Clarification of the Critical Access Hospital (CAH) Criteria for Rural Location and Mountainous Terrain Distance Standard
• Rural Location: The Centers for Medicare & Medicaid Services (CMS) is updating Chapter 2 and Appendix W of the State Operations
Manual (SOM) to reflect the guidance issued in SC-11-33, July 15, 2011.
• Mountainous Terrain Criteria for Distance From Hospitals/\Other CAHs: A CAH is eligible, based on location in mountainous
terrain, to use the shorter minimum distance from a hospital/other CAH standard if over 15 miles of the roads on the travel
route(s) from the CAH to any hospital or another CAH:
• Are located in a mountain range; and
• Have either of the following characteristics:
• Consists of extensive sections of roads with steep grades (i.e., greater than 5 percent), continuous abrupt and frequent
changes in elevation or direction, or any combination of horizontal and vertical alignment that causes heavy vehicles to operate
at crawl speeds for significant distances or at frequent intervals; or
• The roads on the travel route are considered by the State Transportation or Highway agency to be located in mountainous
terrain based on significantly more complicated than usual construction techniques required to achieve compatibility between
the road alignment and surrounding rugged terrain.
• A letter from the State Transportation or Highway agency specific to the travel route(s) in question is required to support
the claim of mountainous terrain.