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​An Acute Care facility may qualify as a Critical Access Hospital if the acute care facility is non-profit, public or for profit. The Office of Inspector General, Division of Healthcare shall certify the acute care facility as a necessary provider of health services.

Criteria

  • The facility must be located in a rural county more than 35 miles from another acute care facility, 15 miles if in a mountainous area.
  • The emergency room should have 24-hour availability.
  • A Critical Access Hospital must be in compliance with 42 CFR 485.645(d)(1–9).
  • A Critical Access Hospital (CAH) may maintain no more than 25 inpatient beds. When a CAH has Medicare approval to furnish swing bed services, for Kentucky Medicaid it may use any of its 25 inpatient beds for either acute care or SNF-level care. 
    A yearly average length of stay may not exceed 96 hours.
  • According to 906 KAR 1:110, the acute care facility also needs to meet one of the following criteria:
    1. Be located in a county where the percentage of the population with income less than 200 percent of poverty is greater than the state average, based on data published by the UK Center for Rural Health;
    2. Be located in a county that has an unemployment rate higher than the state average unemployment rate, based on data published by the Cabinet for Health and Family Services (CHFS);
    3. Be located in a county with a greater number of people age sixty-four (64) or older than the state average, based on data published by the UK Center for Rural Health;
    4. Treat on average a higher than state average percentage of Medicare patients, based on data published by CHFS;

Services

A critical access hospital shall provide the services in accordance with KRS 216.380(5).

Information

Regarding licensure: contact Office of Inspector General, Division of Health Care at 502-564-7963 (phone) or 502-564-6546 (fax).

Regarding billing: contact HPE at 800-807-1232 or visit their website.

Regarding members: contact Member Services at 800-635-2570.

Provider Services: contact (855) 824-5615.

Regarding Provider Enrollment: contact Provider Enrollment at 877-838-5085 or visit their website.