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The Critical Access Hospital (CAH)
is an alternative approach for rural hospitals to help maintain access to
essential health services. This
approach offers a degree of regulatory flexibility and cost-based
reimbursement in exchange for limitations on the amount of inpatient
services. This program is administrated by the Department of Health
through the Office of Rural Health. Listed
below are World Wide Web Resources that provide information on
regulations, application process, existence of present and future CAH, and
links for finding additional information.
State Resources
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ARIZONA: Arizona Rural Health Plan
Provides
definitions of Arizona Critical Access Hospital (ACAH), Arizona Medically
Underserved Area (AZMUA), Federal Medically Underserved Area (MUA), Health
Professional Shortage Area (HPSA), Necessary Provider, Rural, Rural Health
Network, how to develop a Rural Health Network and six steps in the
designation process for implementing the ACAH.
http://www.rho.arizona.edu/cah/plandesignation.html
http://www.rho.arizona.edu/cah/cahresources.html
[Resources for CAH and
Potential CAH Rural Hospitals.
National, state and Arizona resources including agencies,
programs, and organizations for CAH.]
http://www.rho.arizona.edu/cah/cahtabcont.html
[Arizona CAH Application Packet contains all materials and instructions
necessary for CAH application.]
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MINNESOTA:
Materials for Participation in the Minnesota Medicare Rural
Hospital Flexibility Program Critical Access Hospital (CAH)
Information
includes a link to the Critical Access News with updates to federal
information pertinent to all states.
Provides an application, criteria for participation as a candidate,
FAQ’a regarding enrollment, and considerations for electing to become a
CAH.
http://www.health.state.mn.us/divs/chs/rhpc/cah/
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MONTANA: The
Critical Access Hospital Resource Page.
Brief
description of the history and definition of CAH with links to information
about Montana’s Medical Assistance Facilities, Research Reports, and a
Resource Library with additional articles on rural health issues and a
copy (available for downloading) of the West Virginia Rural Health Plan
which each state must develop and have approved by HCFA.
http://healthinfo.montana.edu/cah/default.htm
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NORTH
CAROLINA: North Carolina Rural Health Research and Policy Analysis
CAH Project
From the
cartographic archive, these U.S. maps show locations of actual and
potential critical access hospitals, potential critical access hospitals
most likely to benefit from conversion and critical access hospitals in
existence as of May 19, 2000.
http://www.shepscenter.unc.edu/research_programs/Rural_Program/maps/maps.html
http://www.med.und.nodak.edu/depts/rural/srhf.application.htm
[Critical Access Hospital Grant Program Application Guidelines
for applying for a CAH including an online application form.]
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OREGON:
The Medicare Rural Hospital Flexibility Program - Oregon
Complete
program materials including criteria for designation, technical
assistance, application form, checklist, CAH designation flow chart, steps
in the evaluation process, list of relevant acronyms and sources for
additional CAH information.
http://www.ohsu.edu/aa-RuralHlth/cahpgmmat.html
http://www.ohsu.edu/aa-RuralHlth/cahinfopg.html
[The Medicare Rural Hospital Flexibility Program. Explanation of the CAH
program and contact information for
the program director.]
http://www.ohsu.edu/aa-RuralHlth/CAHPLAN.PDF
[Download a copy of the 56 page Oregon Rural Health Plan.]
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PENNSYLVANIA:
The Pennsylvania Rural Hospital Flexibility Program
Critical Access Hospital Program
Links
to program overview, qualifications for application, the Pennsylvania
Rural Health Plan, technical assistance service center from the University
of Minnesota, and a national evaluation plan of the Medicare Rural
Hospital Flexibility Program/Critical Access Hospital (CAH) Program using
a consortium approach. Includes
links to other rural health sites.
http://porh.cas.psu.edu/cahweb/cahmain.htm
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SOUTH
DAKOTA: South Dakota Critical Access Hospital Program.
Contact
information for the director and program coordinator and members of the
task force who developed the plan. Contents
include an introduction with definitions, an overview of hospital trends
and statistics, CAH designation policies and procedures, CAH networking
certification policies and procedures, procedures for plan review and
revision and technical assistance.
http://www.state.sd.us/doh/rural/plan.htm
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TEXAS: Critical Access Hospital Program
From the
Center for Rural Health Initiatives Home Page, select Programs and
Critical Access Hospital Program for a brief description of the CAH
program with contact person and link to application package.
From the
Center for Rural Health Initiatives Home Page select Publications.
Scroll to Press Releases. Select
Free Critical Access Workshop for information on a (CAH) workshop for
rural healthcare providers and facilities on July 28, 2000 in Austin.
http://www.crhi.state.tx.us/
http://www.crhi.state.tx.us/pdf/rh2_reporter/dec_14.html
[Article from the December 1999 Rural Health Reporter highlighting
the
current status of CAH in Texas.]
http://www.doh.wa.gov/hsqa/ocrh/RHS/cah399.html
[Critical Access Hospital Program (CAH) outlines the process for
submission of the state rural health plan for the critical access hospital
application, current application status and a list of ongoing members of
the CAH workgroup.]
http://www.legis.state.wi.us/rsb/code/hfs/hfs124.pdf
[Wisconsin Administrative Code Department of Health and Family Services
Section VI (HFS124.37-124.41) outlines applicability, definitions,
designations, requirements, and the rural health plan format for CAH.]
National Resources
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Rural
Implications of the Medicare, Medicaid and SCHIP
Balanced Budget Refinement Act of 1999: A Rural
Analysis of the Health Policy Provisions
This is a
December 1999 report from the Rural Policy Research Institute explaining
how the policy changes of the Balanced Budget Refinement Act of 1999
affects the rural health care deliver systems.
Scroll down to Table of Contents, select part A. Choices For Small
Rural Hospitals. Section 403
deals with Improvements in the CAH program.
http://www.rupri.org/pubs/archive/reports/P99-11/
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American
Hospital Association CAH
Contains
an update of CAH legislation, a directory of CAH resources, FAQ’s
concerning certification, conversion, credentialing, grants, licensure,
networks, personnel, plan development and reimbursement, an explanation of
the grant program, state association links, and state health plans online.
http://www.aha.org/MemberServ/cah.html
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Rural
Hospitals, Health Care Systems Strengthened By $13 Million In Grant Awards
September
10, 1999 press release from the Department of Health and Human Services
announcing the first grant awards for CAH with a list of grantees and
grant amounts awarded by state.
http://www.hhs.gov/news/press/1999pres/990910.html
U.S. Government Codes For Critical Access Hospitals
Search
these documents by selecting Edit from the browser, then Find (on this
page), enter Critical Access Hospital in the query box and click Find
Next.
Sec.
1395cc. Agreements with providers of services
http://www4.law.cornell.edu/uscode/42/1395cc.html
Sec.
1395x. Definitions
http://www4.law.cornell.edu/uscode/42/1395x.html
Sec.
1395y. Exclusions from
coverage and Medicare as secondary payer
http://www4.law.cornell.edu/uscode/42/1395y.html
Sec.
1395f. Conditions of and limitations on payment for services
http://www4.law.cornell.edu/uscode/42/1395f.html
Sec.
1320b-4. Nonprofit hospital or critical access hospital philanthropy
http://www4.law.cornell.edu/uscode/42/1320b-4.html
Sec.
1395i-4. Medicare rural hospital flexibility program
http://www4.law.cornell.edu/uscode/42/1395i-4.html
Sec.
1320a-7a. Civil monetary penalties
http://www4.law.cornell.edu/uscode/42/1320a-7a.html
Sec.
1395n. Procedure for payment of claims of providers of services
http://www4.law.cornell.edu/uscode/42/1395n.html
Sec.
1395e. Deductibles and coinsurance
http://www4.law.cornell.edu/uscode/42/1395e.html
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From
the U.S. Government Printing Office
This
subpart of the Code of Federal Regulations Title 42 revised as of October
1, 1998, sets forth the conditions that a hospital must meet to be
designated as a CAH.
http://www.nal.usda.gov/orhp/CFR-flex.htm
Additional Readings
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North
Carolina Rural Health Research and Policy Analysis Publications
Download
findings brief entitled The Role Of CAH Status In Mitigating The
Effects of New Prospective Payment Systems Under Medicare, January
2000. Examines rural
hospitals that may qualify as CAH and identifies facilities at risk due to
Medicare’s expansion of prospective payment systems (PPS) to non-acute
settings. Scroll down to
FB60.
http://www.shepscenter.unc.edu/research_programs/Rural_Program/papers.html
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Community
decision-making about critical access hospitals: lessons learned from
Montana's Medical Assistance Facility Program.
Abstract
of an article in the Journal of Rural Health, Spring 1999.
The purpose of this study was to examine rural community
decision-making regarding MAF conversion from the perspectives of key
informants who were involved in the decision-making process.
The article is available from Medline.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10511754&dopt=Abstract
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