noridian has to review the application
|Application Type||Processing Time|
|PECOS||On average, it can take 45 calendar days before application is sent to the state and CMS for approval|
|Paper||On average, it can take 60 calendar days before application is sent to the state and CMS for approval|
- The state agency and the CMS regional office work together on the approval process. Once the regional office has all the required information, they will issue the approval letter. This is sent to the provider and to Noridian.
After receiving the tie-in Noridian will have the following time-frames to complete the application.
- If a site visit is needed, Noridian will have 45 days to complete the application
- If a site visit is not needed, Noridian will have 21 days to complete the application
Last Updated Wed, 04 Sep 2019 14:28:20 +0000