CMS proposes COPs for new rural emergency hospital provider type

CMS has published a proposed list of 23 Conditions of Participation (CoP) for the new rural emergency hospital provider type. The same Federal Register posting on Thursday, June 30, also included revisions to CoP for critical access hospitals (CAH).

The agency is seeking comment on its proposal through August 29.

The proposal noted the concerns over the closure of large numbers of rural hospitals and CAHs for more than a decade. “Rural hospitals report they continue to face the threat of closure because they lack sufficient patient volume to offer traditional hospital inpatient acute care services required for Medicare payment; however, the demand still exists for emergency and outpatient services in areas served by these hospitals,” said CMS.

“Rural hospitals are essential to providing health care to their communities and the closure of these hospitals limits access to care for the communities they once served and reduces employment opportunities, further impacting local economies. Barriers such as workforce shortages, can impact health care access in rural communities and can lead to unmet health needs, delays in receiving appropriate care, inability to get preventive services, financial burdens, and preventable hospitalizations,” noted the proposal.

In recognition of these concerns, Congress established rural emergency hospitals (REH) as a new provider type in 2020 and the legislation was signed December 27, 2020. “These providers will furnish emergency department and observation care, and other specified outpatient medical and health services, if elected by the REH, that do not exceed an annual per patient average of 24 hours,” said CMS.

Hospitals that were CAHs or rural hospitals with not more than 50 beds, participating in Medicare, as of the date the legislation was signed, “may submit an application to convert to and enroll in Medicare as an REH. An REH will receive Medicare payment for REH services furnished on or after January 1, 2023. REHs are expected to help address the barriers in access to health care, particularly emergency services and other outpatient services that result from rural hospital closures, and by doing so, may help address observed inequities in health care in rural areas.”

The new CoP cover governing body responsibilities, patients’ rights, infection control, quality assurance and performance improvement, physical environment, and emergency preparedness, among other requirements, much like other provider types.

Among the revisions to the CAH requirements is an attempt to clarify the parameters for distance from other facilities that would allow a hospital to seek CAH status and changes in patients’ rights regarding restraint and seclusion.

To read the full proposal, and for instructions about how to submit comments, go to https://public-inspection.federalregister.gov/2022-14153.pdf.