Critical Access Hospitals (CAHs) – Resources
Selected recent or important resources focusing on Critical Access Hospitals (CAHs).
Sustaining Rural Labor & Delivery Programs: Strategies for Financial Analyses and Considerations for Maintaining Services
A guide for Critical Access Hospital and other rural hospital executives to use when assessing the financial viability of their Labor & Delivery programs. Outlines three strategies that may bring a Labor & Delivery program closer to sustainability and prevent unnecessary closure of services in rural areas.
Author(s): Eric Shell, Dahlia McGrath, Jeff Sommer, et al.
Date: 09/2025
Sponsoring organization: Flex Monitoring Team
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A guide for Critical Access Hospital and other rural hospital executives to use when assessing the financial viability of their Labor & Delivery programs. Outlines three strategies that may bring a Labor & Delivery program closer to sustainability and prevent unnecessary closure of services in rural areas.
Author(s): Eric Shell, Dahlia McGrath, Jeff Sommer, et al.
Date: 09/2025
Sponsoring organization: Flex Monitoring Team
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Rural Resource: Availability of Obstetric Simulation Training by State
Explores the availability of simulation training and continuing medical education (CME)/distance learning opportunities for both rural hospitals with obstetric units and those without obstetric units. Presents findings of an environmental scan of national, regional, and state-level obstetric training resources. Offers recommendations for ways State Flex Programs and Critical Access Hospitals can use this resource to identify applicable simulation trainings.
Author(s): Madeleine Pick, Hamdi Abas, Megan Lahr
Date: 09/2025
Sponsoring organization: Flex Monitoring Team
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Explores the availability of simulation training and continuing medical education (CME)/distance learning opportunities for both rural hospitals with obstetric units and those without obstetric units. Presents findings of an environmental scan of national, regional, and state-level obstetric training resources. Offers recommendations for ways State Flex Programs and Critical Access Hospitals can use this resource to identify applicable simulation trainings.
Author(s): Madeleine Pick, Hamdi Abas, Megan Lahr
Date: 09/2025
Sponsoring organization: Flex Monitoring Team
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MBQIP Navigator: Your Guide to Quality Reporting Success
Offers Flex Coordinators, Critical Access Hospital staff, and others who are working with the Medicare Beneficiary Quality Improvement Project (MBQIP) information to better understand the measure reporting process. Discusses how to register for the reporting site, which measures are to be reported, and how to submit data for each measure.
Date: 09/2025
Sponsoring organization: Rural Quality Improvement Technical Assistance (RQITA) Resource Center
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Offers Flex Coordinators, Critical Access Hospital staff, and others who are working with the Medicare Beneficiary Quality Improvement Project (MBQIP) information to better understand the measure reporting process. Discusses how to register for the reporting site, which measures are to be reported, and how to submit data for each measure.
Date: 09/2025
Sponsoring organization: Rural Quality Improvement Technical Assistance (RQITA) Resource Center
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An Evaluation of State Flex Program Initiatives to Support Critical Access Hospital-Based Rural Health Clinics
Describes the 16 State Flex Program (SFP) Critical Access Hospital (CAH)-based Rural Health Clinic (RHC) initiatives for the 2023-2024 funding year. Explores the various strategies SFPs have employed to assist CAH-based RHCs by highlighting common activities, challenges, and successes observed across their programs. Summarizes interviews with seven SFPs identifying common themes and notable variations in how they engage with CAH-based RHCs.
Author(s): Bridget Harr, Rebecca Stearns, John Gale
Date: 09/2025
Sponsoring organization: Flex Monitoring Team
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Describes the 16 State Flex Program (SFP) Critical Access Hospital (CAH)-based Rural Health Clinic (RHC) initiatives for the 2023-2024 funding year. Explores the various strategies SFPs have employed to assist CAH-based RHCs by highlighting common activities, challenges, and successes observed across their programs. Summarizes interviews with seven SFPs identifying common themes and notable variations in how they engage with CAH-based RHCs.
Author(s): Bridget Harr, Rebecca Stearns, John Gale
Date: 09/2025
Sponsoring organization: Flex Monitoring Team
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Skill Mix Versus Flexibility: Decoding Nurse Staffing Impacts on Critical Access Hospitals
Presents a study on the skill mix and flexibility of nurse staffing on the financial stability, care quality, and efficacy of Critical Access Hospitals (CAHs) in Pennsylvania from 2000 to 2023. Correlates skill mix and flexibility with hospital outcomes and controls for hospital-specific, socioeconomic, and demographic factors.
Author(s): Dinesh R. Pai, Esmaeil Bahalkeh
Citation: Journal of Rural Health, 41(3), e70075
Date: 08/2025
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Presents a study on the skill mix and flexibility of nurse staffing on the financial stability, care quality, and efficacy of Critical Access Hospitals (CAHs) in Pennsylvania from 2000 to 2023. Correlates skill mix and flexibility with hospital outcomes and controls for hospital-specific, socioeconomic, and demographic factors.
Author(s): Dinesh R. Pai, Esmaeil Bahalkeh
Citation: Journal of Rural Health, 41(3), e70075
Date: 08/2025
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HCAHPS Toolkit for Critical Access Hospitals
Designed to assist Critical Access Hospitals (CAHs) in reporting and utilizing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data. Provides a detailed description of HCAHPS as a Medicare Beneficiary Quality Improvement Project (MBQIP) core measure, strategies for improving HCAHPS survey response rates, and answers to common HCAHPS questions. Offers recommendations for utilizing HCAHPS data reports from vendors and the Flex Monitoring Team (FMT) and improving HCAHPS scores.
Date: 08/2025
Sponsoring organization: Flex Monitoring Team
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Designed to assist Critical Access Hospitals (CAHs) in reporting and utilizing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data. Provides a detailed description of HCAHPS as a Medicare Beneficiary Quality Improvement Project (MBQIP) core measure, strategies for improving HCAHPS survey response rates, and answers to common HCAHPS questions. Offers recommendations for utilizing HCAHPS data reports from vendors and the Flex Monitoring Team (FMT) and improving HCAHPS scores.
Date: 08/2025
Sponsoring organization: Flex Monitoring Team
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Critical Access Hospital and Hospital Requirements Streamlined to Reduce Burden
Outlines streamlined Joint Commission requirements for accreditation and Elements of Performance (EPs) for hospitals and Critical Access Hospitals (CAHs). Includes links to survey process guides, disposition reports, and crosswalk and crosswalk compare reports for each deemed program's Conditions of Participation and the equivalent Joint Commission EPs.
Date: 07/2025
Sponsoring organization: Joint Commission
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Outlines streamlined Joint Commission requirements for accreditation and Elements of Performance (EPs) for hospitals and Critical Access Hospitals (CAHs). Includes links to survey process guides, disposition reports, and crosswalk and crosswalk compare reports for each deemed program's Conditions of Participation and the equivalent Joint Commission EPs.
Date: 07/2025
Sponsoring organization: Joint Commission
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AHEAD CMS-Designed Medicare FFS Hospital Global Budget Calculator Tool for Critical Access Hospital
Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool for Critical Access Hospitals, which aims to support eligible CAHs in understanding the key elements of the AHEAD Medicare Fee-for-Service (FFS) HGB methodology. Discusses key differences in the hospital global budget construction and methodology for Critical Access Hospitals and fee-for-service hospitals.
Additional links: AHEAD Model CMS-Designed Medicare FFS Critical Access Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Critical Access Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool for Critical Access Hospitals, which aims to support eligible CAHs in understanding the key elements of the AHEAD Medicare Fee-for-Service (FFS) HGB methodology. Discusses key differences in the hospital global budget construction and methodology for Critical Access Hospitals and fee-for-service hospitals.
Additional links: AHEAD Model CMS-Designed Medicare FFS Critical Access Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Critical Access Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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The Impact of High Hospital Fixed-Cost Ratios on Rural Populations
Explores how rurality relates to hospital cost structures as categorized by Urban Influence Codes (UICs). Describes the characteristics of hospitals at different fixed-to-total-cost ratio levels, the demographics associated with hospitals at different ratio levels, and the share of nonmetropolitan hospitals that have Critical Access Hospital (CAH) or Low-Volume Hospital (LVH) designations. Discusses how findings could be used to refine hospital payment policies.
Author(s): Abigail Barker, Eliot Jost, Timothy McBride, Keith Mueller
Date: 06/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Explores how rurality relates to hospital cost structures as categorized by Urban Influence Codes (UICs). Describes the characteristics of hospitals at different fixed-to-total-cost ratio levels, the demographics associated with hospitals at different ratio levels, and the share of nonmetropolitan hospitals that have Critical Access Hospital (CAH) or Low-Volume Hospital (LVH) designations. Discusses how findings could be used to refine hospital payment policies.
Author(s): Abigail Barker, Eliot Jost, Timothy McBride, Keith Mueller
Date: 06/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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CAHMPAS Technical Bulletin: Revised Benchmarks and Data Exclusion Rules
Describes a review of 12 Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) benchmarks to reflect current operating conditions. Details which benchmarks were revised, unchanged, discontinued, or added. Also discusses revisions to the data exclusion rules to improve data quality.
Author(s): Aditya R. Pillutla, Kristie W. Thompson, George Pink, Kristin L. Reiter
Date: 06/2025
Sponsoring organization: Flex Monitoring Team
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Describes a review of 12 Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) benchmarks to reflect current operating conditions. Details which benchmarks were revised, unchanged, discontinued, or added. Also discusses revisions to the data exclusion rules to improve data quality.
Author(s): Aditya R. Pillutla, Kristie W. Thompson, George Pink, Kristin L. Reiter
Date: 06/2025
Sponsoring organization: Flex Monitoring Team
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