Is your hospital considering an REH conversion?

Assessing the REH Conversion

The RHRC will guide you through our process to help you make an informed decision on whether the REH designation is right for your organization and community.

What is a Rural Emergency Hospital?

Established by Congress, Rural Emergency Hospital is a new Medicare provider designation. Rural Emergency Hospitals can strengthen access to outpatient medical services and reduce health disparities in underserved areas by preserving access to local care.

How Can a Rural Emergency Hospital Designation Benefit Your Community?

Rural Emergency Hospital is a new Medicare provider designation designed to avert hospital closures and keep care in rural communities, providing the following benefits:

The region’s residents continue receiving the exceptional care and emergency medical attention you provide in their community.

Rural Emergency Hospitals provide local services and reduce transportation and associated costs for patients and families.

Rural Emergency Hospitals provide job opportunities for talented, knowledgeable, local healthcare professionals.

Community members who understand patients’ unique healthcare needs staff Rural Emergency Hospitals.

Rural Emergency Hospitals can engage in preventative care efforts, address local health concerns, and foster the well-being of the region’s residents.

Rural Emergency Hospitals are better equipped to be sensitive to their communities’ cultural needs and preferences.

What are the REH Eligibility Requirements?

To qualify as an REH, the hospital must:

  • Be in a rural area and licensed as a critical access hospital (CAH) or rural prospective payment system (PPS) hospital as of December 27, 2020, with fewer than 50 beds
  • Be a licensed Medicare provider
  • Meet staff training and certification requirements
  • Meet annual average length of stay requirements*
  • Have an established transfer agreement with a Level I or Level II trauma center
  • Meet conditions of participation (similar to a CAH or PPS hospital for emergency services) 
  • Have an action plan including provisions for staffing, a transition plan, and a description of services offered
*The annual per patient average length of stay (LOS) cannot exceed 24 hours. The LOS begins at the time of registration, check-in, or triage of the patient, whichever occurs first, and ends upon discharge from the REH. District part SNFs are not subject to 24-hour annual average LOS.

What is the REH Technical Assistance Center Approach?

Leveraging collective experience and a commitment to improving the lives within rural communities, we are equipped to provide thorough technical assistance in alignment with the terms of our cooperative agreement with the Health Services and Resources Administration (HRSA).
Work cooperatively with HRSA, State Offices of Rural Health, and Flex Coordinators to identify interested hospitals
Respond quickly to direct inquiries made through our support line at
Protect the identity of each hospital organization we work with through an NDA
Provide a rurally relevant subject matter expert/coach to provide one-on-one guidance and support 
Provide detailed financial modeling when there is an indication that the REH could be a viable option
Support strategic planning once a community identifies that REH is a viable path forward 
Assist with the application and provide ongoing support

What Services Does RHRC Provide Throughout This Process?

We work with your team(s) end-to-end throughout the process to promote your hospital’s long-term success. Services include:

Hospital Financial Analysis

Clinical Transformation / Value-based Transition Support

Strategic Planning

Organizational Culture Development

Legal Advice

Marketing Toolkit

Service Line and Outmigration Analysis

Leadership and Team Development

Regulatory and Compliance Support

Quality Performance Management

Data Analytics and Dashboards

What Are the Steps in the REH Conversion Process?

RHRC specialists work to make the REH conversion process seamless and swift. 

Determine Eligibility
Ongoing Support

Determine whether the hospital meets REH requirements

Assess benefits and downsides to conversion:

• Financial analysis
• Service line analysis
• Outmigration reports

Consider operational and staffing changes needed

Submit application with required documentation (action plan, transfer agreement(s), COP attestation)

Implement operational and staffing changes

Address challenges of operational changes

Incorporate transformational systems that address ongoing challenges and build on strengths

Interested in Receiving Support from the Rural Emergency Hospital Technical Assistance Center?

Let us know by completing our brief intake form and telling us a little about your organization and the type(s) of support you are looking for.

If you have a question or would like to request more information, reach out to us directly at

REH Frequently Asked Questions

What types of provider facilities are eligible to enroll as an REH?

A facility is eligible to enroll as an REH if it is a critical access hospital (CAH) or a rural hospital with 50 beds or fewer as of the date of enactment of the Consolidated Appropriations Act, December 27, 2020.ii

What are the benefits of converting to an REH?

Financial or operational benefits from REH conversion are highly dependent on the hospital’s circumstances. Rural hospitals facing a high likelihood of closure may benefit from enhanced payments made available to REHs, which receive the Outpatient Prospective Payment System rate plus an additional 5 percent for REH-covered services. Non-REH services (such as laboratory and distinct part Skilled Nursing Facility services) are paid according to the facility’s respective fee schedule and do not qualify for the additional five percent payment. In addition, REHs will receive a monthly facility payment of $272,866 before sequestration in 2023, with annual increases determined by the hospital market basket. The hospital market basket adjustments are made on January 1 to align with the calendar year. REHs can also determine the appropriate licensure and credentials for a 24/7 staffed Emergency Department. Hospital leadership can elect to provide additional services that meet the community’s needs.

Which states have legislation that supports the REH provider designation at the state level?

As the REH provider designation became active for Medicare on January 1, 2023, states have varied legislative and regulatory responses to recognizing the provider type. The National Conference of State Legislatures is currently tracking legislation and regulatory action in states related to REHs. To access the most recent information about state-level REH legislation, visit the Health Costs, Coverage and Delivery State Legislation database and filter on “Payment and Delivery Reform” under “Market” in the topic search section. You can also filter by state and status (as in, adopted, enacted, to the governor) of the legislation. For additional support related to state legislation: NASHP NACSL.

Our rural hospital closed prior to December 27, 2020. Can we reopen as an REH?

A hospital must meet all REH requirements and have been operating as a licensed hospital on the date the legislation passed allowing the new REH designation. Since the hospital closed before December 27, 2020, and was not functioning as a hospital as of that date, it is not currently eligible to be reopened as a licensed REH.

Our hospital is scheduled to close. Can we reopen as an REH?

The enrollment process was simplified to allow existing hospitals and CAHs to submit the CMS-855A – change of information application to prevent closure of facilities that may disrupt services in the community. The hospital should submit its enrollment application prior to closure. If the hospital continues operating while the application is reviewed, it is eligible for the attestation of compliance. If the hospital closes before the REH designation, an on-site survey is required to ensure CoP compliance. More information is available in the Guidance for Rural Emergency Hospital Provisions, Conversion Process and Conditions of Participation memo. 

How does an REH maintain certification when relocating?

The REH must maintain rural status or remain in an area designated or reclassified rural per 42 CFR §412.103. When an REH plans to relocate, it must update the CMS-855A form and submit it for reapproval. More information is available in the Guidance for Rural Emergency Hospital Provisions, Conversion Process and Conditions of Participation memo.

For more commonly asked questions, please refer to this guide

Our REH Footprint and Impact

The RHRC has been an invaluable partner and great help at this time. They have provided insight, instructions, professionals, support, you name it. Their work and commitment is totally different from any other advisor or consultant we have been able to hire. Their goal is our success, the same as ours; that is their difference between others we have hired.”

Carla Flack

Board Member, Bucktail Medical Center

Bucktail Medical Center

REH Interest and Enrollment

Enrollment into our technical assistance process occurs on an ongoing basis and we encourage interested hospitals to reach out at any time. Our team is committed to meeting the urgency of your needs.

Janice Walters
Executive Director
Janice has been leading the work of the RHRC since its inception. She has a background in health finance and is a highly rated rural health expert with over 20 years of relevant leadership experience.