Since 2010, 138 rural hospitals have closed — with a record-breaking 19 hospitals closing in 2020 alone. The Centers for Medicare & Medicaid Services (CMS) recently released a new proposed rule seeking to protect access to emergency care and additional outpatient services for people in rural communities.

CMS is establishing the Conditions of Participation (CoPs) for Rural Emergency Hospitals (REHs). The proposed rule will allow small rural hospitals to seek this new provider designation and provide continued access to emergency services, observation care, and additional medical and outpatient services.

Conversion to an REH allows for the provision of emergency services, observation care, and additional medical and health outpatient services, if elected by the REH, that do not exceed an annual per patient average of 24 hours.

In accordance with the statutory legislation, REHs will be eligible to receive payment for services provided on or after Jan. 1, 2023.

CMS says this is a significant step in building on the Biden Administration’s efforts to reduce healthcare disparities and maintain access to services in rural communities. It notes that these hospital closures occur disproportionately within communities with a higher proportion of people of color and communities with higher poverty rates. Rural communities experience shorter life expectancy, higher mortality, and have fewer local health care providers, leading to worse health outcomes than in other communities. Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care.

“The availability of the new Rural Emergency Hospital provider type will maintain access to essential healthcare services and help to reduce disparities in rural communities,” said CMS Administrator Chiquita Brooks-LaSure, in a statement.

The Rural Emergency Hospital designation will provide an opportunity for small rural hospitals and community access hospitals (CAHs) to right-size their service footprint and avoid potential closure so they can continue to provide essential services for their communities. The REH provider type was established by the Consolidated Appropriations Act of 2021 to address the growing concern over closures of rural hospitals.

Allowing providers to take advantage of the new designation will ensure that people in rural communities will be able to receive critical outpatient services, including emergency, maternal health, behavioral health, and substance use disorder services.

In some instances, the proposed REH policies closely align to the current hospital and ambulatory surgical center standards, such as the polices for outpatient services’ requirements and life safety code, respectively. CMS is seeking input from the rural community on specific proposed REH standards, including the ability of an REH to provide low-risk childbirth-related labor and delivery services and whether CMS should require that an REH also provide outpatient surgical services in the event that surgical labor and delivery intervention is necessary. CMS is also requesting comments regarding whether it is appropriate for an REH to allow a doctor of medicine or osteopathy, a physician assistant, a nurse practitioner, or a clinical nurse specialist, with training or experience in emergency medicine, to be on call and immediately available by telephone or radio contact and available on site within specified timeframes.

The proposed rule includes several updates for CAHs. Specifically, CMS is proposing to add a definition of “primary roads” to the current location and distance requirements, which is used to determine if facilities qualify as CAHs. The proposed rule also contains proposals allowing CAHs that are a part of a larger health system (containing other hospitals and/or CAHs) to unify and integrate their infection control and prevention and antibiotic stewardship programs, medical staff, and quality assessment and performance improvement programs (known as QAPI) to ensure consistent and safe care. CMS also is proposing to establish a patient’s rights Condition of Participation for CAHs to provide for clear requirements for the protection and promotion patient’s rights.  

The release of this proposed rule, which is a result of multiple engagements with stakeholders and a Request for Information (RFI), is the first step in the implementation of this new provider type. CMS anticipates including further discussion on important aspects for REHs, such as Medicare enrollment, payment, quality reporting, and more in the upcoming Calendar Year 2023 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule.

CMS is taking more feedback as it develops its final, comprehensive policies for REHs later this year. For this rule, the comment period closes on Aug. 29, 2022.

 

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