Curry General Hospital has until April 19, 2019, to prove it is a “necessary provider” or lose its designation as a critical access facility — and its ability to bill the federal government on a “cost plus” basis for its Medicare and Medicaid.
The issue was brought up during a regular recertification of all critical access hospitals nationwide, said Curry Health Network CEO Gini Razo, at a board meeting April 11. The Centers for Medicare and Medicaid Services (CMS) notified Curry Health Network last November that they would receive a letter this month citing their alleged noncompliance with a federal regulation requiring critical access hospitals be a minimum of 35 miles from each other.
Sutter Coast Hospital in Crescent City — a nonprofit that is not critical access hospital — is about 25 miles from Brookings, where it and Curry Health Network both have specialty clinics. Gold Beach Hospital is about 28 miles from its clinic in Brookings.
Brookings is the only city of its size in Oregon without a hospital.
“This is not a Curry Health Network issue; this is going on across the country,” she said. “In 2013, the Office of Inspector General audited all the critical access requirements and found a number of critical access hospitals that didn’t comply. As they go through the recertification cycle, they have to demonstrate they meet the requirements; that’s what tipped this over. The potential could have a very large impact on a number of critical access hospitals in the country.”
It could affect Curry General Hospital, as well.
CMS is interpreting provider-based clinics as extensions of the hospital as they bill Medicaid and Medicare under the hospital license, Razo explained. The agency also interprets Sutter Coast’s clinics the same way, and because they are across the street from Curry Medical Clinic, CMS says they all are in violation of the 35 mile-limit requirement.
CHN has been collecting proof to show CMS that it is a necessary provider, Razo said.
“If those clinics didn’t exist, the impact to this community … but CMS doesn’t care about that,” she said. “They’re just here to enforce the laws.”
The network will first send a letter outlining how the hospital and its clinics are in compliance with the Oregon Rural Health Plan.
“They never designated us as a necessary provider prior to 2006 because we clearly met the CMS distance requirement,” she said. “CMS has a state operations manual and one section clearly states that if a critical access hospital has an off-campus facility — as we do — and it was established prior to 2008, which it was, the mileage requirement would not apply.”
CHN’s original clinic in Brookings clinic was operating under the hospital’s license in 2004 when the hospital first obtained its critical access designation, so it was grandfathered in.
“If CMS agrees, this all goes away,” Razo continued. “If they don’t, we enter into the federal appeal process, and I’m told by the attorney that can be a protracted, long series of events that would not likely get resolved within one year’s time.”
Phone calls to Julius Bunch, manager of the division of certification and enforcement at the state level, were not answered.
“The sky isn’t falling,” Razo said. “We’re just setting the right things in motion to protect our status. Hopefully they’ll agree with us and the Oregon Health Authority and OMS conclusions that we are a necessary provider.”
Reach Jane Stebbins at email@example.com .