Critical Access Hospital is a designation given to eligible rural hospitals by the Centers for Medicare & Medicaid Services (CMS). Congress created the Critical Access Hospital (CAH) designation through the Balanced Budget Act of 1997 in response to over 400 rural hospital closures during the 1980s and early 1990s.*

Key components of a CAH Designation:

  • Have 25 or fewer acute care inpatient beds
  • Located more than 35 miles from another hospital
  • Maintain an annual average length of stay of 96 hours or less for acute care patients
  • Provide 24/7 emergency care services


There are currently approximately 1,360 Critical Access Hospitals across the United States.  Doster Construction has been privileged to be a part of many of these new builds.  In addition to Critical Access Hospitals, Doster has completed many freestanding rehabilitation hospitals and emergency departments similar in scope of complexity of CAH and REH projects. Click here to read more about Doster’s expertise in healthcare construction.

The newly completed Jane Todd Crawford Critical Access Hospital

“This is a crowning achievement,” said Rusty Tungate, Administrator/CEO of Jane Todd Crawford Hospital. “This beautiful facility has become a reality that will serve our residents here in Green County for many years to come.”


A hospital with a Rural Emergency Hospital (REH) designation must provide emergency services and observation care, and may provide additional medical and health outpatient services while not exceeding an annual per patient average visit length of 24 hours.

This is the first new rural provider type since the Critical Access Hospital was created in 1997.  Congress established this new provider type in the Consolidated Appropriations Act of 2021 to address mounting concerns around closures of rural hospitals. Effective January 1, 2023, eligible hospitals may seek an REH designation, which would result in an increase in Medicare reimbursement for relevant outpatient services and a monthly facility payment. States will need to enable eligible hospitals to apply for the designation and adopt regulations and licensure to support the provider type.  To be eligible to receive the REH designation, a hospital must be a Critical Access Hospital (CAH) or a rural Prospective Payment System (PPS) hospital with no more than 50 beds. A hospital with a REH designation must provide emergency services and observation care, and may provide additional medical and health outpatient services while not exceeding an annual per patient average visit length of 24 hours.*

 Casey County Critical Access Hospital

The quality of your work, the experience, professionalism and dedication to us the owners and our project that the Doster Construction Team brought to the Hospital campus in building our new hospital and administration building was second to none.” – Casey County Hospital



Oftentimes, CAH projects are working within a tight budget; that’s why preconstruction is a key to success. The earlier you bring a contractor in the process the more value you will get for your money (see chart below). Doster can provide numerous value engineering options and use our wealth of knowledge and experience to help guide budget and design decisions.


One of the challenges of Critical Access Hospital construction is in its name – you have to be so many miles away from an acute care hospital to qualify for this designation, almost exclusively meaning the hospital is located in a rural area. Doster will involve as many local trade partners as possible, but due to the rural location will also have the ability to tap into our extensive subcontractor database to bring skilled and qualified trade partners to your project.


Doster can bring our large buying power to increase speed of material delivery that smaller sized trade partners may not have access to. In addition to speed of material procurement, Doster also brings our experience in material tracking to the process.


In most cases, hospital administrators at Critical Access Hospitals do not have previous construction experience within the hospital. Our expertise in final inspections, equipment installation and testing, and just getting the hospital ready for opening is something our clients have found great value in. We will help put together timelines, procurement, scheduling and more to ensure we are bringing the hospitals as quickly and efficiently as possible to these communities.


Doster has proven success in going into a rural area where we don’t have a presence and Building Relationships and trust with hospital administrators, local subcontractors, and the community as a whole. We really become a part of the team and community.

We asked Bobby Ferrell, Doster Senior Project Manager, why Critical Access Hospitals are his favorite project type to build? He said, “They may not be the largest or splashiest healthcare project out there, but one thing I know: they have the largest impact on their community than any other project I’ve seen. I’ve been working on the Jane Todd Crawford hospital and our team really became a part of the community. Some of the community members even joked that some of our team should run for Mayor of Greensburg. These projects make a real impact and I’m so proud to be a part of that.”

For more information on Doster’s CAH construction experience or how we can help you in the planning stages, email info@dosterconstruction.com

*Some information included from the Centers for Medicare & Medicaid Services (CMS)