July 6, 2022

“Country roads, take me home to the place I belong.  West Virginia, mountain mama, take me home, country roads.”  There is an allure to the idyllic lands that lie outside of our nation’s cities and suburbs.  A slow-paced spot where sweeping landscapes and peaceful pastures create a longing, perhaps even a belonging, within the human heart.  But the countryside, with its hills and hollows, streams and forests, is suddenly less alluring when medical attention is required—that is, if there is no healthcare facility that is locally available.  That is why the building of rural hospitals over the last several decades has been so important to those who were once forced to drive 50 miles or more to seek care.  Now, in many rural communities, there is a healthcare facility that is within a short driving distance. 

Unfortunately, these rural hospitals have become endangered in recent years.  In fact, many have closed their doors.  Because of the massive impact of these closures on our country farmers and rural citizens, the federal government has taken recent steps to once again protect and enhance access to rural hospital services.

On June 30, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would create a new hospital classification, along with a set of Medicare Conditions of Participation (CoPs) that would apply to this type of facility.  The proposed rule will allow small rural hospitals to seek this new healthcare provider designation, to be styled “Rural Emergency Hospital” (REH).  Those facilities so designated would be afforded the ability to provide continued access to emergency services, observation care, and additional medical and outpatient services.

Rationale for Proposal

According to CMS, rural communities represent a fifth of the U.S. population, and the Department of Health and Human Services (HHS) has undertaken efforts to improve health outcomes and promote health equity in rural America.  Since 2010, 138 rural hospitals have closed, with a record-breaking 19 hospitals closing in 2020 alone.  These closures occur disproportionately within communities with higher poverty rates.  Rural communities experience shorter life expectancy, higher mortality, and have fewer local healthcare providers, leading to worse health outcomes than in other communities.  Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care.

According to CMS Administrator Chiquita Brooks-LaSure:

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.  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 health care.

The Specifics

In an effort to alleviate the concerns listed in the above section, the U.S. Congress passed the Consolidated Appropriations Act of 2021, which contained provisions meant to address the issue of rural hospital closures.  The Act created the REH classification and directed HHS to create rules that would implement the intent of the legislation.  The CMS proposed rule, cited above, reflects the department’s first attempt at that directive.

Hospitals that are able to take advantage of the new designation will be in a better position to provide critical outpatient services, emergency services, maternal health, behavioral health, and substance use disorder services.  In accordance with the statutory legislation, REHs will be eligible to receive payment for services provided on or after January 1, 2023. 

Critical Access

In addition to the REH payments, the proposed rule includes several updates for Critical Access Hospitals (CAHs).  Specifically, CMS is proposing to add a definition of “primary roads” to the current location and distance requirements, which is used to determine whether or not a facility may qualify as a CAH.

According to CMS, 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 (known as QAPI) to ensure consistent and safe care.”

Lastly, CMS is proposing to establish a “patient’s rights” CoP for CAHs to provide for the protection and promotion of patient’s rights.  If you wish to know more about the proposed rule and the associated CoPs, please go to the CMS fact sheet link here: https://www.cms.gov/newsroom/fact-sheets/conditions-participation-rural-emergency-hospitals-and-critical-access-hospital-cop-updates-cms-3419.  To learn more about hospital-specific services that we at MiraMed Global Services provide, please visit us at info@miramedgs.com.