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Critical Access Hospitals Better Medicare Financing For Smaller Hospitals Serving Rural Communities

Critical Access Hospitals Better Medicare Financing For Smaller Hospitals Serving Rural Communities. CAH $ Due To Long Fight For Medicare Equity. Critical Access Hospital Background.

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Critical Access Hospitals Better Medicare Financing For Smaller Hospitals Serving Rural Communities

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  1. Critical Access HospitalsBetter Medicare Financing For Smaller Hospitals Serving Rural Communities

  2. CAH $ Due To Long Fight For Medicare Equity

  3. Critical Access Hospital Background The opportunity to be paid as a Critical Access Hospital (CAH) is part of Medicare’s Rural Hospital Flexibility Program. CAHs have grown rapidly in popularity, in the states and with Congress, since Congress authorized them in October of 1997. Since then, the program has been significantly enhanced twice, mostly recently in the Medicare Prescription Drug Bill.

  4. CAH Benefits • Reimbursed at 101% of reasonable costs for inpatient, outpatient, and covered skilled nursing facility services • Reimbursement for on-call providers is extended to include PAs, NPs, and CNPs. • Periodic interim payments for inpatient services. • Eligible for enhanced outpatient payments based on facility costs plus 115% of the physician fee schedule for services provided by those physicians assigning their billings to the CAH.

  5. CAH Eligibility Criteria • Must be > 35 miles from another hospital • OR • be designated as a “Necessary Provider” by the State. CAHs using this option must be certified as a CAH by Medicare before 1/1/06 when the option expires. • CAHs may become a PPS hospital at anytime but must meet the then current “Life Safety Codes.”

  6. CAH Operational Requirements • No restriction on services which can be offered. • Can operate up to 25 beds, acute (GMS, OB, ICU, etc) or swing. • Annual Average Length Of Stay < 96 hrs. • Quality assurance maintained. • Emergency services always available. • Can establish a distinct part unit (psych. or rehab.); beds in the distinct part units cannot exceed 10.

  7. 846 CAHs in 45 states as of 1/1/04* * 2/3 rural hospital’s under 50 beds, approved when cap still only 15 beds

  8. 32 WI CAHs & 17 Actively Considering as of 1/01/04* * >95% of Wisconsin hospitals <50 beds

  9. Fed.Application & P.R. Emphasizes Local Gains • Communicates hospital strengths & resources. • Emphasis on local need. • Opportunity for new services that build on strengths and meet community needs. • Opportunity to eliminate services that cannot be supported by population base. • Keep the community informed during the decision-making process.

  10. Coalition Guiding WI CAH Implementation Statewide policy and program issues are determined collaboratively through a coalition consisting of current and future CAHs, the WI Bureau of Quality Assurance, WI Office of Rural Health, Wisconsin Hospital Association, RWHC.

  11. Important On-Line Resources CMS Critical Access Hospital Web Page http://www.cms.hhs.gov/providers/cah/default.asp Technical Assistance and Services Center (TASC) http://www.ruralresource.org/index.asp Rural Hospital Flex. Tracking Project http://www.rupri.org/rhfp-track Wisconsin Office of Rural Health http://www.worh.org/

  12. Traditional Medicare Unlikely To Improve

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