Hospital to Retain Critical Access StatusCMS rescinds termination notice
GOLD BEACH, OR (May 8, 2018)- Curry Health Network's CEO Ginny Razo announced today that Centers for Medicare and Medicaid Services (CMS) has rescinded their earlier determination that Curry General Hospital's Critical Access Hospital (CAH) status would be terminated because it no longer met location requirements to retain the status.
"I am so pleased to announce that the evidence we submitted to CMS was accepted, and Curry Health Network (CHN) will continue to be designated as a Critical Access Hospital," Razo said. "Maintaining this status allows Curry to continue to receive the financial benefit of cost-based reimbursement for Medicare services."
The letter from CMS received via fax on the afternoon of May 7 stated, "CMS recognizes Curry as a necessary provider and rescinds its termination of Curry's designation as a CAH." It further went on to explain that CHN had provided acceptable evidence that Curry's clinic in Brookings, Curry Medical Center, is a "grandfathered off-campus site" and as such, is exempt from the need to meet the 35-mile location test from other hospitals or off-campus sites.
When Curry General became a CAH in 2004, CMS did not interpret the regulations requiring a 35-mile distance from another hospital to include off-campus, provider-based clinics. In fact, at that time in 2004, Curry operated a clinic in Brookings and that clinic was licensed under the hospital license. In addition, Sutter Coast Hospital's provider-based clinic in Brookings was also in existence when Curry General became a CAH.
A letter received April 3, 2018 from CMS said the CAH status would be terminated in April 2019 because it no longer met the mileage requirements, citing the distance from the Curry clinic to Sutter Coast Hospital in Crescent City, California, as well as the distance from the Sutter clinic to Curry General Hospital in Gold Beach. As Razo said at the time, "It appears CMS is now interpreting those location requirements differently."
Razo had two possible plans of action, each with the same 60-day deadline to respond. If no action was taken, the CAH status would be terminated in 2019, the favorable reimbursement rates would be eliminated, and the financial impact would likely have been immense.
The first plan of action was to provide evidence to CMS to establish that Curry met Necessary Provider (NP) status prior to January 1, 2006 (a date established by CMS). NP status criteria was established by the Office of Rural Health, a responsibility delegated to the agency by the Oregon Health Authority. In 2004, neither Curry nor the Office of Rural Health could anticipate the need to establish NP status, as Curry met all the federal criteria including the distance requirement - and it would have been impossible to predict that CMS would, years later, interpret the location requirements to include provider-based clinics.
The second plan of action was to file an appeal through the federal court system - a plan that may have been costly but is now unnecessary.
Razo was working on both plans simultaneously, and on April 27, submitted evidence to CMS to support it met NP status in 2006. "The evidence showed we met Necessary Provider status in 2004 when Curry was designated a Critical Access Hospital, that it has continued to meet the criteria, and that - even today - still meets that criteria," Razo said.
"Gathering the evidence to support our position was accomplished with assistance from many different persons and many different agencies," Razo said. "Meredith Guardino and others with the Office of Rural Health, Dana Selover of the Oregon Health Authority, Gary Milliman with the City of Brookings, Jim Kolen, Amy and Tracy with the Curry County Assessor's office - all these individuals made themselves immediately available and provided key pieces of evidence. Without it, CMS may not have come to this favorable decision."