Small & Rural Definitions
The definition of rural is based on distance and is defined in statute as "all geographic areas 10 or more miles from the center of a population of 30,000 or more." The Oregon Office of Rural Health uses population data from the Population Research Center at Portland State University to determine the definition of rural. Definition of rural – link to Oregon Office of Rural Health: http://www.ohsu.edu/ohsuedu/outreach/oregonruralhealth/data/definitions/index.cfm
Small, rural hospitals are defined in the Oregon administration rules, ORS 442.470 as those hospitals operating fewer than 100 beds. Rural hospitals are classified by type using the following definitions:
- Type A hospitals are small and remote and have 50 or fewer beds. Type A hospitals are located more than 30 miles from another acute care, inpatient facility.
- Type B hospitals are small and rural and have 50 or fewer beds. Type B hospitals are located 30 miles or less from another acute care facility.
- Type C hospitals are considered rural and more that 50 beds, but are not a rural referral center.
Critical Access Hospital (CAH) is another type or federal designation of rural hospitals. Legislation enacted as part of the Balanced Budget Act of 1997 authorizes states to establish State Rural Hospital Flexibility Programs (Flex Program), allowing certain facilities participating in Medicare to become Critical Access Hospitals (CAH). CAH is a separate provider type that has its own Conditions of Participation and payment method. The CAH Flex Program was created to assure Medicare beneficiaries living in rural areas access to health care services. The CAH Flex program is designed to allow more flexible staffing options relative to community need, simplify billing methods and create incentives to develop local integrated health delivery systems, including acute, primary, emergency and long-term care.
Critical Access Hospital (CAH) Designation
A Critical Access Hospital (CAH) is a rural community hospital that is certified to receive cost-based reimbursement from Medicare. CAHs must meet defined criteria outlined in the Conditions of Participation 42CFR485. link: http://www.cms.hhs.gov/CertificationandComplianc/04_CAHs.asp
A hospital must meet the following criteria to be designated as CAH:
- Be located in a state that has established a State Flex Program;
- Be located in a rural area or be treated as rural under a special provision that allows hospitals in urban areas to be treated as rural for purposes of becoming CAH;
- Provide 24-hour emergency care services, using either on-site or on-call staff;
- Provide no more than 25 inpatient beds;
- Have an average length of stay of 96 hours or less; and
- Be either more than 35 miles from a hospital or another CAH or more than 15 miles by areas with mountainous terrain or only secondary roads, or be certified by the State as of December 31, 2005, as being a "necessary provider" of health care services to residents in the area.
The Oregon CAH Program is administered by the Oregon Office of Rural Health and the Oregon Department of Health, Licensing Division in close collaboration with the OAHHS. Oregon has 25 CAHs located in rural communities across the state.
Building 2, Suite 100
Lake Oswego, Oregon 97035
503-636-2204 | Fax: 503-636-8310
info@oahhs.org
Copyright © 2009 Oregon Association of Hospitals and Health Systems. All rights reserved.