GRANTS, NM - This fall, Cibola General Hospital qualified for Critical Access Hospital status by the Centers for Medicare and Medicaid Services (CMS). The change in status is retroactive dating back to September of 2008. Cibola General Hospital applied for this change in status several years ago, but was initially denied. CGH appealed the CMS’s initial decision.

The change in status will allow Cibola General to be reimbursed more fully by the Medicaid and Medicare programs without impacting patient services. Critical Access Hospitals are reimbursed by Medicaid/Medicare based on the actual cost of providing care, the way all hospitals were reimbursed when the programs were created in 1965. Medicare reform changed that system of reimbursement for most hospitals in 1983, creating the Prospective Payment System, which reimburses hospitals based on the diseases and diagnosis treated rather than the actual cost of care.

Because reformers recognized that the new payment system would be unsustainable for small and rural hospitals, the Critical Access Hospital (CAH) program was implemented at the same time.

In order to qualify as a CAH, a hospital must meet three basic criteria. First, it must be at least 35 miles from the next nearest hospital, a condition that Cibola General did not meet easily, due to the proximity to the ACL Indian Health Services Hospital. Second, the hospital must maintain an annual average length of stay of 96 hours per patient for acute inpatient care. Finally, to be a CAH, the average number of medical/surgical, ICU, OB and swing beds must be 25 or less.

Hospital leadership stresses that the CAH status will not dictate any change in services offered at Cibola General or in the payments required from patients. It is strictly a change in federal reimbursement.

"Critical access is strictly a reimbursement model with the federal government. It has nothing to do with the services offered," added CEO, Michael Makosky. “With potential increased reimbursement, the hospital will also be able to provide more equipment and technology, which is vital for patient care and physician recruitment,” added Makosky.

Together, patients covered by Medicare and Medicaid account for roughly 65-75% of services provided at Cibola General, so this change in reimbursement will have a significant effect on the facility's bottom line.

Other Critical Access Hospitals in New Mexico include those in Tucumcari, Ruidoso, Raton, Lovington, Truth or Consequences, Socorro, and Clayton.

For more information about Cibola General Hospital visit www.cibolahospital.com