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Experience. Integrity. Advocacy.

Final rule outlines conditions of participation in CMS’s Critical Access Hospital program

The Centers for Medicare and Medicaid Services (CMS) recently published the final rule of the Reform of Hospital and Critical Access Hospital (CAH) Conditions of Participation outlining the requirements that these entities must meet to participate in Medicare and Medicaid programs. The guidelines were revised to alleviate some of the burden on providers, who primarily are in rural and underserved areas.

CDR Scott Cooper of the United States Public Health Service outlined the major provisions in a recent CMS Rural Health Open Forum. Among those provisions are allowing a single governing body for multiple hospitals; changing reporting requirements for restraint-related deaths; broadening of the concept of “medical staff” to include NPPs; allowing podiatrists to be in medical leadership positions; and lessening requirements for medication and blood products and for various rules related to orders to be no more restrictive than state law requires. The final rule in its entirety is available in the Federal Register Volume 77, No. 95 on the CMS website.

The 1997 Balanced Budget Act authorized states to establish a State Medicare Rural Hospital Flexibility Program (Flex Program) under which certain facilities can become CAHs. Generally, Medicare pays CAHs at 101 percent of reasonable costs for most inpatient and outpatient services to Medicare beneficiaries. An optional payment method for outpatient services also is available.

Additionally, physicians who furnish care in a CAH that is located within a geographic-based, primary care Health Professional Shortage Area (HPSA) also are eligible for a 10 percent HPSA bonus payment for outpatient professional services furnished to Medicare patients. Physicians who practice within a zip code on the HPSA list will automatically receive the incentive payment on a quarterly basis.

Under the Affordable Care Act, the HPSA incentive was expanded to include some surgery and office-based procedures performed by providers within the specified HPSA areas.

The Flex Program also provides a state grant program that supports the development of community-based rural organized systems of care.

For more information on Critical Access Hospitals and the Rural Hospital Flex Program, review the Critical Access Hospital Fact Sheet published by CMS.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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