Alternatives to the 96-Hour Rule for Critical Access Hospitals
The Medicare Rural Hospital Flexibility Program, part of the Balanced Budget Act, created the Critical Access Hospital (CAH) designation for small rural hospitals. CAHs are paid on a cost basis under Medicare, but certain stipulations must be met. One requirement is that the hospital s average length-of-stay (LOS) not exceed 96 hours. Although research has identified types of stays that will likely be treated by new CAHs, implications of this requirement for small rural hospitals that are expected to convert to CAH status are not well understood. This project examines how LOS varies among hospitals that are likely to be candidates for CAH conversion, and whether there should be any exceptions or alternatives to the 96-hour rule based on patient diagnosis. Data are from the Healthcare Cost and Utilization Project-State Inpatient Database (HCUP-SID) for all hospital discharges in California, Colorado, Iowa, Kansas, and West Virginia; the HCUP-National Inpatient Sample (HCUP-NIS) database of discharges from a sample of hospitals in 15 other states; and discharge level data compiled from inpatient claims for Medicare beneficiaries in Montana and five other states. Candidates for the CAH designation, identified in a previous study, include hospitals that meet all criteria for CAH status as specified in the Medicare Rural Hospital Flexibility Act as well as hospitals that may qualify if the distance and bed size criteria are relaxed.
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