The Rural Emergency Hospital (REH) designation was created to help preserve access to essential healthcare services in rural communities facing hospital closures. Effective January 1, 2023, REHs are a new Medicare provider type that offer 24/7 emergency and outpatient services but do not provide inpatient care. Eligible facilities include Critical Access Hospitals and small rural hospitals with 50 or fewer beds that were open as of December 27, 2020.
In Iowa, the REH designation is supported by state legislation signed in 2023, with licensing rules enacted in 2024. REHs receive enhanced Medicare reimbursement, including a 5% add-on to outpatient payments and a fixed monthly facility payment. This model aims to sustain emergency care access while allowing hospitals to tailor outpatient services to community needs.
For more details, visit the Rural Health Information Hub
Frequently Asked Questions
What is a Rural Emergency Hospital (REH)? An REH is a new Medicare provider type created to maintain access to emergency and outpatient services in rural areas where full-service hospitals may no longer be sustainable. REHs do not offer inpatient care but must provide 24/7 emergency services.
Who is eligible to become an REH? Critical Access Hospitals and rural hospitals with 50 or fewer beds that were open as of December 27, 2020, are eligible. Hospitals that closed after that date may also qualify if they meet federal and state requirements.
What services can an REH provide? REHs are required to offer emergency and observation services around the clock. They may also provide outpatient services such as lab work, imaging, behavioral health, telehealth, and skilled nursing through a distinct part unit.
How is an REH reimbursed? REHs receive a 5% add-on to Medicare’s outpatient payment rates and a fixed monthly facility payment. This financial model is designed to support sustainability while focusing on community-specific outpatient needs.
What are the staffing requirements? REHs must have emergency department staff available 24/7. This includes a physician, nurse practitioner, physician assistant, or clinical nurse specialist with emergency care expertise.
Is there a limit on how long patients can stay? Yes. REHs must maintain an annual average patient stay of 24 hours or less. This ensures the facility remains focused on emergency and short-term outpatient care.
Can a hospital revert back after converting to REH status? Yes, but with limitations. For example, Critical Access Hospitals that held “necessary provider” status before 2006 may not be able to regain that designation if they convert back.
How does Iowa support REH designation? Iowa enacted legislation in 2023 to authorize REH licensure, with administrative rules taking effect in 2024. The Iowa Department of Health and Human Services and IRHA provide technical assistance and resources to support hospitals exploring this option.