Hospitals that participate in the new Rural Emergency Hospital model will have to meet the criteria for participation similar to those for critical-access hospitals, the Centers for Medicare and Medicaid Services proposed Thursday.

Rural Emergency Hospitals would need to accept Medicare, have average lengths of stay of 24 hours or shorter, eliminate acute care inpatient services, have transfer agreements with Level I or Level II trauma centers and meet federal employee training and certification requirements, according to a draft regulation. CMS expects the new model to keep more rural hospitals afloat, given that many have low inpatient occupancy rates.

Starting next year, Rural Emergency Hospitals would be reimbursed 5% more for outpatient care than full-service hospitals and receive monthly facility payments. More details on the payment policies and quality requirements will be included in upcoming regulations, CMS said.

The agency asks for input on certain proposed Rural Emergency Hospital standards, including whether they can provide low-risk childbirth services and related outpatient surgeries. CMS also requests comments on whether these facilities should have medical doctors or osteopaths, physician assistants, nurse practitioners, or clinical nurse specialists with training in emergency medicine on call, CMS said.

More than 180 rural hospitals have closed or stopped providing inpatient services since 2005, according to University of North Carolina data. Many rural hospitals have cut back service lines to remain viable, limiting access to care in some regions. About one-fourth of rural hospitals are vulnerable to closure, the Chartis Center for Rural Health research shows.