GRMC to apply for Medicare critical access reimbursement system
By Mary Alice Murphy
At a special meeting Friday, March 6, 2020, the Gila Regional Medical Center Board of Trustees came out of executive session and approved the recommendation of Interim Chief Executive Officer and Chief Financial Officer Richard Stokes to authorize staff to file a Medicare Form 855 to request the designation of GRMC as a critical access hospital. The application will include the appropriate documentation to show the hospital fits the criteria.
Stokes has made it clear that the critical access reimbursement system takes away no services already provided at Gila Regional. The hospital by his calculations should benefit from the designation with an additional $4 million to as much as $5.8 million more received each year.
The criteria for a critical access hospital include filling no more than 25 acute care in-patient beds a day. At present and for the past few years, the hospital has filled an average of 18 beds a day. A critical access hospital must be located more than 35 miles from another hospital. It must maintain an annual average length of stay of no more than 96 hours for acute care patients. The average stay at Gila Regional is about 76 hours. And a critical care hospital must provide 24/7 emergency care services, which GRMC already does in its emergency room.
In the Balanced Budget Act of 1997, Congress created the Medicare Rural Hospital Flexibility Program to support new and existing critical access hospitals. It provides resources concerning payment/reimbursement and financial information, as well as other funding opportunities.
As of January 1, 2004, the cost-based reimbursement from Medicare makes CAHs eligible for allowable cost plus1 percent reimbursement. The designation allows for flexible staffing and services, as well as capital improvement costs, which can be included in allowable costs.
At a recent Board of Trustees meeting, Stokes estimated the process to receive the designation will take from six to nine months. "I call it a critical access reimbursement system that I believe ensures the viability of this hospital to stay in this community and continue to serve the residents, with no change in services."