Rural Emergency Hospitals Increase Access to Care in Rural Communities

by Audrey Snyder, PhD, RN, FAANP, FAEN, FAAN

Residents in rural areas face great health disparities. Over the last decade, rural hospitals have continued to close forcing many residents to travel far distances for healthcare and many nurses to travel significant distances for work. According to the North Carolina Rural Health Research Program, since 2010 there have been 148 rural hospital closures leaving many rural communities without access to lifesaving care.

To increase access to healthcare in rural areas and to respond to the hospital closures, in 2021 congress passed the Consolidated Appropriations Act (Public Law 116-260). CMS (2022) created rural emergency hospitals (REH) as a separate provider designation effective January 1, 2023. Since the ruling took effect, eighteen rural hospitals converted to rural emergency hospital status in the first year. These hospitals provide emergency department services and observation care with optional additional outpatient and health services not exceeding an annual per patient length of stay of 24 hours.

Hospitals within a rural area with not more than 50 beds or that closed after December 27, 2020, can seek designation as a REH as long as they meet the conditions of participation to participate in Medicare and Medicaid programs. They must still comply with regulations related to emergency care, such as the Emergency Medical Treatment and Labor Act (EMTALA). The REH designation is one way that rural communities can maintain rural hospitals and keep rural nurses in their communities.


NC Rural Health Research Program. Rural Hospital Closures. Retrieved March 6, 2024.

NC Rural Health Research Program. Rural Emergency Hospitals. Retrieved March 6, 2024.

U.S. Centers for Medicare & Medicaid Services. Rural Emergency Hospitals. Retrieved March 6, 2024.

U.S. Government. (December 27, 2020). Consolidated Appropriations Act.

Dr. Audrey Snyder is a nurse who has served on the Rural Nurse Organization board. Dr. Snyder is a Professor and Associate Dean for Community Engagement and Academic Partnerships in the School of Nursing at the University of North Carolina- Greensboro. Her significant contributions have focused on promoting access to care for rural and under resourced populations and decreasing barriers to access advanced education for rural nurses. She is the Program Director of the Transforming Primary Advanced Practice in Medically Underserved Communities HRSA Nursing Workforce Development grant and the Minerva’s Mobile Health HRSA grant at UNC Greensboro, which increases access to healthcare for residents of rural and underserved communities in the Piedmont region of North Carolina. She has a passion for building working teams to address community and educational needs.

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