The Centers for Medicare and Medicaid Services (“CMS”) recently released new guidance about the process for converting to a Rural Emergency Hospital (“REH”) – a new Medicaid provider type effective Jan. 1, 2023. REHs are eligible to furnish emergency department services, observation care, and, if elected by the REH, other specified outpatient medical and health services that do not exceed an annual per patient average length of stay of 24 hours.

Although CMS previously finalized Conditions of Participation (“CoPs”) for REHs, many details regarding the REH enrollment and conversion process remained unclear. CMS’s guidance issued Jan. 26, 2023, addresses those details.

Specifically, CMS clarified that Critical Access Hospitals (“CAHs”) and certain rural hospitals with not more than 50 beds that were enrolled and certified to participate in Medicare as of Dec. 27, 2020, are eligible to be an REH. In addition, facilities that previously enrolled as CAHs or rural hospitals with not more than 50 beds as of Dec. 27, 2020, and then subsequently closed are eligible to seek REH designation if they re-enroll in Medicare and meet REH CoPs and other requirements.

Eligible facilities must submit a CMS 855-A Change of Information (CHOI) application, along with an action plan for initiating REH services. The action plan should address, among other things, the facility’s plan for converting to an REH, including services the REH will retain, modify, add, and discontinue, along with specific staffing details. Action plans will be available to the public and ultimately will be posted on CMS’s website.

Other information should also be provided, such as a copy of the facility’s transfer agreement with a Medicare-certified hospital that is designated as a level I or level II trauma center, as well as an attestation that the facility meets the REH CoPs.

The CMS guidance includes a template action plan that facilities may use, as well as a number of Frequently Asked Questions that provide additional guidance on the REH conversion process. Survey protocols are also included.