How to Become a Critical Access Hospital
  1. Contact CRHC for information and to help arrange a financial feasibility study to determine if cost-based reimbursement under CAH status will be advantageous: info@coruralhealth.org

  2. The hospital administration, board, and medical staff should review the results of the financial feasibility study to determine whether or not it is appropriate to convert to CAH status. At this point, it is also recommended that the local community members become educated regarding CAH status either through town meetings, newspaper articles, or printed brochures. CRHC can provide assistance with community education.

  3. If it is determined that it is appropriate for the facility to convert to CAH status, a letter signed by the facility's administrator must be submitted requesting "designation as a Critical Access Hospital" to:
    Colorado Rural Health Center
    Attn: Critical Access Hospital Program Staff
    3033 S. Parker Rd., Suite 606
    Aurora, CO 80014
    FAX: 303.832.7496


  4. The request will be forwarded to the Health Facilities Division (HFD) of the Colorado Department of Public Health and Environment (CDPHE). The HFD will send a packet to the facility containing information for the survey. Specific documents will be requested BEFORE the survey is scheduled. The HFD will review the information, and then schedule the survey.
     
  5. The survey is conducted in two parts: The Life and Safety code (physical plant) survey, and the policy survey. Usually these surveys are conducted at least a week apart. The Life and Safety code survey is usually conducted first and is usually not scheduled in advance. The surveyors will present to the facility unannounced. The subsequent policy survey will be scheduled in advance.
     
  6. Upon satisfactory completion of the survey and/or submitting an acceptable "Plan of Correction", the HFD will send paperwork to the Centers for Medicare & Medicaid Services (CMS) Regional Office.
     
  7. CMS will send a CAH certification letter to the facility, which will include the effective date of conversion and a new provider number. CMS will forward a copy of this letter to the facility's fiscal intermediary (FI). The facility should also immediately forward a copy of the letter to the FI.  In Colorado, the FI is TrailBlazer Health Enterprises (www.trailblazerhealth.com).
     
  8. The certification date will be the date of a completed, deficiency-free survey OR the date the facility administrator signs the acceptable Plan of Correction (POC). If your facility wants a certification date LATER than the date of the survey or POC you MUST request the date in writing to CMS. A certification date on the first of the month, or the beginning of the year is optimal. This prevents the submission of multiple cost reports for partial months/years.
     
  9. VERY IMPORTANT: Throughout the conversion process, the facility should remain in close contact with the FI. A representative from the hospital should be designated to communicate with an FI representative who is familiar with CAH conversion. Ask for written instructions and timeframes for how to communicate with the FI. For Electronic Data Interchange (EDI), the facility must file a new application with the new provider number. Stay in close communication with the FI to find out when the new number is in the system and the facility may begin billing. If you would like assistance in communicating with the FI, please contact CRHC at info@coruralhealth.org.

Please do not hesitate to ask questions! Contact CRHC’s CAH staff at info@coruralhealth.org or call us at 800.851.6782.

CAH Survey Preparation
  1. he purpose of the CAH survey is to examine facility compliance with the Medicare Conditions of Participation (CoPs). The CoP’s can be found on the CMS website.  Hospitals are surveyed either through the Colorado Department of Public Health and Environment (CDPHE), the Joint Commission or through the American Osteopathic Association Healthcare Facilities Accreditation Program.  For information about CAH surveys, contact CRHC at info@coruralhealth.org or 303.832.7493.
     
  2. Complete your written agreements with your referring hospital. Agreement(s) must cover at a minimum:
    • Referral and Transfer of patients
    • Transportation services, both emergency and non-emergency
    • Communications
    • Agreement for credentialing and quality assurance

  3. Policies and procedures must be in place for all CAH requirements (i.e. infections control, pharmacy, emergency department, dietary, nursing, medical records and outpatient/clinics).

  4. There are sample documents on the Rural Health Resource Center website.

  5. There is grant money available to help with conversion to CAH. For more information, contact Jen Dunn at jd@coruralhealth.org or 303.832.7492.

  6. Technical assistance with Quality Assurance is available at no cost to your facility from the QIO, the Colorado Foundation for Medical Care, and Beth Katzenberg (303.784.5702).