The Critical Access Hospital program is a United States federal program established in 1997 as part of the

Balanced Budget Act The Balanced Budget Act of 1997 () was an omnibus legislative package enacted by the United States Congress, using the budget reconciliation process, and designed to balance the federal budget by 2002. This act was enacted during Bill Clinton's ...

. The program aims to offer small hospitals in rural areas to serve residents that would otherwise be a long distance from emergency care. As of January 2018, there are 1,343 certified Critical Access Hospitals in 45 states. Connecticut, Delaware, Maryland, New Jersey and Rhode Island do not have any CAHs.

Requirements

To receive federal funding, Critical Access Hospitals must adhere to several guidelines. They may have no more than 25 beds and must have an average duration of hospital stay under 96 hours. They must also be more than 35 miles from another hospital, with exceptions allowed for areas with poor roads or difficult terrain. CAHs have more flexibility than other hospitals in staffing requirements. They must offer 24/7 emergency care and have a physician on-call available to be on-site within 60 minutes. They are required to have a Registered Nurse on site at all times when acutely ill patients are in the hospital. At other times, a Licensed Practical Nurse (LPN) may fill in. In most cases, a

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, a

physician assistant A physician assistant or physician associate (PA) is a type of mid-level health care provider. In North America PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and may serve as a principal healthcare prov ...

, a

nurse practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe ...

, or a clinical nurse specialist (defined as a nurse with at least a master's degree in nursing) must be available for immediate contact by phone or radio. The provider must be able to be on-site within 30 minutes unless it is an area designated by the census as a "frontier area" or if the state has determined that it is not possible for the hospital to keep staff available within 30 minutes, and a registered nurse is available on-site. In CAHs with 10 or fewer beds, a registered nurse with training in emergency care is allowed to fulfill the role of the on-call physician. Critical access hospitals must have all the equipment and medications required for essential medical treatment, and have agreements in place with larger hospitals for the transport of patients in need of further care. Pharmaceutical companies are legally required to pay for a portion of the medications used by critical access hospitals as part of the

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. Few CAHs provide intensive care treatment. A review of CAHs in the early 2000s counted 26% of the hospitals providing intensive care-level treatment to at least one patient. About two-thirds of these hospitals had a physical

intensive care unit 220px, Intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensi ...

, while the remainder provided intensive care treatment in areas of the hospital also treating acute care patients. The mean number of intensive care beds in each hospital was 3.5. Two-thirds of the hospitals providing intensive care treatment staffed these areas with registered nurses only. Most of the hospitals providing intensive care services also provided surgical services.

Key legislation

The program was created with the Balanced Budget Act of 1997, and modified with the Balanced Budget Refinement Act of 1999. The

Medicare Prescription Drug, Improvement, and Modernization Act The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health progr ...

of 2003 increased reimbursement for CAHs to 101% of care costs. The Medicare Improvements to the Patients and Providers Act of 2008 expanded grants available to CAHs and further incentivized reimbursement.

References

{{reflist United States federal health legislation 1997 establishments in the United States Hospitals in the United States