Rural Emergency Hospitals: New Institutional Provider Type Effective Jan. 1

AHA Special Bulletin
January 17, 2023

CMS issues additional information on the application process to become a Rural Emergency Hospital (REH)

The Centers for Medicare and Medicaid Services (CMS) released more information on how rural hospitals and critical access hospitals (CAHs) can apply for conversion to an REH. Specifically, eligible providers can begin by submitting a change of information online via the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) or a paper CMS-855A application to Medicare Administrative Contractors (MACs). Providers are not required to submit a voluntary termination application for existing enrollment as a CAH or rural hospital — termination of existing enrollment will take effect when REH enrollment is approved.

The MAC will screen applications to confirm eligibility and to ensure compliance with all Medicare enrollment requirements. It will then send its recommendation for approval to the state which will perform a survey and refer the application to CMS for final review. The MAC will notify the provider when its application has been approved or denied. The effective date for billing privileges is based on when the MAC deems all applicable federal requirements have been met.

Should an enrolled REH want to return to its former status as a CAH or rural hospital, it must submit an initial enrollment application for its former provider type. It would also need to submit a voluntary termination application for its REH enrollment.

REH technical assistance is provided by the Rural Health Redesign Center Organization (RHRCO), in cooperation with the Health Resources and Services Administration (HRSA) and CMS. It will be hosting a webinar to provide an overview of the REH model on Jan. 18, 2023 at 12:30 p.m. EST. You can register here.

For more information on the REH model, see AHA’s summary of the finalized REH rules from the CY 2023 OPPS/ASC final rule. CMS has also issued a Fact Sheet with details on the model.


If you have further questions, please contact Shannon Wu, AHA’s senior associate director of payment policy, at

Cover Rural Emergency Hospitals: New Institutional Provider Type Effective Jan. 1