CRITICAL
ACCESS HOSPITALS - HISTORY
In
October 1998, Congress appropriated $25 million in the first of five years of
support for the program. This money
was used to fund an infrastructure at the state level to support interested
communities and hospitals weigh conversion to a CAH.
-
Since
the BBA of 1997, Congress has passed additional legislation that provided
incentives to CAH designated hospitals.
-
In
late 1999, Congress passed the Balanced Budget Refinement Act (BBRA) which
allowed payment for outpatient services provided by CAHs to be based on the
reasonable costs of the hospital.
-
In
addition, the BBRA expanded eligibility to include investor-owned hospitals,
and modified the length-of-stay requirements to an average of 96 hours.
-
In late 2000, congress passed the Benefits Improvement Protection Act (BIPA)
which added incentives to convert to CAH status by exempting CAH swing-beds
from Skilled Nursing Facilities (SNF)
-
Prospective
Payment System (PPS). In
addition, they made this retroactive to the BBRA.
-
BIPA also eliminated beneficiary coinsurance for clinical diagnostic lab
tests.
These
incentives, along with the original legislation have seen an explosion in
hospitals designated as CAHs. From 4
in August, 1997 to 560 in January, 2002.
Although
not in
Michigan
, other states began to reimburse CAHs
on the basis of cost for Medicaid beneficiaries.
As of August 2001, 16 states offer cost-based reimbursement for inpatient
Medicaid services and 17 states offer it for outpatient services.
This incentive has added to the rapid increase in CAH designation.
THE
MICHIGAN
EXPERIENCE
To
date, 14
Michigan
hospitals have received CAH
designation:
-
Paul
Oliver
Memorial
Hospital
Frankfort
9/1999
-
Kalkaska
Memorial
Health
Center
Kalkaska
12/1999
-
Leelanau
Memorial
Hospital
Northport
12/1999
-
Schoolcraft
Memorial
Hospital
Manistique
1/2000
-
Helen
Newberry
Joy
Hospital
Newberry
1/2000
-
Standish
Community
Hospital
Standish
2/2000
-
Mackinac
Straits
Hospital
Saint
Ignace
4/2000
-
Baraga
County
Memorial
Hospital
L'anse
5/2000
-
Ontonagon
Memorial
Hospital
Ontonagon
6/2000
-
Munising
Memorial
Hospital
Munising
6/2000
-
Scheurer
Hospital
Pigeon
8/2000
-
Deckerville
Community
Hospital
Deckerville
8/2000
-
Sheridan
Community
Hospital
Sheridan
9/2000
-
Harbor
Beach Community Hospital, Inc.
Harbor
Beach
3/2001
In
the first two years of the Rural Hospital Flexibility Program,
Michigan
, through the Center for Rural Health,
has provided mini-grants to CAHs. In
the first year,
Michigan
’s grant allotment created two mini-grants.
The first was a $5,000 Quality of Care grant and the second a Network
Development grant, budgeted at a maximum of $7,500 for each CAH.
In the second year, fourteen Community Health Initiative grants of $10,000
were offered and three Innovative Network Development grants of $25,000.
Laura
Appel, Senior Director of Legislative Policy at the Michigan Health &
Hospital Association, wrote an article last year for MI
Health & Hospitals, MHA’s publication, outlining highlights of how
some of the grants in
Michigan
were put to use. For specific
information on the experience of
Leelanau
Memorial
Health
Center
,
Paul
Oliver
Memorial
Hospital
,
Kalkaska
Memorial
Health
Center
,
Mackinac
Straits
Hospital
,
Standish
Community
Hospital
Munising
Memorial
Hospital
and
Scheurer
Hospital
you can read Ms. Appel’s article at:
http://www.mha.org/resources/magazine/2001/appelhtml5.htm
Further
information regarding CAHs can be found on the following links: