Rural Health Bills


AHA Position 

Approximately 51 million Americans live in rural areas and depend upon the hospitals in their communities. Remote geographic location, small size, limited workforce, physician shortages and often constrained financial resources pose a unique set of challenges for rural hospitals. Rural hospitals’ patient mix also makes them more reliant on public programs and, thus, particularly vulnerable to Medicare and Medicaid payment cuts.

Medicare and other federal programs must account for the special circumstances of rural communities. The AHA focuses on protecting vital funding, securing the future of existing special rural payment programs – including the critical access hospital (CAH), sole community hospital (SCH), Medicare-dependent hospital (MDH) and rural referral center (RRC) programs – and relieving regulatory burden. With congressional budget crises a continued threat in Washington, the continued viability of small and rural health care providers remains in jeopardy.

Key Priorities

The AHA supports policies and legislation that enable rural hospitals to care for their communities. Below are some of the key areas of focus for our 2015 advocacy agenda. 

Secure the Future of Critical Rural Programs and Policies

  • MDH and low-volume adjustment. Pass the Rural Hospital Access Act (S. 332/H.R. 663), which would permanently extend the Medicare-dependent hospitals (MDH) and enhanced low-volume adjustment programs. Please see the AHA Action Alert.
  • Ambulance add-on payment. Pass the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 377/H.R. 745), which would permanently extend the ambulance add-on payment adjustment. Please see the AHA Action Alert.
  • RCH Demo. Pass the Rural Community Hospital (RCH) Demonstration Extension Act (S. 607/ H.R. 672), which would extend the program for five years. Please see the AHA Action Alert.
  • Repeal caps on outpatient therapy. Pass the Medicare Access to Rehabilitation Services Act of 2015 (S. 539/H.R. 775) to repeal existing caps on physical therapy, occupational therapy, and speech-language pathology services.

Relieve Regulatory Burden

  • Direct supervision. Pass the Protecting Access to Rural Therapy Services (PARTS) Act (S. 257/ H.R.1611) to 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. Please see the AHA Action Alert.
  • 96-hour physician certification. Pass the Critical Access Hospital Relief Act (S. 258/H.R. 169), which would remove the 96-hour physician certification requirement as a condition of payment for CAHs. These hospitals would still be required to satisfy the condition of participation requiring a 96-hour annual average length of stay. Please see the AHA Action Alert.
  • IT and meaningful use. AHA supports the Flexibility in Health IT Reporting (Flex-IT) Act (H.R. 270), which would establish a 90-day reporting period in fiscal year 2015 to give hospitals and eligible professionals more flexibility in meeting meaningful use requirements.
  • Equity in hospital readmissions: Pass the Establishing Beneficiary Equity in the Hospital Readmissions Program Act (S 688/HR 1343) that adjusts ratios to account for dual eligible beneficiaries and socio-economic status. Please see the AHA Action Alert.


Small or Rural Section

Click here to access the Section for Small or Rural Hospitals page.

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