What a Rural Emergency Hospital does
Congress created REHs in the Consolidated Appropriations Act, 2021, as an option for small rural hospitals that might otherwise close. CMS's rules took effect January 1, 2023. Under 42 CFR Part 485, Subpart E, an REH:
- provides emergency department services, observation care and other outpatient services;
- keeps an annual average patient stay of 24 hours or less;
- provides no inpatient care, except in a separately licensed skilled nursing unit;
- transfers patients who need to be admitted to a hospital.
CMS's fact sheet says Medicare-covered REH services include outpatient radiology, lab, rehabilitation, surgical and behavioral health services. Part B's deductible and coinsurance apply as at other hospital outpatient departments.
Ohio's status
No Ohio facility is listed as a Rural Emergency Hospital in CMS's Hospital General Information file (October 2026), and HRSA's July 2026 count, shown on the Rural Health Information Hub, also lists zero for Ohio. Ohio is ready for them: the Ohio Department of Health's rule OAC 3701-22-10, effective September 14, 2024, requires an REH to meet the federal conditions in 42 CFR Part 485, Subpart E.
Instead, much of rural Ohio relies on Critical Access Hospitals: 33 in CMS's October 2026 file (35 in HRSA's July 2026 count). A Critical Access Hospital has no more than 25 inpatient beds, an average inpatient stay of 96 hours or less, a 24-hour emergency department, and is generally more than a 35-mile drive from another hospital (15 miles in mountainous areas or where only secondary roads exist). Medicare covers care there like care at other hospitals.
| Critical Access Hospital | Rural Emergency Hospital | |
|---|---|---|
| Inpatient beds | Up to 25 | None |
| 24-hour emergency care | Yes | Yes |
| Average stay limit | 96 hours | 24 hours |
| Number in Ohio (CMS, October 2026) | 33 | 0 |
If your nearest hospital is small
- Use it for emergencies. Emergency care is covered anywhere in the U.S., in or out of network.
- Know where you'd be transferred. Ask which larger hospital it sends patients to, and if you have Medicare Advantage, check that hospital is in your network.
- Ask about outpatient services such as lab, imaging or therapy close to home.
More in Medicare in rural and Appalachian Ohio. To check networks from the companies they work with, you can request a call from a licensed insurance agent.
Related questions
Air ambulance in Ohio
Transfers to larger hospitals.
Telehealth in rural Ohio
Visits from home through 2027.
Appalachian Ohio options
Plans and hospitals.
Sources
- CMS — Rural Emergency Hospitals
- CMS — Rural Emergency Hospitals fact sheet
- eCFR — 42 CFR Part 485, Subpart E, conditions of participation for Rural Emergency Hospitals
- CMS — Hospital General Information (October 2026)
- Rural Health Information Hub — Ohio (HRSA data, July 2026)
- Ohio Administrative Code 3701-22-10 — Rural emergency hospitals
More questions in this guide
- Can I get an early prescription refill before a winter storm in Ohio?
- Does Medicare cover telehealth in rural Ohio?
- Does Medicare pay for a generator for oxygen or medical equipment?
- Does Medicare pay for an air ambulance in Ohio?
- Is there a Medicare special enrollment period after a disaster in Ohio?
- What happens to my Medicare after a flood in Ohio?
- What Medicare options are there in Appalachian Ohio?
Part of the guide: Medicare in Rural and Appalachian Ohio · All questions
Frequently asked questions
What's the difference between a Rural Emergency Hospital and a Critical Access Hospital?
A Critical Access Hospital keeps up to 25 inpatient beds and admits patients for short stays. A Rural Emergency Hospital has no inpatient beds (except a separately licensed skilled nursing unit) and transfers patients who need to be admitted.
Do I pay more at a Rural Emergency Hospital?
No. CMS pays REHs 5% more than the standard outpatient rate, but your copayment is based on the standard rate without that increase.
Could an Ohio hospital become a Rural Emergency Hospital?
Yes. Ohio adopted OAC 3701-22-10, a licensing rule for REHs, effective September 14, 2024. Under federal rules, only Critical Access Hospitals and rural hospitals with 50 or fewer beds that were enrolled on December 27, 2020 can convert.
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