MALONE — After applying for a change in designation earlier in the year, Alice Hyde Medical Center has received designation as a Critical Access Hospital.

The federal Centers for Medicare and Medicaid Services approved the change in designation, according to Phillip A. Rau, a spokesperson for the Malone hospital.

“Effective immediately we are a Critical Access Hospital, it’s been retroactively dated to Oct. 1, we got the letter last week but it is effective on Oct. 1,” Rau said.

The Critical Access Hospital designation provides hospitals with enhanced reimbursement rates to help keep essential healthcare services in rural communities, according to Rau.

“The federal government is reimbursing the hospital more money and it is actually covering the cost of care,” Rau said, “This new reimbursement model is going to provide more financial stability and it is going to make us a more sustainable organization over the long term. If we are getting more equitable reimbursement for the care we provide we will have more money to invest in the hospital, invest in our facilities, our people, and our services. It’s about financial stability and sustainability.”

In addition to the application process through the Centers for Medicare and Medicaid Services, the change in designation process included review and approval from the state’s Department of Health, according to Rau.

“This is really a reimbursement model change for the hospital, it provides enhanced reimbursement from CMS for the care and services the hospital provides to Medicare patients,” Rau said, “In general round numbers the way the reimbursement works for hospitals, most get somewhere in the neighborhood of 80 to 85% reimbursement of the cost of care. We provide $100 worth of care and we get $80 to $85 back. With critical access status it is more equitable and actually reflects the cost of providing care.”

To become a CAH, Alice Hyde had to meet certain eligibility requirements, including being located in a rural area more than 35 miles from the next nearest hospital, having a maximum of 25 inpatient beds, maintaining an average length of stay of 96 hours or less for patients receiving acute inpatient care and providing 24-hour emergency care seven days per week, according to a prepared statement from the Malone hospital.

“Our hospital already operates like a Critical Access Hospital in many ways — but we don’t get the financial benefits that Critical Access Hospitals enjoy,” Alice Hyde President Michelle LeBeau, said in the press release, “Members of our community can rest assured that Critical Access status won’t reduce services or change the way our patients receive care. This is about doing everything we can to ensure we are here always to provide the care our community needs.”

A CAH accreditation survey conducted in late August, part of the change in designation process, reviewed every aspect of Alice Hyde’s clinical operations, administrative and operational policies and procedures, patient and family experience apparatus, and emergency preparedness and planning, according to the release.

“Our successful Joint Commission Critical Access Hospital survey confirmed that Alice Hyde has met and exceeded the high bars we set for patient safety, clinical best practices and organizational operations every day,” Becca Shutts, Alice Hyde’s chief nursing officer, said in the release. “This was the culmination of many months of hard work by teams across our hospital.”

The North Country Chamber of Commerce released a statement in support of the change in designation Monday afternoon, which said the chamber met in May with the North Country’s federally elected officials, Senator Kirsten Gillibrand, D-N.Y., Chuck Schumer, senate majority leader, and Elise Stefanik, R-Schuylerville, to support the move.

“All three were highly receptive and engaged in active support, understanding the importance of this designation to enhancing federal payment for care and thereby strengthening the hospital’s operations and all of its invaluable services,” Garry Douglas, the chamber’s president, said in a press release, “We congratulate Alice Hyde and join them in thanking our federal representatives for going to bat. Onward and upward.”

In April, Malone hospital officials said the move will mean more funding for the community hospital amid a time of financial and operational challenges for rural health care providers across the country.

Officials said the move has been considered in the past but did not make financial sense until this year.

Changes in reimbursement rates, the impact of the coronoavirus pandemic, and a nationwide trend of rural hospitals operating at losses all contributed to the decision to submit the certificate of need, officials said, earlier in the year.

There are no restrictions on the services a CAH can provide, and Alice Hyde does not expect any service reductions as a result of pursuing CAH status. There are no staffing losses expected and officials said they continue to actively recruit, according to a past press release from the University of Vermont Health Network.

As part of its transition to CAH status, Alice Hyde instituted a sub-acute care program known as a swing bed program, according to Monday’s press release, which states swing bed programs allow patients who meet certain eligibility requirements to receive sub-acute care and rehabilitation services that they would otherwise need to transfer to a skilled nursing facility to receive.

All of the hospital’s 25 inpatient beds have been designated as swing beds, and the hospital combined its Intermediate Care and Medical-Surgical Inpatient Care units to give Alice Hyde’s nursing and hospitalist teams more flexibility and support as they respond to patients’ emerging clinical needs throughout the day.

“Utilizing swing beds gives our providers the ability to care for more patients and ensure those patients get the individualized, in-hospital care and rehabilitation services that can help prevent unnecessary hospital re-admissions,” Dr. Paul El Azoury, MD, Director of Alice Hyde’s hospitalist program, said, in the hospital’s press release.

The change in designation will help the hospital maintain essential care for Malone and other Franklin County communities, according to a prepared statement from Schumer’s office.

According to Schumer, Alice Hyde’s new status will reduce the community hospital’s financial vulnerability amid financial and operational challenges for rural health care organizations in New York.

“This designation is a game-changer for Alice Hyde, providing enhanced reimbursement rates that will fortify its financial resilience amid the current challenges facing rural health care organizations,” Schumer said in a press release from his office, “This victory for Alice Hyde underscores the importance of advocating for our rural hospitals in Franklin County and across New York State, ensuring they receive the support they need to thrive for generations to come.”

According to Schumer, the critical access hospital program specifically allows smaller rural providers, like Alice Hyde, to receive greater federal reimbursements for care to keep these otherwise financially vulnerable rural hospitals in the communities that need them most.

Prior the receiving this designation, Alice Hyde was considered a Sole Community Hospital, meaning it received lower reimbursement for services to patients on federally-funded health insurance plans such as Medicare, which make up a significant portion of the population served by the hospital, according to the release.

CAH hospitals are reimbursed 101% of “reasonable costs” for services, while the federal reimbursement rate for non-CAH hospitals is much lower, the release said, and Alice Hyde estimates that it will receive between $3 million and $4.5 million more per year in service reimbursements with its new status.

In 2015, the CMS issued a new policy change without going through the proper notice and rule-making required by law that would have enacted more restrictive eligibility definitions for the CAH program, potentially costing rural hospitals millions, according to the release, which states the decision to undo the previous ruling that changed the guidelines was finalized and went into effect on Jan. 1, allowing current hospitals to maintain their CAH status, and other hospitals, which were previously denied, to reapply for designation.

The CAH designation was created by the Balanced Budget Act of 1997 to give small rural healthcare providers greater financial reimbursement for servicing Medicare and Medicaid patients, as well as provide other resources, in order to keep vulnerable rural hospitals financially stable, according to the release from Schumer’s office, which states one factor for CAH eligibility requires that a hospital be a certain distance from another hospital by either a primary or secondary road and provide around-the-clock emergency services.

Previously, CMS regulations stated that a CAH hospital must be at least 35 miles from the nearest hospital by “primary road,” defined as any road in an interstate system or a US-numbered highway, or at least 15 miles in areas with mountainous terrain or only “secondary roads,” defined to include single lane state routes, according to the release.

The Critical Access Hospital designation provides hospitals enhanced reimbursement rates to keep essential healthcare services in rural communities, according to a prepared statement from Stefanik’s congressional office, which states in the North Country, Lewis County General Hospital, Carthage Area Hospital, River Hospital, University of Vermont Health Network — Elizabethtown, Clifton-Fine Hospital, and Gouverneur Hospital currently maintain this designation.

Alice Hyde Medical Center has received designation as a Critical Access Hospital from the federal Centers for Medicare and Medicaid Services. The Critical Access Hospital designation provides hospitals with enhanced reimbursement rates to help keep essential healthcare services in rural communities.