Rural Emergency Hospitals and Critical Access Hospitals: Eligibility for New Provider Type and Potential for Increased Reimbursement
New Conditions of Participation and Payment Rules, Stark Law Regulatory Modifications Pausing Flexibilities
Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
- work Practice Area
Health
- event Date
Wednesday, February 8, 2023
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE webinar will guide healthcare counsel on the new rural emergency hospital (REH) provider type eligible for reimbursement under Medicare, including the REH services eligible for increased reimbursement. The panel will discuss the REH reimbursement methodology, conditions of participation, and enrollment provisions. The panel will also address the limited Stark Law regulatory modifications implemented to accommodate REHs.
Ms. DiVarco focuses her practice on the representation of hospitals and health systems. She counsels healthcare facility and system clients regarding all aspects of health law transactions and health system restructurings. She has a deep knowledge of regulatory, licensing and accreditation issues of particular concern to healthcare providers. She regularly advises clients on the legal aspects of clinical regulatory issues and policy/procedure and operational matters. She is a registered nurse, and holding a current license in Illinois, she brings a pragmatic perspective and first-hand knowledge of health care operations to these complex and mission-critical matters.
Ms. Reignley provides strategic legal, regulatory and compliance counsel to for-profit and nonprofit hospitals, health systems, other healthcare providers, life sciences and technology companies. She counsels clients on interpretation and risk mitigation under the Anti-Kickback Statute, Stark Law and EKRA. She also advises on internal and government investigations related to the False Claims Act, Stark Law and Anti-Kickback Statue. Ms. Reignley advises clients involved in digital health on the applicable legal and regulatory infrastructure, with a particular focus on remote patient monitoring programs. She also advises Medicare providers, consultants and vendors on a wide range of business, legal and regulatory issues. She has extensive experience advising clients on Medicare and Medicaid fee-for-service reimbursement, billing and coding. She also advises clients on professional licensure, scope of practice, physician and health care professional clinician relationships and supervision, together with overall corporate compliance.
Currently, REHs are not a provider type recognized under Medicare. This changes on Jan. 1, 2023, when REHs are eligible to enroll in Medicare and receive increased reimbursement despite not providing inpatient services, which historically was required to meet the Medicare definition of a hospital.
On Nov. 1, 2022, the CMS finalized the REH conditions of participation (CoPs) and payment rates that apply to emergency department and outpatient services provided by REHs. The CoPs require an REH to maintain a staffed emergency department 24/7 with a physician, nurse practitioner, clinical nurse specialist, or physician assistant immediately available to provide emergency services in the facility. The CoPs also include several other requirements, including that REHs must have a transfer agreement in place with a Level I or Level II trauma center. Further, REHs must maintain appropriate state licensure to operate as an REH.
Some Stark Law exceptions related to compensation arrangements were revised to protect financial relationships that would no longer be available to REHs, as REHs do not fit into the definition of a hospital under the Stark Law. CMS clarified that REHs can rely on the rural provider exception. This is important to note because when a critical access hospital or a small rural hospital switches to an REH, it no longer qualifies as a "hospital" under Stark law and cannot use the whole hospital exception.
Listen as our authoritative panel of healthcare attorneys examines the new REH provider type, including REH services eligible for increased reimbursement. The panel will discuss the REH reimbursement methodology, REH conditions of participation, and REH enrollment provisions. The panel will also address the Stark Law regulatory modifications to accommodate REHs.
- Enrollment provisions
- Conditions of participation
- REH services eligible for increased reimbursement
- Reimbursement methodology
- Stark Law regulatory modifications and the implications for rural hospitals
The panel will review these and other key issues:
- How can REHs take advantage of the increased Medicare reimbursement available to them?
- What changes to the CoPs and payment rates have been made?
- What changes to Stark law have been made to accommodate REHs?
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