A CAH must meet certain criteria for designation. Among the criteria are distance requirements relative to other hospitals or CAHs. Currently, CAHs must be:
(1) 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
(2) certified before January 1, 2006, by the state as being a necessary provider of health care services to residents in the area.
CMS is proposing to incorporate the definition of “primary road” into the CAH distance requirement regulations, both as part of the 35-mile drive requirement, and as applicable through the secondary roads definition for the 15-mile drive requirement. Specifically, CMS proposed to clarify that the location distance for a CAH is one for more than a 35-mile drive on primary roads (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. The proposed rule defines a primary road of travel for determining the driving distance of a CAH and its proximity to other providers as a numbered Federal highway, including interstates, intrastates, expressways or any other numbered Federal highway; or a numbered state highway with two or more lanes each way.
In addition to location requirements, CMS is proposing to establish a centralized, data-driven review process that focuses on hospitals being certified in proximity to a CAH, rather than focusing specifically on road classifications. CMS would review all hospitals and CAHs within a 50-mile radius of the CAH during each review of eligibility, and then subsequently on a three-year cycle. Those CAHs with no new hospitals within 50 miles would be immediately recertified. Those CAHs with new hospitals within 50 miles will receive additional review based on the distance from the new hospital and the definitions for Primary Roads and Mountainous Terrain.
CMS is seeking comments on the proposed rule ahead of implementation in the CY 2023 OPPS/ASC final rule, anticipated this fall. Comments are due by August 29, 2022. For more information on the proposed rule and the impacts, call (708) 478-7030.