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What is a Rural Hospital?
Rural hospitals are a crucial part of New Hampshire’s healthcare delivery system and make up 16 of the 26 acute-care hospitals in the state. Rural hospitals provide essential emergency department services, inpatient care, long-term care, and care coordination services to areas that otherwise would not have access. Populations served in rural hospitals tend to be older, poorer, and more likely to have chronic diseases and depend on public programs for healthcare coverage. In addition to providing access to healthcare for these populations, rural hospitals also significantly impact the local economy by providing jobs, utilizing area businesses for equipment and resource needs, and attracting new businesses to the area due to availability of services.

There are unique financial and staffing challenges faced by rural hospitals, and since these challenges have been recognized, several designations have been created to positively impact their bottom line. There are four different designations for rural hospitals that allow different financial compensation for services:

  • Critical Access Hospital (CAH),
  • Disproportionate Share Hospital (DSH),
  • Rural Referral Center (RRC), or
  • Sole Community Hospital (SCH)

For more information on DSH, RRC, or SCH designations visit the Rural Health Information (RHI) Hub . The New Hampshire State Office of Rural Health manages two grant programs that target our Critical Access Hospitals.

What is a Critical Access Hospital (CAH)?
Critical Access Hospitals (CAHs) are a designation given to certain rural hospitals by the Centers for Medicare and Medicaid Services (CMS) as part of the 1997 Balanced Budget Act. Critical Access Hospitals are supported by a federal grant called the Medicare Rural Hospital Flexibility (Flex) Program. The Flex grant is just part of the important work being done by the New Hampshire’s State Office of Rural Health, housed within the Division of Public Health Services.

A Critical Access Hospital is a small, rural hospital with 25 or fewer acute care inpatient beds, located more than 35 miles from another hospital, or 15 miles by mountainous terrain or secondary roads. The length of stay in a CAH must average 96 hours or less for acute care services, and the hospital must provide 24/7 emergency care services. If all qualifications are met, a hospital will be designated as a CAH and receive 101 percent of allowable costs for reimbursement from Medicare.

Find out more about New Hampshire Critical Access Hospitals and the Flex Program Adobe Acrobat Reader Symbol.

Medicare Beneficiary Quality Improvement Project
The Medicare Beneficiary Quality Improvement Project (MBQIP) is one way New Hampshire’s Critical Access Hospitals work to continuously improve patient care. MBQIP is a component of the Medicare Rural Hospital Flexibility grant program administered by the State Office of Rural Health and Primary Care. See the federal Rural Hospital Program web page for more information about the federal program.

Critical Access Hospitals report their performance on MBQIP quality measures related to patient safety, patient engagement, care transitions, and outpatient care of patients in the emergency department.

The following are MBQIP Resources to assist Critical Access Hospitals with the quality reporting process:


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New Hampshire Department of Health and Human Services
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