Mississippi State Department of Health

Conversion to a Rural Emergency Hospital (REH)


Medicare has established Rural Emergency Hospitals (REHs) as a new Medicare provider type to address the growing concern over closures of rural hospitals.

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Who Can Convert to an REH

A facility is eligible to convert to an REH if it was a Critical Access Hospital (CAH) or rural hospital with not more than 50 beds as of December 27, 2020 (including a hospital that closed after December 27, 2020). REHs must provide emergency services and observation care and are prohibited by the statute from providing inpatient services.


Notify the MSDH Office of Licensure of the intent to convert to a REH on facility letterhead to HFLC-NLTC@msdh.ms.gov.

Required Documents

The following documents must be included with CMS Federal Enrollment application (CMS PECOS) and State Licensure application:

Federal Application: How to Enroll

Prior to completing the licensure application, facilities should complete the CMS enrollment process to convert to a REH. See the following for enrollment steps:

Complete CMS Enrollment through the CMS PECOS website:

REH Initial Survey

Eligible facilities that are existing CAHs and hospitals converting to an REH may attest to meeting the REH CoPs and will not require an automatic on-site initial survey as eligible facilities are expected to be in full compliance with the existing CAH and hospital requirements (as applicable) at the time of the request for conversion (See QSO-23-07-REH for full details).

License Application

After CMS has approved the conversion to a REH and the facility has received their new CMS REH provider number with effective date, complete this online license application:

Fees: There are no licensure fees to convert to a REH.

License Effective Date: Upon approval of the licensure application, the MSDH License Administrator will issue a REH License backdated to the effective CMS REH Certification date.

Certificate of Need (CON): CON approval is not required to convert to a REH. However, after receiving CMS Certification as an REH, your facility must contact the MSDH Office of Health Policy and Planning (CON) at (601) 576-7874 to request placing inpatient beds in abeyance (do not include acute beds allocated for a SNF Unit).

SNF Unit: Facilities considering adding SNF services in a Distinct Part Unit: 

  1. Contact the CON Office for a Determination.
  2. Complete the CMS enrollment process: Contact the MSDH Long Term Care Division for additional information at 601-364-1110.

License Renewal

REH License year is January 1 – December 31. 


Contact the MSDH License Administrator at (601) 364-2722 with any questions.

Links referenced on this page
HFLC-NLTC@msdh.ms.gov    mailto:HFLC-NLTC@msdh.ms.gov
EXHIBIT: Model Attestation    http://msdh.ms.gov/msdhsite/index.cfm/30,19679,83,docx/REH_Model_Attestation_Template.docx
EXHIBIT: Model REH Action Plan    http://msdh.ms.gov/msdhsite/index.cfm/30,19678,83,docx/REH_Model_Action_Plan_Template.docx
QSO-23-07-REH: Guidance for Rural Emergency Hospital Conversion    https://www.cms.gov/files/document/qso-23-07-reh.pdf
QSO-23-07-REH    https://www.cms.gov/files/document/qso-23-07-reh.pdf
REH Medicare Provider Instructions    https://www.cms.gov/files/document/reh-medicare-provider-instructions.pdf
MLN2259384: CMS Rural Emergency Hospital Enrollment    https://www.cms.gov/files/document/mln2259384-rural-emergency-hospitals.pdf
Visit the PECOS website    https://pecos.cms.hhs.gov
REH Enrollment Instructions    https://www.cms.gov/files/document/reh-medicare-provider-instructions.pdf
See QSO-23-07-REH    https://www.cms.gov/files/document/qso-23-07-reh.pdf
MSDH Rural Emergency Hospital License application    https://app.smartsheet.com/b/form/e688589dd5304695a4c78efaebfcd38e

Find this page at http://msdh.ms.gov/msdhsite/index.cfm/index.cfm

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