Critical Access Hospital
"Critical Access Hospitals" are limited service hospitals
designed to provide essential services to rural communities. The
Balanced Budget Act of 1997 established the Medicare Rural Hospital
Flexibility Program (RHFP) which provided grants to States for designation
of hospitals as Critical Access Hospitals or CAH. Because of relaxed
staffing requirements and cost-based reimbursement for Medicare
and Montana Medicaid patients, converting a struggling rural hospital
to a CAH can allow the community to stabilize and maintain local
health care access. A current listing on Montana CAHs is available
by clicking here.
Key criteria for designation of CAHs include:
- located more than 35 road miles or, in the case of a facility
located in mountainous terrain or where only secondary roads
exist, more than 15 road miles from a hospital or another critical
access hospital; or be certified by the State as a necessary
provider of health care services to residents in the area (in
Montana, this includes all hospitals located in a frontier county
or a non-IHS hospital located within the boundaries of an Indian
- provide 24-hour emergency care that is necessary for ensuring
access to emergency care services in the area served by the facility.
- has no more than 15 acute care inpatient beds or in the case
of a facility with swing beds, 25 acute care inpatient beds,
which no more than 15 are used for acute care at any one time.
- provide inpatient care for a period not exceeding 96 hours,
as determined on an average, annual basis for each patient.
- operates a quality assessment and performance improvement program
and follows appropriate procedures for review of utilization of
Besides designation of CAHs, the RHFP addresses four major goals:
- Creation and maintenance of a State Rural Health Plan.
- Development and implementation of Rural Health Networks.
- Improvement and integration of Emergency Medical Services.
- Ability to address Quality of Care issues.