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Florida agency adopts rules to license rural emergency hospitals; none designated yet
Summary
The Agency for Health Care Administration finalized state rules to license the new rural emergency hospital designation created by federal law. The rules took effect June 1, 2025; as of the committee meeting AHCA had received no completed designations in Florida though one hospital has expressed interest.
The Agency for Health Care Administration has adopted state rules to license and oversee hospitals seeking the federal rural emergency hospital designation, AHCA Deputy Secretary Kimberly Smoak told the Senate Health Policy Committee. The rules became effective June 1, 2025.
The federal rural emergency hospital (REH) option was created by the Consolidated Appropriations Act of 2021 to allow rural facilities to provide emergency and outpatient services under a distinct Medicare certification. Under the state rule package, hospitals that convert to the REH classification must remove inpatient beds from their licensed bed inventory, maintain 24/7 emergency services, meet staffing and equipment standards, and hold transfer agreements with level 1 or level 2 trauma centers.
Smoak told senators the agency updated several hospital licensure rules and created a new hospital classification to incorporate the federal REH criteria into Florida licensure. She said the state currently has 24 hospitals designated as rural hospitals and 12 of those are critical access hospitals, but “as of June 1 of this year these rules were adopted and became effective June 1. Right now in the state, we do not have any rural emergency hospitals designated.”
Committee members asked whether existing small hospitals would convert to the REH model and whether the state would perform surveys instead of an accrediting organization. Smoak said federal accreditation organizations (for example, The Joint Commission) had not been approved to accredit REHs on behalf of CMS and that AHCA, as the state survey agency, would perform the required surveys and license conversions.
Senators also noted a specific facility — North Walton Hospital (referred to in committee discussion as the hospital in the Phoenix Springs area) — that had expressed interest after re‑licensure earlier in 2024. Smoak said that hospital was licensed as an acute care hospital but had inquired about conversion to the federal REH designation.
The AHCA presentation flagged that REH status is tied to federal Medicare reimbursement incentives and to the federal statute that created the designation. Smoak and committee members discussed potential interest among other rural hospitals and said AHCA will continue outreach.
Ending: AHCA has adopted the licensing rules needed to recognize rural emergency hospitals in Florida, but no facilities had completed conversion by the date of the committee meeting. The agency said it stands ready to review conversion applications and to survey facilities under the new classification.
