Rural Emergency Hospitals
State policymakers have an important role to play in establishing and regulating this new provider type, as REHs are required to meet applicable state licensing, staffing, educational training, and scope of practice requirements.
A handful of states have enacted laws establishing REH licensure:
- Kansas HB 2208 (2021)—Enacts the Rural Emergency Hospital Act and creates a category of licensure to enable certain Kansas hospitals to receive federal health care reimbursement as rural emergency hospitals.
- Nebraska LB 697 (2022)—Provides for the licensure of rural emergency hospitals and requires coverage for REH services.
- South Dakota HB 1123 (2022)—Establishes licensure for rural emergency hospitals.
- Michigan SB 183 (2022)—Establishes licensure for rural emergency hospitals.
Other Health Care Facilities
Many rural hospitals struggle to maintain financial viability under traditional Medicare payment models. In response, other types of health care facilities, including critical access hospitals (CAHs) and freestanding emergency departments (FSEDs), have emerged as options for rural communities.
The new REH provider type aims to fill a gap in the services offered by other types of health care facilities, like critical access hospitals (CAHs) and freestanding emergency departments (FSEDs). REHs are intended to provide emergency services as a new Medicare provider.
Critical Access Hospitals
Critical Access Hospitals (CAH) are one of two types of facilities that can convert to an REH. CAH designation was created in 1997 in response to widespread rural hospital closures. Similar to an REH, it is designed to reduce the financial vulnerability of hospitals and improve access to health care. CAHs receive cost-based reimbursement for Medicare services and other benefits, including flexible staffing and services, and access to certain resources and technical assistance.
Kansas was one of the first states to codify CAH designation in through SB 425 in 1998, followed over the next several years by Washington, North Carolina and West Virginia, among others. As of July 2022, 1,360 CAHs were operating across all 50 states.
Visit the Rural Health Information Hub for additional information on CAHs.
Freestanding Emergency Departments
Free-standing emergency departments (FSEDs) function as fully operational emergency departments and are often required by state statute to be open 24/7. These stand-alone facilities operate either under a larger health system, subjecting them to the same federal or state regulations as the parent health system, or are independently owned and operated. However, since independent FSEDs do not meet the federal definition of a hospital, they are ineligible for Medicare and Medicaid reimbursement.
At least 21 states have established licensure requirements for FSEDs, beginning with Texas HB 1357 in 2009. In addition, at least seven states maintain Certificate of Need approval for establishing or expanding the service capacity of FSEDs in state statute.