Balanced Budget Refinement Act (1999)

The Balanced Budget Refinement Act of 1999 (BBRA) increased the flexibility of the critical access hospital (CAH) program. It included the following changes to the original 1997 legislation, the Balanced Budget Act:  change to an annual average 96-hour length-of-stay limitation; permitted CAHs to bill at the all-inclusive rate or continue to bill hospital and physician services separately; granted CAH status to hospitals that have closed in the past 10 years, or had downsized to a health clinic or center; created the swing bed program; eliminated beneficiary coinsurance for clinical laboratory services furnished on an outpatient basis; and, extended CAH eligibility to for-profit hospitals.