Miss. Senator Introduces ‘Rural Health Sustainability Act’ to Broaden Rural Emergency Hospital Designation Eligibility to At-Risk or Closed Rural Hospitals

WASHINGTON, D.C. – U.S. Senator Cindy Hyde-Smith (R-Miss.) today introduced legislation to reestablish some healthcare services in rural areas by making more at-risk or closed hospitals eligible for a Rural Emergency Hospital (REH) designation.

The Rural Health Sustainability Act (S.4201) would amend the eligibility dates for REH designation applications and clarify how healthcare facilities are defined as “rural”—changes that would allow more rural facilities to reestablish or maintain access to emergency outpatient hospital services.

“People who live and work in rural areas need basic emergency health services, but too many rural hospitals are in danger of closing or have already closed.  The Rural Health Sustainability Act would make minor changes to an existing program to improve chances that rural residents can keep or regain access to healthcare without having to drive an hour or more to get help,” said Hyde-Smith, who serves on the Senate Labor, Health and Human Services, and Education Appropriations Subcommittee.

Congress created the REH designation in the FY2021 Consolidated Appropriations Act and the Centers for Medicare and Medicaid Services (CMS) launched the program on Jan. 1, 2023.  It is designed to help sustain emergency outpatient hospital services in communities that may not be able to support or sustain a Critical Access Hospital (CAH) or small rural hospital.  REH-designated facilities receive enhanced Medicare payments for certain outpatient services and additional monthly payments to provide 24-hour emergency and observation services.

However, current REH eligibility is limited to CAHs and hospitals with no more than 50 beds located in rural areas if they participated in Medicare as of Dec. 27, 2020, and to facilities that closed after that date if they re-enroll in Medicare and meet all REH requirements.  Additionally, CMS follows the definition of “rural” determined by the Office of Management and Budget (OMB) to determine REH eligibility.

S.4201 would extend REH designation eligibility to Jan. 1, 2014, and by allowing hospitals to qualify by meeting the definition of “rural” as set by the Health Resources and Services Administration (HRSA) Office of Rural Health Policy.

“The rural hospital closures and rural health crisis have been with us well before 2020, which is why I think we must extend the qualifying date to 2014.  There are hospitals in rural Mississippi that have closed since 2014 and would like to reopen to the public as a REH-designated hospital,” Hyde-Smith said.  “This legislation would give them that opportunity.”

Hyde-Smith also stressed that more hospitals would qualify for REH designation by following the HRSA “rural” definition, particularly those hospitals whose applications were rejected because of the CMS/OMB definition that wrongly categorizes their truly rural communities as “urban.”

“There are hospitals across this country like the Magee General Hospital in Magee, Mississippi, that have been denied REH because they’re tagged as being in an urban statistical area.  Magee isn’t urban by any means.  It has less than 4,000 people and is about an hour away from emergency care in Jackson,” Hyde-Smith said.  “I think we can do better and ensure that people who live in small communities like Magee have better access to emergency care.  It can be a matter of life or death.”

“We appreciate Senator Hyde-Smith and her team for their help in identifying a significant barrier for small rural hospitals in Mississippi, and one that Magee General Hospital knows all too well.  Rural Emergency Hospitals should exist in areas that are designated as rural by the Office of Rural Health Policy, like Magee, Mississippi,” said Magee General Hospital CEO Gregg Gibbes.  “The current pathway for hospitals to convert to REH is too narrow, and I think that’s absolutely the reason why so few exist.  If the intent of a REH designation is to secure access to care in areas that are rural and low in utilization, the Office of Rural Health Policy language should be added to the rule.”

The Rural Health Sustainability Act is supported by the National Rural Health Association, Mississippi Hospital Association (MHA), and Mississippi Rural Health Association (MRHA).

“The Mississippi Hospital Association greatly appreciates Senator Hyde-Smith’s efforts to protect access to care in our rural communities.   Amending the definition of rural and allowing more hospitals access to this designation is a tremendous support to rural communities that have been denied access to this designation.  Our rural communities deserve this opportunity to adequate access to care,” said Chad Netterville, MHA Director of Rural Hospital Alliance and Center for Rural Health.

“Rural emergency hospitals are an excellent option for select communities who need access to emergency care, but do not have as much of a need for in-patient stays and advanced services.  However, we also acknowledge that several hospitals in Mississippi desire the REH model, but due to limiting administrative language they are unable to obtain this status,” said MRHA Executive Director Ryan Kelly.  “We hope that with small changes to the REH language it will allow more facilities to convert to REH in order to best serve the rural communities in which they reside.”