Critical Access Hospitals.

There are 39 hospitals in Washington that are certified as critical access hospitals.  These are hospitals with 25 beds or less that are generally located in rural areas.  They must deliver continuous emergency department services, and they may not have an average length of stay of more than 96 hours per patient.  The Critical Access Hospital (CAH) program allows hospitals under Washington's medical assistance programs to receive payment for hospital services based on allowable costs and to have more flexibility in staffing.

Rural Emergency Hospitals. 

In 2020 the Centers for Medicare and Medicaid Services (CMS) established Rural Emergency Hospitals (REHs) as a new Medicare provider type.  As of January 2023, CAHs and small rural hospitals with no more than 50 beds as of December 27, 2020, may apply for REH designation and receive Medicare payment for providing emergency services.  Closed facilities are also eligible to seek REH designation if they re-enroll in Medicare and meet all REH conditions of participation and requirements.  There are currently no REH-designated hospitals in Washington.

Rural Emergency Hospital's Services. 

The REHs must:

• not provide acute care inpatient services with some exceptions, such as posthospital extended care services;
• not exceed an annual average patient length of stay of 24 hours;
• have a transfer agreement with a level I or II trauma center;
• meet certain licensure and staffing requirements; and
• meet other requirements, including those the Secretary of Health and Human Services finds necessary.

Payments for medical assistance services provided by a rural hospital designated by the CMS as an REH, regardless of the managed care enrollment status of the beneficiary, are subject to appropriation.

(In support) The federal government created the REH designation, but there is nothing in state statute to recognize that designation.  The REHs need state recognition so they can be cost-based reimbursed like CAHs and maintain eligibility through the Hospital Safety Net Program.  The REH model allows small hospitals with limited populations and massive clinical responsibilities to financially survive by switching from inpatient care to an outpatient and emergency focused model.  East Adams Hospital is a public hospital district serving a large geographic area.  Because of financial difficulties, East Adams Hospital is applying to be the first REH in Washington.  The CMS supports this transition and is also providing an annual $3.4 million subsidy, but state law lacks the framework for REH Medicaid claims.  This bill had a lot of input at the staff and agency level.

(Opposed) None.

Todd Nida, East Adams Rural Health; and Lisa Thatcher, Washington State Hospital Association.