Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.
By James Swann
Roughly two-thirds of all critical access hospitals (CAHs) would not have met location requirements for Medicare certification if they had been required to re-enroll in 2011, according to a report from the Department of Health and Human Services Office of Inspector General released Aug. 15.
“Because services provided at CAHs are typically reimbursed at rates that are higher than the base rates, Medicare could realize substantial savings if CMS [Centers for Medicare & Medicaid Services] were to decertify some CAHs that would not meet the location requirements,” the report said.
However, 88 percent of the non-qualifying CAHs were categorized as “necessary provider” CAHs, which are permanently exempt from having to meet one of the location requirements for Medicare certification, OIG said.
The report, Most Critical Access Hospitals Would Not Meet The Location Requirements If Required To Re-Enroll In Medicare (OEI-05-12-00080), said that out of the 1,329 CAHs across the country, 849 would not have met location requirements.
Out of the non-qualifying CAHs, 846 would not have met a requirement that they be located at least 35 miles from another hospitals or at least 15 miles in mountainous terrain or areas that are only served by secondary roads.
The remaining three CAHs would not have met a requirement that they be located in rural areas.
The Medicare program and beneficiaries could have saved $449 million in 2011 if CMS had been able to decertify all CAHs operating within 15 miles of another hospital, OIG said.
CAH certification was created by the Balanced Budget Act of 1997 to ensure that rural beneficiaries had access to services. In exchange for meeting several requirements, such as being located a certain distance away from other hospitals, Medicare reimburses CAHs at 101 percent of their costs.
OIG said CMS should certify only CAHsthat provide services to beneficiaries who would otherwise not have access to a hospital and recommended that CMS:
• ask Congress to remove the permanent exemption from the distance requirement for necessary provider CAHs;
• ask Congress to revise CAH conditions of participation to include alternative location-based requirements. For example, if a CAH did not meet location requirements, but served a population with elevated levels of poverty, it could still be certified;
• make sure to reassess CAH compliance with location requirements on a regular basis; and
• apply a uniform definition of mountainous terrain to all CAHs.
CMS agreed with all of OIG's recommendations, with the exception of creating alternative location-based requirements.
“Establishing new criteria such as those that have been recommended could not only be duplicative of existing criteria, but could be administratively burdensome to implement,” CMS said in response to the OIG report.
Alan Morgan, the chief executive officer of the National Rural Health Association, said the report's recommendations would harm rural health care.
“If the full report were implemented, it would result in shutting down up to 70 percent of a state's rural hospitals,” Morgan said in an Aug. 15 blog post.
The OIG report is at https://oig.hhs.gov/oei/reports/oei-05-12-00080.pdf.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)