Oregon Health Authority is seeking public input on a proposal by Adventist Health Columbia Gorge in The Dalles to become a critical access hospital. Before the federal government will consider the proposal, two OHA programs are expected to review it. OHA’s Health Care Market Oversight, or HCMO, program is requesting public input.
In an effort to increase health care access in rural areas, the U.S. Centers for Medicare and Medicaid Services grants its critical access hospital classification to certain rural hospitals. Critical access hospitals must:
- Be recommended for critical access hospital status by their state
- Be located either more than 35 miles from the nearest hospital or critical access hospital or more than 15 miles away in areas with mountainous terrain or in areas that are only served by secondary roads
- Maintain no more than 25 inpatient beds
- Maintain an annual average patient length of stay of 96 hours or less for acute inpatient care
- Provide 24-hour emergency care services seven days a week
To become a critical access hospital, Adventist Health Columbia Gorge would need to reduce its number of hospital beds to 25, which is less than the 49 inpatient beds for which it is currently licensed.
OHA’s HCMO program is seeking input because granting the hospital’s proposal would require amending OHA’s 2023 approval of the affiliation between Adventist Health and what was formerly known as Mid-Columbia Medical Center. OHA’s approval was made with conditions, including that hospital services would not be significantly reduced, and it would continue to be a general hospital, which is a state license for hospitals that requires a hospital to provide general medical, maternity, surgical and emergency department services.
Adventist Health Columbia Gorge has submitted a proposal to amend the conditions of OHA’s 2023 approval of the hospital’s affiliation with Adventist Health. The HCMO program requested additional information from the hospital on Sept. 16. Once OHA receives all information that it needs, OHA will have15 business days to review and rule on the hospital’s proposed amendment.
OHA will accept public comments throughout the course of its review. Because the 15-day clock on OHA’s review is currently paused while it awaits additional information from the hospital, the public’s deadline to provide comment cannot be determined at this time. The OHA webpage for this transaction has more information, including the review’s current status.
Members of the public can provide comment by sending an email to [email protected], filling out an online public comment form, or leaving a voicemail at 503-945-6161. Individuals should include the “Adventist” in their comment. Because comments will be posted to OHA’s website, individuals should not include information that they do not want publicly shared.
Another part of OHA – the Health Facility Licensing & Certification, or HFLC, program – is also expected to consider the hospital’s proposal. When the hospital submits a license change request to reduce its number of beds, the HFLC program will issue the new license. In addition, HFLC evaluates Oregon hospital critical access hospital applications. Either HFLC or a hospital’s accrediting organization will conduct an on-site survey to determine if a hospital meets federal requirements for critical access hospitals. After the survey, HFLC would forward a hospital’s application to the U.S. Centers for Medicare & Medicaid Services for final consideration.
More information is available in the following documents that were submitted to OHA by Adventist Health Columbia Gorge:
- Petition to modify HCMO’s 2023 order approving Adventist Health’s acquisition of what was then known as Mid-Columbia Medical Center: https://www.oregon.gov/oha/HPA/HP/HCMOPageDocs/006-AHCG-CAH-Modification-Petition-OHA.pdf
- Critical access hospital application for HFLC’s consideration: https://www.oregon.gov/oha/HPA/HP/HCMOPageDocs/006-ACHG-CAH-Application-Public.pdf
In addition, please see the below notification that the HCMO program issued via email this afternoon.
Health Care Market Oversight
Adventist Health Columbia Gorge Application to Modify Order
Oregon Health Authority (OHA) completed a preliminary review of Adventist Health System’s acquisition of the Mid-Columbia Medical Center (MCMC) on April 13, 2023 and approved the transaction with conditions. The report and order are posted on the Health Care Market Oversight (HCMO) program website. MCMC is now known as Adventist Health Columbia Gorge (AHCG).
Under Condition 2.h of OHA’s order, AHCG must obtain HCMO’s prior approval to “significantly reduce, restrict, or terminate the facilities, services, or programs” referenced in the order. On September 16, 2025, HCMO accepted an application from AHCG requesting approval of AHCG’s plans to seek federal certification as a Critical Access Hospital (CAH) and corresponding modification of OHA’s order. The application and supporting documents have been posted to HCMO’s website. The application describes plans for AHCG to reduce its licensed inpatient beds from 49 to 25 to meet federal requirements for a CAH. AHCG further intends to designate the 25 beds as “swing beds,” which can be used for either acute care or skilled nursing facility care as needed.
HCMO will complete a review of the application, decide whether to approve AHCG’s plans, and if approved, issue a modified order. Should the application be approved and the order modified, AHCG must obtain a new license from OHA’s Health Facility Licensing & Certification (HFLC) program and undergo an on-site survey to determine if the hospital meets federal CAH requirements. After the survey, HFLC will issue a recommendation to the Centers for Medicare & Medicaid Services (CMS) for a final decision on whether AHCG should be granted CAH status.
HCMO is seeking public input about this application. To submit a public comment, email [email protected], leave a voicemail at 503-945-6161 or fill out the public comment form. Please mention “Adventist” in your comment. Public comments will be posted to HCMO’s website.
About HCMO
Launched in 2022, the Health Care Market Oversight program reviews heath care business deals to make sure they support Oregon’s goals of health equity, lower costs, increased access, and better care. For more information, visit OHA’s website or email [email protected].