Critical Access Hospitals Celebrate 25 Years of Service

This month marks the 25th anniversary of the passage of the Balanced Budget Act of 1997.  Included in the law was the creation of the Critical Access Hospital (CAH) designation.  This landmark legislation has proved to be a significant policy achievement for the delivery of rural healthcare.  Montana and the Montana Hospital Association have been leaders in rural health policy development.

Prior to the enactment of the CAH designation, the Medical Assistance Facility (MAF) demonstration was created by the federal government and managed by the Montana Health Research Education Foundation (MHREF), which was considered the most successful limited-service hospital model.  MAF played a major role in the reopening of McCone County Health Center in Circle, followed by Garfield County Hospital in Jordan and Dahl Memorial in Ekalaka.  With MHA’s assistance, this program evolved into the Essential Access Community Hospital (EACH) and then to the Primary Care Rural Hospital (RPCH) demonstration.  These efforts tested new approaches to ensuring the viability of rural and frontier hospitals.  The work of MHREF and MHA resulted in the creation of the CAH designation, which has ensured access to healthcare services in our nation’s most vulnerable communities.  Again, the focus on rural and frontier hospitals came from Montana with former Senator Max Baucus serving as the author of the CAH law and the work of the Senate Finance Committee.

As an association, we have much to celebrate this month.  Our collective work helped change healthcare in America.  Here in Montana, we have not lost a critical access hospital since the passage of the law, and some that had closed re-opened because of the groundbreaking work leading up to the CAH designation.  Another essential feature of the CAH development is the creation of the Medicare Rural Hospital Flexibility (FLEX) Program, which MHREF also manages in partnership with the Department of Public Health and Human Services (DPHHS).  Montana’s approach to managing the FLEX program builds on the collective work of MHREF’s quality improvement, clinical support, Performance Improvement Network (PIN), education, hospital engagement, and state and national support services which further strengthen the operational and financial performance of Montana’s 49 critical access hospitals.  Often recognized as one of the best FLEX programs in the country, MHREF’s model in partnership with DPHHS, engages the membership in workplan development that is timely, relevant, measurable, and impactful.

With more than 180 rural hospital closures in America over the past 25 years and none in Montana, MHA is proud of its work in support of our state’s critical access hospitals and its collaboration with DPHHS.  Together, we have built a model that has sustained our state’s hospitals and demonstrated to the nation how to improve health and healthcare in rural and frontier communities.


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