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

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.