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CMS Fixes Flawed Reinterpretation of CAH Distance Requirement

As a result of NRHA advocacy and education efforts, CMS announced on an Open Door Forum today that they will ensure the reinstatement of the longstanding interpretation of the CAH mileage requirements. Specifically, CMS affirmed mileage will be based on the CAH and its provider-based clinic to another like hospital, and it will not be based on the mileage on the proximity to another hospital provider-based clinic. On today’s call, CMS also committed to reinforce the plain language interpretation to the different regional offices. 
After news broke regarding a recent reinterpretation of the rule, NRHA hosted a webinar for members to inform them of the issue, and began working to educate both Capitol Hill and the Administration about the importance of Critical Access Hospitals (CAHs), as well as the longstanding interpretation of the distance requirement. Additionally, we sent letters to Congressional Leadership, as well as HHS Secretary Alex Azar and CMS Administrator Seema Verma, requesting that CMS reconsider the new flawed reinterpretation.
This issue began in April 2017 when Curry General Hospital, a remote rural CAH on the southern Oregon Coast which provides exceptional care for thousands of rural patients, received a letter from CMS threatening termination of its status as a CAH. CMS asserted that the Oregon hospital had violated its conditions of participation because another hospital located in a different state (California) opened a provider-based clinic within 35 miles of the hospital. The provider-based clinic that caused the letter provides limited health care services, does not have an emergency department, and only sees patients with an appointment and during business hours of 8 a.m. to 5 p.m.
Virginia Razo, CEO of Curry General Hospital, informed the community and CMS that termination of the hospital’s CAH status would “force closure of the hospital.” If Curry General Hospital is forced to close its doors, thousands of Oregon residents would lose accessible emergency and inpatient care as well as economic hardship for the region. While Curry General Hospital was able to remain a CAH because it had preivously been deemed a Necessary Provider, achieving this result is not possible for many of the other CAHs who would be at risk. Further, it required the hospital to expend their limited resources unnecessary legal fees, rather than critical patient care. 
Rural Americans desperately need local access to a hospital. The rural population is, per capita older, sicker, and poorer than their urban counterparts, suffering higher rates of chronic diseases and struggling to afford care. If a rural hospital closes, 20% of the rural economy vanishes and other health providers in the community, who are almost always hospital-based, leave the rural area, and these vulnerable patients lose access to community care. Critical Access Hospitals (CAHs) are the cornerstone of the rural health care safety net. These small, rural facilities provide vital emergency care to millions of rural patients across the nation. CAHs represent over 74% of all rural community hospitals, Medicare expenditures to CAHs are less than 4% of the entire Medicare budget. Medicare payments to non-hospital services grow at over twice the rate of CAHs.
NRHA is pleased the Administration listened and reexamined the impacts of this policy on rural hospitals and the patients they serve, ultimately choosing to utilize the longstanding interpretation of the CAH requirements.

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