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EXHIBIT 286 (Rev. 80, Issued: 03-01-12) HOSPITAL/CAH DATABASE WORKSHEET completed by the SA surveyor to gather data of worksheet, not to be given to provider to fill out. CMS Certification Number
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The Hospital/CAH Medicare Database Worksheet, Exhibit 286 is an important tool used by the Centers for Medicare & Medicaid Services (CMS) to gather detailed information about hospitals and critical access hospitals (CAHs) participating in Medicare.
The Centers for Medicare and Medicaid Services (CMS) describes CAHs as having: An average stay of no more than 96 hours. 24-hour emergency department services. Less than 25 acute care inpatient beds. A location over 35 miles from the closest hospital (or 15 miles by secondary roads or mountains)
What is the difference between an Acute Care Hospital and a Critical Access Hospital? Acute Care Hospitals (ACH) are hospitals that provide short-term patient care, whereas Critical Access Hospitals (CAH) are small facilities that give limited outpatient and inpatient hospital services to people in rural areas.
The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, CAHs receive certain benefits, such as cost-based reimbursement for Medicare services.
CAHs receive cost based reimbursement for inpatient and outpatient services provided to Medicare patients (and Medicaid patients depending on policy of the state in which they are located).
The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, CAHs receive certain benefits, such as cost-based reimbursement for Medicare services.

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