Oregon Critical Access Hospitals

The Medicare Rural Hospital Flexibility (Flex) Program, established by the Balanced Budget Act of 1997 (Public Law 105-33), is available to all 50 states. Its intent is to allow rural communities to preserve access to primary care and emergency health care services, provide health care services that meet community needs, and help assure the financial viability of small, rural hospitals. The Flex Program enables certain rural hospitals to be classified as Critical Access Hospitals. A critical access hospital (CAH) is able to improve its financial stability through enhanced Medicare reimbursement and reduced operating costs. In Oregon the process of designation is coordinated by the Oregon Office of Rural Health, and is called the Critical Access Hospital Program. To qualify as a CAH, the hospital must meet/agree to the following requirements:

• Be a for-profit, non-profit, or public hospital that is open and operating. Hospitals that have either closed or downsized to health centers or clinics in the past 10 years (from November 29, 1999) are also eligible for CAH designation;
• Be located more than a 35-mile drive (or, in the case of mountainous terrain or in areas with only secondary roads available, a 15-mile drive) from a hospital or another CAH, or before January 1, 2006, the CAH is certified by the State as being a necessary provider of health care services to residents in the area. A CAH that is designated as a necessary provider as of December 31, 2005, will maintain its necessary provider designation after January 1, 2006;
• Be located in a rural area or classified by the Secretary as rural in an urban county if located in a census tract that is considered rural under the most recent update of the Goldsmith Modification; or located in an area designated by State law or regulation as a rural area or designated by the state as rural providers; or meets other criteria as specified by the Secretary;
• Limit bed size to 25 except in any combination of acute inpatient and swing beds;
• Have an annual average length of stay of less than 96 hours;
• Make available 24 hour emergency services and nursing services but need not meet all the staffing and service requirements that apply to other hospitals;
• Participate in a rural health network, which is defined as an organization consisting of at least one CAH and at least one non-CAH hospital where participants have entered into specific agreements regarding patient referral and transfer, communication, and
• Establish credentialing and quality assurance agreements with at least one network partner hospital, a Quality Improvement Organization or equivalent, or another entity identified in the rural health plan of the state.

Potential benefits of being a Critical Access Hospital include the following:

• Reimbursed at 101% of reasonable costs for inpatient, outpatient and laboratory services. 
• Extends cost-based reimbursement to additional on-call emergency care providers. 
• Ability to bill under the all-inclusive rate structure (this allows the hospital to bill for both the hospital and patient services).
• Reasonable cost-based reimbursement for ambulance services provided to Medicare beneficiaries if the ambulance service is owned and operated by the CAH and is the only service within 35-miles of the CAH. 
• Opportunity to receive period interim payments, as is currently the case for eligible hospitals, skilled nursing facilities, and hospices.
• A mid-level practitioner (physician assistant or nurse practitioner) may provide inpatient care under remote supervision of a physician. 
• Permission to establish psychiatric and rehabilitation distinct part units. 
• Opportunity to collaborate, access programs and funding through the Oregon Office of Rural Health Flex Program. 

Hospitals that are potentially eligible for designation as CAHs, and the communities in which they are located, are able to receive free technical assistance in the following areas:

• integration of emergency medical services
• quality improvement programs
• community health planning
• network development

For more information about the Flex Program, please contact Kassie Clarke, Community Grants Coordinator,  503-494-4450, e-mail clarkek@ohsu.edu.

To learn more about the ORHQN projects listed below, please click here.

Blue Mountain Hospital
Administrator: Robert Houser
170 Ford Rd., John Day, OR 97845-2009
Phone: (541) 575-1311
Fax: (541) 575-1255
ORHQN Projects: Performance Measurement Program

Columbia Memorial Hospital
Administrator: Terry Finklein
2111 Exchange St., Astoria, OR 97103-3329
Phone: (503) 325-4321
Fax: (503) 338-7586
ORHQN Projects: Performance Measurement Program, Peer Review Network

Coquille Valley Hospital
Administrator: Dennis Zielinski
940 E 5th St., Coquille, OR 97423-1699
Phone: (541) 396-3101
Fax: (541) 396-5760
ORHQN Projects: Performance Measurement Program, Peer Review Network

Cottage Grove Community Hospital
Administrator: Randy Mee
1515 Village Dr., Cottage Grove, OR 97424
Phone: (541) 942-6748
Fax: (541) 349-8030
ORHQN Projects: Performance Measurement Program, Peer Review Network

Curry General Hospital
Administrator: Tom Troy
94220 E 4th St., Gold Beach, OR 97444-7772
Phone: (541) 247-6621
Fax: (541) 247-2012

Good Shepherd Medical Center
Administrator: Dennis Burke
610 NW 11th., Hermiston, OR 97838
Phone: (541) 567-6483
Fax: (541) 567-6483
ORHQN Projects: Performance Measurement Program

Grande Ronde Hospital
Administrator: James Mattes
PO Box 3290, La Grande, OR 97850-7290
Phone: (541) 963-8421
Fax: (541) 963-1476
ORHQN Projects: Performance Measurement Program, Peer Review Network, Core Measures Project

Harney District Hospital
Administrator: Jim Bishop
557 W Washington, Burns, OR 97720-1497
Phone: (541) 573-7281
Fax: (541) 573-8353
ORHQN Projects: Performance Measurement Program

Lake District Hospital
Administrator: Gordon Ensley
700 S J St., Lakeview, OR 97630-1623
Phone: (541) 947-2114
Fax: (541) 947-2433
ORHQN Projects: Performance Measurement Program

Lower Umpqua Hospital
Administrator: Sandra Reese
600 Ranch Rd., Reedsport, OR 97467-1795
Phone: (541) 271-2171
Fax: (541) 271-2941
ORHQN Projects: Performance Measurement Program, Peer Review Network

Mountain View Hospital
Administrator: Jay Henry
470 NE A St., Madras, OR 97741
Phone: (541) 475-3882
Fax: (541) 475-4804
ORHQN Projects: Performance Measurement Program, Peer Review Network

Peace Harbor Hospital
Administrator: James Barnhart
400 9th St., Florence, OR 97439
Phone: (541) 997-8412
Fax: (541) 997-9155
ORHQN Projects: Performance Measurement Program

Pioneer Memorial Hospital — Heppner
Administrator: Victor Vander Does
PO Box 9, Heppner, OR 97836-0009
Phone: (541) 676-9133
Fax: (541) 676-2900
ORHQN Projects: Performance Measurement Program

Pioneer Memorial Hospital — Prineville
Administrator: Donald Wee
1201 NE Elm, Prineville, OR 97754-1299
Phone: (541) 447-2501
Fax: (541) 447-6705
ORHQN Projects: Performance Measurement Program

Providence Hood River Memorial Hospital
Administrator: Ty Erickson
PO Box 149, Hood River, OR 97031-0055
ORHQN Projects: Performance Measurement Program

Providence Seaside Hospital
Administrator: Bill Sexton
725 S Wahanna Rd., Seaside, OR 97138-7735
Phone: (503) 717-7000
Fax: (503) 717-7505
ORHQN Projects: Performance Measurement Program, Peer Review Network

Samaritan Lebanon Community Hospital
Administrator: Becky Pape
PO Box 739, Lebanon, OR 97355
Phone: (541) 451-7114
Fax: (541) 451-7071
ORHQN Projects: Performance Measurement Program

Samaritan North Lincoln Hospital
Administrator: Jack Flaig
PO Box 767, Lincoln City, OR 97367-0767
Phone: (541) 994-3661
Fax: (541) 996-7386
ORHQN Projects: Performance Measurement Program

Samaritan Pacific Communities Hospital
Administrator: David Bigelow
PO Box 945, Newport, OR 97365-0072
Phone: (541) 265-2244
Fax: (541) 574-1832
ORHQN Projects: Performance Measurement Program

Southern Coos Hospital & Health Center
Administrator: Jim Wathen
900 11th St. SE, Bandon, OR 97411-9114
Phone: (541) 347-2426
Fax: (541) 347-3923
ORHQN Projects: Performance Measurement Program

St. Anthony Hospital
1601 SE Court Ave., Pendleton, OR 97801-3217
Phone: (541) 276-5121
Fax: (541) 278-3227

St. Elizabeth Health Services
Administrator: George Winn
3325 Pocahontas Rd., Baker City, OR 97814-1464
Phone: (541) 523-6461
Fax: (541) 523-8151
ORHQN Projects: Performance Measurement Program, Peer Review Network

Tillamook County General Hospital
Administrator: Larry Davy
1000 3rd, Tillamook, OR 97141-3498
Phone: (503) 842-4444
Fax: (503) 842-3062
ORHQN Projects: Peer Review Network

Wallowa Memorial Hospital
Administrator: Dave Harman
401 NE 1st St., Enterprise, OR 97828
Phone: (541) 426-3111
Fax: (541) 426-4095
ORHQN Projects: Performance Measurement Program, Peer Review Network

West Valley Hospital
Administrator: Eric Buckland
PO Box 378, Dallas, OR 97338-0378
Phone: (503) 623-8301
Fax: (503) 623-7345
ORHQN Projects: Performance Measurement Program, Peer Review Network