Are you with a State Office of Rural Health or an association and want to get your hospitals connected?

REH Conversion for Public Health Offices

Help Your Hospitals Understand Our Technical Assistance and Support Services

Support is tailored to the needs of the individual communities at no cost and allows for both one-on-one education and guidance as well as interaction with other organizations that are on a similar journey.

Financial modeling
Application assistance and tools
Board of Directors and community education and marketing tools
Strategic Planning
Access to Our Peer Network
A host of other services to support hospitals in the REH journey

Technical Assistance Service Slide Decks

This complimentary slide deck has been developed for your use to help educate your hospital networks on the no-cost technical assistance that is available. If you would prefer to have a member of our team present to your hospitals, please reach out to

Understand How To Qualify As An REH

To qualify as an REH, a hospital must:

*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.

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 fifty beds or less 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. REHs will 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.
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.