New Rural Emergency Hospital Program Takes Effect

The Centers for Medicare & Medicaid Services (CMS) has begun implementation of a new provider type that is designed to preserve emergency medical care in rural areas that can no longer afford to support a fully operational inpatient hospital.

The new rural emergency hospital (REH) designation is voluntary. It was established in late 2020 as part of the Consolidated Appropriations Act of 2021 and allows for the provision of emergency services, observation care, and additional medical and health outpatient services, as long as the patient is discharged or transferred within 24 hours.

In return, the REH would receive a monthly facility payment and a Medicare outpatient rate that is 5% higher than what a “full service” hospital would receive.

Senator Chuck Grassley (R-IA), who was the Finance Committee chair when the law was passed, said the goal is to help critical access hospitals and certain rural hospital avert potential closure and provide essential services for the communities they serve. “The existence of a rural hospital contributes to economic growth and can sustain a community. I believe CMS must continue to implement REH with minimal administrative burden and maximum flexibility for rural hospitals, while maintaining safe and high-quality care for patients,” he said in a recent statement.

A New York Times article (subscription required), published in December, described the difficult decisions that some hospital officials are now trying to make. It cited data that 180 rural hospitals have closed in the US since 2005, with a record 19 closing in 2020. Only two facilities closed in 2021, likely due to $15 billion in pandemic-era federal aid.

More information about the REH designation is available on the CMS website, including conditions of participation, provider enrollment, and the REH Quality Reporting Program.

The ACS is monitoring implementation of this designation and how it will affect provision of surgical care in the affected communities. Later this week, the Advisory Council for Rural Surgery will be meeting to discuss the topic, and the College will provide relevant updates when they are available.