Minnesota Hospital Association

Policy & Advocacy

Rural Hospitals Provide Access to Care

Rural hospitals are essential to providing access to care in Greater Minnesota communities. In addition, they contribute significantly to their communities' economic vitality through the staff they employ and the goods they purchase. The association works with rural Minnesota hospitals to address a number of unique challenges from recruitment to reimbursement.

Critical access hospitals

Minnesota has 78 hospitals designated as critical access hospitals (CAH), the third highest number in the nation. Located in rural areas, these hospitals are critical to ensuring residents and visitors in Greater Minnesota have access to vital hospital services when needed.

CAH designation allows hospitals to be reimbursed by the federal government for the actual costs of caring for Minnesotans on Medicare. The guarantee of cost-based reimbursement offers financial stability for small, rural hospitals and protects access to essential health care services in smaller communities. The cost-based reimbursement also can help these hospitals make necessary investments in equipment, facilities and staff. Federal lawmakers created this designation option in 1997.

Requirements for critical access hospitals

CAH hospitals in Minnesota must be able to provide 24-hour nursing and emergency services. In addition, they must:

  • be a licensed and operating not-for-profit hospital that currently participates in the Medicare program and is located in a rural area;
  • be located at least 35 miles from another hospital or 15 miles if it is an area with only secondary roads or be certified by the state as a "necessary provider";
  • limit inpatient acute care beds to no more than 25 beds, with up to 10 swing beds allowed as well;
  • have an average length of stay of no more than 96 hours;
  • participate in a rural health network; and
  • meet certain credentialing and quality improvement standards.

For complete federal and state eligibility requirements visit the Minnesota Department of Health, Office of Rural Health and Primary Care's website.

Minnesota's "tweener" hospitals

Minnesota also benefits from 21 regional hospitals that sometimes face the additional challenges of managing patient volumes that can be too low to thrive under the traditional below-cost payment system used by Medicare. At the same time, these hospitals provide levels of care that are too high to qualify for CAH status. These hospitals — unofficially referred to as “tweener” hospitals — provide crucial services to entire regions of the state.