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Grassley Relays Concerns of Iowa Rural Hospitals to CMS as Deadline Approaches for New Rural Emergency Hospital Program

CMS will finalize regulations later this year for a Grassley law supporting rural emergency hospitals

Sen. Chuck Grassley (R-Iowa) is calling on the Centers for Medicare & Medicaid Services (CMS) to finalize regulations for the new rural emergency hospital (REH) designation, a voluntary Medicare payment for rural hospitals that ensures minimal administrative burden, maximum flexibility and timely implementation. Over the last several years, Grassley has visited more than 35 rural hospitals and clinics. His letter contains several recommendations for CMS to consider, which are based on concerns Grassley heard directly from Iowans during these meetings.

“REH is a bipartisan solution that enables rural hospitals the option to right-size their health care infrastructure while maintaining essential medical services for their communities. The existence of a rural hospital contributes to economic growth and can sustain a community,” Grassley wrote. “CMS must finalize regulations with minimal administrative burden, maximum flexibility, and without delay.”

“Senator Grassley’s Rural Emergency Hospital (REH) legislation, which IHA and Iowa hospitals successfully advocated and supported throughout the legislative process, has made another important step forward with CMS issuing their proposed plan for implementation and operation of REHs. The REH designation will help ensure access to critical health care services remain available wherever the patient is located, and hospitals will have what they need to take care of their communities,” said Iowa Hospital Association (IHA) President and CEO Chris Mitchell.

In 2020, Grassley was instrumental in getting a REH designation signed into law. REH offers a financial lifeline for providers by allowing certain rural hospitals to customize their health care infrastructure and provide services that better align with the specific needs of their patient populations. The policy creates a new, voluntary Medicare payment designation that allows either a Critical Access Hospital (CAH) or a small, rural hospital with less than 50 beds to convert to an REH. The goal is to preserve patient access to emergency medical care in rural areas that can no longer support a fully operational inpatient hospital.

Grassley has consistently pressed the Biden administration on timely implementation of the REH – including in hearings with HHS Secretary BecerraCMS Administrator Brooks-LaSure and HHS Deputy Secretary Palm. In 2021, Grassley wrote to CMS about prioritizing REH implementation.

As a lifelong resident of rural Iowa, Grassley understands the importance of having accessible health care services close to home and has fought to ensure rural America has access to health care. In 2015, he brought rural health care stakeholders together to develop the framework of what eventually became REH. As Finance Committee chairman, Grassley worked with his colleagues to enact several victories for rural health care, including supporting rural hospitals in response to the COVID-19 pandemic and making mental telehealth visits a permanent benefit under Medicare. This Congress, he has worked in a bipartisan manner to pass the Rural Health Clinic Protection Act and introduce the Rural Hospital Support Act to protect key Medicare rural hospital programs.

This work builds on his successful efforts to support the critical access hospital program, reauthorize the Medicare-dependent hospital program, establish and reauthorize the low volume hospital program and establish and reauthorize the rural community hospital demonstration, to name a few.


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