Navigating the New Frontier of Rural Emergency Hospitals
Rural healthcare is undergoing a transformation, thanks to recent changes in guidance from the Centers for Medicare & Medicaid Services (CMS). On September 6th, 2024, CMS released revised guidance designed to assist hospitals that may be considering the Rural Emergency Hospital (REH) enrollment and conversion process. This guidance is crucial for rural healthcare providers, hospital administrators, and medical professionals seeking to optimize care in rural areas. Let’s explore the significance of these updates and how to enroll as a REH.
What is a Rural Emergency Hospital (REH)?
Rural areas often face unique healthcare challenges, including limited access to emergency services. It’s no secret that many rural hospitals are struggling to keep the doors open. The establishment of the Rural Emergency Hospitals designation aims to help these rural hospitals to remain financially viable while continuing to provide vital emergency and outpatient services to their communities. The REH designation preserves access to emergency care and provides for significant cost savings by eliminating inpatient care and focusing on outpatient, emergency and observation services. In order to qualify as an REH, a facility must meet the following criteria:
- Is located in a rural area
- Is licensed as a critical access hospital (CAH) or rural prospective payment system (PPS) hospital as of December 27, 2020
- Provides emergency health services
- Has fewer than 50 beds
- Is a licensed Medicare provider
- Average length of stay per patient is 24 hours
- Has a transfer agreement with a Level I or Level II trauma center
- Meets staff training and personnel requirements
- Does NOT provide inpatient services
- Participates in quality reporting programs
For more details about qualifications, see this comprehensive list.
How to Enroll as an REH
If a facility meets the above criteria, they can apply to convert to an REH by either:
- Filling out this form online via Medicare Provider Enrollment, Chain, and Ownership System (PECOS), or
- Submitting a paper CMS-855A application to your Medicare Administrative Contractor (MAC)
There is no application fee to apply.
Benefits of Enrolling as an REH
There are many benefits to adapting a facility’s care model to focus on the needs of their community. Most notably, REHs enjoy a 5% increase in Medicare payments for covered outpatient services. These include relevant radiology, laboratory, outpatient rehabilitation, surgical, maternal health, and behavioral health. This increase not only strengthens financial stability but also enables providers to deliver top-notch patient care.
Please note that copayments for REH services are determined according to the standard rates established by the Outpatient Prospective Payment System (OPPS).
Changes to the Enrollment Process
As of September 2024, CMS has rolled out significant updates to the enrollment process for REHs. These enhancements are designed to streamline the conversion for eligible rural hospitals and clarify enrollment requirements as an REH. Let’s take a look at what has changed.
Simplified Application Process
The government has simplified the application process for hospitals aiming to become REHs by clarifying paperwork and regulations. In the past, hospitals faced the burden of submitting extensive financial reports, operational plans, and compliance documents. The new changes reduce administrative hurdles, making it quicker for eligible hospitals to apply. This means less red tape and more focus on what truly matters—enhancing patient care.
Better Guidance
There are updated guides and answers to common questions that help hospitals understand the steps they need to take. This includes how to meet certain quality standards and what rules they need to follow to stay compliant with Medicare.
Flexibility for Hospitals
Rural hospitals have been given more options on how they can switch to the REH model. Instead of an abrupt switch, they can phase out inpatient services over time while ramping up emergency and outpatient care. This allows hospitals to keep serving their communities during the transition without disrupting care.
The new rules also offer flexibility in terms of which outpatient services hospitals can focus on. This means hospitals can choose which outpatient services best meet the needs of their community, whether it’s emergency care, diagnostic services, or observation care, rather than being forced to follow a one-size-fits-all approach.
REHs can also continue to offer short-term observation stays (under 24 hours), allowing them to stabilize patients before transferring them to larger hospitals if necessary.
Conclusion
CMS remains committed to the success and viability of rural hospitals. These updates to the REH designation further strengthen the role of the REH hospital in providing essential healthcare services for the underserved rural health communities. For more detailed information about enrolling as a rural emergency hospital, refer to the CMS fact sheet and complete guidance document. To further understand the latest REH Conditions of Participation, visit the eCFR website.
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