From Application to Operation: The Journey of a Rural Emergency Hospital

The Rural Emergency Hospital (REH) designation is an important step in the mission to preserve healthcare in rural America. This article outlines the journey from application to operation for a rural hospital seeking REH status.



The REH designation was established as a response to rural hospital closures. These closures deprive rural communities of essential health services and have adverse economic impacts. The Rural Health Redesign Center (RHRC) was awarded a Cooperative Agreement by the Health Resources and Services Administration (HRSA) to provide technical assistance to eligible rural hospitals, all at no cost to the hospitals.


Eligibility Requirements

To be eligible for REH designation, a hospital must be licensed as a Critical Access Hospital (CAH) or a rural hospital with fewer than 50 beds as of December 27, 2020. Post conversion, the hospital must provide emergency services and observation care but cannot provide inpatient care. 


Application Assistance

For hospitals considering the REH pathway, the RHRC provides resources to assist in the application process to the Centers for Medicare & Medicaid Services (CMS). This support includes education on the application process and documentation required for submission: 

  • Attestation for meeting REH conditions of participation.

  • Action Plan including a description of services, staffing provisions, and a transition plan.

  • Transfer Agreement with level I or II trauma centers.

This process is supported by a Provider Liaison, a former rural hospital executive with expertise in leading organizations through significant change. 

Strategic Planning and Transition

Strategic planning is critical to the transition to an REH. The RHRC provides hospitals with services that help communicate the REH designation to stakeholders, identify alternative care pathways, and provide data analytics to address community health needs. Strategic planning tools and project management support ensure that transition goals are clear and actionable.


Ongoing Support

Post application, the journey to becoming an operational REH is facilitated by ongoing assistance from the RHRC through its REH Peer Network. This support includes ongoing monitoring of the transition plan, access to learning forums, implementation of population health initiatives, and other assistance.  


Transitioning to an REH can support the continuity of care and advance health equity for underserved regions. The RHRC guides hospitals through the application to the final steps of conversion and operation, providing hope for the future of rural healthcare.

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.