West Virginia Rural Hospital Flexibility (Flex) Program
Introduction
The WV Rural Hospital Flexibility Program (WVRHFP), often referred to as the Critical Access Hospital Program or the Flex Program, resulted from a major national initiative to strengthen rural health care by:
Allowing small hospitals the flexibility to reconfigure their operations, particularly for acute inpatient care as Critical Access Hospitals (CAHs).
Offering cost-based reimbursement for Medicare acute inpatient, swing bed services and outpatient services. The West Virginia Bureau for Medical Services supports the program by also offering cost-based reimbursement for Medicaid patients.
Encouraging the development of rural health networks.
Offering grants to hospitals to strengthen the rural health care infrastructure.
The CAH program requires participating states to develop rural health plans, and funds the states to support and implement community-level outreach and technical assistance. Although focused on very small, rural hospitals, this complex intervention operates on the national, state, community and facility levels and covers a broad range of health service issues.
WV Critical Access Hospital Map (PDF Format, requires Adobe Acrobat Reader)
Program History
In February 1998, West Virginia became the first state in the nation to receive approval from the Centers for Medicare and Medicaid Services to implement the Medicare Rural Hospital Flexibility Program. The program is administered in West Virginia by the Division of Rural Health in the Office of Community and Rural Health Services, Bureau for Public Health, in collaboration with the West Virginia Hospital Association.
The Medicare Rural Hospital Flexibility Program (MRHFP) was created by the Balanced Budget Act of 1997, which was signed into law in August 1997. The MRHFP replaced the Essential Access Community Hospital (EACH) Program, which was established in 1989, and authorized in seven states only, including: West Virginia , New York, North Carolina, South Dakota, Kansas, Colorado and California. The EACH Program was designed to increase rural health care access. The program essentially paired small rural hospitals with larger hospital facilities and focused on sharing of resources and elimination of service duplications. This affiliation provided benefits to both hospitals. West Virginia designated six hospitals as Rural Primary Care Hospitals under this Program.
Designation Criteria
To be designated by the state as a Critical Access Hospital (CAH) in West Virginia, and subsequently certified by the Centers for Medicare and Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA); a hospital must be located more than a 35 mile drive from another health care facility (15 miles in the case of mountainous terrain) to residents in the area. CAHs provide a maximum of 25 acute or swing care beds for inpatient care for a period not to exceed an annual average of 96 hours.
A CAH must have emergency services available on a 24 hour basis, but need not otherwise staff the facility except when an inpatient is present. Such inpatient services may be provided by a physician assistant, nurse practitioner, or clinical nurse specialist subject to the oversight of a physician who does not have to be present int the facility. Staffing decisions, made by the individual hospitals, take into consideration preferences and support of the community.
The CAH in West Virginia must have an agreement with at least one EMS agency for Emergency and Non-Emergency transport.
The CAH in West Virginia must have an agreement with at least one hospital for patient referral and transfer and use of communication systems. Additionally, the CAH must have an agreement with a network member hospital or other organization for credentialing and quality assurance. In West Virginia these agreements are typically made with the Affiliate Hospital.
Critical Access Hospital Definition - A printable PDF Version is available.
Application Process
In West Virginia, any hospital considering conversion to Critical Access Hospital status must submit an application to the Division of Rural Health. The Application must be initiated by the hospital and signed by the Hospital CEO and Board President. The application must include a completed Community Needs Assessment (CNA) and Financial Feasibility Study (FFS).
The CNA is a comprehensive study of the existing health care system. It identifies the services available to the community service duplications and services needed by the community.
The CNA process helps define those services the CAH might offer which are most likely to be utilized by the community. The Financial Feasibility Study provides information regarding the financial impact on the hospital should conversion occur.
When all eligibility criteria is met, the state may designate the hospital as a CAH. The newly designated facility must then be surveyed by the WV Office of Health Facilities Licensure and Certification (OHFLAC). When a satisfactory survey is completed, OHFLAC will recommend to the Centers for Medicare and Medicaid Services (CMS) that the facility be certified as a Critical Access Hospital.
Rural Health Networks
Network participation has proven to be vital to Critical Access Hospitals. Agreements developed with larger hospitals (Affiliate Hospitals) often afford access to management expertise, purchasing power, and training opportunities that may have otherwise been unavailable to the smaller facility. Most CAHs participate in the WV Rural Health Education Partnerships (WVRHEP) Program and/or other programs linking small rural providers to educational resources such as medical schools, colleges and universities. West Virginia CAHs also benefit from collaborative efforts such as those with social services agencies and school based health centers. WVRHEP staff continue working with hospitals who are either considering conversion to CAH or are going through the application process.
Presently, West Virginia has eighteen hospitals certified as Critical Access Hospitals - A printable PDF Version is available.
Grant Program
Congress first approved Medicare Rural Hospital Flexibility, often referred to as "Flex" Program grant funds in Fiscal Year 1999-2000. The WV Rural Hospital Flexibility Program applied for, and was awarded, Flex grant funds by the Federal Office of Rural Health Policy. These grants have allowed the Program to award grant funds to certified CAHs and to hospitals interested in studying the feasibility of conversion to CAH.
CAH Grant Program Funding Priorities - A printable PDF Version is available.
