In 1997, Congress, through the Balanced Budget Act, authorized creation of what is called the Medicare Rural Hospital Flexibility (FLEX) Program. This program has led to the creation of what is being called the Critical Access Hospital(CAH). By establishing limited service hospitals and rural health networks, these acute care facilities can provide outpatient, emergency, and limited inpatient services. The Department of Health has developed a Critical Access Hospital plan in consultation with the Arkansas Hospital Association. That plan was approved and funded by the Health Care Financing Administration, now known as the Centers for Medicare and Medicaid Services (CMS). There are currently 29 hospitals in the state that are designated as Critical Access Hospitals.
Each Critical Access Hospital is required by the plan:
- To meet certain staffing requirements and to enter into a patient referral and transfer agreement with a larger, more viable acute care hospital (referred to as an Affiliate Hospital).
- To participate in the development and implementation of a communication system with its network hospitals.
- To enter into a transport agreement for emergency and non-emergency transportation with the area Emergency Medical Service.
- To ensure the quality of its services. (Quality assurance and credentialing will be performed by the Affiliate Hospital with which the CAH has contracted).
To satisfy state requirements for designation as a CAH, the plan specifies that a hospital must first agree to meet all Federal requirements for designation. The hospital must submit an Application for Final Designation as a member of a rural health network along with other supporting documentation. The application must include a completed community needs assessment, local health services delivery plan and a financial feasibility study with cost projections for at least a three-year period.
This program provides more opportunity for States and their rural communities to improve access to essential health care services, especially for communities that cannot support a fully operational facility. The CAH, recognized by CMS as a new type of provider, is eligible for enhanced reimbursement.