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    v1.0.28
    OpenPayerPolicy UpdatesPost-Acute & Facility CareMississippi Medicaid REH Coverage Update | OpenPay…
    Ask Trek AI about this page
    CurrentMississippi Division of MedicaidPolicy N/A

    Rural Emergency Hospitals (REH) — Coverage Criteria

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    Defines enrollment, provider and staffing requirements, covered and non-covered services, length-of-stay limits, and reimbursement for Rural Emergency Hospitals (REH) under Mississippi Medicaid. Affects REH facilities seeking Medicaid enrollment and reimbursement.

    Policy Summary
    PayerMississippi Division of Medicaid
    PolicyRural Emergency Hospitals (REH) — Coverage Criteria
    Policy CodePolicy N/A
    Change TypeTechnical — new rule effective dateno material coverage changes
    Effective DateJan 1, 2025
    Last ReviewJan 1, 2025
    Next Review DateN/A
    Key ActionDocument Medicare REH provider status, a transfer agreement with a Level I/II trauma center, bed count (<50), and that the facility does not provide acute inpatient services (except SNF distinct unit) when enrolling.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    24hmax LOS (annual per patient)
    24/7ED staffing
    5%OPPS add-on
    ≤50bed-count limit

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    Coverage Criteria for REH Services

    Covered Outpatient REH Services

    Covered when services are outpatient and furnished by a REH:

    Covered outpatient services: Includes emergency department services, laboratory services, diagnostic radiologic services, behavioral health services, and low-risk labor and delivery services when furnished by a REH.

    Non-Covered / Not Covered Inpatient Services

    Not covered:

    Inpatient services exclusion: Inpatient services are not covered in Rural Emergency Hospitals, except for post-hospital extended care services furnished in a distinct unit licensed as a skilled nursing facility (SNF).

    Provider Enrollment and Operational Requirements

    REH enrollment and operational requirements that must be met:

    Enrollment and status: Facility must be a Medicare REH provider and meet the REH definition (converted from a CAH or rural hospital with <50 beds) at time of enrollment.
    Transfer agreement: Have a transfer agreement in effect with a Level I or Level II trauma center.
    Length of stay limit: Not exceed an annual per patient length of stay of 24 hours.<= 24 hours per patient per year
    Inpatient restrictions: Not provide any acute care inpatient services other than post-hospital extended care services provided in a distinct unit licensed as a skilled nursing facility (SNF).
    Definition at enrollment: Meet the REH definition in Rule 6.1 (conversion from CAH or rural hospital with less than 50 beds and not providing acute inpatient services except SNF distinct part) at the time of enrollment.

    Staffing Requirements

    REH must meet the following staffing conditions:

    24/7 ED staffing: The emergency department must be staffed 24 hours a day, 7 days a week.
    Clinical coverage: An MD/DO, physician assistant, nurse practitioner, or clinical nurse specialist with training or expertise in emergency care must always be onsite or on-call and available onsite within 30 minutes, or within 60 minutes when frontier or remote area criteria apply.30 minutes (60 minutes in certain frontier/remote areas)
    Privileges: The governing body may grant medical staff privileges to nurse practitioners and physician assistants in accordance with state scope-of-practice laws.

    Inpatient services are not covered when furnished in a Rural Emergency Hospital (REH). The only exception is for post-hospital extended care services that are provided in a distinct unit licensed as a skilled nursing facility (SNF).

    Admission Criteria for REH Outpatient/Emergency Services

    REH outpatient/emergency services

    Admission to REH: Facility must meet the REH definition (converted from CAH or rural hospital with <50 beds) and be enrolled as a Medicare REH provider; may not provide acute inpatient services except post-hospital extended care services in a distinct licensed SNF unit.

    Criteria for Continued Stay in REH

    REH — Continued Stay Criteria

    Continued stay / length limit: Annual per patient length of stay must not exceed 24 hours.<= 24 hours per patient per year

    Discharge Criteria

    Patients in a Rural Emergency Hospital (REH) are discharged according to the policy definition of length of stay, which is the time from registration, check-in, or triage (whichever occurs first) until discharge. Discharge should occur once the episode meets that definition and the REH determines the patient no longer requires the outpatient emergency/REH services provided.

    Limits on Length of Stay

    REH — maximum length of stay value (24 hours)
    Maximum length of stayNot exceed an annual per-patient length of stay of 24 hours.
    Measurement periodPer patient, per year
    Consequence of exceedanceFailure to meet this requirement may result in denial of enrollment or reimbursement.

    Reimbursement and Coding

    Reimbursement basismixed
    OPPSCertain procedure codes reimbursed at the appropriate OPPS rate plus 5%

    Provider Actions, Billing, and Documentation Requirements

    Billing Rule

    Billing: OPPS + 5%; no prior authorization specified

    Reimbursement for covered REH procedure codes is paid at the applicable OPPS outpatient rate plus five percent (5%). The rule text does not specify any prior authorization requirement for REH services.

    • REH are reimbursed for certain procedure codes at the appropriate Outpatient Prospective Payment System (OPPS) rate, plus five percent (5%).
    Note

    Comply with REH enrollment, staffing, and service rules

    Maintain documentation and comply with enrollment and operational requirements at time of Medicaid enrollment; follow staffing and service restrictions required of REHs.

    • Facility must meet the REH definition and be a Medicare REH provider at enrollment.

    Background on Rural Emergency Hospitals (REH)

    A Rural Emergency Hospital (REH) is a facility converted from a qualifying critical access hospital (CAH) or rural hospital with less than 50 beds that focuses on outpatient emergency and related services and does not provide general acute inpatient care. REHs may, however, provide post-hospital extended care services if those services are furnished in a distinct part/unit licensed as a skilled nursing facility. REHs must maintain continuous emergency department coverage and meet the enrollment and operational requirements for REH status.

    Definitions

    Rural Emergency Hospital (REH) — definition and qualifying characteristics
    DefinitionA facility converted from a critical access hospital (CAH) or a rural hospital (or one treated as such) with less than 50 beds that does not provide acute care inpatient services except for skilled nursing facility services furnished in a distinct part/unit.
    Medicare enrollmentMust be a Medicare Rural Emergency Hospital provider at time of Medicaid enrollment.
    Transfer agreementMust have a transfer agreement in effect with a Level I or Level II trauma center.
    Inpatient restrictionMay not provide acute inpatient services except post-hospital extended care in a distinct licensed SNF unit.
    Length of stay — definition
    Length of stay (definition)Time from registration, check-in, or triage, whichever occurs first, until discharge.
    Policy Summary
    PayerMississippi Division of Medicaid
    PolicyRural Emergency Hospitals (REH) — Coverage Criteria
    Policy CodePolicy N/A
    Change TypeTechnical — new rule effective dateno material coverage changes
    Effective DateJan 1, 2025
    Last ReviewJan 1, 2025
    Next Review DateN/A
    Key ActionDocument Medicare REH provider status, a transfer agreement with a Level I/II trauma center, bed count (<50), and that the facility does not provide acute inpatient services (except SNF distinct unit) when enrolling.
    SourceLink
    On This Page
    Coverage Criteria for REH ServicesAdmission Criteria for REH Outpatient/Emergency ServicesCriteria for Continued Stay in REHDischarge CriteriaLimits on Length of StayReimbursement and CodingProvider Actions, Billing, and Documentation RequirementsBackground on Rural Emergency Hospitals (REH)Definitions
  1. Do not provide acute inpatient services except post-hospital extended care in a distinct SNF unit.
  2. Emergency department must be staffed 24/7 and required clinical coverage must be onsite or available within required response times.
    3. Documentation Required

    Document Medicare REH status, transfer agreement, bed count, and inpatient restrictions at enrollment

    At enrollment, document Medicare REH provider status, an active transfer agreement with a Level I or Level II trauma center, facility bed count/REH definition compliance, and that the facility does not provide acute inpatient services other than post‑hospital extended care in a distinct licensed SNF unit.

    • Be a Medicare Rural Emergency Hospital provider.
    • Have a transfer agreement in effect with a Level I or Level II trauma center.
    • Meet the REH definition (converted from CAH or rural hospital with ≤50 beds) at the time of enrollment.
    • Document that the facility does not provide acute care inpatient services other than post‑hospital extended care services in a distinct licensed SNF unit.
    Denial Risk

    Denial risk for failing REH provider requirements

    Failure to meet provider requirements may result in denial of enrollment or reimbursement — e.g., not being a Medicare REH provider, lacking a transfer agreement with a Level I/II trauma center, exceeding the 24‑hour annual per‑patient length of stay, or providing prohibited acute inpatient services.

    • Noncompliance with enrollment/operational requirements can lead to denial of enrollment or reimbursement.
    • Exceeding the annual per patient length of stay limit (24 hours) or providing acute inpatient services (other than permitted SNF distinct unit services) are grounds for denial.
    Applies toAll REH outpatient and emergency encounters for measuring the 24-hour annual per-patient limit.
    Use for discharge decisionPatients are discharged when length of stay reaches the defined discharge point (registration/check-in/triage to discharge).