Rural Emergency Hospital Designation

Resources & Learning Briefs

Welcome to the RHRC’s resources page, with documents and videos to help you understand and evaluate the Rural Emergency Hospital (REH) designation. Whether you’re exploring the possibility of converting your facility to an REH or simply seeking more information, this page is designed to equip you with the knowledge and tools you need.

Resources for Informed Decision-Making

Gain insights into the operational impacts and successes of the REH designation through comprehensive research and publications. These documents are invaluable for public agencies seeking to understand the implications and outcomes of the REH model.

What does it mean to be a Rural Emergency Hospital?

Learn about the REH provider type and the no-cost technical assistance for hospitals considering a conversion, available through the Rural Emergency Hospital Technical Assistance Center.

This session features a Fireside Chat where you can hear directly from a former Kansas hospital CEO who worked with the Technical Assistance Center throughout the REH assessment and conversion journey.

REH Frequently Asked Questions

Have questions? We’ve got answers. Browse our FAQ section to find information on common queries related to the REH designation, conversion process, and more.

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 CAH or a rural hospital with 50 or fewer beds 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 of converting to an REH depend greatly on the circumstances of the hospital. Rural hospitals facing a high likelihood of closure might 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 or distinct part skilled nursing facility [SNF] services) are paid according to the facility’s respective fee schedule and do not qualify for the additional 5 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 occur on January 1 to align with the calendar year.

REHs also have the flexibility to determine the appropriate licensure and credentials for a 24/7 staffed emergency department. Hospital leadership can elect to provide additional services that meet the needs of the community.

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’ legislative and regulatory responses to recognizing the provider type have varied. The National Conference of State Legislatures is currently tracking state legislation and regulatory action related to REHs. To access the most recent information about state-level legislation related to REHs, go to 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.

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. As a result, because the hospital closed before December 27, 2020, and was not functioning as a hospital as of this date, it is not currently eligible to reopen as a licensed REH.

Our hospital is scheduled to close, can we reopen as an REH?

It depends. The enrollment process was simplified to allow existing hospitals and CAHs to submit the CMS-855A – change of information application to prevent facility closures that might disrupt services in the community. The hospital should submit its enrollment application before closure. If the hospital continues operating while the application is under review, it is eligible for the attestation of compliance versus if the hospital closes before receiving the REH designation, an on-site survey to ensure compliance with the Conditions of Participation (CoP) is required. More information is available in the Guidance for Rural Emergency Hospital Provisions, Conversion Process and Conditions of Participation memo.

How does my hospital apply to convert to an REH?
The application process for converting to an REH includes a change of information application—Form CMS-855A. An eligible hospital can apply by submitting the form along with an action plan and transfer agreement. The complete process for eligible facilities to convert to an REH is outlined in the Medicare Enrollment of Rural Emergency Hospitals iii and the Guidance for Rural Emergency Hospital Provisions, Conversion Process and Conditions of Participation memos.


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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.