2011 Small/Rural Advocacy Agenda

2011 Small/Rural Advocacy Agenda (PDF)


Because of their small size, modest assets and financial reserves, and higher percentages of Medicare patients, rural hospitals disproportionately rely on government payments. Medicare payment systems often fail to recognize the unique circumstances of small, rural hospitals. Many rural hospitals are too large to qualify for critical access hospital (CAH) status, but too small to absorb the financial risk associated with prospective payment system (PPS) programs.

AHA View

The AHA’s 2011 advocacy agenda focuses on ensuring all hospitals have the resources they need to provide high-quality care and meet the needs of their communities. That means:

  • Advocating for appropriate Medicare payments;
  • Working to extend expiring Medicare provisions;
  • Improving federal programs to account for special circumstances in rural communities; and
  • Seeking adequate funding for annually appropriated rural health programs.

Small or Rural Hospitals

The AHA will work with Congress to:

  • Allow hospitals to claim the full cost of provider taxes as allowable costs;
  • Ensure CAHs are paid at least 101 percent of costs by Medicare Advantage plans;
  • Ensure that the Centers for Medicare & Medicaid Services (CMS) appropriately addresses the issue of direct supervision for outpatient therapeutic services for rural hospitals and CAHs;
  • Ensure rural hospitals and CAHs have adequate reimbursement for certified registered nurse anesthetist and stand-by services;
  • Exempt CAHs from the Independent Payment Advisory Board;
  • Extend expiring provisions;
  • Provide small, rural hospitals with cost-based reimbursement for outpatient laboratory services and ambulance services;
  • Provide CAHs bed size flexibility;
  • Reinstate CAH necessary provider status;
  • Remove unreasonable restrictions on CAHs’ ability to rebuild.

About AHA


Member Constituency Sections

Key Relationships

News Center

Performance Improvement

Advocacy Issues

Products & Services


Research & Trends


155 N. Wacker Dr.
Chicago, Illinois 60606

800 10th Street, N.W.
Two CityCenter, Suite 400
Washington, DC 20001-4956