CMS Creates a New Type of Provider, Rural Emergency Hospitals

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The Centers for Medicare and Medicaid Services have offered a new rule that creates a pathway for rural hospitals and critical access hospitals to increase access to emergency and ambulatory care.

This is the first step in establishing a new type of provider, Rural Emergency Hospitals (REH).

Small rural hospitals can apply for this vendor designation through a Conditions of participation for REHs. This will enable them to provide continued access to emergency services, observational care, and additional medical and outpatient services, and to provide maternal health, behavioral health, and substance use disorder services. .

Rural hospitals under the designation will be eligible to receive payment for services provided beginning January 1, 2023.

CMS anticipates further WER discussions regarding issues such as Medicare enrollment, payment, quality reporting and more in the upcoming calendar year 2023 prospective outpatient payment system and proposed rule for the outpatient surgery center payment system.

Additionally, the proposed rule includes several updates for HPCs that serve rural communities.

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 HACs.

The proposed rule also contains proposals allowing HPCs that are part of a larger healthcare system (containing other hospitals and/or HPCs) to unify and integrate their infection control and prevention programs and management of antibiotics, their medical staff and their quality assessment and performance improvement programs. .

CMS also proposes to establish a condition of participation of the patient’s rights. This will give HPCs clear information they can share about protecting and promoting a patient’s rights.

Stakeholders are encouraged to review the two proposed rules, as appropriate, and submit formal comments by August 29. All comments will be taken into consideration when CMS develops its final and comprehensive policies for WER later this year.


Since 2010, 138 rural hospitals have closed – with a record 19 hospitals closed in 2020 alone. Rural hospital closures deprive people living in rural areas of essential services, including access to emergency care.

They occur disproportionately in communities with a higher proportion of people of color and communities with higher poverty rates, according to the Department of Health and Human Services.

Rural communities represent one-fifth of the US population. Rural populations experience shorter life expectancies and higher mortality, and have fewer local health care providers, resulting in poorer health outcomes than in other communities, HHS said.

“The availability of the new type of rural emergency hospital provider will maintain access to essential health care services and help reduce disparities in rural communities,” said CMS Administrator Chiquita Brooks-LaSure. . “CMS is committed to advancing health equity, fostering high-quality, people-centered care, and promoting the sustainability of our programs. Today’s action to strengthen rural health continues our goal to ensure that everyone served by our programs has access to affordable, quality health care.”


The new health insurance provider designation will allow rural hospitals to properly size their service footprint and avoid potential closure, CMS said.

The WER provider type was established by the Consolidated Appropriations Act of 2021 to address growing concerns about rural hospital closures.

The rule bolsters efforts to reduce health care disparities and maintain access to services in rural communities. One aspect is the ability to keep doctors, nurses and other staff in rural communities. More than 22,700 primary care clinicians work in underserved tribal, rural and urban communities.

Last year, HHS provided a historically high number of loan repayment and bursary programs to healthcare workers due to a new investment of $1.5 billion, including $1 billion in additional funding from the US bailout and other mandatory and annual credits.

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