Recognizing that many rural hospitals are the only health care facility in their communities and that their survival is vital to ensure access to health care, Federal policymakers in the 1980s and 1990s created five special payment designations under Medicare: Critical Access Hospitals (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), Essential Access Community Hospitals (EACHs), and Rural Referral Centers (RRCs). CAHs, MDHs, and SCHs are required to be in a rural area, but RRCs can be in either a rural or an urban area. In addition, there are urban hospitals that qualify for a special payment designation under current statutory authority for reclassification as a rural hospital.

The purpose of this brief is to provide a snapshot of the types of rural and urban hospitals and the counties where they are located.

Study data are from files produced by the Centers for Medicare & Medicaid Services. Hospital type was obtained from the 2020 Provider Specific File, and inpatient acute care bed days were obtained from the Healthcare Cost Report Information System (HCRIS 8-30-21) file. We defined hospitals as rural using the Federal Office of Rural Health Policy (FORHP) definition effective on October 1, 2021. FORHP defines a rural area as: All non-metro counties; all metro census tracts with RUCA codes 4-10; large area Metro census tracts of at least 400 sq. miles in area with population density of 35 or less per sq. mile with RUCA codes 2-3, and; all outlying metro counties without an urbanized area. County population size was obtained from the U.S. Census Bureau.