As urged by AHA, states may immediately use alternative ways to document that a critical access hospital is a “necessary provider,” the Centers for Medicare & Medicaid Services announced today in guidance to state survey agencies. CMS last year issued interpretive guidance that allowed only a state letter dated prior to Jan. 1, 2006 to document that a CAH is an NP. In response, AHA urged CMS to allow a wider variety of documentation, consistent with its past policies. “AHA looks forward to working with CMS as it implements this new guidance to ensure that those CAHs that have rightfully obtained NP designation may continue to participate in the CAH program,” said Priya Bathija, AHA senior associate director of policy. The evaluation guidance and an associated checklist are available at, and should be available at next week. AHA members affected by the guidance will receive a Special Bulletin next week with more information.