CMS is creating a new provider type, Rural Emergency Hospitals
The upcoming 2023 outpatient payment rule is expected to provide more on Medicare enrollment, payment and quality reporting.
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The Centers for Medicare and Medicaid Services has proposed a new rule that creates a pathway for rural hospitals and critical access hospitals to increase access to emergency and outpatient care.
It is the first step in the implementation of a new provider type, Rural Emergency Hospitals (REHs).
Small rural hospitals can seek this provider designation through a Conditions of Participation for REHs. This will allow them to provide continued access to emergency services, observation care, and additional medical and outpatient services, and to provide maternal health, behavioral health and substance use disorder services.
Rural hospitals under the designation will be eligible to receive payment for services provided on or after January 1, 2023.
CMS anticipates further discussion on REHs regarding such issues as Medicare enrollment, payment, quality reporting and more in the upcoming Calendar Year 2023 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule.
In addition, the proposed rule includes several updates for CAHs that serve rural communities.
Specifically, CMS is proposing to add a definition of "primary roads" to the current location and distance requirements, which is used to determine if facilities qualify as CAHs.
The proposed rule also contains proposals allowing CAHs that are a part of a larger health system (containing other hospitals and/or CAHs) to unify and integrate their infection control and prevention and antibiotic stewardship programs, medical staff, and quality assessment and performance improvement programs.
CMS is also proposing to establish a patient's rights Condition of Participation. This will give CAHs clear information they can share on the protection and promotion of a patient's rights.
Stakeholders are encouraged to review both proposed rules, as applicable, and submit formal comments by August 29. All feedback will be taken into consideration as CMS develops its final, comprehensive policies for REHs later this year.
WHY THIS MATTERS
Since 2010, 138 rural hospitals have closed – with a record-breaking 19 hospitals closing in 2020 alone. Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care.
They occur disproportionately within communities with a higher proportion of people of color and communities with higher poverty rates, according to the Department of Health and Human Services.
Rural communities represent a fifth of the U.S. population. Rural populations experience shorter life expectancy and higher mortality, and have fewer local healthcare providers, leading to worse health outcomes than in other communities, HHS said.
"The availability of the new Rural Emergency Hospital provider type will maintain access to essential health care services and help to reduce disparities in rural communities," said CMS Administrator Chiquita Brooks-LaSure. "CMS is committed to advancing health equity, driving high-quality person-centered care, and promoting the sustainability of our programs. Today's action to strengthen rural health furthers our goal of ensuring everyone served by our programs has access to quality, affordable healthcare."
THE LARGER TREND
The new Medicare provider designation will allow rural hospitals to right-size their service footprint and avoid potential closure, CMS said.
The REH provider type was established by the Consolidated Appropriations Act of 2021 to address the growing concern over closures of rural hospitals.
The rule furthers efforts to reduce healthcare disparities and maintain access to services in rural communities. One aspect is the ability to keep physicians, nurses and other staff in rural communities. More than 22,700 primary care clinicians serve in underserved tribal, rural and urban communities.
Last year, HHS awarded a historically high number of health workforce loan repayment and scholarship programs due to a new $1.5 billion investment, including $1 billion in supplemental American Rescue Plan funding and other mandatory and annual appropriations.
Twitter: @SusanJMorse
Email the writer: SMorse@HIMSS.org
