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Critical Access Hospital Accreditation Fact Sheet

The Joint Commission has been accrediting hospitals for over 70 years and critical access hospitals (CAH) for more than 20 years. Currently, of the CAHs in the U.S., 360, or about 26.8%, are accredited by The Joint Commission, and 68% of accredited CAHs are accredited by The Joint Commission.

The Joint Commission obtained deemed status recognition for its Critical Access Hospital Accreditation Program from the Centers for Medicare & Medicaid Services (CMS) in 2002, allowing The Joint Commission to conduct both conversion (the initial survey to transition from a general acute care hospital to become a CAH) and recertification surveys.

For a facility to be designated by CMS as a CAH, it must:

  • Be located in a state that has established a state Medicare Rural Hospital Flexibility Program.
  • Be designated by the state as a CAH.
  • Be located in a rural area or be treated as rural.
  • Be located more than a 35-mile drive from any other hospital or CAH (in mountainous terrain or in areas with only secondary roads available, the mileage criterion is 15 miles), or prior to January 1, 2006, was certified as a CAH based on state designation as a "necessary provider" of healthcare services to residents in the area.
  • Maintain no more than 25 inpatient beds that can be used for either inpatient or swing-bed services.
  • Maintain an annual average length of stay of 96 hours per patient for acute inpatient care.
  • Comply with all CAH Conditions of Participation (COPs), including the requirement to make available 24-hour emergency care services 7 days per week.
  • Additionally, the following providers may become eligible to transition to a CAH: Currently participating Medicare hospitals; a participating hospital that ceased operation after Nov. 29, 1989; a health clinic or health center that was downsized from a hospital.

The CAH accreditation experience with The Joint Commission includes: 

  • Support from dedicated staff to help a CAH navigate the accreditation process and assist in the interpretation of standards.
  • Expert employed surveyors familiar with CAHs who conduct the on-site survey and provide best practices to hospital staff to help them learn from the experience of others.
  • Data analytics tools to support CAHs in driving quality improvement and reducing risk within their organization.
  • Survey preparation and planning tools, such as survey activity and documentation lists, and survey preparation notes.
  • Complimentary resources to guide organizations through their own performance improvement and quality safety initiatives.

Cost of Critical Access Hospital Accreditation

The Joint Commission uses an annual subscription billing model which spreads the accreditation costs over a three-year period. The on-site survey fee is invoiced after the on-site survey is concluded and covers survey-related costs. For more information, contact the pricing unit at 630-792-5115 or  .

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