CMS releases Rural Emergency Hospital final rule: 5 things to know

CMS unveiled the final rules for the Rural Emergency Hospital designation that is set to go into effect Jan. 1, 2023. 

Five things to know:

1. CMS defines "rural emergency hospitals" as "facilities that convert from either a critical access hospital or a rural hospital with no more than 50 beds and do not provide acute care inpatient services, with the exception of post-hospital extended care services furnished in a distinct part unit licensed as a skilled-nursing facility," according a CMS fact sheet.

2. Conversion to the designation allows hospitals to continue providing emergency services, observation care and, if elected by the hospital, additional medical and health outpatient services, that do not exceed an annual per-patient average of 24 hours. 

3. Rural Emergency Hospitals will be paid for services at a rate that is equal to the Outpatient Prospective Payment System payment rate for the equivalent covered outpatient department service, increased by 5 percent. Beneficiaries will not be charged coinsurance on the additional 5 percent. 

4. Rural Emergency Hospitals may provide outpatient services that are not otherwise paid under the OPPS — such as services paid under the Clinical Lab Fee Schedule — and post-hospital extended care services, furnished in a unit of the facility that is a distinct part of the facility licensed as a skilled nursing facility. These services will not be considered Rural Emergency Hospital services and will not receive the additional 5 percent payment increase. 

5. Conditions of participation are:

  • Hospitals must have a clinician on-call at all times and available on-site within 30 or 60 minutes depending on if the facility is located in a frontier area.
  • Emergency departments must be staffed 24 hours per day, seven days per week by an individual competent in the skills needed to address emergency medical care. This individual must be able to receive patients and activate the appropriate medical resources to meet the care needed by the patient. 
  • Hospitals must develop, implement and maintain an effective, hospital-wide, data-driven quality assurance and performance improvement program, and it must address outcome indicators related to staffing. 
  • The annual per-patient average lengths of stay cannot exceed 24 hours and time calculation begins with registration, check-in or triage of the patient and ends with the discharge of the patient from the hospital.
  • Hospitals must have an infection prevention and control and antibiotic stewardship program that adheres to nationally recognized guidelines.

Read the CMS fact sheet on the final rule here

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