Yakima County commissioners unanimously back letter supporting Astrea Toppenish Hospital’s critical access designation

Cathy Bambrick, administrator at Astrea Toppenish Hospital, asked the Yakima County Board of Commissioners to provide a letter of support for the hospital’s application to obtain critical access hospital (CAH) designation and explained the legal and financial steps required.

Bambrick told the board the hospital is seeking a federal “fix” so it can meet CAH rules; she said Toppenish was ineligible when the initial CAH conversions occurred because the hospital was owned by a for‑profit entity at the time. She said Congressman Dan Newhouse is working to secure two waivers required for designation: an exception related to inpatient behavioral-health bed counts and a distance-based waiver tied to hospitals on tribal land.

Bambrick described key CAH features and eligibility rules: cost-based Medicare reimbursement (and, in Washington, cost-based Medicaid), a 96-hour average-length-of-stay cap for acute care, a maximum of 25 acute-care beds and the potential for up to 10 inpatient psychiatric or rehab beds without a waiver. She explained Toppenish currently has 14 beds and anticipated growth; the hospital is requesting a waiver because behavioral-health beds exceed the typical CAH limits. She also said Toppenish is the only hospital in Washington located on an Indian reservation and is asking for a tribal-related distance exception.

Bambrick estimated the designation would bring roughly $6,000,000 in annual funding to the hospital, a sum she said would move the hospital close to break-even and help sustain services in the rural community. She said the hospital has the required transfer and referral agreements, EMS partnerships, credentialing and quality programs in place and that the state Department of Health would process the CAH application once federal waivers are obtained.

Commissioner Lindy moved to sign the support letter; Commissioner Curtis seconded the motion. The board voted unanimously to approve the letter. Commissioner McKinney and others expressed support, noting the designation’s importance for sustaining rural hospital services.

Bambrick also agreed to attempt to provide commissioners data on the number and cost of emergency visits by patients who are not U.S. citizens, saying citizenship is not uniformly recorded but that she would try to pull comparable figures; commissioners requested that data be broken out by payer type and by visits versus unique patients where available.