Critical Access Hospital Conversion



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How to Become a Critical Access Hospital

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.

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

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.

The survey will include a Life and Safety code (physical plant) survey, and the policy survey. The survey will be unannounced.

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.

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 Novitas Solutions, Inc. (

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.

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


 CAH Survey Preparation

The 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 through the Colorado Department of Public Health and Environment (CDPHE), the Joint Commission, the American Osteopathic Association Healthcare Facilities Accreditation Program, or through Det Norske Veritas (DNV). For information about CAH surveys, contact CRHC at or 303.832.7493.

Complete your written agreements with your referring hospital. Agreement(s) must cover at a minimum:

  1. Referral and Transfer of patients
  2. Transportation services, both emergency and non-emergency
  3. Communications
  4. Agreement for credentialing and quality assurance

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).

CRHC has resources to assist in CAH conversion and survey preparation. Contact CRHC at or 303-832-7493.

Technical assistance with Quality Assurance is available from Colorado’s Quality Improvement Organization (QIO), the Colorado Foundation for Medical Care.

Participant Expense

Member: Free

Nonmember: Free

For more information

Member Login

Login to your account to access member only resources and information.  Don’t know your facility’s login? Contact or call 303.832.7493.  Once your membership status is confirmed, you will be granted access and sent login credentials.

Not sure if your facility is a current CRHC member?  Review the membership list.