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New Part A specialty type: Rural emergency hospital
Last Modified: 4/30/2024
Location: FL, PR, USVI
Business: Part A
Rural emergency hospital (REH) eligibility
If your facility was enrolled as a critical access hospital (CAH) or a rural hospital on or before December 27, 2020, you are eligible to enroll as a REH.
Note: Facilities that were in a deactivated status in PECOS pursuant 42 CFR § 424.540(a)(2) or (3) on or before December 27, 2020 still qualify as having been enrolled at that time.
Section 1886(d)(1)(B) of the Act defines a rural hospital as a hospital "with not more than 50 beds located in a county (or equivalent unit of local government) in a rural area (as defined in section 1886(d)(2)(D)), or was a subsection (d) hospital (as so defined) with not more than 50 beds that was treated as being located in a rural area pursuant to section 1886(d)(8)(E)."
• An REH is a facility who:
• Is enrolled in Medicare
• Does not provide any acute care inpatient services (other than post-hospital extended care services furnished in a distinct part unit licensed as a skilled nursing facility)
• Has a transfer agreement in effect with a level I or level II trauma center
• Meets certain licensure requirements
• Meets requirements to be a staffed emergency department
• Meets staff training and certification requirements established by the Secretary
• Meets Conditions of Participation (CoPs) applicable to CAHs with respect to emergency services and, as determined applicable by the Secretary, to hospital departments
As of October 28, 2022, CAHs and small rural hospitals can convert to REHs in order to receive payment beginning in 2023. In order for the REH to be eligible, the facility must have been enrolled as a CAH or rural hospital on or before December 27, 2020.
If your facility would like to convert to an REH, the facility must:
• Submit a paper CMS-855A change of information application or PECOS initial enrollment application:
• CMS-855A paper application (change of information):
• Must check "Other" in section 2A2 and write "rural emergency hospital" or "REH".
• Complete section 2B, 3, and 15 and/or 16 (as applicable).
• Report any additions/deletions/changes to current enrollment information that will stem from converting to the REH.
• PECOS application (initial enrollment):
• In the provider type dropdown, select rural emergency hospital
• Complete all applicable sections
• Submit application through PECOS
• Submit all required state licenses/certifications for operation as an REH (if available)
Note: No application fee is required.
The facility is not required to submit a voluntary termination application to terminate its existing CAH or rural hospital enrollment. Any termination will be effectuated upon the approval of the REH's enrollment.
Once enrolled, the REH, like all providers and suppliers, must maintain compliance with the enrollment requirements in 42 CFR Part 424, subpart P. This includes, but is not limited to, reporting changes to its enrollment information, undergoing revalidation (and submitting the required fee with its application), etc.
It is possible that an enrolled REH may seek to return to its former status as a CAH or rural hospital. To do so, and consistent with 42 CFR Part 424, subpart P and this chapter, it must submit an initial enrollment application, and for the REH enrollment, a voluntary termination application. It cannot do so via a change of information.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.