Report: Rural Virginia Hospitals Won’t Qualify if Required to Re-Enroll in Medicare

Published October 22, 2013

Nearly two-thirds of rural hospitals in the United States would fail to meet location requirements if required to re-enroll in Medicare, an inspector general’s report from the Department of Health and Human Services has found.

This could prove problematic for Virginia, whose rural hospitals serve a significant portion of the Commonwealth’s population, with several key hospitals that may not qualify under any future reassessment from the Centers for Medicare and Medicaid Services (CMS).

Requirements for Rural Hospitals

 The hospitals—critical access hospitals, or CAHs—provide care in rural areas and are required to be at least 35 miles away from of any other CAH or hospital, or 15 miles if in a mountainous area where only two-lane roads are available. They must also be in designated rural tracts, have more than 25 beds for acute care, offer 24-hour emergency services, and have an average length of stay of fewer than 96 hours.

Before Jan. 1, 2006, states could exempt their CAHs from the distance requirement if they were deemed “necessary providers,” but the new report recommended CMS rewrite the rules to remove the necessary provider exemption and reassess the certification of the CAHs.

Nationwide, 849 out of 1,329 CAHs would not meet the location requirements, and 88 percent of those were necessary provider hospitals, the report found. If CAHs within 15 miles of a hospital were decertified, the report concluded, Medicare would save $449 million.

In Virginia, seven CAHs are operating, with Shenandoah Memorial Hospital in Winchester and Page Memorial Hospital in Luray within 35 miles of each other. Other hospitals, too, may not be able to qualify under the requirements.

Could Impact Access

As implementation of President Obama’s health care law moves forward, questions continue about access and Medicaid eligibility. Many states are still weighing whether to accept the expansion of Medicaid rolls in exchange for more federal funds.

Access to care has emerged as one of the issues related to expansion, as analysts have speculated less than 66 percent of primary care physicians would accept Medicaid reimbursement.

Rural care and other outlets are expected to provide some of the access. The Medicaid Innovation and Reform Commission, which will advise on whether to accept Medicaid expansion, is meeting in Richmond to estimate the costs of proceeding with the expansion or keeping to the status quo.

Carten Cordell ([email protected]) writes for Virginia Watchdog.


Internet Resources:

Department of Health and Human Services: “Most Critical Access Hospitals Would Not Meet the Location Requirements if Required to Re-Enroll in Medicare.”