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Rural Health

Critical Access Hospitals

Critical Access Hospital (PDF) is a federal designation under the Rural Hospital Flexibility Program (Flex Program), administered by the federal Office of Rural Health Policy. The purpose of the program is to ensure people enrolled in Medicare have access to healthcare services in rural areas, particularly hospital care.

Critical Access Hospitals (CAHs) are small hospitals with fewer than 25 beds in rural areas. There are 39 CAHs in Washington. A map of CAHs in Washington is online (PDF). Most CAHs are operated by public hospital districts.

CAHs are often the central hub of health services in their communities, providing primary care, long-term care, physical and occupational therapy, cardiac rehabilitation and other services in addition to emergency and acute care. Hospital staff provide these services either directly or in partnership with other community providers.

Medicare rules and payment for CAHs are a little different from larger, urban hospitals. CAHs are paid based on reasonable costs for Medicare, rather than a set amount per diagnosis or procedure. In Washington, this is also true for Medicaid. CAHs also have some flexibility in staffing requirements and some other Medicare rules.

The Department of Health receives Flex Program funding to support CAHs and encourage the development of cooperative systems of care in rural areas, joining together CAHs, EMS providers, clinics and health practitioners to increase efficiencies and quality of care. Program priorities and activities include:

  • Quality Improvement – Improve and sustain the quality of care provided by CAHs so that rural citizens receive high-quality, appropriate care in their communities.
  • Operational and Financial Improvement – Support efforts to improve CAH financial and operational performance.
  • Health System Development and Community Engagement – Assist CAHs in developing collaborative regional or local systems of care, addressing community needs, and integrating EMS in those regional and local systems of care.

Resources for Critical Access and Rural Hospitals

For more information, contact:

Kim Kelley, Critical Access Hospital program manager

Phone: 360-236-2807


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