LOWVILLE — A 2015 sub-regulation change involving the definition of roads could have a massive financial impact on three north country hospitals.
At the New York State Critical Access Hospital Performance Improvement meeting on Jan. 24 in Troy, the state Department of Health gave a presentation that revealed the reason Massena Memorial Hospital was not approved for the Critical Access designation last year.
According to the program regulations created by the Centers for Medicare and Medicaid Services, hospitals must be either 35 miles away from the nearest hospital on primary roads or “15 miles in areas with mountainous terrain or only secondary roads” to be eligible for Critical Access designation.
In 2015, the regulation stating the definitions for primary roads changed to include any “US-Numbered Highway (also called “US Routes” or “US Highways”) as designated by the American Association of the State Highway and Transportation Officials,” all of which have “six point shield” signs that have “US” or “I” above the number, according to the sub-regulation.
The Department of Health provided a map showing that State Routes 26, 3 and 11 are all considered part of the U.S. Highway system with the new definition and therefore Lewis County General Hospital, Carthage Area Hospital and Gouverneur Hospital would all be disqualified
The Lewis County, Carthage and Gouverneur hospitals are all up for recertification this summer for the first time since they were designated as Critical Access Hospitals in 2014, leaving time to prepare the lengthy recertification application while trying to ensure the sub-regulation doesn’t prevent their recertification.
According to information provided at the meeting, there is likely to be nine of the 18 Critical Access hospitals in the state, including the three north country facilities, that will not meet the updated criteria, resulting in a $39 million total loss to those budgets. For Lewis County alone the loss would be more than $5 million.
“Imagine a $5.3 million cut to the hospital’s budget. Right now, today, I don’t think we could withstand this providing the services that we do,” Mr. Cayer said.
Both Lewis County and Carthage Area Hospitals are in the process of organizing large capital projects to improve their facilities and improve the service they provide.
“I think this would make us rethink that entire project,” said Carthage Area CEO Richard A. Duvall, “This is a new potential threat to all Critical Access Hospitals and it needs more evaluation.”
Carthage stands to lose $9.7 million should it lose its certification, while Gouverneur would lose $3.3 million.
There hasn’t been a new Critical Access designation in the state since 2014, according to Mr. Cayer, and while there were new designations and certifications nationwide, the rule was not interpreted in the same way in every region.
Mr. Cayer addressed the hospital Board of Managers in its monthly meeting Jan. 30, and the Board of Legislators in its Tuesday night meeting, informing them of the issue.
No public hearing is needed for a sub-regulation change and the Department of Health representative at the meeting said they weren’t aware of the change until they received notice that it was the reason the Massena hospital was not granted the designation.
“At this point we have no reason to think CMS has tried to decrease the number of certified hospitals. We believe they just didn’t realize the full impact of the change,” Mr. Cayer said.
The Department of Health is leading the group of hospitals to address the issue on three fronts: through the CMS administration to reverse the sub-regulation; supporting legislation to give primary roads a definition specifically for the Critical Access regulations; and pursing legal action to stop the enforcement of the sub-regulation.
Because one-third of the hospitals in the state potentially impacted by the issue are in Rep. Elise Stefanik’s district, hospital representatives have also been in communication with her office, Mr. Cayer said.
In addition to distance qualifications Critical Access hospitals must have 25 or less inpatient beds, an annual average inpatient length of stay of 96 hours or less and provide 24-hour emergency services seven days every week.
Spokesperson for Massena Memorial Hospital Tina Corcoran said the hospital’s application for Critical Access designation was not officially denied and although approval would have resulted in more money for the hospital, she said the plan to become a non-profit instead of a municipal hospital was not related.
“We have been talking about joining the St. Lawrence Healthcare System for years,” Ms. Corcoran said, “Long before we even applied for Critical Access.”
The Centers for Medicare and Medicaid Services created the Critical Access Hospital designation in 1997 after many rural hospitals closed. It’s designed to “reduce the financial vulnerability of rural hospitals and improve access to healthcare.”