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March 19, 2020

Centers for Medicare & Medicaid Services Waive Critical Access Hospital Bed and Inpatient Hours Limits

The Centers for Medicare & Medicaid Services (CMS) allotted a blanket waiver to critical access hospitals (CAHs) of certain Medicare certification requirements to aid their response to 2019 novel coronavirus disease (COVID-19) in CMS’s recent Emergency Declaration issued on March 13, 2020. Namely, CMS waived the requirement that CAHs maintain no more than 25 inpatient beds and that CAHs provide acute inpatient care for no longer than 96 hours per average annual inpatient.1 At this time, we could find no additional guidance regarding these blanket waivers.

Clearly, these waivers are intended to create flexibility for CAHs in responding to outbreaks of COVID-19 in rural areas by ensuring that health care decision-making is not restricted by federal, primarily reimbursement-related, hospital designation. That said, while the 96-hour waiver is likely easily operationalized, most CAHs license no more than 25 beds due to the federal regulation. Therefore, to expand beyond 25 beds (assuming they have space), most CAHs would require an additional state waiver of their licensed bed limit. At the time of this writing, we are unaware of any state waivers of hospital licensed bed limits (although we suspect one-off state waivers would be forthcoming, if necessary).

  1. See 42 C.F.R. § 485.620.

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