[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR485.610]



[Page 603-604]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 485_CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS--Table 

of Contents

 

 Subpart F_Conditions of Participation: Critical Access Hospitals (CAHs)

 

Sec. 485.610  Condition of participation: Status and location.



    (a) Standard: Status. The facility is--

    (1) A currently participating hospital that meets all conditions of 

participation set forth in this subpart;

    (2) A recently closed facility, provided that the facility--

    (i) Was a hospital that ceased operations on or after the date that 

is 10 years before November 29, 1999; and

    (ii) Meets the criteria for designation under this subpart as of the 

effective date of its designation; or

    (3) A health clinic or a health center (as defined by the State) 

that--

    (i) Is licensed by the State as a health clinic or a health center;

    (ii) Was a hospital that was downsized to a health clinic or a 

health center; and

    (iii) As of the effective date of its designation, meets the 

criteria for designation set forth in this subpart.

    (b) Standard: Location in a rural area or treatment as rural. The 

CAH meets the requirements of either paragraph (b)(1) or (b)(2) or 

(b)(3) of this section.

    (1) The CAH meets the following requirements:

    (i) The CAH is located outside any area that is a Metropolitan 

Statistical Area, as defined by the Office of Management and Budget, or 

that has been recognized as urban under Sec. 412.64(b), excluding 

paragraph (b)(3) of this chapter;

    (ii) The CAH has not been classified as an urban hospital for 

purposes of the standardized payment amount by CMS or the Medicare 

Geographic Classification Review Board under Sec. 412.230(e) of this 

chapter, and is not among a group of hospitals that have been 

redesignated to an adjacent urban area under Sec. 412.232 of this 

chapter.

    (2) The CAH is located within a Metropolitan Statistical Area, as 

defined by the Office of Management and Budget, but is being treated as 

being located in a rural area in accordance with Sec. 412.103 of this 

chapter.

    (3) Effective only for October 1, 2004 through September 30, 2006, 

the CAH does not meet the location requirements in either paragraph 

(b)(1) or (b)(2) of this section and is located in a county that, in FY 

2004, was not part of a Metropolitan Statistical Area as defined by the 

Office of Management and Budget, but as of FY 2005 was included as part 

of such an MSA as a result of the most recent census data and 

implementation of the new MSA definitions announced by OMB on June 6, 

2003.

    (c) Standard: Location relative to other facilities or necessary 

provider certification. The CAH is 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 October 1, 2006, 

will maintain its necessary provider designation after January 1, 2006.

    (d) Standard: Relocation of CAHs with a necessary provider 

designation. A CAH



[[Page 604]]



that has a necessary provider designation from the State that was in 

effect prior to January 1, 2006, and relocates its facility after 

January 1, 2006, can continue to meet the location requirement of 

paragraph (c) of this section based on the necessary provider 

designation only if the relocated facility meets the requirements as 

specified in paragraph (d)(1) of this section.

    (1) If a necessary provider CAH relocates its facility and begins 

providing services in a new location, the CAH can continue to meet the 

location requirement of paragraph (c) of this section based on the 

necessary provider designation only if the CAH in its new location--

    (i) Serves at least 75 percent of the same service area that it 

served prior to its relocation;

    (ii) Provides at least 75 percent of the same services that it 

provided prior to the relocation; and

    (iii) Is staffed by 75 percent of the same staff (including medical 

staff, contracted staff, and employees) that were on staff at the 

original location.

    (2) If a CAH that has been designated as a necessary provider by the 

State begins providing services at another location after January 1, 

2006, and does not meet the requirements in paragraph (d)(1) of this 

section, the action will be considered a cessation of business as 

described in Sec. 489.52(b)(3).



[62 FR 46036, Aug. 29, 1997, as amended at 65 FR 47052, Aug. 1, 2000; 66 

FR 39938, Aug. 1, 2001; 69 FR 49271, Aug. 11, 2004; 69 FR 60252, Oct. 7, 

2004; 70 FR 47490, Aug. 12, 2005]