Critical Access Hospitals (CAH)

Critical Access Hospital

The Critical Access Hospital (CAH) program is a federal designation given to health care facilities that met certain federal criteria. The program was established through legislation enacted as part of the Balanced Budget Act (BBA) of 1997 through the State Medicare Rural Hospital Flexibility Program (Flex). The criteria include:

    • Located in a state with an established FLEX program;
    • Located in a rural area or an area treated as rural under federal guidelines;
    • Provide 24-hour emergency care services;
    • Furnish no more than 25 acute care inpatient beds and include the following provisions:
      • That the facility provide no more than 25 inpatient beds that can be used for either inpatient or swing bed services, and/or;
      • To include a separate provision for up to 10 additional rehab or psych beds in a “distinct part unit.”
    • Possess a length of stay averaging no more than 96 hours; and
    • Meet Geographic conditions.

Critical Access Hospitals (CAH) are designated health care facilities are exempt from the prospective payment system (PPS) and receive cost-based reimbursement for most Medicare beneficiary inpatient and outpatient services at 101 percent of their allowable and reasonable costs. This enables small rural hospitals to:

      • Maintain quality access to primary and emergency health care services;
      • Offer adequate health care services that meet the needs of the community citizens (such as radiology, laboratory services, outpatient rehab and surgery; and
      • Assist in ensuring financial viability of small rural hospitals through enhanced reimbursements.
      • Participate in FTO assessments improvement coaching.

Virginia currently has eight (8) designated CAH Hospital Update

If you are interested in your facility being designated as a CAH, the VA-SORH can assist you in the process.  Contact Brandon Rivenbark at

For more information on Virginia’s Critical Access Hospital program, contact, Director, Division of Primary Care and Rural Health.