On September 30, the federal District Court for the District of Columbia ruled that Bayside Community Hospital (Bayside), a critical access hospital (CAH) physically located in an "urban" metropolitan statistical area, was entitled to receive reasonable cost (or "pass-through") reimbursement for the costs of obtaining the services of its certified registered nurse anesthetists (CRNAs). See Bayside Community Hospital v. Sebelius, Civ. Action. No. 07-1562(EGS) (D.D.C. 2009). CRNA pass-through payment is a special payment mechanism designed to help rural hospitals afford the cost of providing anesthesiology services. Bayside argued that, although it was physically located in an "urban" metropolitan statistical area, it was entitled to receive CRNA pass-through payment because of its CAH status. According to the applicable statutes, certain hospitals can apply to be "redesignated as rural" in order to become a CAH. Bayside argued that CAHs are, by definition, "rural" providers, and must, therefore, be permitted to obtain CRNA pass-through reimbursement. The Secretary of HHS recognized Bayside's CAH status, but took the position that the CRNA pass-through payment mechanism is available only to hospitals that are truly "rural" -- that is, hospitals that physically are located outside of an urban metropolitan statistical area. In a case of first impression, the court ruled that under the plain and unambiguous language of the governing statutes, a hospital redesignated as rural for purposes of obtaining CAH status is also rural for purposes of CRNA pass-though reimbursement eligibility. The Bayside decision may serve as a helpful precedent for a number of CAHs nationwide that physically are located in urban areas, but were "redesignated as rural" by virtue of obtaining CAH status. CAHs that wish to obtain CRNA pass-through reimbursement are permitted to apply for it on an annual basis. To the extent that such requests are denied, CAHs should appeal the denial to the Provider Reimbursement Review Board in order to take advantage of the favorable case law set in the Bayside case. Bayside was represented in its litigation by Baker Hostetler.