Hospital Support Programs

Supporting Louisiana Hospitals in Rural Areas

Connecting Rural Facilities to Hospital Support Programs

In support of meeting the unique needs in Louisiana, Well-Ahead connects rural facilities to hospital support programs that help ensure the success of healthcare development projects and provide technical assistance to address the healthcare needs in rural areas.

What is the Critical Access Hospital Program?

The Critical Access Hospital (CAH) Program was included in the Balanced Budget Act of 1997 (BBA). The BBA had a severe financial impact on hospitals around the country. To help alleviate the impact on small, rural hospitals, the BBA created the Medicare Rural Hospital Flexibility Program, which allows rural hospitals to receive a higher reimbursement rate and have greater flexibility from federal rules and regulations. Across the United States, more than 700 rural hospitals have converted to CAH status since 1999.

Critical Access Hospital Guidance

Program Benefits

  • 101 percent Medicare cost-based reimbursement for inpatient, outpatient and swing bed care
  • Relief from Federal regulations of full-time coverage of dietary, pharmacy, lab and x-ray
  • Cost-based reimbursement for CAH ambulance service allowed if 35-mile requirement is met
  • Allowable on-call coverage cost of the emergency room, includes mid-level providers
  • Distinct Part Units 10 bed allowance (geri-psych or rehab) effective 10/04
  • 115 percent of the Medicare physician fee schedule on physician assigned billing
  • Technical Assistance including:
    • Health system network development services
    • State-wide CAH quality improvement initiatives
    • Performance improvement services:
      • Financial
      • Practice management
      • Recruitment

Eligibility Requirements

The program accepts eligible hospitals who serve in a rural parish, are 35 miles from another hospital (15 miles on secondary road) or designated as “necessary provider” by the State and licensed hospital participating in the Medicare program. In addition, hospitals must meet the following program requirements:

  • May have up to 25 acute and/or swing beds
  • 96 hours annual length of stay
    • Excluding swing and hospice beds
  • Offer inpatient and outpatient care services
  • Emergency care available 24 hours a day with medical staff on-call and available within 30 minutes
    • Staff must be trained or experienced in emergency care
  • Medical staff must consist of at least one MD or DO and may include mid-level providers
  • One RN on duty 24 hours a day
    • Can serve in the emergency room, acute and swing-bed units;
  • Patient referral and transfer agreement with a network hospital
  • Must have available routine and emergency patient transportation
  • Credentialing and quality assurance assistance agreement with a hospital or quality improvement organization (QIO)

State Operations Manual for Critical Access Hospitals (rev. 6-7-13)

What is the Medicare Beneficiary Quality Improvement Project (MBQIP)?

The Medicare Beneficiary Quality Improvement Project (MBQIP) is a quality improvement activity under the Federal Office of Rural Health Policy’s (FORHP) Medicare Rural Hospital Flexibility (FLEX) grant program. Implemented in 2011, the goal of MBQIP is to improve the quality of care provided in critical access hospitals (CAHs) by increasing quality data reporting by CAHs and then driving quality improvement activities based on the data.

MBQIP provides an opportunity for individual hospitals to look at their own data, compare their results against other CAHs and partner with other hospitals around quality improvement initiatives to improve outcomes and provide the highest quality care to each and every one of their patients. As the U.S. moves rapidly toward a health care system that pays for value versus volume of care provided, it is crucial for CAHs to participate in federal, public quality reporting programs to demonstrate the quality of the care they are providing. Low numbers are not a valid reason for CAHs to not report quality data. It is important to provide evidence-based care for every patient, 100 percent of the time. MBQIP takes a proactive approach to ensure CAHs are well-prepared to meet future quality requirements.

What is the Medicare Rural Hospital Flexibility (FLEX) Program?

The Medicare Rural Hospital Flexibility (FLEX) Program is a 100% federally funded grant program through Health Resources and Services Administration (HRSA). The FLEX program supports Louisiana critical access hospitals participating in the MBQIP and operates on the National, State, community and facility levels to cover a broad range of fundamental health service issues and respond to the changing needs specific to Louisiana CAHs and the communities they serve. Funds are used to provide training, technical assistance and other relevant activities aimed at improving the quality of patient care and the financial and operational outcomes of CAHs. 

  • Supports 25 CAHs participating in the Medicare Beneficiary Quality Improvement Program (MBQIP) to report on core measures and use reports to make improvements in patient care and administrative efficiency
  • Supports a targeted financial assessment to provide information and assistance to Louisiana CAHs
  • Supports training in new and upcoming health industry changes (i.e. Quality Payment Program)
  • Supports individualized innovative projects when new funding opportunities arise

What is the Small Rural Hospital Improvement (SHIP) Program?

The Small Rural Hospital Improvement Program (SHIP) is a 100% federally funded grant program through HRSA. The program supports Louisiana hospitals with 49 beds or less located in rural locations. The SHIP Program provides training, technical assistance and other supports to SHIP hospitals in the follow service areas:

  • Value-Based Purchasing
  • Accountable Care Organizations and/or Shared Savings
  • Payment Bundling and/or Prospective Payment System
  • Facilitates rural hospital network development (cuts across both the FLEX and SHIP grant programs)