1. Rural Wisconsin Health Cooperative Critical Access Hospitals Better Medicare Financing For Smaller Hospitals Serving Rural Communities

2. Rural Wisconsin Health Cooperative CAH $ Due To Long Fight For Medicare Equity

3. Rural Wisconsin Health Cooperative Critical Access Hospital Background The opportunity to be paid as a Critical Access Hospital (CAH) is part of Medicare’s Rural Hospital Flexibility Program. CAHs have grown rapidly in popularity, in the states and with Congress, since Congress authorized them in October of 1997. Since then, the program has been significantly enhanced twice, mostly recently in the Medicare Prescription Drug Bill.

4. Rural Wisconsin Health Cooperative CAH Benefits Reimbursed at 101% of reasonable costs for inpatient, outpatient, and covered skilled nursing facility servicesReimbursed at 101% of reasonable costs for inpatient, outpatient, and covered skilled nursing facility services Reimbursement for on-call providers is extended to include PAs, NPs, and CNPs.Reimbursement for on-call providers is extended to include PAs, NPs, and CNPs. Periodic interim payments for inpatient services.Periodic interim payments for inpatient services. Eligible for enhanced outpatient payments based on facility costs plus 115% of the physician fee schedule for services provided by those physicians assigning their billings to the CAH.Eligible for enhanced outpatient payments based on facility costs plus 115% of the physician fee schedule for services provided by those physicians assigning their billings to the CAH. Reimbursed at 101% of reasonable costs for inpatient, outpatient, and covered skilled nursing facility servicesReimbursed at 101% of reasonable costs for inpatient, outpatient, and covered skilled nursing facility services Reimbursement for on-call providers is extended to include PAs, NPs, and CNPs.Reimbursement for on-call providers is extended to include PAs, NPs, and CNPs. Periodic interim payments for inpatient services.Periodic interim payments for inpatient services. Eligible for enhanced outpatient payments based on facility costs plus 115% of the physician fee schedule for services provided by those physicians assigning their billings to the CAH.Eligible for enhanced outpatient payments based on facility costs plus 115% of the physician fee schedule for services provided by those physicians assigning their billings to the CAH.

5. Rural Wisconsin Health Cooperative CAH Eligibility Criteria Must be > 35 miles from another hospitalMust be > 35 miles from another hospital OROR be designated as a “Necessary Provider” by the State. CAHs using this option must be certified as a CAH by Medicare before 1/1/06 when the option expires.be designated as a “Necessary Provider” by the State. CAHs using this option must be certified as a CAH by Medicare before 1/1/06 when the option expires. CAHs may become a PPS hospital at anytime but must meet the then current “Life Safety Codes.”CAHs may become a PPS hospital at anytime but must meet the then current “Life Safety Codes.” Must be > 35 miles from another hospitalMust be > 35 miles from another hospital OROR be designated as a “Necessary Provider” by the State. CAHs using this option must be certified as a CAH by Medicare before 1/1/06 when the option expires.be designated as a “Necessary Provider” by the State. CAHs using this option must be certified as a CAH by Medicare before 1/1/06 when the option expires. CAHs may become a PPS hospital at anytime but must meet the then current “Life Safety Codes.”CAHs may become a PPS hospital at anytime but must meet the then current “Life Safety Codes.”

6. Rural Wisconsin Health Cooperative CAH Operational Requirements No restriction on services which can be offered.No restriction on services which can be offered. Can operate up to 25 beds, acute (GMS, OB, ICU, etc) or swing.Can operate up to 25 beds, acute (GMS, OB, ICU, etc) or swing. Annual Average Length Of Stay < 96 hrs.Annual Average Length Of Stay < 96 hrs. Quality assurance maintained.Quality assurance maintained. Emergency services always available.Emergency services always available. Can establish a distinct part unit (psych. or rehab.); beds in the distinct part units cannot exceed 10.Can establish a distinct part unit (psych. or rehab.); beds in the distinct part units cannot exceed 10. No restriction on services which can be offered.No restriction on services which can be offered. Can operate up to 25 beds, acute (GMS, OB, ICU, etc) or swing.Can operate up to 25 beds, acute (GMS, OB, ICU, etc) or swing. Annual Average Length Of Stay < 96 hrs.Annual Average Length Of Stay < 96 hrs. Quality assurance maintained.Quality assurance maintained. Emergency services always available.Emergency services always available. Can establish a distinct part unit (psych. or rehab.); beds in the distinct part units cannot exceed 10.Can establish a distinct part unit (psych. or rehab.); beds in the distinct part units cannot exceed 10.

7. Rural Wisconsin Health Cooperative 846 CAHs in 45 states as of 1/1/04* * 2/3 rural hospital’s under 50 beds, approved when cap still only 15 beds

8. Rural Wisconsin Health Cooperative 32 WI CAHs & 17 Actively Considering as of 1/01/04* * >95% of Wisconsinhospitals <50 beds

9. Rural Wisconsin Health Cooperative Fed. Application & P.R. Emphasizes Local Gains Communicates hospital strengths & resources.Communicates hospital strengths & resources. Emphasis on local need.Emphasis on local need. Opportunity for new services that build on strengths and meet community needs.Opportunity for new services that build on strengths and meet community needs. Opportunity to eliminate services that cannot be supported by population base.Opportunity to eliminate services that cannot be supported by population base. Keep the community informed during the decision- making process.Keep the community informed during the decision- making process. Communicates hospital strengths & resources.Communicates hospital strengths & resources. Emphasis on local need.Emphasis on local need. Opportunity for new services that build on strengths and meet community needs.Opportunity for new services that build on strengths and meet community needs. Opportunity to eliminate services that cannot be supported by population base.Opportunity to eliminate services that cannot be supported by population base. Keep the community informed during the decision- making process.Keep the community informed during the decision- making process.

10. Rural Wisconsin Health Cooperative Coalition Guiding WI CAH Implementation Statewide policy and program issues are determined collaboratively through a coalition consisting of current and future CAHs, the WI Bureau of Quality Assurance, WI Office of Rural Health, Wisconsin Hospital Association, RWHC.

11. Rural Wisconsin Health Cooperative Important On-Line Resources CMS Critical Access Hospital Web Page http://www.cms.hhs.gov/providers/cah/default.asp Technical Assistance and Services Center (TASC) http://www.ruralresource.org/index.asp Rural Hospital Flex. Tracking Project http://www.rupri.org/rhfp-track Wisconsin Office of Rural Health http://www.worh.org/ CMS Critical Access Hospital Web Page http://www.cms.hhs.gov/providers/cah/default.asp Technical Assistance and Services Center (TASC) http://www.ruralresource.org/index.asp Rural Hospital Flex. Tracking Project http://www.rupri.org/rhfp-track Wisconsin Office of Rural Health http://www.worh.org/

12. Rural Wisconsin Health Cooperative Traditional Medicare Unlikely To Improve