Rural Emergency Hospitals and Critical Access Hospitals: Eligibility for New Provider Type and Potential for Increased Reimbursement

New Conditions of Participation and Payment Rules, Stark Law Regulatory Modifications Pausing Flexibilities

A live 90-minute CLE video webinar with interactive Q&A

This program is included with the Strafford CLE Pass. Click for more information.
This program is included with the Strafford All-Access Pass. Click for more information.

Wednesday, February 8, 2023 (in 1 day)

1:00pm-2:30pm EST, 10:00am-11:30am PST

or call 1-800-926-7926
Course Materials

This CLE webinar will guide healthcare counsel on the new rural emergency hospital (REH) provider type eligible for reimbursement under Medicare, including the REH services eligible for increased reimbursement. The panel will discuss the REH reimbursement methodology, conditions of participation, and enrollment provisions. The panel will also address the limited Stark Law regulatory modifications implemented to accommodate REHs.

Description

Currently, REHs are not a provider type recognized under Medicare. This changes on Jan. 1, 2023, when REHs are eligible to enroll in Medicare and receive increased reimbursement despite not providing inpatient services, which historically was required to meet the Medicare definition of a hospital.

On Nov. 1, 2022, the CMS finalized the REH conditions of participation (CoPs) and payment rates that apply to emergency department and outpatient services provided by REHs. The CoPs require an REH to maintain a staffed emergency department 24/7 with a physician, nurse practitioner, clinical nurse specialist, or physician assistant immediately available to provide emergency services in the facility. The CoPs also include several other requirements, including that REHs must have a transfer agreement in place with a Level I or Level II trauma center. Further, REHs must maintain appropriate state licensure to operate as an REH.

Some Stark Law exceptions related to compensation arrangements were revised to protect financial relationships that would no longer be available to REHs, as REHs do not fit into the definition of a hospital under the Stark Law. CMS clarified that REHs can rely on the rural provider exception. This is important to note because when a critical access hospital or a small rural hospital switches to an REH, it no longer qualifies as a "hospital" under Stark law and cannot use the whole hospital exception.

Listen as our authoritative panel of healthcare attorneys examines the new REH provider type, including REH services eligible for increased reimbursement. The panel will discuss the REH reimbursement methodology, REH conditions of participation, and REH enrollment provisions. The panel will also address the Stark Law regulatory modifications to accommodate REHs.

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Outline

  1. Enrollment provisions
  2. Conditions of participation
  3. REH services eligible for increased reimbursement
  4. Reimbursement methodology
  5. Stark Law regulatory modifications and the implications for rural hospitals

Benefits

The panel will review these and other key issues:

  • How can REHs take advantage of the increased Medicare reimbursement available to them?
  • What changes to the CoPs and payment rates have been made?
  • What changes to Stark law have been made to accommodate REHs?

Faculty

DiVarco, Sandra
Sandra M. DiVarco

Partner
McDermott Will & Emery

Ms. DiVarco focuses her practice on the representation of hospitals and health systems. She counsels healthcare...  |  Read More

Reignley, Caroline
Caroline Reignley

Partner
McDermott Will & Emery

Ms. Reignley provides strategic legal, regulatory and compliance counsel to for-profit and nonprofit hospitals, health...  |  Read More

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You may pre-order a recording to listen at your convenience. Recordings are available 48 hours after the webinar. Strafford will process CLE credit for one person on each recording. All formats include course handouts.

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