The CAH Program was created by Congress in 1998. It was established to help
ameliorate the negative impact the Balanced Budget Act had on the fragile healthcare delivery system. The CAH program is part of a
national initiative called the Rural Hospital Flexibility Program to strengthen rural healthcare. This is a $35 million per year,
four-year program of grants to help states implement the CAH initiative. State awards have ranged from $200,000 to $700,000 per state,
depending upon need and the likely number of hospital conversions.
States are required to help local communities and their hospitals decide on the feasibility of CAH status
and to provide technical assistance for hospitals that undertake conversion. States are also required to work with emergency medical
systems, hospital associations, and other groups in doing so. In addition to these activities, states may use the funds to support
communities as they develop or implement healthcare networks, support expansion of programs to improve and integrate rural emergency
medical services into rural health networks, and develop or enhance local health system quality improvement activities.
In order for a hospital to participate in the CAH Program, it must:
be located in a rural area or be treated as rural under a special provision that allows qualified hospital providers in urban areas to be treated as rural for purposes of becoming a CAH
be or have been a licensed hospital in the past 10 years
furnish 24-hour emergency care services, using either on-site or on-call staff
not have more than 25 licensed beds (but it may utilize any combination of "swing” beds and acute beds up to the maximum of 25 beds)
have an average length of stay of 96 hours or less
be located either more than 35 miles from the nearest hospital or CAH or more than 15 miles in areas with mountainous terrain or only secondary roads OR be State certified by December 31, 2005 as a "necessary provider" of healthcare services to the residents in the area
have written agreements with larger hospital(s) for appropriate transfer and communication about patients
CRHC is the recipient of the Federal HRSA Medicare Rural Hospital Flexibility Grant (Flex grant), houses the office of the CAH Director, disperses Capacity Building grants to CAH communities, and coordinates statewide meetings and CAH Advisory Council meetings. The Colorado Hospital Association (CHA) provides financial analysis and support for the hospitals and works with Medicaid and insurance carriers to increase the reimbursement to the CAH hospitals. The Colorado Department of Public Health and Environment facilitates the conversion and works with the hospitals to develop networks and strengthen their EMS systems.