Beginning January 1, 2023, the Rural Emergency Hospitals (REHs) designation will become available. Announced in the Consolidated Appropriations Act of 2021, it was created to address the specific complications that rural providers face in the health care system. Eligible hospitals can apply for this new Medicare designation if they align with the conditions. When hospitals are approved, they will receive a 5% increase on payments and a monthly facility payment. The change aims to increase revenue to prevent more rural providers from closing.
CMS finalized the rules earlier this month and the conditions include, taken from the article: 
- REHs must have a clinician on-call at all times and available on-site within 30 or 60 minutes depending on if the facility is located in a frontier area.
- The REH emergency department must be staffed 24 hours per day and seven days per week by an individual competent in the skills needed to address emergency medical care, and this individual must be able to receive patients and activate the appropriate medical resources to meet the care needed by the patient.
- REHs must develop, implement, and maintain an effective, ongoing, REH-wide, data-driven Quality Assurance and Performance Improvement (QAPI) program, and it must address outcome indicators related to staffing.
- The annual per-patient average length of stay cannot exceed 24 hours, in accordance with the statute, and the time calculation begins with the registration, check-in, or triage of the patient and ends with the discharge of the patient from the REH (which occurs when the physician or other appropriate clinician has signed the discharge order or at the time the outpatient service is completed and documented in the medical record).
- REHs must have an infection prevention and control and antibiotic stewardship program that adhere to nationally recognized guidelines.
However, there’s some uncertainty to the number of hospitals that will apply for the new designation. According to NC Rural Health Research Program’s study, they found that “68 rural hospitals are predicted to consider conversion to REHs (“REH converters”) in comparison to 1,605 hospitals not predicted to consider conversion.” It’s difficult to know if that will come to pass or it will be more requested than guessed until next year.
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