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Compliance Programs for Critical Access Hospitals

Critical access hospitals are hospitals that receive reimbursement from Medicare. Medicare is a government program that gives tax-funded money to those who are 65 or older. Reimbursement helps the critical access hospitals remain in business by allowing them to cover costs. Critical access hospitals are differentiated from acute care hospitals by the different sets of requirements that they have to comply with to continue to receive Medicare reimbursement.

  1. Distance Compliance

    • Critical access hospitals must be in a specific location to qualify for Medicare under the critical access hospital conditions. They must be located in a rural area and must be at least 35 miles away from another hospital -- 15 miles from another hospital in mountainous terrain, according to the Minnesota Department of Health.

    Patient Stay Compliance

    • The average length of time for all patients combined who stayed at the hospital must be 96 hours or less. The average length of time is checked annually, according to the Minnesota Department of Health. This is to prevent hospitals from keeping patients in the hospital for an unnecessary length of time.

    Hospital Bed Compliance

    • Critical access hospitals are limited on how many patients they can have in the hospital at a given time. They can only have 25 hospital beds at the clinic at any given time, according to the Rural Assistance Center, a program created by the U.S. Department of Health and Human Services. Examination beds, procedure beds, stretchers and operating room tables do not count towards the 25 bed limit.

    Emergency Service Compliance

    • To maintain the critical access designation, the hospital must be open 24 hours a day so that patients can have emergency access, according to the Rural Assistance Center. Ambulances must arrive at a patient's house within 30 minutes. In certain frontier conditions, such as mountainous areas, the response time can be extended to 60 minutes.

    Application Compliance

    • Hospitals interested in becoming critical access hospitals must request application materials from their state survey agency, according to the Rural Assistance Center. If the state survey agency decides that the hospital meets the requirements, the agency sends the information to the Centers for Medicare and Medicaid Services (CMS). The CMS then conducts a survey of the hospital and makes photocopies of all documents that prove that the hospital meets the requirement. Based on the information, the surveyors will hold a discussion meeting and determine whether or not the hospital has met all requirements for the critical access hospital designation, according to the Centers for Medicare and Medicaid Services. Selected hospital staff and the surveyors have an exit meeting where they discuss the findings of the survey. CMS makes the final determination of whether or not the requirements are satisfied.

    Hospital Communication Compliance

    • Critical access hospitals must communicate with nearby acute care hospitals and exchange communication regarding patient referrals, transfer and emergency patient transportation, according to the Rural Assistance Center. Acute care hospitals are hospitals that provide emergency services to patients regardless of their ability to pay.

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