Should You Be a Rural Emergency Hospital?

The Centers for Medicare and Medicare Services (CMS) published the proposed rule for establishing Rural Emergency Hospitals on June 30, 2022. The federal assistance opportunities for these types of providers may prompt facilities to transition to this model — we delve into their requirements.

The Consolidated Appropriations Act of 2021 created a new provider type, Rural Emergency Hospitals (REH), in response to the increasing closure of rural and Critical Access Hospitals (CAH) and in an effort to preserve access to emergency and outpatient departments and skilled nursing services in rural communities. CMS estimates that 68 facilities may choose to convert to this new provider type to obtain federal assistance for emergency and outpatient department care (including maternal health, behavioral health and substance use disorder services) that does not exceed an annual per patient average of 24 hours.

What is required of the facility?

  • Have either been a CAH or a rural hospital with not more than 50 beds, participating in Medicare as of December 27, 2022
  • Be either located in a rural area or in an urban area reclassified as rural for Medicare payment purposes
  • Maintain licensure and operate under applicable state and/or local licensure laws
  • Have an annual average length of stay of no more than 24 hours (CMS stated that REHs could keep patients for more than 24 hours if necessary, but does not anticipate that the frequency with which this might be required would result in an REH exceeding the 24-hour average annual length of stay requirement)
  • Apply staffing requirements that are similar to those for CAHs
  • Develop, implement and maintain a data-driven quality assessment and performance improvement program (QAPI) consisting of program and scope, program data collection and analysis, program activities, executive responsibilities, and unified and integrated QAPI program for an REH in a multi-hospital system
  • Provide emergency, laboratory, radiologic and pharmaceutical services to meet the needs of an REH’s patients in a manner consistent with the Conditions of Participation (CoPs) for CAHs
  • Require discharge planning that focuses on returning the patient to a home or community-based setting, and align with CoPs for hospitals and CAHs

REHs may serve as telehealth originating sites and would apply medical staff credentialing rules for telehealth providers similar to those for telehealth services provided in hospitals and CAHs.

Comments to the proposed rule can be submitted to CMS electronically or by mail no later than August 29, 2022, with reference to file code CMS-3419-P. CMS is obligated to finalize regulations establishing and governing REHs in time for the statutorily-required effective date of January 1, 2023.